It usually begins when the hair fall out at a circumscribed. It usually begins when clumps of hair fall out, resulting in totally smooth, round hairless patches on the scalp. In some cases the hair may become thinner without noticeable patches of baldness, or it may grow and break off, leaving short stubs (called "exclamation point" hair). In rare cases, complete loss of scalp hair and body hair occurs. The hair loss often comes and goes-hair will grow back over several months in one area but will fall out in another area.
When a patient comes to me because of hair loss,, the symptoms usually persist for a long time , the patient has often already gone through the urologist , gynecologist, otolaryngologist and dentist. Perhaps, despite his adulthood, his tonsils have been removed.
In most cases, the healing process is failed.
How will I help:
The patient interview is the primary way of obtaining comprehensive information about the patient in order to provide effective patient-centered-care. A comprehensive patient interview includes inquiring about the patient’s medical, medication, social, personal and family history, as well as a thorough review of the examination. By reviewing the medical history, we determine whether there is a general inflamatory process, for example to see if the clinical aspects of go back to immune processes, eg. a prolonged antigen stimulation
The cause may not be elucidated, sometimes the only was might be sort of local, immune-based treatment that does not affect the whole organism, Unfortunately,not all the cases with patchy hair are curable, however immunological consultaion may be recommended.
Fever of unknown origin (FUO) is defined s defined as a temperature higher than normal that lasts for weeks with no obvious source despite appropriate investigation. When the patient present itself at the examination, he has already been tired of searching.
When a patient seeks for advice, previous data usually contain almost everything and the routine lab tests also have already been done. That includes chest X-ray, abdominal ultrasound, laboratorical testing. The patient has already visited otolaryngologist many times. Some patients arrive with their tonsils removed, or they have already received one or more antibiotics treatment. Its typical symptoms are: weakness, tiredness, loss of appetite, decreased performance, or even the catarrhal symptoms of night sweats.
How will I help:
First of all, look carefully at the reports and interview the patient which is followed by the medical checking.
It is decided whether there is inflammation, autoimmune disease, infection or cancer in the background. It is common for accelerated sedimentation, anemia, asiderosis. The older of the complaint, the lower of the chance for infection.
Generally, there is non- exotic disease in the background, during the medical checking, we would prefer to search for often occurred diseases which require urgent reaction.
In some cases – the quarter of the cases – the source of the complaint has never been found, and usually it disappears by time. The medical check-up is being built by this fact, so if the examinations do not take us forward, I suggest to my patients (next to the treatment of the symptoms) that we should wait and see what time will bring. In order to see if there is any problem or if there is any clinical aspects blooming, I propose the periodic control, so we can easily find out and it is easier to detect.
In most cases, there is no medical emergency, but the complaints are unpleasant.
Autoimmune thyroiditis, known as Hashimoto's thyroiditis, is relatively frequent disease. There is a protracter infflamation ongoing in the thyroid gland, usually not coming with pain, is often remaining unnoticed. The final result is the definitive destruction of the gland with the consequence is hypofunctionality (hypothyrosis). While the inflammation is ongoing, the autoimmune disease namely active, thyroid function can be temporarily enhanced. Then thyroid gland slowly "burns out" and remains the reduced function.
There are various ways of detecting the disease : blood tests, histological sample from thyroid tissue, taking isotope scan. If atrophy has occurred, it is no longer necessary or possible to restrain the inflammation, remains only to replace the hormonal loss.
With this method, we can create a complete balance and in case of proper medical treatment, the life expectations and quality are not worse. In these cases ithe best if the patient is treated by an endocrinogist.
Typically there are endocrinological/hormone production disorders, easy to test by blood tests that also are indicative to say, if there is ongoing inflammation. Low-grade fever, tremors , increased sweating, palpitations can occur.
How will I help:
During medical checking, one has to decide whether there is an ongoing inflamatory process, if there are anti- thyroid-anytbodies in the blood, if the disease is active, is patient in thyreotoxic stadium, or the thyroids began to decrease production.
Thyroid inflammation may be associated with other autoimmune diseases, a thoroughful take of the medical history and examination, as well as overview of the detailed findings is very important.
SLE is a chronic autoimmune disease that can affect almost any organ system; thus, its presentation and course are highly variable, ranging from indolent to fulminant. Most of the cases of SLE occur in young women, frequently starting at childbearing age. Symptoms can vary and can change over time: characteristic of an arthritis, fever, abnormal laboratory findings are indicative of inflammation, abnormal urine findings, sun provoked skin symptoms.
The most common symptoms and signs include fatigue and fever, joint pain, stiffness and swelling, butterfly-shaped rash on the face that covers the cheeks and bridge of the nose, skin lesions that appear or worsen with sun exposure (photosensitivity), fingers and toes that turn white or blue when exposed to cold or during stressful periods (Raynaud's phenomenon), shortness of breath, chest pain, dry eyes, headaches, confusion and memory loss. Typical immunological findings: f.ex.: ANA positivity, ds- DNA positivity.
