Left-side Ureteric Colic Case Study

Left-side Ureteric Colic Case Study Case Study – Group B Introduction A 46 year old secretary was admitted to emergency with left-side ureteric colic. She had a similar case 3 years ago and she passed a small calculus spontaneously. She has been taking cimetidine (for the last 6 months), for dyspepsia treatment. Physical examination revealed a tenderness in the left loin. Symptoms Left-side ureteric colic. Small calculus passed spontaneously (3 years ago). Tenderness in the left loin. Medication Taken Cimetidine (last 6 months) for dyspepsia treatment. Serum Results (compared to ‘normal’) Creatinine 150 umol/L (50-110) Na+ 141mM (135-145) K+ 4.2mM (3.5-5.1) Total CO2 20nM (23-29) Urea 8.1Mm (4.0-8.2) Albumin 40g/L (35-50) Calcium 3.49mM (2.1-2.5) Phosphate 0.60mM (1.0-1.5) ALP Activity 160U/L (20-140) Results that differ from ‘normal’ levels are underlined. Suspected/Differential Diagnosis This patient has been admitted to emergency with 3 major symptoms, all of which occurred within the last 3 years (symptoms are stated above). Along with this the patient has been subscribed cimetidine for the last 6 months which is advised to not be taken when the patient is known to have kidney problems, this could potentially be increasing the problematic symptoms. The most recent symptom, to which the patient was initially admitted, is left-side ureteric colic. This is caused by movement of the calculus that produces unpleasant sensations of abdominal pain often in waves (colicky) or sometimes a constant pain, both of which will typically move until it reaches the hypochondrium (or groin area). This supports the results from the physical examination which state that there was a tenderness in the patients left loin, due to the movement of the calculus and pain from there-forth. These symptoms are most commonly developed after passing of a kidney stone, such as the small calculus that this patient passed 3 years ago. These stones can be static or moving, the latter of which can be more painful and cause more symptoms as it travels. Renal calculi are generally formed when the urine is overly saturated with minerals and salts such as calcium and others. This is supported by the patient’s blood-serum results which indicate a high amount of calcium (3.49mM) where the ideal level is around 2.1-2.5mM. Kidney stones are primarily made out of 60-80% calcium, so the excess amount found in the patient’s blood can easily result in a build-up of a calculus. In addition to the excess of calcium, there is also an excess of other substrates in the blood. One of which is creatinine which is ideally found between 50-110 umol/L but the patient contains excess of 150 umol/L. High amounts of creatinine is known to effect the ability for the kidneys to filter fluid within the body. This will lead to a build-up of certain substrates in the blood such as the calcium mentioned previously. Therefore, high amounts of creatinine can cause a ‘domino effect’ where high amounts of creatinine = high amounts of other substrates, this could cause major problems in the body if not treated immediately. Also within the results of the patient’s blood-serum test is the abnormality of low amounts of CO2 (20nM) known as hypocapnia, this is can be used to indicate that the patient may be beginning to show signs of kidney failure. Similarly, low amounts of phosphate are shown (0.60mM), this is also an indication of kidney failure due to inadequate filtration of substrates by the kidney to be excreted as urine. The parathyroid hormone (PTH) regulates the amount of phosphate and calcium in the blood, typically the substrates react oppositely: as phosphate increases, calcium will decrease. Due to there being a great excess in calcium the PTH hormone reacts to decrease the amount of phosphate in the blood serum. Finally, as phosphate is used to repair bones, help the function of nerves and muscle contraction, low amounts of it can cause a severe problem in the patient. This links into the high amounts of ALP activity that are found in this patient’s blood-serum at 160U/L which can be caused by stones such as the small calculus being obstructive. This can lead to problems with bones, which being linked to low amounts of phosphate also, could cause severe problems in the patient and even bone cancer. However, high amounts of ALP have been found in women in the third trimester of pregnancy, which could be the case with this patient, but this is currently unknown. Further Tests to confirm the diagnosis Urine examination can be used to find if there is any blood in the patient’s urine (haematuria) which often occurs after passing a stone. Also the pH of the urine can be examined to indicate either the urine is ‘normal’, acidic (8.0) indicating that an infection could be present from organisms such as Proteus or Pseudomonas. As well as this, the urinalysis can show