Triglyceride Test

What are triglycerides?

Triglycerides are chemical compounds digested by the body to provide it with the energy for metabolism. Triglycerides are the most common form of fat that we digest, and are the main ingredient in vegetable oils and animal fats.
The triglyceride molecule is a form of the chemical glycerol (tri=three molecules of fatty acid + glyceride=glycerol) that contains three fatty acids. To be absorbed, these parts are broken apart in the small intestine, and afterwards are reassembled with cholesterol to form chylomicrons. This is the source of energy for cells in the body. Fat cells and liver cells are used as storage sites and release chylomicrons when the body needs the energy.
Elevated triglyceride levels are a risk factor for atherosclerosis, the narrowing of arteries with the buildup of fatty plaques that may lead to heart attack, stroke, and peripheral artery disease. Markedly elevated triglyceride levels may also cause fatty liver disease and pancreatitis.
Elevated triglyceride levels in the blood may be associated with other diseases including:

• poorly-controlled diabetes,
  
• kidney disease,
  
• some medications (for example, beta blockers, diuretics, birth control pills).

Alcohol consumption can raise triglyceride blood levels by causing the liver to produce more fatty acids. However, there are some beneficial aspects of moderate alcohol consumption, defined as one alcoholic beverage per day (a glass of wine, a bottle of beer, or an ounce of hard liquor), that may balance this triglyceride rise. Moderate consumption may mildly increase HDL (the good cholesterol) levels in the bloodstream and red wine, which contains antioxidants, may decrease the risk of heart disease. However, it is not recommended that people start to drink alcohol to obtain these effects.

How are triglyceride levels measured?

Triglyceride levels in the blood are measured by a simple blood test. Often, triglycerides are measured as part of a lipoprotein panel (lipid panel) in which triglycerides, cholesterol, HDL (high density lipoprotein), and LDL (low density lipoprotein) are measured at the same time.
Fasting for 9-12 hours before the test is required. Fat levels in the blood are affected by recent eating and digestion. Falsely elevated results may occur if the blood test is done just after eating.

What are normal triglyceride levels, and what does high triglyceride levels mean?

Elevated triglycerides place an individual at risk for atherosclerosis. Triglyceride and cholesterol levels are measured in the blood to provide a method of screening for this risk.

• Normal triglyceride levels in the blood are less than 150mg per deciliter (mg/dL).
  
• Borderline levels are between 150-200 mg/dL.
  
• High levels of triglycerides (greater than 200 mg/dl) are associated with a increased risk of atherosclerosis and therefore coronary artery disease and stroke.
  
• Extremely high triglyceride levels (greater than 500mg/dl) may cause pancreatitis (inflammation of the pancreas).

How can I lower my triglyceride levels?

Returning triglyceride levels to normal may decrease the risk of heart attack, stroke, and peripheral artery disease. Controlling high triglycerides and high cholesterol is a lifelong challenge. A healthy lifestyle includes eating well, exercising routinely, smoking cessation, and weight loss. This may be all that is needed, but some people additionally require medications to lower triglyceride levels in the blood. Your health care practitioner will help make decisions with you to decide what treatment combination is most appropriate

Changes in diet

The following dietary changes may be helpful in lowering triglycerides.

1. Decreasing your intake of sugar: If you have a sweet tooth, try to set limits on how often and how much sugar you consume. You can cut your intake in half to begin with, and continue cutting back from there. Remember to read the labels to check for sugar content in both food and beverages.
   
2. Changing from white to brown: If you eat white rice, bread, and pasta, switch to whole wheat products. It may take a little while to get used to the difference in taste, but it's worth the effort for the benefits to your health. There are a variety of whole wheat products on the market, so experiment until you find the one that you like best.
   
3. Switching fats: Limit or avoid foods with saturated and trans fats. These include fried foods, lard, butter, whole milk, ice cream, commercial baked goods, meats, and cheese. Read the nutrition labels to determine whether these unhealthy fats are present.

Switch to monounsaturated and polyunsaturated fats. The best sources of these fats are olive oil, canola oil, nuts, and fatty fish like salmon, mackerel, lake trout, sardines, herring, and albacore tuna. Learning to interpret food labels will help you understand the kinds of fat in the food you buy and consume.

4. TLC Diet Daily Food Guide: This is a tip sheet, organized according to food groups, is a guide to choosing a diet low in saturated fat and cholesterol. The chart lists the number of servings recommended for each day plus examples of typical serving sizes. Click on individual food groups for more information.

Medication

Fibrates (for example, gemfibrozil [Lopid] or fenofibrate [Tricor]) and niacin are medications that lower both cholesterol and triglycerides. The decision to use these medications depends upon a variety of factors including the patient's past medical history, other medications taken, and other risk factors for atherosclerosis that might be present. Medication use does not replace diet, exercise, and other healthy lifestyle choices.

Rectal Bleeding

What is rectal bleeding?

Rectal bleeding (known medically as hematochezia) refers to the passage of red blood from the anus, often mixed with stools and/or blood clots. (It is called rectal bleeding because the rectum lies immediately above the anus, and although the bleeding indeed may be coming from the rectum, as discussed later, it also may be coming from other parts of the gastrointestinal tract.) The severity of rectal bleeding (i.e., the quantity of blood that is passed) varies widely. Most episodes of rectal bleeding are mild and stop on their own. Many patients report only passing a few drops of fresh blood that turns the toilet water pink or observing spots of blood on the tissue paper. Others may report brief passage of a spoonful or two of blood. Generally, mild rectal bleeding can be evaluated and treated in the doctor's office without hospitalization or the need for urgent diagnosis and treatment.
Rectal bleeding also may be moderate or severe. Patients with moderate bleeding will repeatedly pass larger quantities of bright or dark red (maroon-colored) blood often mixed with stools and/or blood clots. Patients with severe bleeding may pass several bowel movements or a single bowel movement containing a large amount of blood. Moderate or severe rectal bleeding can quickly deplete a patient's body of blood, leading to symptoms of weakness, dizziness, near-fainting or fainting, and signs of low blood pressure or orthostatic hypotension (a drop in blood pressure when going from the sitting or lying position to the standing position). Rarely, the bleeding may be so severe as to cause shock from the loss of blood. Moderate or severe rectal bleeding usually is evaluated and treated in the hospital. Patients with signs and symptoms of reduced volume of blood often require emergency hospitalization, and transfusion of blood.
Origin of rectal bleeding (where the blood comes from)
Most rectal bleeding comes from the colon, rectum, or anus. The colon is the part of the gastrointestinal tract through which food passes after it has been digested in the small intestine. The colon is primarily responsible for removing water from the undigested food and storing it until it is eliminated from the body as stool. The rectum is the last 15 cm of the colon. The anus (anal canal) is the opening through which stool passes when it is being eliminated from the body. Together, the colon, rectum, and anus form a long (several feet in length), muscular tube that also is known as the large intestine, large bowel, or the lower gastrointestinal tract. (The esophagus, stomach, duodenum, and small intestine are referred to as the upper gastrointestinal tract.)
The colon can be divided further into three regions; the right colon, the transverse colon, and the left colon. The right colon, also known as the ascending colon, is the part of the colon into which undigested food from the small intestine is first deposited. It is furthest from the rectum and anus. The transverse colon forms a bridge between the right and the left colon. The left colon is made up of the descending colon and the sigmoid colon. The sigmoid colon connects the descending colon to the rectum.
The color of blood during rectal bleeding often depends on the location of the bleeding in the gastrointestinal tract. Generally, the closer the bleeding site is to the anus, the brighter red the blood will be. Thus, bleeding from the anus, rectum, and the sigmoid colon tends to be bright red, whereas bleeding from the transverse colon and the right colon tends to be dark red or maroon-colored.
In some patients bleeding from the right colon can be black, "tarry" (sticky) and foul smelling. The black, smelly and tarry stool is called melena. Melena occurs when the bleeding is in the stomach where the blood is exposed to acid or is in the small intestine or colon for a long enough period of time for the intestinal bacteria to break it down into chemicals (hematin) that are black. Therefore, melena usually signifies that the bleeding is from the upper gastrointestinal tract (for example, bleeding from ulcers in the stomach or the duodenum or from the small intestine) because the blood is exposed to stomach acid or is in the intestines for a longer period of time before it exits the body. Although it is possible for melena to occur with bleeding from the right colon, blood from the sigmoid colon and the rectum usually does not stay in the colon long enough for the bacteria to turn it black.
Rarely, massive bleeding from the right colon, from the small intestine, or from ulcers of the stomach or duodenum can cause rapid transit of the blood through the gastrointestinal tract and result in bright red rectal bleeding. In these situations, the blood is moving through the colon so rapidly that there is not enough time for the bacteria to turn the blood black. Sometimes, bleeding from the gastrointestinal tract (upper or lower) will be so minimal that it will not cause either rectal bleeding or melena. In such situations, blood can be found only by the use of special tests done on samples of stool. (See occult gastrointestinal bleeding)
Occult gastrointestinal bleeding
Rectal bleeding needs to be distinguished from another type of gastrointestinal bleeding, occult gastrointestinal bleeding. Occult gastrointestinal bleeding refers to a slow loss of blood into the upper or lower gastrointestinal tract that does not change the color of the stool or result in the presence of visible bright red blood. The blood is detected only by testing the stool for blood (fecal occult blood testing) in the laboratory. Occult bleeding has many of the same causes as rectal bleeding and may result in the same symptoms as rectal bleeding. For example, slow bleeding from ulcers, colon polyps, or cancers can cause small amounts of blood to mix and be lost within the stool. It is often associated with anemia that is due to loss of iron along with the blood (iron deficiency anemia).