The disease is characterized by periods of spontaneous remission and relapse, but it could trigger life-threatening, serious condition. During the waves of activity, more and more new symptoms may appear. In cases of internal organ involvement form the worse prognosis group.
Involvement of the joints is quite common (90%), inflammation of joints ( arthritis ), the joints are aching, limited movement is described, in particular the characteristics of the morning stiffness. Affected joint’s permanent deformity is rare. The different mucous membranes, palate, nasal septum rarely get sick.
The kidneys’ life expectancy is essential. In the care of the kidney is one of those organs that we should absolutely check. The heart can be damaged in many ways, the disease can affect the pericardium, the heart muscle, cardiac valves.
How will I help:
When I first meet the patient, who suspects SLE, it is essential to examine the reports and I have to interview the patient.
It is very important that, the patient brings the completed, previous findings. I must first determine whether there is indeed lupus. In this case, an international point system has been applied. If internal organs affected, the best place for the patient is between hands of an internal medicine – immunologist.
The treatment aims to reduce the inflammation processes, prevent the development of organ damage. The treatment includes adrenocortical hormones (steroids) and other immunomodulatory medications. The regular medical check-ups are highly important for SLE patients. Some laboratory studies suggest that it may have been premature ignition. Particular care is needed for family planning, especially the immunological point of view regarding the selection of the appropriate periods, and the necessary medication.
It is the rheumatologist who sees patients with low back pain, searching for the diagnosis and caring of patients. However, there are cases where the process has immunological origin, as a result of inflammation. These complaints occure in the morning, but nightly pain can also develop as a result of inflammation, leading to sleep disorder
In the morning the joints are stiff and relief can take several hours. Typical symptoms are low-grade fever or pain in other joints pain, fatigue. Sometimes joints are tender along the sternum as well. In most of the cases the sacrum is involved - that is the so-called "sacroileitis". Its recognition is of importance, as iit can help to set the correct diagnosis. Early active anti-inflammatory therapy is indicated. Localization is typical, and often there is no accompaniing immunological finding. The case is called "seronegative" arthritis. A wide variety of diseases belongs to this, and it sometimes causes concerns, because there is no undeniable laboratorical or clinical symptom, so the diagnosis should be based on the doctor's experience. In addition the effect of the therapy does not come immediately, so it might be very difficult to monitorize the effectiveness of the medication.
The physician must meet two contradictory tasks: secured diagnosis and early treatment. Indeed, when the disease is already certain in fact, eg. alteration in X-ray, the treatment will no longer be early - the diagnosis is too late. Once the disease onset is slow, we are too cautious, therefore, the chosen medication is not given.
Certain skills, experience and courage must meet for diagnosis and early detection of cases. There are surprizingly many cases, most of them have misplaced in the first period.
How will I help:
If the origin of low backache is the inflammation of the joints (or perhaps the first sign of disease), early diagnosis and immunoklogical check up is important.
Getting rid of pain is not an unimportant issue, but early active immunosuppressive therapy may stop the progress.
Due to inflammatory metabolites formed in the joints (which sooner or later, but surely will "chew" the articular surface", definitive impairment can develop. This event must be prevented, because at this stage, possibilities are limited.
If the first sign is the low-backache, there are immense advanages of timely recognition.
Patients are encouraged for early medical examination - that includes laboratorical tests in order in time detection of these immunological cases.
Sjögren syndrome is a systemic chronic inflammatory disorder characterized by lymphocytic infiltrates in exocrine organs. Most individuals with Sjögren syndrome present with sicca symptoms, such as xerophthalmia (dry eyes), xerostomia (dry mouth), and parotid gland enlargement. Sometimes it affects organs. Sjogren's syndrome often accompanies other immune system disorders, such as rheumatoid arthritis and lupus. In Sjogren's syndrome, the mucous membranes and moisture-secreting glands of your eyes and mouth are usually affected first — resulting in decreased production of tears and saliva.
The patient is a middle-aged woman. The disease is not so uncommon, every 100th person is affected. The majority of the cases develop very slowly, it may take several years,.It can be accompanied with inflammation, muscle inflammation, lung involvement with accidental flaring. In some cases palpable enlarged lymph nodes can be felt, or even malignant hematological disease can develop..
How will I help:
In case Sjögren's syndrome, is suspected, there is a thoroughful elaboration is needed on existing findings and medicxal history. One of the most important thing is to determine whether the disease is in active stadium or is not. The latter means the disease is "dormant" or extinct, there is no need to treat it. In these cases we are facing only to the result of the destruction: decreased mucus production from the atrophied glands. The treatment aims to reduce inflammation and to prevent the development of organ damage. The illness can be treated by taking adrenocortical hormones (steroids) and other immunomodulatory medicines.