substrate crystals such as calcium oxalate- quite likely due to excess calcium in the patient. Imaging (X-ray, Ultrasound etc.) Firstly, KUB x-rays can be used to show abnormalities in the kidneys, ureters or bladders, these are indicated by dark shadows in the renal-tract but can be mistaken for phleboliths which is venous and not a form of calculus. Ultrasounds are easy and quick and does not use any form of radiation, this method will indicate stones that are of 0.5cm in diameter or larger. Next, Intravenous Pyelogram (IVP) provides a clear outline of the urinary tract system and shows-up many indicators of kidney problems such as mild hydronephrosis, however this test can cause unwanted reactions in the patient that are best avoided. Finally, a test for the PTH hormone can be undertaken with the calcium, phosphate and ALP blood tests. This will help to identify hyperparathyroidism, which is a hyperactivity of the hormone, as well as finding the cause for the high amounts of calcium in this patient. Treatments and Prognosis The patient that is suffering from left-side ureteric colic, small calculi and tenderness in the left loin should drink plenty of liquids, primarily water. This will encourage any further renal stones to be passed and it will also begin to reduce any possible damage to the functionality of urinary/renal tracts. If there are further stones found in the patient (possible due to high calcium amongst other substrate fluctuations) then with liquids they should pass spontaneously, unless they are large in-which they will need specific removal that could involve surgery. Spontaneous movement and passing of stones may take as long as 40 day so the patient is likely to be under a lot of pain that is often compared to being worse than child birth, therefore pain killers such as paracetamol at a standard dosage of 1 or 2 tablets up to 4 times a day for an adult such as this patient, may be required to alleviate the pain. If by taking further tests, such as the urinary examination, it is found that the patient is suffering from an infection (pyonephrosis) then treatment is required such as percutaneous nephrostomy. This is usually an emergency procedure that is used to relieve an obstructed and infected renal collecting system by percutaneous puncture with ultrasound guidance. Also, Medical Expulsive Therapies can be used such as calcium antagonists. These work by blocking the calcium ion channels to supress the fast component for contracting the ureter, this in turn will help relax the smooth muscles and help stones to pass more easily. Overall, the patient is likely to be in a lot of pain for some time, therefore, strong painkillers will be required and if in the case of infections then antibiotics could also be necessary to overcome the patient’s symptoms and to finally be cured. References Clinical chemistry-Marshall, William J.,Bangert, S. K.,Lapsley, Marta2012. Referenced 05.01.14 Clinical biochemistry: an Illustrated Colour Text-Gaw, Allan, eauthor2013. Referenced 05.01.14 Royal College of Physicians and Surgeons of Canada. Normal Values. Referenced 05.01.14 [royalcollege.ca] Salman S, Castilla C, Vela N R. Action of calcium antagonists on ureteral dynamics.Actas Urol Esp1989. [PubMed] Referenced 05.01.14 Freeman SJ, Sells H, Investigation of loin pain, Imaging (2005) 17, 19-33, British Journal of Radiology. Referenced 05.01.14 Miller OF, Kane CJ; Time to stone passage for observed ureteral calculi: a guide for patient education. J Urol. 1999. Referenced 05.01.14 Amiel J, Choong S; Renal stone disease: the urological perspective. Nephron Clin Pract. 2004. Referenced 05.01.14

Love and Loneliness using Sputnik Sweetheart by Haruki Murakami Essay

Humans are probably the greediest animals that have walked on the face of earth. There is always a want to achieve something greater than what one has. This might be a positive force on one hand, but on the other it can leave someone completely unsatisfied and unhappy with their life. One of the things out of the many which humans strive to look for in their life is love. Love, a recurring theme in novels, movies, music, poetry, drama and what not, is hard to escape from. Whether it is motherly, friendly or romantic love, we all have experienced it at some point in our lives. But does love actually exist? If we look at this question from Haruki Murakami’s Sputnik Sweetheart’s point of view, the answer would be no. Even though love is a major part of the book, there is not a single moment where two people are in love with each other. All the characters of the book have had some experience with love, but in the end all of them are managing their own lives all by themselves. The book strongly hints the nonexistence of love and the loneliness caused by it. The best way to know as to what exactly love is, is to look inside our own self. If we claim to â€Å"feel† it, something must be going