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Drug detox is a drug treatment to help addicts recover from addiction problems. It is the way that used to control the addiction of the patients and to remove the toxin inside the patients’ body. In drug detox, the medical staff will be analyzing patients to find out the symptoms of the addiction. Once they have found them, the process of removing the toxin will be commenced. After that, the patients will need to follow certain programs to gain a full recovery of addiction. In the process of recovery in drug detox, medical staff will be monitoring and supervising the patients to ensure that the recovery process is successful.

Drug detox medication is famous these days as a way of curing addiction as well as removing toxic from the addicts. This treatment can have a great impact on patient’s addiction since it is not only controlling the addiction habit, but it also cures and removes the toxins of the drugs inside the patients’ body. With friendly and convenient place of rehabilitation, drug detox medication process will be running more smoothly and the patients can quickly regain the healthy and happy life without drug addiction.

Thyroid Nodules

The thyroid nodule is the most common thyroid disease, and like all diseases of the thyroid affects more frequently in females than in males affecting approximately 6.4% of those aged between 30 and 59 years. In fact, its incidence is probably even higher (in the autopsy findings was accomplished almost 50% of cases) but not diagnosed by the absence of symptoms. Its prevalence in the general population increases progressively with age and sometimes is accompanied by an enlargement of the gland (goiter).

Goiter is often compensatory hypertrophy of the thyroid gland, particularly frequent in areas with a low content of iodine in the diet.

This is a newly-formed rounded, single or multiple (multinodular goiter), solid or cystic (sometimes mixed) that can grow a few inches sometimes causing disturbances by compression on adjacent organs.

The feedback is done by palpation and / or visually (often during a clinical examination) or ultrasound during an investigation aimed at the neck region. Many small solitary nodules are often completely asymptomatic and are diagnosed occasionally, large nodules as well as being visible (often see them for the first patient) and create an aesthetic problem, can cause problems by compression on adjacent organs such as the larynx and trachea (dysphonia, dyspnea) and esophagus (dysphagia).

The nature of thyroid nodules are benign in most cases, particularly in women, only 5-6% have an origin tumor (papillary carcinoma of the most common).

The diagnostic is intended to distinguish malignant from benign thyroid nodules, to describe its size and structure, whether it belongs to a simple or multinodular goiter, subacute or chronic thyroiditis to.

Elements of alarm are:

previous radiation to the neck
increased volume of lateral cervical lymph nodes
rapid growth
increase of consistency
compression disorders (dysphonia, dysphagia)
previous cases of thyroid cancer in the family.
Elements of tranquility are (but not absolutely exclude the need for surveys):

immediate appearance, with acute pain and tension
Concomitant relief of symptoms of hyperthyroidism (tachycardia, etc..)
Normally, the first professional to take care of the problem is the general practitioner, he will judge whether it is necessary to use the Specialist Endocrinologist.

The laboratory investigations that are both instrumental and possibly Cytomorphology.

LABORATORY INVESTIGATIONS

Evaluation of thyroid function by TSH (a pituitary hormone that controls the small thyroid) and thyroid hormones (free circulating fractions) FT3, FT4. The finding of an increase in thyroid hormones (particularly dell’FT3) might lay down for a hyperfunctioning nodule (toxic adenoma), and low values ​​(FT4) with raised TSH are more typical example of a chronic autoimmune thyroiditis with hypothyroidism. In pregnancy, the stimulation by chorionic gonadotropin (HCG) on the thyroid in the first few weeks can result in a slight lowering of the physiological TSH (down regulation) not to be confused with situations of hyperthyroidism.
Calcitonin: useful to identify or exclude the presence of medullary thyroid carcinoma.
Dosage antitireoglobulina antibody (TgAb) and antitireoperossidasi (TPOAb): their identification and titration helps to identify any chronic autoimmune process (Haschimoto thyroiditis).

SURVEY INSTRUMENT

Thyroid ultrasound is a very important role. Highlight the thyroid nodule, its size, its structure, and also describes the context in which the gland is located, it can also describe the presence of enlarged lymph nodes (lymph node enlargement), locoregional (neighbors).
The echo-Doppler-Article by information on the vascularity of the nodule: an intense blood flow could be suspect, but is also present in hyperfunctioning adenomas entirely benign.
The CT scan (Computerized Axial Tomography) and MRI (Magnetic Resonance Imaging) are sometimes useful in analyzing the relationship of the Thyroid with neighboring organs and vascular structures as well as in the study of development in retrosternal goiters.
The thyroid scan through the study of the uptake of a radioactive isotope of iodine helps to distinguish themselves functioning nodules (lumps hot ipercaptanti) from non-functioning (cold nodules) or isocaptanti than the rest of the gland. This exam is absolutely contraindicated in pregnancy.

