Migraine

Migraine

Migraine, severe headache that occurs periodically and is sometimes confined to only one side of the head. A migraine is characterized by intense, throbbing, often blinding pain, and one or more of the following symptoms: sensitivity to light, nausea, vomiting, chills, facial swelling, tenderness of the scalp, sweating, frequent urination, irritability, visual hallucinations, and malaise. The headache may be preceded by a warning sensation, known as an aura, that may include flashes or patterns before the eyes, illusory tastes or odors, dizziness, tingling, or numbness.

More than 26 million people in the United States suffer from migraines, which can last for hours or days at a time and recur at intervals ranging from one day to several years. Women are twice as likely as men to experience these headaches, and some evidence suggests that migraines are inherited. They tend to affect people for the first time between the ages of 10 and 30; symptoms tend to become far less intense after the age of 50.

At the onset of a migraine headache, blood vessels within the head constrict, causing a decrease in blood flow to the surface of the brain. Swelling of blood vessels in the head and scalp then sets off a chain of reactions that result in the headache. Among the biochemical changes associated with migraines are a reduced level of the neurotransmitter serotonin as well as an insufficient supply of enkephalins, the brain’s pain-relieving chemicals.

Hormonal level changes (such as those experienced by women during menopause or menstruation), endocrine imbalances, and stress due to anything from overwork to loud noises are considered precipitating factors of migraine headaches in susceptible people. Other factors that may trigger attacks include allergies, excess carbohydrates in the diet, foods rich in the trace element iodine, and alcoholic beverages.

Several treatments have been successful in helping migraine sufferers. These include medications such as sumatriptan and ergotamine tartrate, both of which shrink swollen blood vessels, thereby aborting the acute phase of a migraine attack; and propranolol, which stabilizes blood vessel tone and helps prevent subsequent attacks. Other drugs often prescribed to migraine sufferers are amitriptyline, phenelzine, and verapamil. Biofeedback techniques have also proven useful.

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Urinary Tract Infection

Urinary Tract Infection (UTI)
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What is a Urinary (yoor-ih-nehr-ee) Tract Infection (UTI)?
What causes Urinary Tract Infections (UTIs)?
What are the signs of a Urinary Tract Infection (UTI)?
How does a doctor find out I have a Urinary Tract Infection (UTI)?
How is a Urinary Tract Infection (UTI) treated?
Are there steps I can take to help prevent a Urinary Tract Infection (UTI)?

See also...

Interstitial Cystitis
Urinary Incontinence

"It was a normal day at work, but I was tired and felt like I had to pass urine the whole day. But when I went to the bathroom, not much came out. When I did pass urine, it burned and smelled bad―and looked cloudy too. These problems lasted a few days. So I called my doctor, and she said it sounded like a Urinary Tract Infection, or UTI. I went to her office, and she asked me to pass urine into a cup. She tested the urine and told me I had a UTI. She called my drug store and ordered pills for me. I took all of the pills she prescribed, and then the UTI and the symptoms were gone."



What is a Urinary (yoor-ih-nehr-ee) Tract Infection (UTI)?
The urinary tract makes and stores urine. Bacteria (bak-teer-ee-uh), a type of germ that gets into your urinary tract, cause a UTI. This infection can happen in parts of your urinary tract, like your kidneys, bladder, or urethra (yuh-ree-thra).

What causes Urinary Tract Infections (UTIs)?
Many things can help to cause UTIs:

Wiping from back to front after a bowel movement (BM). Germs can get into your urethra, which has its opening in front of the vagina.

Having sexual intercourse. Germs in the vagina can be pushed into the urethra.
Waiting too long to pass urine. When urine stays in the bladder for a long time, more germs are made, and the worse a UTI can become.

Using a diaphragm for birth control, or spermicides with a diaphragm or on a condom. To read more about diaphragms, go to www.plannedparenthood.org/bc/DIAPHRAGMS.HTM.
Anything that makes it hard to completely empty your bladder, like a kidney stone.

Having diabetes, which makes it harder for your body to fight other health problems.
Loss of estrogen and changes in the vagina after menopause. Menopause is when you stop getting your period.

What are the signs of a Urinary Tract Infection (UTI)?
There are signs if you have an infection:

Pain or stinging when you pass urine.
An urge to pass urine a lot.
Pressure in your lower belly.
Urine that smells bad or looks milky, cloudy, or reddish in color.
Feeling tired or shaky or having a fever.

