rious body parts such as the hands, head, facial structures, vocal cords, trunk, and legs; most tremors, however, occur in the hands. Tremor often accompanies neurological disorders associated with aging. Although the disorder is not life-threatening, it can be responsible for functional disability and social embarrassment.

the hands are lying on the lap. This type of tremor is often seen in patients with Parkinson's disease. Postural tremor occurs when a patient attempts to maintain posture, such as holding the hands outstretched. Postural tremors include physiological tremor, essential tremor, tremor with basal ganglia disease (also seen in patients with Parkinson's disease), cerebellar postural tremor, tremor with peripheral neuropathy, post-traumatic tremor, and alcoholic tremor. Kinetic or intention (action) tremor occurs during purposeful movement, for example during finger-to-nose testing. Task-specific tremor appears when performing goal-oriented tasks such as handwriting, speaking, or standing. This group consists of primary writing tremor, vocal tremor, and orthostatic tremor. Psychogenic tremor occurs in both older and younger patients. The key feature of this tremor is that it dramatically lessens or disappears when the patient is distracted. BR

pain be pain which radiates into the leg or buttock. In general, the symptoms tend to be worse with activity or certain positions and are improved or relieved with rest. The sacral nerve roots, which pass through the lower spine along with the lumbar nerve roots, supply function to the bladder and bowel. It is not uncommon to have dysfunction of these nerves with bowel and bladder abnormalities is association with lumbar radiculopathy.

out life, and in the middle and later years, a shortage of calcium may lead to thin, fragile bones that break easily (a condition called osteoporosis). A concern, then, for both children and adults with lactose intolerance is how to get enough calcium in a diet that includes little or no milk.BRAlthough the RDA (recommended daily allowance) for calcium, set in 1980, is 800 mg per day, many experts in bone disease believe this is too low. The results of a 1984 conference at the National Institutes of Health (NIH), suggest that women who have not yet reached menopause and older women who are taking the hormone estrogen after menopause should consume about 1,000 mg of calcium daily (roughly the amount in a quart of milk). Pregnant women and nursing mothers need about 1,200 mg of calcium per day. Postmenopausal women not taking estrogen may need as much as 1,500 mg of calcium per day. The RDA for adult men is 1,000 mg per day and 1,500 mg per day for men in their later years.BRIt is important, therefore, in meal planning to make sure that each day's diet includes enough calcium, even if the diet does not contain dairy products. Quite a few foods are high in calcium and low in lactose. Many green vegetables and fish with soft, edible bones are excellent examples. To help in planning a high-calcium/low-lactose diet, the following varchart lists some common foods that are good sources of dietary calcium and shows how much lactose the foods contain. BRRecent research has shown that yogurt may be a very good source of calcium for many lactose intolerant people, even though it is fairly high in lactose. There is evidence that the bacterial cultures used in making yogurt produce the lactase required for proper digestion.BRClearly, many foods can provide the calcium and other nutri

r to that of the stomach. Narrowing of the esophagus may occur at the upper portion of this new lining leading to esophageal stricture. Also, the diseases that occur in the stomach, e.g. ulcer disease and GI bleeding, can now occur in this portion of the abnormal esophagus. Cancer can form in this region as well as perforation of the esophagus.

nstant or increased pain and bleeding may occur if an ulcer or bleeding occurs in the lower esophagus. Bleeding may lead to vomiting blood or black tarry stools. Excessive bleeding can lead to weakness, shortness of breath and rapid heart rate. The development of esophageal strictures can lead to painful swallowing and difficult swallowing.

tween .4 and .8% of the population is affected. There is often a strong family tendency to develop this disorder. It usually begins shortly after puberty. Due to the kyphosis, or forward deformity of the spine, there is often hyperlordosis of the lumbar spine. This hyperextension of the lumbar spine attempts to compensate for the area bent forward by Scheuermann's disease. Pain is more common when the disorder affects the part of the spine between the thoracic and lumbar region. About one third of people with this disorder will have scoliosis, or a sideward curvature of the spine.

ects people over 50. BRBRPrevious aortic surgery with inadvertent damage to the artery supplying the colon can lead to this disorder. Similarly, a history of stroke, hypotension (or low blood pressure) and congestive heart failure may produce ischemic colitis. Diabetes is a condition that is associated with this, probably by accelerating peripheral vascular disease. BR

tis, peripheral neuropathy serum sickness. Allergic responses develop when a substance, or allergen, has previously stimulated the immune system. Upon a repeated exposure, this same allergen can then trigger the release of histamine, leading to mild to severe allergic reactions. Some drug reactions represent the effect of the drug on the particular tissue. Some examples of this are Gastric bleeding from the use of aspirin or Chemical hepatitis from the use of dilantin.

axis can occur. In this situation there is a rapid allergic response to an antigen, or substance, that has previously stimulated the immune system. This leads to wheezing, difficulty breathing, pallor, shock, lightheadedness and sometimes death. Serum sickness can develop. This develops when substance produced in an immune reaction accumulate and are deposited in various organs. Serum sickness can lead to fever, rash, joint pain and nerve damage. Various blood disorders, such as hemolytic anemia, can occur from direct reaction to some drugs. Peripheral neuropathy (nerve damage) and vasculitis (blood vessel inflammation) can both occur from direct action of the drug as well as being the product of immune system. Other hypersensitivity reactions which are not allergic responses include vomiting, diarrhea, fever, and photosensitivity (a skin reaction to sunlight). Dizziness and vertigo may develop from the hypersensitivity response.