What are the causes of rectal bleeding?

Many diseases and conditions can cause rectal bleeding. Common causes include:

• anal fissures,
  
• hemorrhoids,
  
• cancers and polyps of the rectum and colon,
  
• diverticulosis,
  
• abnormal blood vessels (angiodysplasia),
  
• ulcerative colitis,
  
• ulcerative proctitis,
  
• Crohn's colitis,
  
• infectious colitis,
  
• ischemic colitis, and
  
• Meckel's diverticula.

Anal Fissure

An anal fissure is a fairly common, painful condition in which the lining of the anal canal is torn. An anal fissure is caused by constipation or a forceful bowel movement, though a tight anal muscle also may be a contributing factor. Once the skin is torn, each subsequent bowel movement can be painful, and the pain often is severe. The amount of bleeding that occurs with an anal fissure is small and usually is noticed in the toilet bowl or on the toilet paper as bright red in color. The symptoms of an anal fissure are commonly mistaken for hemorrhoids, but hemorrhoids generally do not cause pain with bowel movements.

Hemorrhoids

Hemorrhoids are masses or clumps ("cushions") of tissue within the anal canal that contain blood vessels. Although most people think hemorrhoids are abnormal, they are present in everyone. It is only when the hemorrhoidal cushions enlarge that hemorrhoids can cause problems (such as bleeding or anal discomfort) and be considered abnormal or a disease. Like anal fissures, bleeding from hemorrhoids is usually mild and does not cause anemia or low blood pressure. Rarely, a person may develop an iron deficiency anemia as a result of repeated hemorrhoidal bleeding over several months to years.

Constipation

Constipation facts

• Constipation is defined medically as fewer than three stools per week and severe constipation as less than one stool per week.
  
• Constipation usually is caused by the slow movement of stool through the colon.
  
• There are many causes of constipation including medications, poor bowel habits, low fiber diets, abuse of laxatives, hormonal disorders, and diseases primarily of other parts of the body that also affect the colon.
  
• The two disorders limited to the colon that cause constipation are colonic inertia and pelvic floor dysfunction.
  
• Medical evaluation for the cause of constipation should be done when constipation is of sudden onset, severe, worsening, associated with other worrisome symptoms such as loss of weight, or is not responding to simple, safe treatments.
  
• Medical evaluation of constipation may include a history, physical examination, blood tests, abdominal X-rays, barium enema, colonic transit studies, defecography, ano-rectal motility studies, and colonic motility studies.
  
• The goal of therapy for constipation is one bowel movement every two to three days without straining.
  
• Treatment of constipation may include dietary fiber, non-stimulant laxatives, stimulant laxatives, enemas, suppositories, biofeedback training, and surgery.
  
• Stimulant laxatives should be used as a last resort because of the possibility that they may permanently damage the colon and worsen constipation.
  
• Most herbal laxatives contain stimulant-type laxatives and should be used, if at all, as a last resort.

What is constipation?

Constipation means different things to different people. For many people, it simply means infrequent stools. For others, however, constipation means hard stools, difficulty passing stools (straining), or a sense of incomplete emptying after a bowel movement. The cause of each of these "types" of constipation probably is different, and the approach to each should be tailored to the specific type of constipation.
Constipation also can alternate with diarrhea. This pattern commonly occurs as part of the irritable bowel syndrome (IBS). At the extreme end of the constipation spectrum is fecal impaction, a condition in which stool hardens in the rectum and prevents the passage of any stool.
The number of bowel movements generally decreases with age. Ninety-five percent of adults have bowel movements between three and 21 times per week, and this would be considered normal. The most common pattern is one bowel movement a day, but this pattern is seen in less than 50% of people. Moreover, most people are irregular and do not have bowel movements every day or the same number of bowel movements each day.
Medically speaking, constipation usually is defined as fewer than three bowel movements per week. Severe constipation is defined as less than one bowel movement per week. There is no medical reason to have a bowel movement every day. Going without a bowel movement for two or three days does not cause physical discomfort, only mental distress for some people. Contrary to popular belief, there is no evidence that "toxins" accumulate when bowel movements are infrequent or that constipation leads to cancer.
It is important to distinguish acute (recent onset) constipation from chronic (long duration) constipation. Acute constipation requires urgent assessment because a serious medical illness may be the underlying cause (for example, tumors of the colon). Constipation also requires an immediate assessment if it is accompanied by worrisome symptoms such as rectal bleeding, abdominal pain and cramps, nausea and vomiting, and involuntary loss of weight. In contrast, the evaluation of chronic constipation may not be urgent, particularly if simple measures bring relief.

What causes constipation?

Theoretically, constipation can be caused by the slow passage of digesting food through any part of the intestine. More than 95% of the time, however, the slowing occurs in the colon.