INVESTIGATIONS Cytomorphology

The FNA is a valuable investigation in the differential diagnosis between benign and malignant thyroid nodules. With a needle under ultrasound guidance and proceed to the aspiration of the nodule and the cells are removed and so ‘important that the sample (sampling) is adequate for the purposes of the cytological diagnosis. He has no contraindication in pregnancy and as a rule all palpable nodules larger than 1 cm should undergo this procedure.
Within these investigations, however, elements of alarm or concern (in a tumor) is the identification of structurally solid nodules, mixed or scintigraphic examination ipocaptanti (cold), fine-needle aspiration will identify those really dangerous, fortunately a small minority.

Treatment depends on the benign or malignant thyroid nodules, the combination of a goiter, the patient’s general medical condition, including (since often women) a possible pregnancy. A large part (up to almost 50%) of benign nodules undergoes spontaneous regression.
Benign nodules showed documented growth or aesthetic damage or compression problems can be treated by administration of levo-thyroxine (LT4): The exogenous administration of thyroid hormones suppress the pituitary secretion of TSH in fact and in many cases this leads to a significant reduction in the size of the nodule, the attempt is always made with the minimum effective dose, requires a selection of patients to rule out contraindications (eg, cardiovascular disease, age, the risk for postmenopausal osteoporosis) and usually without success does not come persisted for more than a year. While the LT4 seems useful in preventing the formation of nodules, and still further to curb its growth was not demonstrated an ability in preventing neoplastic transformation.
Cystic nodules of kindness can be safely treated with aspiration (frequently burdened by recurrence), the US-guided percutaneous alcoholics (sclerosed walls and is effective in 80-95% of cases), surgery.
Different and more complex is the attitude in cases of malignancy, which obviously takes also the biological characteristics of the tumor (histological type): surgical therapy is the first choice and go by lobectomy (partial removal), total removal of the thyroid (thyroidectomy ), making use where necessary of the radioiodine adjuvant therapy (administration of radioactive iodine, which destroys cells remaining), chemotherapy, radiation therapy.

In pregnancy, the finding of one or more thyroid nodules generates anxiety, perhaps even greater than normal and is not justified to wait for a diagnosis, because most of the surveys can also be made during the gestational period also included fine-needle aspiration, is a absolute contraindication scintigraphy. When therapy with LT4 this can be done with care to always start with suboptimal doses and increase them gradually. In the nodules may be reasonable doubt keep a close watch and postpone further evaluation and treatment options after delivery (in some cases can be justified even though treatment with LT4). Nodules whose cytology for malignancy is indicated lays surgery: the timing should take account of operational risks for mother and fetus and should be thoroughly discussed with the patient. The finding of a papillary carcinoma (most common) is not an indication of termination of pregnancy, these tumors have a slow growth and low tendency to metastasize, malignant forms are fortunately very rare. In many cases, delaying the intervention of a few months could provide easier reproductive success (reaching safe for the fetus gestational age) without affecting the viability of the mother, this is how you can easily understand the decisions that need to be extremely sensitive taken by specialist teams (endocrinologists, obstetricians, neonatologists) in each case and on which one can not generalize.

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Varicocele

Few topics in medicine are still so controversial and discussed how the varicocele and its significance in human pathology. But first, what is varicocele? It is made of a dilated varicose veins treatment of testicular (pampiniform plexus, to the involvement of the internal spermatic veins), which finds its highest incidence between ages 15 and 25 years. It affects about 10-20% of the general population male and 85% of cases is on the left, right or bilateral resulting in a minority of situations.

But why so much interest in a varicose vein? Undoubtedly the peculiarity of the place in itself highlights the disease, particularly if the varicocele is high grade (note that, clinically, according to the size and evidenziabilità, the varicocele is ranked from first to third degree). Although often asymptomatic, can cause clinical symptoms ranging from a sense of heaviness to a real pain oppressive in the region corresponding scrotal And ‘But certainly the potential that the relationship with infertility has given a prominent place in the pathology of’ male genitalia, a relationship that still puts him to the attention of the medical assessment of Andrology.

What are the pathogenetic mechanisms of varicocele?

Over 95% of the conditions of varicocele are related to a situation idiopathic (the so-called primary forms). The veins from the testicle waste, for embryological reasons, drain into the renal vein on the left and right in the quarry, the erect stature, evolutionarily acquired by man, means that the column effluent blood from the testicle severe spermatic veins, which are equipped with a containment valve systems. It ‘possible that constitutional factors, similar to what occurs in the veins of the legs, to condition a weakness of the vein wall, with a gradual wearing out of the same, this leads to a subsequent valvular incontinence, conditioned by the occurrence of reflux is the retrograde blood salient feature of the varicocele. The anatomy (entry angle of the left spermatic vein into the renal vein, any compression of the left spermatic vein from the mesenteric artery) gives an account of the fact that this form of varicocele affects mainly the left side. It should be noted, however, that any expansive retroperitoneal or pelvic processes compressing the venous structures can cause an obstruction to venous outflow and the appearance of varicocele (in particular the appearance of varicocele in adulthood or in the right place to suggest the exclusion of any disease extrinsic compression – Secondary varicocele).