How does a doctor find out I have a Urinary Tract Infection (UTI)?
To find out if you have a UTI, your doctor will ask you to pass urine into a plastic cup. When you open the cup, don’t touch the inside of the lid or inside of the cup. Before you pass urine, wipe the area between the labium majora, or outer lips of the vagina, with a special tissue, given to you by your doctor. Then, pass a little bit of urine into the toilet and then into the cup.

How is a Urinary Tract Infection (UTI) treated?
UTIs are treated with antibiotics (an-ty-by-ah-tiks), a medicine that kills the infection. Your doctor will tell you how long you need to take the medicine. Make sure you take all of your medicine, even if you feel better!

If you don't take medicine for a UTI, the UTI can hurt other parts of your body. Also, if you're pregnant and have signs of a UTI, see your doctor right away. A UTI could cause problems in your pregnancy, such as having your baby too early or getting high blood pressure.

Are there steps I can take to help prevent a Urinary Tract Infection (UTI)?
These are steps you can take to try to prevent a UTI. But you may follow these steps and still get a UTI. If you have symptoms of a UTI, call your doctor.

Urinate when you need to. Don't hold it. Pass urine before and after sex. After you pass urine or have a bowel movement (BM), wipe from front to back.
Drink water every day and after sex.
Clean the outer lips of your vagina and anus each day. The anus is the place where a bowel movement leaves your body, located between the buttocks.
Don't use douches or feminine hygiene sprays.
If you get a lot of UTIs and use spermicides, or creams that kill sperm, talk to your doctor about using other forms of birth control.
Wear underwear with a cotton crotch.
For more information...
For more information about urinary tract infections, contact the National Women's Health Information Center at (800) 994-WOMAN (9662) or TDD at 1-888-220-5446. Visit NWHIC's web site at http://www.womenshealth.gov/.

National Kidney and Urologic Diseases Information Clearinghouse
Phone Number(s): (800) 891-5390 Internet
Address: http://kidney.niddk.nih.gov/

American Foundation for Urologic Disease
Phone Number(s): (800) 242-2383
Internet Address: http://www.afud.org/

American College of Obstetricians and Gynecologists (ACOG) Resource Center
Phone Number(s): (202) 638-5577
Resource Center Internet Address: http://www.acog.org/

All material contained in the FAQs is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services; citation of the sources is appreciated.

Back to FAQ Index

The Urinary Tract Infection FAQ was reviewed by Dr. Leroy Nyberg, Dr. Josie Briggs, and Kathy Kranzfelder at the National Institute of Diabetes & Digestive & Kidney Diseases.