Medications that cause constipation

A frequently over-looked cause of constipation is medications. The most common offending medications include:

• Narcotic pain medications such as codeine (for example, Tylenol #3), oxycodone (for example, Percocet), and hydromorphone (Dilaudid);
  
• Antidepressants such as amitriptyline (Elavil) and imipramine (Tofranil)
  
• Anticonvulsants such as phenytoin (Dilantin) and carbamazepine (Tegretol)
  
• Iron supplements
  
• Calcium channel blocking drugs such as diltiazem (Cardizem) and nifedipine (Procardia)
  
• Aluminum-containing antacids such as Amphojel and Basaljel

In addition to the medications listed above, there are many others that can cause constipation. Simple measures (for example, increasing dietary fiber) for treating the constipation caused by medications are often are effective, and discontinuing the medication is not necessary. If simple measures don't work, it may be possible to substitute a less constipating medication. For example, a nonsteroidal antiinflammatory drug (for example, ibuprofen) may be substituted for narcotic pain medications. Additionally, one of the newer and less constipating anti-depressant medications [for example, fluoxetine (Prozac)] may be substituted for amitriptyline and imipramine.

What is anorexia nervosa

Anorexia nervosa, commonly referred to simply as anorexia, is one type of eating disorder. More importantly, it is also a psychological disorder. Anorexia is a condition that goes beyond concern about obesity or out-of-control dieting. A person with anorexia often initially begins dieting to lose weight. Over time, the weight loss becomes a sign of mastery and control. The drive to become thinner is actually secondary to concerns about control and/or fears relating to one's body. The individual continues the ongoing cycle of restrictive eating, often accompanied by other behaviors such as excessive exercising or the overuse of diet pills to induce loss of appetite, and/or diuretics, laxatives, or enemas in order to reduce body weight, often to a point close to starvation in order to feel a sense of control over his or her body. This cycle becomes an obsession and, in this way, is similar to an addiction.

Who is at risk for anorexia nervosa?

Approximately 95% of those affected by anorexia are female, most often teenage girls, but males can develop the disorder as well. While anorexia typically begins to manifest itself during early adolescence, it is also seen in young children and adults. In the U.S. and other countries with high economic status, it is estimated that about one out of every 100 adolescent girls has the disorder. Caucasians are more often affected than people of other racial backgrounds, and anorexia is more common in middle and upper socioeconomic groups. According to the U.S. National Institute of Mental Health (NIMH), other statistics about this disorder include the fact that an estimated 0.5%-3.7% of women will suffer from this disorder at some point in their lives. About 0.3% of men are thought to develop anorexia in their lifetimes
Many experts consider people for whom thinness is especially desirable, or a professional requirement (such as athletes, models, dancers, and actors), to be at risk for eating disorders such as anorexia nervosa. Health-care professionals are usually encouraged to present the facts about the dangers of anorexia through education of their patients and of the general public as a means of preventing this and other eating disorders.

What causes anorexia nervosa?

At this time, no definite cause of anorexia nervosa has been determined. However, research within the medical and psychological fields continues to explore possible causes.
Studies suggest that a genetic (inherited) component may play a more significant role in determining a person's susceptibility to anorexia than was previously thought. Researchers are currently attempting to identify the particular gene or genes that might affect a person's tendency to develop this disorder, and preliminary studies suggest that a gene located at chromosome 1p seems to be involved in determining a person's susceptibility to anorexia nervosa.
Other evidence had pinpointed a dysfunction in the part of the brain, the hypothalamus (which regulates certain metabolic processes), as contributing to the development of anorexia. Other studies have suggested that imbalances in neurotransmitter (brain chemicals involved in signaling and regulatory processes) levels in the brain may occur in people suffering from anorexia.
Feeding problems as an infant, a general history of undereating, and maternal depressive symptoms tend to be risk factors for developing anorexia. Other personal characteristics that can predispose an individual to the development of anorexia include a high level of negative feelings and perfectionism. For many individuals with anorexia, the destructive cycle begins with the pressure to be thin and attractive. A poor self-image compounds the problem. People who suffer from any eating disorder are more likely to have been the victim of childhood abuse.
While some professionals remain of the opinion that family discord and high demands from parents can put a person at risk for developing this disorder, the increasing evidence against the idea that families cause anorexia has mounted to such an extent that professional mental-health organizations no longer ascribe to that theory. Possible factors that protect against the development of anorexia include high maternal body mass index (BMI) as well as personal high self-esteem.

How is anorexia nervosa diagnosed?

Anorexia nervosa can be a difficult disorder to diagnose, since individuals with anorexia often attempt to hide the disorder. Denial and secrecy frequently accompany other symptoms. It is unusual for an individual with anorexia to seek professional help because the individual typically does not accept that she or he has a problem (denial). In many cases, the actual diagnosis is not made until medical complications have developed. The individual is often brought to the attention of a professional by family members only after marked weight loss has occurred. When anorexics finally come to the attention of the health-care professional, they often lack insight into their problem despite being severely malnourished and may be unreliable in terms of providing accurate information. Therefore, it is often necessary to obtain information from parents, a spouse, or other family members in order to evaluate the degree of weight loss and extent of the disorder. Health professionals will sometimes administer questionnaires for anorexia as part of screening for the disorder.
Warning signs of developing anorexia or one of the other eating disorders include excessive interest in dieting or thinness. One example of such interest includes a movement called "thinspiration," which promotes extreme thinness as a lifestyle choice rather than as a symptom of illness. There are a variety of web sites that attempt to inspire others toward extreme thinness by featuring information on achieving that goal, photos of famous, extremely thin celebrities, and testimonials, as well as before and after pictures of individuals who ascribe to extreme thinness.
The actual criteria for anorexia nervosa are found in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).
There are four basic criteria for the diagnosis of anorexia nervosa that are characteristic:

1. The refusal to maintain body weight at or above a minimally normal weight for age and height (maintaining a body weight less than 85% of the expected weight)
2. An intense fear of gaining weight or becoming fat, even though the person is underweight
3. Self-perception that is grossly distorted, excessive emphasis on body weight in self-assessment, and weight loss that is either minimized or not acknowledged completely
4. In women who have already begun their menstrual cycle, at least three consecutive periods are missed (amenorrhea), or menstrual periods occur only after a hormone is administered.

The DSM-IV-TR further identifies two subtypes of anorexia nervosa. In the binge-eating/purging type, the individual regularly engages in binge eating or purging behavior which involves self-induced vomiting or the misuse of laxatives, diuretics, or enemas during the current episode of anorexia. In the restricting type, the individual severely restricts food intake but does not regularly engage in the behaviors seen in the binge-eating type.

What are anorexia symptoms and signs (psychological and behavioral)?

Anorexia can have dangerous psychological and behavioral effects on all aspects of an individual's life and can affect other family members as well.

• The individual can become seriously underweight, which can lead to depression and social withdrawal.
• The individual can become irritable and easily upset and have difficulty interacting with others.
• Sleep can become disrupted and lead to fatigue during the day.
• Attention and concentration can decrease.
• Most individuals with anorexia become obsessed with food and thoughts of food. They think about it constantly and become compulsive about eating rituals. They may collect recipes, cut their food into tiny pieces, prepare elaborate calorie-laden meals for other people, or hoard food. Additionally, they may exhibit other obsessions and/or compulsions related to food, weight, or body shape that meet the diagnostic criteria for an obsessive compulsive disorder.
• Other psychiatric problems are also common in people with anorexia nervosa, including affective (mood) disorders, anxiety disorders, and personality disorders.
• Generally, individuals with anorexia are compliant in every other aspect of their life except for their relationship with food. Sometimes, they are overly compliant, to the extent that they lack adequate self-perception. They are eager to please and strive for perfection. They usually do well in school and may often overextend themselves in a variety of activities. The families of anorexics often appear to be "perfect." Physical appearances are important to the anorexia sufferer. Performance in other areas is stressed as well, and they are often high achievers in many areas.
• While control and perfection are critical issues for individuals with anorexia, aspects of their life other than their eating habits are often found to be out of control as well. Many have, or have had at some point in their lives, addictions to alcohol, drugs, or gambling. Compulsions involving sex, exercising, housework, and shopping are not uncommon. In particular, people with anorexia often exercise compulsively to speed the weight-loss process.
• Symptoms of anorexia in men tend to co-occur with other psychological problems and more commonly follow a period of being overweight than in women. Men with anorexia also tend to be more likely to have a distorted body image.
• Compared to symptoms in men, symptoms of anorexia in women tend to more frequently include a general displeasure with their body and a possibly stronger desire to be thin. Women with anorexia also tend to experience more perfectionism and cooperativeness.