Regular medical check-up is in need.. Some laboratorical tests can already indicate a flare at an early stage. If the patients takes immunological medication, this has to be under regular control, effects and side effects have to be followed. It is also necessary to control the status of the lymphatic system. There are 2-4/year medical check-ups recommended.
The most common causes of female infertility include problems with ovulation, damage to fallopian tubes or uterus, or problems with the cervix. Age can contribute to infertility because as a woman ages, her fertility naturally tends to decrease.
With pregnancy and complaints related to early abortion, the most appropriate way is to turn to gynecologist first. The recognizable or discoverable immunological causes compose a small margin of cases. Even in such cases, the first step is recourse to adequate gynecological care – regarding the rules of the profession, the diagnose can only be clear after the immunological background tests have been made.
Currently, with few exceptions, practitioners of assisted reproduction tend to attribute “unexplained” and/or repeated IVF failure(s), almost exclusively to poor embryo quality, advocating adjusted protocols for ovarian stimulation and/or gamete and embryo preparation as a potential remedy. The idea that, having failed IVF, all it takes to ultimately succeed is to keep trying over and over using the same recipe is overly simplistic. There are numerous non-embryologic factors that can be responsible for failed IVF. There are two types of immunologic reactions or immune factors involved in conception and infertility:
Autoimmune disorders are more common, implicated in >90% of immune-related infertility. Specifically, it means that woman’s immune cells are forming antibodies – small proteins that target and attach to cells and identify them for destruction – to tissue that is normal and part of their own body. This is an abnormal reaction that is associated with several non-pregnancy related diseases.
Alloimmune disorders, in contrast, involve the formation of antibodies against tissue associated with the male partner (e.g. paternal sperm proteins).
Implantation begins six or seven days after fertilization of the egg. At this time, specialized cells from the embryo (i.e. trophoblast), that later become the placenta, begin to create connections with the endometrial lining; encouraging growth up and around the developing embryo. The process is as much overgrowth of the embryo as it is invasion of the endometrium. At the site where the fetal and maternal tissue meet, the maternal immune cells in the lining, become involved in a “cross talk” with one another through mutual exchange of hormone-like substances called cytokines.
Because of this complex immunologic interplay, the uterus is able to foster the embryo’s successful growth without allowing bacteria and other abnormal cells to have a free pass. In other words, the immune cells aren’t shut down, they agree to host the embryo when all goes right. Thus the trophoblast establishes the very foundation for the nutritional, hormonal, and respiratory interchange between mother and baby. In this manner, the interactive process of implantation is not only central to survival in early pregnancy but also to the health of the baby after birth.
Problems occur when the maternal immune cells don’t cooperate. Typically when this occurs, it will lead to implantation failure or pregnancy loss thereafter.
How will I help
The consultant has the following tasks:
First of all, I try to detect whether the woman has any immunological disorders, which can be treated separately. If there is no other immunological disease, we discuss the other, not examined diagnostic possibilities the patient has and what can be expected. My strategy is to learn as much as we can about the infertility in question before reaching any definitive diagnosis, and to help to that end we offer the best diagnostic test and treatment options available
There are many cases, after all, when there is no difference found, but pregnancy is still failed. Even in this case, small dose of heparin and aspirin could be taken, multivitamins or small doses of steroids could be a possibility: the latter therapy should be initiated after one or two days of the rejection of the egg, but at the latest after the menses outage.
The aspect of immunological infertility certainly is an area of medicine where there is still a lot of progress, a lot of research is being conducted, and even decisive progress can be expected in the future.
Sometinmes there is a hidden cause not comming with symptoms, not painful, not sensitive. It happens, its localization differs from that of the symptoms. To find these hidden causes might be quite difficult, specific and nor characteristic symptoms can ioccure eg. joint-inflammation (arthritis), fever, hair-loss, fatigue, allergical symptoms or inflammation of various layers of the eyes could occur.
The immune system can to react strangely to prolonged irritation, stimulation let say at varius sites: harmful reactions can occur. These kind os stimuli can be might inclde sort of permanent viral presence (hepatitis B or C), autoimmune diseases, previous organ transplant or implant,, as a result of malignant disease or even persistent bacterior infections).
How to help:
When some hidden cause is the issue and the disease or symptoms usually persist for a long time, besides the patient has been already gone through the urologist, gynecologist, otolaryngologist and dentist dentist consultation (or even the tonsils have been removed), the first is to interview the patient - to get comprehensive information about the patient medical history. The aimn is to provide an effective patient-centered-care. The interview includes inquiring about the patient’s medical history medication, social, personal and family history, as well as a thorough review of the previous examination. It is to be determined whether there is a general inflammatory process, or no inflammation is in the background.
Sometimes the reason cannot be determined even against a thoroghful examination: watchful waiting is the only choice, sort of longitudinal examination comes. This means we are waiting for a full clinical picture to begin grow, hence more symptoms might aid to make a more detailed diagnosis.