on inside our bodies to give us that sense of falling or being in love. Firstly, â€Å"it’s your brain, not your heart, that falls in love† (Myers’, 51). It is evident from many scientific and psychological experiments that â€Å"human romantic love is associated with dopaminergic pathways in the brain† (Fisher, Aron, Brown, 2175). So when Sumire, a lesbian in the book Sputnik Sweetheart, â€Å"fell in love, as if she was crossing a field when bang! a bolt of lightning zapped her right in the head,† the real culprits were something known as neurotransmitters and hormones which are, in simple words, chemicals in our body that control us (Murakami, 9). Sumire was in the â€Å"lust phase† and most probably under the influence of the hormones called testosterone and oestrogen. â€Å"These hormones  as Helen Fisher says ‘get you out looking for anything’† (â€Å"The Science of Love†). The second phase or the â€Å"truly love struck phase† is seen in the book when Sumire cannot escape from the thoughts of Miu (â€Å"The science of love†). â€Å"That’s the ballpoint pen she uses; the mug she drinks coffee from† (Murakami, 50). One cannot blame Sumire for being so sappy as she has no control over the dopamine, serotonin and norepinephrine levels in her body. These chemicals are responsible for the â€Å"cloud-nine feeling†, and the loss of appetite, sleep and concentration when one is in love. This is seen in Sumire’s case too when every single time she sat down to start writing something â€Å"no matter how much she stared at the screen, not a single sentence came to her† (Murakami, 36). Heart racing, flushed cheeks, butterflies in the stomach, these all the signs of being in â€Å"love†, but it is not love, it is just chemicals in our bodies making us feel that way. Very closely tied to the brain is our mental psych and genetic makeup and it can help explain the complex topic of love well. The main objective of animals and plants on this earth is to make more of their kind so that their genes are passed on, have a better chance of surviving in the future, and can compete against others genes. Like any other animal, humans are predisposed to this kind of behaviour too. In Sputnik Sweetheart K, the narrator and Sumire’s best friend, is in love with Sumire who is a lesbian and hence cannot reciprocate his love. Even though K knows Sumire is the one he has true feelings for, his body seeks sex. This makes him â€Å"sleep around† with other women on a daily basis. Though â€Å"these little flings never aroused much passion in [him]; they were, at most a kind of comfort† for his body (Murakami, 64). According to the Maslow’s hierarchy of needs, sex is considered as important as air, sleep, food and shelter (Myers’, 331). It is one of the basic needs in life regardless of any emotional connection to the other person. Also, all the women who K had physical relationships with were â€Å"older and either were married or had fiancà ©s or steady boyfriends†. Psychology can explain even this as â€Å"men are most attracted to women who were at ages associated with peak fertility and thus teen boys are most excited by a woman several years older than themselves.† (Myers’, 106). When it comes to attraction every small factor like skin, smell and body shape play a huge role in deciding whether a woman is good to mate with or not (Myers’, 106). All these behaviours are a result of a phenomenon known as  natural selection where â€Å"nature selects behaviours that increase the likelihood of sending one’s gene into the future† (Myers’, 106). So in the end, it is not us who get to decide who we will pair up with and have children with, but it is our genes that get to choose. How can love exist when we do not even get to choose the person we get attracted to? After looking at the scientific explanations of love, it is important to know how philosophy describes it to get an overall idea of what love is. Kierkegaard, an existentialist philosopher believes only â€Å"Christian love† is true and â€Å"all other love, whether humanly speaking it withers early and is altered or lovingly preserves itself for a round of time—such love is still transient; it merely blossoms. This is precisely its weakness and tragedy, whether it blossoms for an hour or for seventy years—it merely blossoms.