October 2004

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Enchondroma

Enchondroma Description Enchondroma (en-kon-DRO-ma) is one type of benign (non-cancerous) cartilage tumor that appears on the inside of the bone. These tumors usually begin and grow in childhood, then stop growing but remain present throughout adulthood. They are often found in patients between the ages of 10 and 20. Some cases become dormant or burned out. Incidence These tumors are very common and often occur in the small bones of the hand and feet. In fact, they are the most common tumor of the hand. They also occur in the long bones of the upper arm and thigh. In rare cases, multiple tumors can appear as part of a syndrome. These syndromes are Ollier's disease and Maffucci's syndrome. Single enchondromas can become cancerous, but this is very rare. The rate of change to a cancerous tumor is a little higher in Ollier's disease and Maffucci's syndrome. Being able to tell the difference between these benign tumors and very low-grade forms of cancerous tumors can be difficult, even for orthopaedic tumor surgeons. Diagnosis Most enchondromas are found when X-rays are taken for another reason, such as injury or arthritis. The diagnosis of an enchondroma is important to make sure it is not a more aggressive or cancerous tumor. The physician evaluates the history and physical exam along with images. It is important to know if the tumor is painful and the kind of pain it causes. There is greater concern if the pain occurs at rest or night pain that doesn't go away. Pain caused by activity is not as troublesome. Often pain from a different reason in a nearby joint may have prompted the X-ray. The next most important information is found on the X-rays. Enchondromas appear as small (smaller than 5 cm) lobe-shaped white tumors in the middle of the bone (Figure 1). The white areas of the tumor usually show a pattern of rings and arcs that indicates the tumor contains cartilage. Characteristics of a more aggressive tumor or malignant chondrosarcoma include: Scalloping of the inner surface of the bone Thickening of the bone cortex Reactive bone growth on the outer surface of the bone Destruction of the bone by the tumor Soft tissue mass Large amounts of erosion of the bone Bone erosion that is growing Erosion surrounded by reactive bone Although most enchondromas are diagnosed on plain X-rays (Figure 2), a computed tomography (CT) or magnetic resonance imaging (MRI) scan of the affected bone may sometimes be helpful. These scans give a more complete picture of the bone around the tumor (Figure 3). Bone scans can be helpful in some circumstances. However, both benign and malignant tumors can show increased uptake of the radioactive tracer used to detect increased bone activity (Figure 4). Under the microscope, enchondromas have islands of cartilage that are easy to tell apart from the normal bone that surrounds them. Usually, cartilage is not found in the center of bones. However, these tumors in the hand and foot or in Ollier's disease or Maffucci's syndrome may contain more odd-looking cartilage. They may be more difficult to tell apart from a mildly cancerous malignant tumor called low-grade chondrosarcoma. Low-grade chondrosarcomas (cancers) look more cellular under a microscope than enchondromas and there is less normal bone in the tumor. Because both these tumors look similar under the microscope, a group effort between experienced surgeons, radiologists and pathologists is important to get the best interpretation of the tumor. Risk Factors/Prevention The cause of enchondromas is not completely clear, but they don't seem to be caused by exposure to chemicals or radiation or patient activities. The chance that a single one of these tumors will become malignant is very rare. For the very few that become cancer, when they become malignant, they usually become a chondrosarcoma. There is a greater risk of a change to a malignant cancer in patients with Ollier's disease or Marfucci's syndrome. Symptoms These tumors are usually painless. They are usually found during an X-ray evaluation of another problem in the same area. When these tumors appear in the hands or feet, or in multiple lesions, they can deform the bone. The symptoms for enchondromas of the hands and feet are enlarged fingers, pathologic fracture or deformities. On an X-ray, they appear as a dark hole in the bone, but usually they have calcification or white spots in the hole. The deformities in patients with Ollier's disease and Maffucci's syndrome can be quite severe. If pain from other nearby sources has been excluded, the tumor should be carefully studied to determine whether it could be a low-grade chondrosarcoma. Pain at night or at rest is more likely to mean a malignant tumor. But pain is also very common with some shoulder conditions like rotator cuff tendonitis. Treatment Options: Non-surgical Most enchondromas require no treatment at all. When needed, treatment for enchondroma can vary. This sometimes causes debate even among orthopaedic oncology surgeons due to the difficulty in determining the aggressiveness of the lesion. Stage 1 latent lesions that show no symptoms can be watched with regular X-rays to ensure the tumor is not growing. Most surgeons think that tumors without symptoms do not need to be removed. Treatment Options: Surgical When enchondromas are treated surgically, it is usually with scraping out and filling of the cavity with bone graft or other filling substances. Although they can come back (recur), most of them will not. Tumors that cause pathologic fractures are usually treated by allowing the fracture to heal. Then the tumor is scraped out to prevent another fracture. More aggressive tumors with bone destruction or with a mass growing outside the bone are usually chondrosarcomas. These tumors need to be removed. Malignant tumors are either scraped out or the entire bone around the lesion must be removed. This decision is made depending on the grade of the tumor. The grade of the tumor is determined by imaging studies and biopsy. Methods to treat tumors that look like simple enchondromas on X-ray studies, but are painful, can be controversial. Some surgeons consider this an in situ low-grade chondrosarcoma and recommend that the tumor should be scraped out. Surgeons call these tumors "grade ½" chondrosarcoma. Other surgeons think that these tumors are completely benign. These surgeons feel these tumors: Are not likely to be the cause of pain in the area Can be observed with regular X-rays Do not require surgical removal Unfortunately, a biopsy will not often help in these cases. Even specialized bone pathologists have trouble determining the difference between a benign enchondroma and a "grade ½" chondrosarcoma. Research on the Horizon/What's New? There is a lot of ongoing research on enchondromas and chondrosarcomas. Ongoing studies are trying to identify chemical markers that can tell doctors the difference between benign and malignant cartilaginous tumors.