What are the symptoms of varicocele?

The symptomatology is strongly influenced by the degree of varicocele and its etiology. It ‘true that the majority of varicoceles are asymptomatic and are found incidentally during diagnostic procedure for infertility or other andrological. The disorder most commonly complained about by patients with varicocele is a heaviness to a real pain oppressive in the region corresponding scrotal. It ‘also be noted that in the rare cases of varicocele secondary processes expansive retroperitoneal or pelvic pain symptoms in these locations may be important.

How is it diagnosed varicocele?

The diagnosis of varicocele is clinical and instrumental (Doppler of the spermatic cord). Clinically it is possible to highlight upright pampiniform plexus vein dilation, both in basal conditions and after provocation maneuvers (the so-called Valsalva maneuver). The confirmation is, however, ultrasound, in particular through the echo-color Doppler scrotal documenting venous reflux, the essential criterion for the diagnosis of varicocele.

Varicocele and male infertility

The role of varicocele in male is certainly the most contentious issue. Multiple arguments can be adduced for and against its involvement in impaired semen quality. I cite for example the fact that the varicocele may be present in subjects with normal semen characteristics (normospermici), although its prevalence is greater in subjects with abnormal semen characteristics (data from a study by the World Health Organization – WHO – in 1992) . Several other studies have documented a negative effect of the presence of varicocele on sperm motility and morphology, the pathogenetic mechanisms involved may be the thermal effect due to increased scrotal temperature, the pressure is related to increased blood flow to the obstacle, the ‘ excess of free radicals. The focal question, however, if the correction of varicocele in men with abnormal semen parameters involving the improvement of the characteristics of the seed itself and increasing the chance of conception, as estimated by the so-called “pregancy rate”. Regard to this crucial point, it should be noted that there are currently only seven randomized controlled trials on the effects of the correction of varicocele in relation to pregnancy rate, of which only one showed a statistically significant improvement in spontaneous conception after varicocele correction. Regarding the effect of the correction of varicocele on semen parameters, controlled studies (ie, performing a comparison with a population “control”

in which the varicocele is not correct) reach contradictory conclusions, in the sense that some studies provide data demonstrating an improvement in semen quality and show no other significant changes. Any improvement in semen parameters in itself could also be useful for optimization of the male seed for couples who decide to resort to assisted reproduction techniques, in the sense that the best semen quality may increase the likelihood of success thereof, or reduce the degree of complexity of intervention (eg, intrauterine insemination rather than IVF, etc.). Finally, the controlled data available today agree that it is highly unlikely that a azoospermia (no sperm in ejaculate) or severe oligospermia or criptozoospermia are caused by varicocele.

Treat or not treat varicocele?

In these terms, the question seems almost to be placed by Shakespeare. Actually, the answer depends on the type of patient and the objective that we aims (would rather expect that you create) the same correction of varicocele. Some key issues in the personal: it is a young person (between 18-20 years old) or adult (> 30-35y.o.)? And ‘symptomatic or not? The purpose of the correction of varicocele is the prevention of any changes in time or the seminal enhancing the capabilities of conception? In this last case, how old is your partner, how long children are looking for and what are the guidelines of the couple about a possible use of assisted reproductive technologies? In practice, it is certainly very different in the case of a young man of 18 with a varicocele symptoms (eg pain oppressive) and seminal alterations compared to the case of an asymptomatic 40 year old man, with a modest asthenospermia, looking for some children years with a partner of 38 years.

The situation should therefore be evaluated individually, depending on the specific proposals from the clinical case. However, there is a broad consensus on treatment of varicocele in the following conditions: i) adults and adolescents with varicocele symptoms (pain), ii) reduction in adolescents with left testicular volume> 2-3 ml compared to the contralateral (prevention) and iii) advanced adolescents with varicocele of grade 3 and progressive deterioration of semen parameters in follow-up of 1-2 years, iv) male partners of infertile couple for less than three years, with unexplained abnormal semen quality with age of the partners

It should also be remembered that the patient) is not likely to expect an improvement in the correction of varicocele in the seminal case of azoospermia or severe oligospermia ii) that are possible

varicocele recurrence of the same, iii) that the correction of varicocele, however, be done, however, is always a ploy and as such invasive with potential complications.

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