† (25). There is no sense of any kind of God in the book Sputnik Sweetheart, so there is no possibility of â€Å"Christian love† which Kierkegaard seems to support. The only kind of love seen in the book is either friendly or erotic love. But what he said about other kind of love, like Eros, seems to be very true since there is not a single moment where two people truly love each other and show it; the love people have for each other never really â€Å"blossoms†. Kierkegaard in his â€Å"Work of love† clearly states that there is no love if it bears no fruit and in the book, there is no â€Å"fruit†, only loneliness which can be considered as the opposite of something fruitful (28). When Miu rejects Sumires love, Sumire disappears from everyone’s lives, which was very painful for K as well as Miu. And when she comes back to K she admits how she feels and says â€Å"I think I cut something’s throat†. One cannot say if she meant it literally or not, but even if she said it metaphorically, she must feel extremely dreadful to say something like that. Secondly, love makes one completely dependent on someone else. When Sumire leaves everyone without any proper explanation K admits, â€Å"She [Sumire] helped me forget the undertone of loneliness in my life†. His love for Sumire is making him completely dependent when throughout the book it is shown how much she who is dependent on him. Love has turned the tables for him and now he is the one who is weak and vulnerable. And anyway, there is no point of loving someone if it keeps making one feel more and more alone. It is impossible to see the good part love plays as there is none. And as Kierkegaard said, love does not exist if it does not bear any fruits. If one was asked to  summarise the story line of Sputnik Sweetheart it would be something like this; K, the narrator, loves Sumire, but Sumire realises she is lesbian when she falls for Miu, a married woman 17 years elder to Sumire, and hence she cannot love K back. But due to an extraordinary incident, Miu has lost all sexual desires and so cannot reciprocate Sumire’s love. So after disappearing â€Å"like smoke† for a few days, Sumire comes back to K to give their love a try even though she knows she is a lesbian (Murakami, 103). It is easy to pick out that there is a constant search for love in Sumire’s life. â€Å"In the spring of her twenty-second year, Sumire fell in love for the first time in her life.† (Murakami, 5). Even though â€Å"in high school she had a few boyfriends, guys she’d go to the cinema with, go swimming with†, she took 22 years long to find the â€Å"right person† to fall in love with, and when she finally did, it was someone she could not get (Murakami, 11). If it was something other than love, one would have long given up on it. It is called learned helplessness in psychology. But, Sumire did not stop from trying to find love all over again and she came back to K. Love clearly seems to be a purpose in life for some people. But what is the purpose of life? There is a point in the book where K realises and says, â€Å"I’d have to survive on my own.† (Murakami, 187) However much we, as humans, feel that we are living for a purpose and there are people who care and love, the truth is that we are all by ourselves. K realises it, even though it is quite far into the book, but he does in, and in a rather painful way. Sputnik Sweetheart, the name of the book itself, suggests loneliness as it refers to Sputnik II, the Soviet satellite which was launched into space with the dog Laika, the first living being to go into space which died barking of hunger. It gives a picture of â€Å"the dark, lustrous eyes of the dog gazing out of the tiny window† into the empty space all alone (Murakami, 10). What is it about love that makes humans so desperate for it? Biology and psychology clearly explain that it is just how our bodies are made and how the animal kingdom functions. Also, according to Kierkegaard, erotic, romantic, friendly or philia love is just temporary and never develops fully. It is also seen that being in love never has a positive outcome and from what Kierkegaard said love does not exist if it does not produce something useful. So why is it that we keep seeking love? Are we just lonely  and anxious to find something more than life itself? Is it that we are lonely and by ourselves in this world, and hence cannot love, or is it that we cannot love that is why we are lonely? Either way, there is no love, but only loneliness. Work Cited â€Å"The Science of Love.† BBC News. BBC, n.d. Web. 14 May 2013. Myers, David G. Myers’ Psychology for AP. New York, NY: Worth, 2011. Print. Helen E. Fisher, Arthur Aron and Lucy L. Brown Philosophical Transactions: Biological Sciences , Vol. 361, No. 1476, The Neurobiology of Social Recognition, Attraction and Bonding (Dec. 29, 2006), pp. 2173-2186

The Crusades Battle For The Holy Lands Essay - 1282 Words

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The History of Terrorism Ancient to Modern Times