Due to the growth and development inherent during childhood and adolescence, symptoms and signs of anorexia in children and teenagers can include a slowing of the natural increase in height or a slowed increase in development of other body functions.
All of these features can negatively affect one's daily activities. Diminished interest in previously preferred activities can result. Some individuals also have symptoms that meet the diagnostic criteria for a major depressive disorder.

Amenorrhea

What is amenorrhea?

Amenorrhea is the medical term for the absence of menstrual periods, either on a permanent or temporary basis. Amenorrhea can be classified as primary or secondary. In primary amenorrhea, menstrual periods have never begun (by age 16), whereas secondary amenorrhea is defined as the absence of menstrual periods for three consecutive cycles or a time period of more than six months in a woman who was previously menstruating.
The menstrual cycle can be influenced by many internal factors such as transient changes in hormonal levels, stress, and illness, as well as external or environmental factors. Missing one menstrual period is rarely a sign of a serious problem or an underlying medical condition, but amenorrhea of longer duration may signal the presence of a disease or chronic condition.

What causes amenorrhea?

The normal menstrual cycle occurs because of changing levels of hormones made and secreted by the ovaries. The ovaries respond to hormonal signals from the pituitary gland located at the base of the brain, which is, in turn, controlled by hormones produced in the hypothalamus of the brain. Disorders that affect any component of this regulatory cycle can lead to amenorrhea. However, a common cause of amenorrhea in young females sometimes overlooked or misunderstood by the individual and others, is an undiagnosed pregnancy. Amenorrhea in pregnancy is a normal physiological function. Occasionally, the same underlying problem can cause or contribute to either primary or secondary amenorrhea. For example, hypothalamic problems, anorexia or extreme exercise can play a major role in causing amenorrhea depending on the age of the person and if she has experienced menarche.

Primary amenorrhea

Primary amenorrhea is typically the result of a genetic or anatomic condition in young females that never develop menstrual periods (by age 16) and is not pregnant. Many genetic conditions that are characterized by amenorrhea are conditions in which some or all of the normal internal female organs either fail to form normally during fetal development or fail to function properly. Diseases of the pituitary gland and hypothalamus (a region of the brain important for the control of hormone production) can also cause primary amenorrhea since these areas play a critical role in the regulation of ovarian hormones.
Gonadal dysgenesis is the name of a condition in which the ovaries are prematurely depleted of follicles and oocytes (egg cells) leading to premature failure of the ovaries. It is one of the most common cases of primary amenorrhea in young women.
Another genetic cause is Turner syndrome, in which women are lacking all or part of one of the two X chromosomes normally present in the female. In Turner syndrome, the ovaries are replaced by scar tissue and estrogen production is minimal, resulting in amenorrhea. Estrogen-induced maturation of the external female genitalia and sex characteristics also fails to occur in Turner syndrome.
Other conditions that may be causes of primary amenorrhea include androgen insensitivity (in which individuals have XY (male) chromosomes but do not develop the external characteristics of males due to a lack of response to testosterone and its effects), congenital adrenal hyperplasia, and polycystic ovary syndrome (PCOS).

Secondary amenorrhea

Pregnancy is an obvious cause of amenorrhea and is the most common reason for secondary amenorrhea. Further causes are varied and may include conditions that affect the ovaries, uterus, hypothalamus, or pituitary gland.
Hypothalamic amenorrhea is defined as amenorrhea that is due to a disruption in the regulator hormones produced by the hypothalamus in the brain. These hormones influence the pituitary gland, which in turn sends signals to the ovaries to produce the characteristic cyclic hormones. A number of conditions can affect the hypothalamus and lead to hypothalamic amenorrhea, such as:

• extreme weight loss,
  
• emotional or physical stress,
  
• rigorous exercise, and
  
• severe illness.

Other types of medical conditions can cause secondary amenorrhea:

• tumors or other diseases of the pituitary gland that lead to elevated levels of the hormone prolactin (which is involved in milk production) also cause amenorrhea due to the elevated prolactin levels;
  
• hypothyroidism;
  
• elevated levels of androgens (male hormones), either from outside sources or from disorders that cause the body to produce too high levels of male hormones;
  
• ovarian failure (premature ovarian failure or early menopause);
  
• polycystic ovary syndrome; and
  
• Asherman's syndrome is an example of uterine disease that causes amenorrhea. It results from scarring of the uterine lining following instrumentation (such as dilation and curettage) of the uterine cavity to manage postpartum bleeding or infection.

Post-pill amenorrhea

Women who have stopped taking oral contraceptive pills should experience the return of menstruation within three months after discontinuing pill use. Previously, it was believed that birth control pills increased a woman's risk of amenorrhea following use of the pill, but this has been proven not to be the case. Women who do not resume menstruation after three months have passed since oral contraceptive pills were stopped should be evaluated for causes of secondary amenorrhea.

Beauty & Body Image (Without Dieting).