se circumstances, exposure to a particular compound or medication can lead to a rash or itching or may unleash a rapid and deadly anaphylactic reaction.BROther side effects may be non-specific. They may cause headache, nausea or vomiting. Other effects may be specific and related to excessive doses of medications. This can reflect abnormal levels of medications or may reflect systemic abnormalities, such as alteration of the potassium in the body, that may then influence the function of a particular drug.BRIn any event, when you feel that you are experiencing unexpected or adverse side effects, it is necessary to contact your medical provider promptly.

els are fragile and are likely to rupture and bleed intermittently, sometimes heavily, especially in older people. Veins in the esophagus can become dilated and twisted, a condition called esophageal varices (varicose veins in the esophagus), making them fragile and prone to bleeding (see Clinical Manifestations of Liver Disease: Portal Hypertension).

agulants) or that dissolve clots once they have formed (thrombolytics such as streptokinase or tissue plasminogen activator) can cause gastrointestinal bleeding as well. BRBRInjury to the esophagus by foreing bodies or repeated vomiting can lead to bleeding. Tumor the the stomach, esophagus and intestinal tract can lead to blood loss. This may occur with both benign and cancerous tumors. BRBRIschemic colitis, where these is impairment of blood flow to the large intestine, can lead to rectal bleeding. Inflammatory bowel disease, such as Crohns disease and ulcerative colitis, are both frequently associate with GI bleeding. Polyps of the colon can bleed. BRBRTrauma to the rectum, hemorrhoids and anal fissures can produce blood loss. BR

crete insulin and glucagon directly in to the blood stream. When one of these cells grows excessively, it will form a tumor that releases increased amounts of insulin and is no longer controlled by the normal pathways that regulate glucose levels. The Beta cells are the ones that produce insulin. These tumors are rare and are most commonly seen in people over 50, although they have been reported in all age groups. The tumors produce excess insulin which can lead to abnormally lowered glucose levels, or hypoglycemia. Some people with this disorder will suffer from multiple endocrine neoplasia, or tumors within many of the hormonal glands.

eta cells tumors of the pancreas. Other causes of fasting hypoglycemia need to be excluded. These include, exogenous insulin, ingestion of sulfonylurea, liver failure and tumors that secrete insulin-like growth factors. The diagnosis of insulinoma depends of the demonstration of inadequate insulin suppression in the face of falling glucose levels.

viscosity ranges from 1.4-1.8 units. Symptoms usually are not seen at viscosities of less than 4 units, and the hyperviscosity syndrome typically requires a viscosity greater than 5 units. BRHyperviscosity syndrome is associated most commonly with plasma cell dyscrasias and is due to the large size of the excess immunoglobulin M (IgM) paraproteins in these disorders. Waldenstr?m macroglobulinemia is the most common cause. Rarely, the disease can occur in multiple myeloma (especially with myeloma proteins of the IgA and IgG types) or connective tissue diseases. BRBR

his facilitates air passing into and out of the lungs. The esophagus penetrates the diaphragm and then enters the stomach. The opening through which it passes, or hiatus, may become stretched or weakened. This may cause the stomach acid or stomach contents to flow backwards into the esophagus. This causes irritation in the esophagus. In addition, a portion of the stomach, or occasionally other organs, may protrude into the chest cavity.

nd family. Motivation for any activity gradually declines. There may be severe limitations of emotions, or inappropriate expression of emotions. Eventually, delusions and hallucinations occur. There is disordered thinking that is varcharacterized by disorganized or disjointed speech. Delusions develop that may cause the individual involved to feel that other people hear and steal one's thoughts, or that one is being controlled by others. Paranoid schizophrenia has many of the features cited above. However, the predominant behavior is unwarranted suspicion and paranoid behavior.

they divide into an external branch which supplies the facial structures, and an internal branch which supplies the brain. Atherosclerosis, the most common form of vascular disease, often occurs at the level of the carotid bifurcation. The disease artery narrows and leads to carotid stenosis. When the narrowing is severe enough, it may produce neurological symptoms because insufficient blood enters the brain. Alternately, small emboli break off of the disease artery and float upwards where they block an artery of the brain. This may produce a transient ischemic attack or a stroke. The narrowed artery may become completely occluded. This can lead to a major stroke or due to the interconnections of the arteries within the brain, it might be asymptomatic.

on dioxide levels. BRBRSome medications may directly affect the lower brainstem or medulla oblongata. Changes int he excitability of certain nerve cells that subserve the diaphragm and respiration may trigger hiccups. BRBRMedications may be interpreted as causing hiccups when underlying diseases, such as diaphragmatic pleurisy, pneumonia, uremia, alcoholism, or abdominal surgery may be the actual cause. In addition, other conditions associated with hiccups, such as disorders of the stomach and esophagus, bowel diseases, pancreatitis, pregnancy, bladder irritation, hepatic metastases, and hepatitis. Thoracic and mediastinal lesions or surgery may be responsible. Posterior fossa tumors or infarcts may stimulate centers in the medulla oblongata. BR

olet. The papules that appear on the lower extremities are frequently darker than those that appear in other places. The papules, or bumps, may form clusters in the shape of a ring that can range from 1 to 10 cm. The lesions are painless and usually do not itch. The ring's center is often darker than the edge. Ringed lesions change in size and shape over a period of several weeks to 6 months.

n Weil's disease, the disorder is much more severe. It is associated with severe jaundice. There is excessive bleeding and easy bruising. Fever and chills occur. Abdominal pain ad swelling occurs, often with right upper abdominal tenderness. Decreased urine output occurs with shortness of breath, cough, chest pain and episodes of coughing up blood.