Terrorism is the unlawful use of violence to achieve political gains, and its history is as old as humans willingness to use violence to achieve political power. Early zealots and assassins such as the Sicarii and the Hashhashin frightened  their contemporaries, but were not really terrorists in the modern sense. The Sicarii,  a first-century Jewish group and one of the earliest, organized groups of assassins,  murdered enemies and collaborators in a campaign to oust their Roman rulers from Judea. They were used small daggers (sicae) hidden in their cloaks to stab people in crowds, then melt quietly away in the throng. The Hashhashin, whose name gave us the English word assassins, were a secretive Islamic sect active in Iran and Syria from the 11th to the 13th century.   Terrorism is best thought of as a modern phenomenon. Its characteristics flow from the international system of nation-states, and its success depends on the existence of a mass media to create an aura of terror  among large groups of people. 1793 and the  Origins of Modern Terrorism The word terrorism comes from the Reign of Terror instigated by Maxmilien Robespierre in 1793, following the French revolution. Robespierre, one of twelve heads of the new state, had enemies of the revolution killed, and installed a dictatorship to stabilize the country. He justified his methods as necessary in the transformation of the monarchy to a liberal democracy: Subdue by terror the enemies of liberty, and you will be right, as founders of the Republic. Robespierres sentiment laid the foundations for modern terrorists, who believe violence will usher in a better system. For example, the 19th century Narodnaya Volya hoped to end Tsarist rule in Russia. But the characterization of terrorism as a state action faded, while the idea of terrorism as an attack against an existing political order became more prominent. 1950s: The Rise of Non-State Terrorism The rise of guerrilla tactics by non-state actors in the last half of the twentieth century was due to several factors.These included the flowering of ethnic nationalism (e.g. Irish, Basque, Zionist), anti-colonial sentiments in the vast British, French and other empires, and new ideologies such as communism. Terrorist groups with a nationalist agenda have formed in every part of the world. For example, the Irish Republican Army  grew from the quest by Irish Catholics to form an independent republic, rather than being part of Great Britain. Similarly, the Kurds, a distinct ethnic and linguistic group in Turkey, Syria, Iran and Iraq, have sought national autonomy since the beginning of the 20th Century. The Kurdistan Workers Party(PKK), formed in the 1970s, uses terrorist tactics to announce its goal of a Kurdish state. The Sri Lankan Liberation Tigers of Tamil Eelam are members of the ethnic Tamil minority. They use suicide bombing and other lethal tactics to wage a battle for independence against the Sinhalese majority government. 1970s: Terrorism Turns International International terrorism became a prominent issue in the late 1960s, when hijacking became a favored tactic. In 1968, the Popular Front for the Liberation of Palestine hijacked an an El Al Flight. Twenty years later, the bombing of a Pan Am flight over Lockerbie, Scotland, shocked the world. The era also gave us our contemporary sense of terrorism as highly theatrical, symbolic acts of violence by organized groups with specific political grievances. The bloody events at the 1972 Munich Olympics were politically motivated. Black September ,a Palestinian group, kidnapped and killed Israeli athletes preparing to compete. Black Septembers political goal was negotiating the release of Palestinian prisoners. They used spectacular tactics to bring international attention to their national cause. Munich radically changed the United States handling of terrorism: The terms counterterrorism and international terrorism formally entered the Washington political lexicon, according to counterterrorism expert Timothy Naftali. Terrorists also took advantage of the black market in Soviet-produced light weaponry, such as AK-47 assault rifles created in the wake of the Soviet Unions 1989 collapse. Most terrorist groups justified violence with a deep belief in the necessity and justice of their cause. Terrorism in the United States also emerged. Groups such as the Weathermen grew out of the non-violent group Students for a Democratic Society. They turned to violent tactics, from rioting to setting off bombs, to protest the Vietnam War. 1990s: The Twenty-First Century: Religious Terrorism and Beyond Religiously motivated terrorism is considered the most alarming terrorist threat today. Groups that justify their violence on Islamic grounds- Al Qaeda, Hamas, Hezbollah—come to mind first. But Christianity, Judaism, Hinduism and other religions have given rise to their own forms of militant extremism. In the view of religion scholar Karen Armstrong this turn represents terrorists departure from any real religious precepts. Muhammad Atta, the architect of the 9/11 attacks, and the Egyptian hijacker who was driving the first plane, was a near alcoholic and was drinking vodka before he boarded the aircraft. Alcohol would be strictly off limits for a highly observant Muslim. Atta, and perhaps many others, are not simply orthodox believers turned violent, but rather violent extremists who manipulate religious concepts for their own purposes.