If you're like most women, looking in the mirror -- particularly a full-length mirror -- is rarely the experience you want it to be. Unlike most men, experts say, women are rarely satisfied with their appearance - and are always seeking a better body image.
"Research suggests that in general, women have slightly lower self-esteem overall when compared to men. But when it comes to body image, there is an enormous gender gap, with women reporting an overwhelmingly greater body dissatisfaction when compared to men," says Denise Martz, PhD, a clinical health psychologist, and professor at Appalachian State University in North Carolina.
Martz, who recently designed and supervised a 2,000-woman body image survey for Slim-Fast, says women of all shapes and sizes are affected.
"Seventy-eight percent of the women in our survey said they wished they could wear a smaller size -- even the ones who were already a size 8," says Martz.
Many believe this dissatisfaction with size and shape is linked to an even more serious problem: a lack of self-esteem.
"Unfortunately, in our culture, self-image and body image are inextricably entwined -- so it becomes extremely difficult to feel good about yourself when, every time you look in a mirror, you see only the negatives," says Michelle May, MD, an Arizona family practice physician and founder and director of Am I Hungry.com.
And many women find themselves unable to break this cycle, even though they realize it's wrong-headed.
"A large percentage of the surveyed women said it is possible for women to be a larger size and have self-esteem, but when it came to them personally, they said it's hard to feel good about themselves when they are a larger size," says Matx. "So what they are saying is that, in theory, we should not equate self-worth with size, but when it comes to us personally, we still do."
So why do women feel this way -- and what can we do about it? The answers may surprise you.
Body Image and the Media
When it comes to eroding women's self-esteem, the first finger of blame almost universally points to the media. From sexy, leggy models in magazines, to ultra-thin celebs on the big and little screen - even ads for healthy and low-fat foods -- media images seem to play on our need to be glamorous and skinny.
"All of it sends just one message to women: That you are only acceptable if you look a certain way," says May.
Clinical psychologist Caroline Kaufman notes that this message has far-reaching effects -- even in places you'd never dream it would matter.
"In 2003, a pair of Harvard researchers noted how, when the Pacific island of Fiji got cable TV in 1995 (Friends, Ally McBeal, Melrose Place, etc.), rates of anorexia and bulimia skyrocketed," says Kaufman, an instructor at Columbus State Community College in Ohio.
Before that, she says, most Fijians preferred a fuller figure, and eating disorders were almost unheard of on the island. But by 1998, she says that girls who watched these shows at least three times a week were 50% more likely to have a distorted body image.
Ironically, Martz points out, many of the images women use to judge themselves aren't even real -- from the airbrushed bodies of lingerie models to digitally enhanced publicity photos of anchorwomen.
Psychologist and weight management expert Abby Aronowitz, PhD, says that while the media do have an effect on how women see themselves, far more dangerous are the product promises behind some of these glamorous campaigns.
"Companies use perfect bodies to point up our own body image dissatisfaction in order to sell us products to change that dissatisfaction. But when the diet doesn't work, or the cream wears off or the lingerie doesn't give you the bust line of your dreams, you feel like you have failed -- and that's when our self-esteem really plummets," says Aronowitz, author of Your Final Diet.
Women and Body Image: The Culture Phenomenon
Given the fact that media messages are aimed at men as well women, why are women seemingly so much more susceptible? For many, the answer harkens back to evolution -- or at least to our days in the baby stroller.
"Some would say women are hardwired to put more emphasis on their looks, that in terms of evolution, the value of attractiveness was programmed into women's DNA, necessary to help them get a mate, and ultimately, the protection that union provided," says Martz.
Fast-forward a few thousand years, and May points out that from our days in the stroller, little boys are valued for their strength and intelligence, while girls are doted on for their looks.
"It's not uncommon for people to compliment a baby boy by saying 'He's so strong, so smart,' while they compliment a baby girl by saying 'She's so cute, so adorable.' That kind of thinking becomes ingrained in our heads," says May.
That said, many experts agree that nothing in our culture or history can hurt a woman's self-worth as much as something many of us do in front of the mirror every day -- negative self-talk.
"Self-denigration is the most damaging thing we can do to our self-esteem because it is so personal," says Aronowitz. "With rejection of the body, a sense of identity and worth is vehemently attacked."
And, she says, women don't just denigrate themselves privately. It's also a group sport.
"What I think women don't realize is that when they turn to their best friend and say 'My cellulite is really gross' they are also saying 'Your cellulite is really gross.' So putting themselves down is not only insulting personally, it's also insulting to other women," says Aronowitz.
6 Ways to Boost Body Image Without Losing a Pound
While losing weight may give a temporary boost to your self-esteem, linking self-worth to a dress size is never going to have a long-lasting effect, experts say. What can make a difference is changing the way you see what's already there in the mirror.
Ironically, doing so often translates into making the kind of self-care changes that can also lead to improvements in the way you look.
"When your self-esteem is high, you care more about yourself, so doing things that are good for you, like eating a healthier diet or exercising regularly, also comes much easier, and we are more successful at it. And that often means we end up looking and feeling better," says Martz.
To help you get started thinking about yourself in a more positive light, our experts say, put away the scale, ignore those size tags, and focus on the following.

1. Stop negative self-talk immediately. While you still may not like what you see in the mirror, Martz says, learning to describe yourself with neutral, objective phrases can help stop the cycle of poor self-esteem. So, instead of saying to yourself "I have really ugly thighs," think "My thighs could use some work."
   
2. Find and focus on the things you like about your looks. It's best not to link your looks to your self-esteem, but with body image so intimately entwined with self-image, that can be hard to do. The next best thing is to find something about your image you really like. "It can be great hair, great nails, terrific teeth. Find the things about yourself you can say something good about, and every time you look in the mirror, go there first and say something positive to yourself," says Martz.
   
3. Treat yourself with the same kindness and respect you show your best friend. "Would you respect and care about a person who says about you what you are saying about yourself? If the answer is no, then begin treating yourself at least as well as you are treating others in your life," says May.
   
4. Say what you mean. Sometimes, hating your thighs is all about wanting thinner thighs. But sometimes, Kaufman says, negative body thoughts are a way of expressing discontent over other issues in your life. Learn to decode these messages, she says.
   
5. Dress the part. If you're putting off buying new clothes until you like your body better -- don't. Whether you're bursting at the seams in duds that are too tight or swimming in oversized clothing to hide your body, you are eroding your self-esteem. "Buy what fits you, and look the very best you can. It sends a powerful message to yourself that you are worth it," says Aronowitz.
   
6. Recognize that people naturally come in different shapes and sizes, and cherish your body's uniqueness. And, Martz says, remember this: "Only 2% of the world's women fall into the supermodel category. That leaves a lot of room for the rest of us!"
   

Healthy Habits

How much do you know about what makes up a healthy lifestyle? Here's a pop quiz.
1. How do you define working out?
a. Going to the gym.
b. Turning the jump-rope for the neighbor's kid.
c. Playing Frisbee with your dog.
2. How do you define good nutrition?
a. Eating a vegetable at every meal.
b. Eating two vegetables at every meal.
c. Drinking a fruit smoothie for breakfast.
3. Which of these is a healthy activity?
a. Push-ups, sit-ups, or running the track.
b. Walking the dog after dinner.
c. Spending Saturday afternoon snoozing on the sofa.
Believe it or not, the correct answer to every question is A, B, and C -- even that Saturday afternoon snooze! According to the growing "Stealth Health" movement, sneaking healthy habits into our daily living is easier than we think.
"You can infuse your life with the power of prevention incrementally and fairly painlessly, and yes, doing something, no matter how small, is infinitely better for you than doing nothing," says David Katz, MD, MPH, director of Yale University's Prevention Research Center and of the Yale Preventive Medicine Center. Katz is also co-author of the book Stealth Health: How to Sneak Age-Defying, Disease-Fighting Habits into Your Life without Really Trying.
From your morning shower to the evening news, from your work commute to your household chores, Katz says, there are at least 2,400 ways to sneak healthy activities into daily living.
"If you let yourself make small changes, they will add up to meaningful changes in the quality of your diet, your physical activity pattern, your capacity to deal with stress, and in your sleep quality -- and those four things comprise an enormously powerful health promotion that can change your life," says Katz.
And yes, he says, a nap on the couch can be a health-giving opportunity -- particularly if you aren't getting enough sleep at night.
Nutritionist and diabetes educator Fran Grossman, RD, CDE, agrees. "You don't have to belong to a gym or live on wheat grass just to be healthy," says Grossman, a nutrition counselor at the Mt. Sinai School of Medicine in New York. "There are dozens of small things you can do every day that make a difference, and you don't always have to do a lot to gain a lot."

Do a Little, Get a Lot

The notion that good health can come in small tidbits is not really new. Research showing that making small changes can add up to a big difference has been quietly accumulating for a while.
For example, a study published in the Archives of Internal Medicine in 2004 found that adding just 30 minutes of walking per day was enough to prevent weight gain and encourage moderate weight loss.
And if 30 minutes is still too big a bite? Another study, published in Medicine & Science in Sports & Exercise, found that three brisk 10-minute walks per day were as effective as a daily 30-minute walk in decreasing risk factors for heart disease.
"Just the act of going from sedentary to moderately active gives you the greatest reduction in your risks," says Helene Glassberg, MD, director of the Preventive Cardiology and Lipid Center at the Temple University School of Medicine in Philadelphia.
But it's not only in fitness where small changes can make a difference. The same principles apply at the kitchen table (and the office snack bar).
"Reducing fat intake, cutting down on sugar, eating a piece of fruit instead of a candy bar -- over time, these things can make a difference," says Grossman.
As long as the changes are moving you toward your goal -- be it weight loss, a reduction in cholesterol or blood pressure, or better blood sugar control -- you can get there by taking baby steps, she says.
Moreover, Grossman tells WebMD, making small changes can help give us the motivation to make bigger ones.
"A lot of bad eating habits are about not taking charge of your life, and that attitude is often reflected in other areas," says Grossman. On the other hand, she says, when you make small changes at the kitchen table, the rewards may show up in other areas of your life.
"It's the act of taking control that makes the difference in motivating you," says Grossman. "An inner confidence and power begins to develop that can be seen in other areas of life."

Tripping Over Baby Steps

Of course, not everyone is certain that baby steps can walk you all the way to good health. Marc Siegel, MD, a clinical associate professor at the NYU School of Medicine, says that while doing something is certainly better than doing nothing, making such small changes is like using a Band-aid to stop a hemorrhage.
"It's a small, gimmicky idea to target people with very unhealthy lifestyles, and for some it may be useful," says Siegel, author of False Alarm: the Truth about the Epidemic of Fear. But he fears that for most people, it's sending the wrong message.
"In some ways it's a resignation, an admission that things can't be changed -- and that's certainly not the long-term answer," Siegel tells WebMD.
Katz concedes that the Stealth Health approach may not be right for everybody.
"There is a trade-off because if you try to make the pursuit of health easier for people, you run the risk of leading them to believe they don't need to do very much -- and that would be the wrong message," he says.
At the same time, Katz believes that for those who find making health changes a daunting task, Stealth Health techniques can make a difference.
"If you want the really big gains, there has to be some pain," says Katz. "But there is a lot to be said for the idea that you can make some gains with little or no pain, and that's infinitely better than no gains."

Try the Stealth Health Approach

Tempted to give "Stealth Health" a try? Katz recommends picking any three of the following 12 changes and incorporating them into your life for four days. When you feel comfortable with those changes, pick three others. Once you've incorporate all dozen changes, you should start to feel a difference within a couple of weeks, he says.

To Improve Nutrition:

1. Buy whole foods -- whether canned, frozen, or fresh from the farm -- and use them in place of processed foods whenever possible.
2. Reject foods and drinks made with corn syrup, a calorie-dense, nutritionally empty sweetener that many believe is worse for the body than sugar, says Katz.
3. Start each dinner with a mixed green salad. Not only will it help reduce your appetite for more caloric foods, but it also will automatically add veggies to your meal.

To Improve Physical Fitness:

1. Do a squat every time you pick something up. Instead of bending over in the usual way, which stresses the lower back, bend your knees and squat. This forces you to use your leg muscles and will build strength.
2. Every time you stop at a traffic light (or the bus does), tighten your thighs and butt muscles and release as many times as you can. (Don't worry, no one will see it!) This will firm leg and buttock muscles, improve blood flow -- and keep you mildly amused!
3. Whenever you're standing on a line, lift one foot a half-inch off the ground. The extra stress on your opposite foot, ankle, calf and thigh, plus your buttocks, will help firm and tone muscles. Switch feet every few minutes.

To Improve Stress Control:

1. Give your partner a hug every day before work. Studies show this simple act can help you remain calm when chaos ensues during your day, Katz says.
2. Have a good cry. It can boost your immune system, reduce levels of stress hormones, eliminate depression, and help you think more clearly.
3. Twice a day, breathe deeply for three to five minutes

To Improve Sleep:

1. Sprinkle just-washed sheets and pillowcases with lavender water. The scent has been shown in studies to promote relaxation, which can lead to better sleep.
2. Buy a new pillow. Katz says that studies show that pillows with an indent in the center can enhance sleep quality and reduce neck pain. Also, try a "cool" pillow -- one containing either all-natural fibers or a combination of sodium sulfate and ceramic fibers that help keep your head cool.
3. Eat a handful of walnuts before bed. You'll be giving yourself a boost of fiber and essential fatty acids along with the amino acid tryptophan -- a natural sleep-inducer.

SOURCES: Archives of Internal Medicine. 2004; vol 164: pp 31-39. Medicine & Science in Sports & Exercise, September 2002. David Katz, MD, MPH, director, Prevention Research Center, Yale University; co-author, Stealth Health: How to Sneak Age-Defying, Disease-Fighting Habits into Your Life without Really Trying. Fran Grossman, MS, RD, CDE, nutrition counselor, Mt. Sinai School of Medicine, New York. Helene Glassberg, MD, director, Preventive Cardiology and Lipid Center, Temple University School of Medicine, Philadelphia. Marc Siegel, MD, clinical associate professor, New York University School of Medicine; author, False Alarm, The Truth about the Epidemic of Fear

Metastasis Cancer

Metastasis, or metastatic disease (sometimes abbreviated mets), is the spread of a disease from one organ or part to another non-adjacent organ or part.^[1][2] It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research.^[3] The word metastasis means "displacement" in Greek, from μετά, meta, "next", and στάσις, stasis, "placement". The plural is metastases.
Cancer occurs after a single cell in a tissue is progressively genetically damaged to produce a cancer stem cell possessing a malignant phenotype. These cancer stem cells are able to undergo uncontrolled abnormal mitosis, which serves to increase the total number of cancer cells at that location. When the area of cancer cells at the originating site becomes clinically detectable, it is called primary tumor. Some cancer cells also acquire the ability to penetrate and infiltrate surrounding normal tissues in the local area, forming a new tumor. The newly formed "daughter" tumor in the adjacent site within the tissue is called a local metastasis.
Some cancer cells acquire the ability to penetrate the walls of lymphatic and/or blood vessels, after which they are able to circulate through the bloodstream (circulating tumor cells) to other sites and tissues in the body. This process is known (respectively) as lymphatic or hematogeneous spread.
After the tumor cells come to rest at another site, they re-penetrate through the vessel or walls, continue to multiply, and eventually another clinically detectable tumor is formed. This new tumor is known as a metastatic (or secondary) tumor. Metastasis is one of three hallmarks of malignancy (contrast benign tumors).^[4] Most tumors and other neoplasms can metastasize, although in varying degrees (e.g. basal cell carcinoma rarely metastasize).^[4]
When tumor cells metastasize, the new tumor is called a secondary or metastatic tumor, and its cells are like those in the original tumor. This means, for example, that, if breast cancer metastasizes to the lungs, the secondary tumor is made up of abnormal breast cells, not of abnormal lung cells. The tumor in the lung is then called metastatic breast cancer, not lung cancer.

1. What is metastatic cancer? Metastatic cancer is cancer that has spread from the place where it first started to another place in the body. A tumor formed by metastatic cancer cells is called a metastatic tumor or a metastasis. The process by which cancer cells spread to other parts of the body is also called metastasis.
   Metastatic cancer has the same name and the same type of cancer cells as the original, or primary, cancer. For example, breast cancer that spreads to the lungs and forms a metastatic tumor is metastatic breast cancer, not lung cancer.
   Under a microscope, metastatic cancer cells generally look the same as cells of the original cancer. Moreover, metastatic cancer cells and cells of the original cancer usually have some molecular features in common, such as the expression of certain proteins or the presence of specific chromosome changes.
   Although some types of metastatic cancer can be cured with current treatments, most cannot. Nevertheless, treatments are available for all patients with metastatic cancer. In general, the primary goal of these treatments is to control the growth of the cancer or to relieve symptoms caused by it. In some cases, metastatic cancer treatments may help prolong life. However, most people who die of cancer die of metastatic disease. 
2. Can any type of cancer form a metastatic tumor? Virtually all cancers, including cancers of the blood and the lymphatic system (leukemia, multiple myeloma, and lymphoma), can form metastatic tumors. Although rare, the metastasis of blood and lymphatic system cancers to the lungs, heart, central nervous system, and other tissues has been reported.  
3. Where does cancer spread? The most common sites of cancer metastasis are the lungs, bones, and liver. Although most cancers have the ability to spread to many different parts of the body, they usually spread to one site more often than others. The following table shows, in descending order from left to right, the three most common sites of metastasis, excluding lymph nodes, for several types of cancer:
   

   Cancer type	Main sites of metastasis
   Breast	Lungs, liver, bones
   Colon	Liver, peritoneum, lungs
   Kidney	Lungs, liver, bones
   Lungs	Adrenal gland, liver, lungs
   Melanoma	Lungs, skin/muscle, liver
   Ovary	Peritoneum, liver, lungs
   Pancreas	Liver, lungs, peritoneum
   Prostate	Bones, lungs, liver
   Rectum	Liver, lungs, adrenal gland
   Stomach	Liver, peritoneum, lungs
   Thyroid	Lungs, liver, bones
   Uterus	Liver, lungs, peritoneum

    
4. How does cancer spread? Cancer cell metastasis usually involves the following steps:
   
   • Local invasion: Cancer cells invade nearby normal tissue.
   • Intravasation: Cancer cells invade and move through the walls of nearby lymph vessels or blood vessels.
   • Circulation: Cancer cells move through the lymphatic system and the bloodstream to other parts of the body.
   
   Metastatic cancer cells invade lymph vessels and blood vessels near a tumor and migrate to other parts of the body.
   • Arrest and extravasation: Cancer cells arrest, or stop moving, in small blood vessels called capillaries at a distant location. They then invade the walls of the capillaries and migrate into the surrounding tissue.
   • Proliferation: Cancer cells multiply at the distant location to form small tumors known as micrometastases.
   • Angiogenesis: Micrometastases stimulate the growth of new blood vessels to obtain a blood supply. A blood supply is needed to obtain the oxygen and nutrients necessary for continued tumor growth.
   Because cancers of the lymphatic system or the blood system are already present inside lymph vessels, lymph nodes, or blood vessels, not all of these steps are needed for their metastasis. Also, the lymphatic system drains into the blood system at two locations in the neck.
   The ability of a cancer cell to metastasize successfully depends on its individual properties; the properties of the noncancerous cells, including immune system cells, present at the original location; and the properties of the cells it encounters in the lymphatic system or the bloodstream and at the final destination in another part of the body. Not all cancer cells, by themselves, have the ability to metastasize. In addition, the noncancerous cells at the original location may be able to block cancer cell metastasis. Furthermore, successfully reaching another location in the body does not guarantee that a metastatic tumor will form. Metastatic cancer cells can lie dormant (not grow) at a distant site for many years before they begin to grow again, if at all. 
5. Does metastatic cancer have symptoms? Some people with metastatic tumors do not have symptoms. Their metastases are found by x-rays or other tests.
   When symptoms of metastatic cancer occur, the type and frequency of the symptoms will depend on the size and location of the metastasis. For example, cancer that spreads to the bones is likely to cause pain and can lead to bone fractures. Cancer that spreads to the brain can cause a variety of symptoms, including headaches, seizures, and unsteadiness. Shortness of breath may be a sign of lung metastasis. Abdominal swelling or jaundice (yellowing of the skin) can indicate that cancer has spread to the liver.
   Sometimes a person’s original cancer is discovered only after a metastatic tumor causes symptoms. For example, a man whose prostate cancer has spread to the bones in his pelvis may have lower back pain (caused by the cancer in his bones) before he experiences any symptoms from the original tumor in his prostate. 
6. Can someone have a metastatic tumor without having a primary cancer? No. A metastatic tumor is always caused by cancer cells from another part of the body.
   In most cases, when a metastatic tumor is found first, the primary cancer can also be found. The search for the primary cancer may involve lab tests, x-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, positron emission tomography (PET) scans, and other procedures.
   However, in some patients, a metastatic tumor is diagnosed but the primary tumor cannot be found, despite extensive tests, because it either is too small or has completely regressed. The pathologist knows that the diagnosed tumor is a metastasis because the cells do not look like those of the organ or tissue in which the tumor was found. Doctors refer to the primary cancer as unknown or occult (hidden), and the patient is said to have cancer of unknown primary origin (CUP).
   Because diagnostic techniques are constantly improving, the number of cases of CUP is going down. More information about this can be found in the CUP PDQ® summary, which is part of NCI’s comprehensive cancer information database. 
7. If a person who was previously treated for cancer gets diagnosed with cancer a second time, is the new cancer a new primary cancer or metastatic cancer? The cancer may be a new primary cancer, but, in most cases, it is metastatic cancer.  
8. What treatments are used for metastatic cancer? Metastatic cancer may be treated with systemic therapy (chemotherapy, biological therapy, targeted therapy, hormonal therapy), local therapy (surgery, radiation therapy), or a combination of these treatments. The choice of treatment generally depends on the type of primary cancer; the size, location, and number of metastatic tumors; the patient’s age and general health; and the types of treatment the patient has had in the past. In patients with CUP, it is possible to treat the disease even though the primary cancer has not been found.
9. Are new treatments for metastatic cancer being developed? Yes, researchers are studying new ways to kill or stop the growth of primary cancer cells and metastatic cancer cells, including new ways to boost the strength of immune responses against tumors. In addition, researchers are trying to find ways to disrupt individual steps in the metastatic process.
   Before any new treatment can be made widely available to patients, it must be studied in clinical trials (research studies) and found to be safe and effective in treating disease. NCI and many other organizations sponsor clinical trials that take place at hospitals, universities, medical schools, and cancer centers around the country. Clinical trials are a critical step in improving cancer care. The results of previous clinical trials have led to progress not only in the treatment of cancer but also in the detection, diagnosis, and prevention of the disease. Patients interested in taking part in a clinical trial should talk with their doctor.

Selected References 

1. Patel JK, Didolkar MS, Pickren JW, Moore RH. Metastatic pattern of malignant melanoma: a study of 216 autopsy cases. American Journal of Surgery 1978; 135(6):807–810. [PubMed Abstract]
   
2. Disibio G, French SW. Metastatic patterns of cancer: results from a large autopsy study. Archives of Pathology & Laboratory Medicine 2008; 132(6):931–939. [PubMed Abstract]
   
3. Talmadge JE, Fidler IJ. AACR centennial series: the biology of cancer metastasis: historical perspective. Cancer Research 2010; 70(14):5649–5669. [PubMed Abstract]
   
4. Coghlin C, Murray GI. Current and emerging concepts in tumour metastasis. Journal of Pathology 2010; 222(1):1–15. [PubMed Abstract]
   
5. Viadana E, Bross ID, Pickren JW. An autopsy study of the metastatic patterns of human leukemias. Oncology 1978; 35(2):87–96. [PubMed Abstract]
   
6. Otto CM. Cardiac masses and potential cardiac “source of embolus.” In: Textbook of Clinical Echocardiography. 4^th ed. Philadelphia: Elsevier, Inc., 2009.
   
7. Schluterman KO, Fassas AB, Van Hemert RL, Harik SI. Multiple myeloma invasion of the central nervous system. Archives of Neurology 2004; 61(9):1423–1429. [PubMed Abstract]
   
8. Grier J, Batchelor T. Metastatic neurologic complications of non-Hodgkin’s lymphoma. Current Oncology Reports 2005; 7(1):55–60. [PubMed Abstract]
   
9. Aragon-Ching JB, Zujewski J. CNS metastasis: an old problem in a new guise. Clinical Cancer Research 2007; 13(6):1644–1647. [PubMed Abstract]

General fitness training

A regular moderate workout regimen and healthy diet can improve general appearance markers of good health such as muscle tone, healthy skin, hair and nails, while minimizing age or lifestyle-related reductions in health.
For more information about the topic General fitness training, read the full article at Wikipedia.org, or see the following related articles:

Detox diet — A detox diet is a dietary regimen involving a change in consumption habits in an attempt to detoxify the body by removal of toxins or other ...  > read more

Physical exercise — Physical exercise is the performance of some activity in order to develop or maintain physical fitness and overall health. It is often directed ...  > read more

Overweight — The term overweight is generally used to indicate that a human (or other mammal) has more body fat than is typical or required for the normal ...  > read more

Aerobic exercise — In physical exercise, aerobic exercise is complementary to anaerobic exercise. Aerobic literally means "with oxygen", and refers to the use of oxygen ...  > read more

Overweight People More Likely To Have Bad Breath

The research, led by breath expert Prof. Mel Rosenberg from the Department of Human Microbiology and The  Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine at Tel Aviv University, was reported in the Journal of Dental Research in October. The study also reported, for the first time, scientific evidence that links bad breath to alcohol consumption.
“The finding on alcohol and bad breath was not surprising because the anecdotal evidence was already there,” says Prof. Rosenberg. “However, the finding that correlated obesity to bad breath was unanticipated.”
A Weighty Sample
The study was done in Israel and included a sample of 88 adults of varying weights and heights. While at a clinic for a regular check-up, they were asked by graduate student Tsachi Knaan, a co-author in the study, whether he could test the odor of their breath and ask questions about their daily habits.
Prof. Rosenberg, Knaan and Prof. Danny Cohen concluded from the data that overweight patients were more likely to have foul-smelling breath. “This finding should hold for the general public,” says Prof. Rosenberg. “But we don’t have any scientific evidence as to why this is the case. That will be the next step.”
He surmises that the connection between obesity and bad breath could be caused by several factors. Obese people may have a diet that promotes the condition of dry mouth. Prof. Rosenberg also suggests that people who are obese may be less in tune with taking care of their mouths and bodies. “We have certainly opened a window of questions here,” says Prof. Rosenberg.
Halitosis of the Ancient World?
While widespread obesity is a modern invention, bad breath is not. The phenomenon goes back thousands of years.
Says Prof. Rosenberg, “I have read reports of bad breath in ancient Egypt.  In ancient Rome there was a man named Cosmos who sold breath-freshening agents.  Bad breath is frequently mentioned in Jewish scripture  The Talmud stating that if you were a ‘Cohen’ (a priest) you couldn’t perform holy duties on the Temple if your breath was bad.
“If you were a newlywed groom, you could annul a marriage if on your wedding night you discovered that your wife has bad breath. In ancient times, we learn, bad breath was considered a ‘no-no,’ as bad as having leprosy.”
Self-Examination Not a Possibility
The problem remains today. Bad breath — and the fear that you might have it — plagues millions of people because it isn’t easy for one to check one’s own breath. Indeed, nine people in the study were unaware of their bad breath.
Says Prof. Rosenberg, who co-edits the Journal of Breath Research, “I can’t go out into the world and smell everybody’s breath, and quite frankly I’ve already smelled many thousands of cases. My goal now is to give people a list of the potential factors that could lead to this condition, so they can treat themselves.” Obesity is now added to the list, which includes dry mouth, poor dental hygiene, and possibly even the morning cup of coffee.
“You should tell people in your family if they have bad breath,” says Prof. Rosenberg. “It is curable in almost all instances, and it can be a sign of disease. As for work colleagues, they might be happy for the advice, but they might not.”
And don’t be embarrassed if it happens to you, he adds. Even professors of dentistry and experts in the field of bad breath sometimes have malodorous mouths.

Easily Embarrassed? Study Finds People Will Trust You More

In short, embarrassment can be a good thing.
"Embarrassment is one emotional signature of a person to whom you can entrust valuable resources. It's part of the social glue that fosters trust and cooperation in everyday life," said UC Berkeley social psychologist Robb Willer, a coauthor of the study published in this month's online issue of the Journal of Personality and Social Psychology.
Not only are the UC Berkeley findings useful for people seeking cooperative and reliable team members and business partners, but they also make for helpful dating advice. Subjects who were more easily embarrassed reported higher levels of monogamy, according to the study.
"Moderate levels of embarrassment are signs of virtue," said Matthew Feinberg, a doctoral student in psychology at UC Berkeley and lead author of the paper. "Our data suggests embarrassment is a good thing, not something you should fight." The paper's third author is UC Berkeley psychologist Dacher Keltner, an expert on pro-social emotions.
Researchers point out that the moderate type of embarrassment they examined should not be confused with debilitating social anxiety or with "shame," which is associated in the psychology literature with such moral transgressions as being caught cheating.
While the most typical gesture of embarrassment is a downward gaze to one side while partially covering the face and either smirking or grimacing, a person who feels shame, as distinguished from embarrassment, will typically cover the whole face, Feinberg said.
The results were gleaned from a series of experiments that used video testimonials, economic trust games and surveys to gauge the relationship between embarrassment and pro-sociality.
In the first experiment, 60 college students were videotaped recounting embarrassing moments such as public flatulence or making incorrect assumptions based on appearances. Typical sources of embarrassment included mistaking an overweight woman for being pregnant or a disheveled person for being a panhandler. Research assistants coded each video testimonial based on the level of embarrassment the subjects showed.
The college students also participated in the "Dictator Game," which is used in economics research to measure altruism. For example, each was given 10 raffle tickets and asked to keep a share of the tickets and give the remainder to a partner. Results showed that those who showed greater levels of embarrassment tended to give away more of their raffle tickets, indicating greater generosity.
Researchers also surveyed 38 Americans whom they recruited through Craigslist. Survey participants were asked how often they feel embarrassed. They were also gauged for their general cooperativeness and generosity through such exercises as the aforementioned dictator game.
In another experiment, participants watched a trained actor being told he received a perfect score on a test. The actor responded with either embarrassment or pride. They then played games with the actor that measured their trust in him based on whether he had shown pride or embarrassment.
Time and again, the results showed that embarrassment signals people's tendency to be pro-social, Feinberg said. "You want to affiliate with them more," he said, "you feel comfortable trusting them."
So, can one infer from the results that overly confident people aren't trustworthy? While the study didn't delve into that question, researchers say they may look into that in the future