Obesity is the excess deposition of fat in the human body. It can from initial stage develop into the last - fourth, which will cause the most serious consequences. Why obesity occurs and how to treat it, you can find out further.

Obesity levels by body mass index

Depending on how much excess fat deposits there are in the body muscle mass, there are 4 degrees of obesity based on body mass index.

Body mass index (BMI) is a calculated value that helps assess whether you are overweight or underweight. It is calculated by dividing a person’s body weight (kg) by the square of his height (m).

If the BMI is between 20.0–25.9, then a person over 25 years of age has normal weight. When the BMI is 26–27.9, this indicates that the person is overweight.

The following degrees of obesity are distinguished.

BMI will be between 28.0–30.9 for people over 25 years old, and 27.5–29.9 for people 18–25 years old.

2nd degree

Pain appears in the spine and joints, profuse sweating. Lipid metabolism is disrupted, which provokes heart disease. Fat deposits make up 30–50% of lean body mass, and BMI for people over 25 years old is 31.0–35.9, for younger people (from 18 to 25 years old) – 30.0–34.9, respectively.

With stage 2 obesity, the risk of developing disorders increases endocrine system and metabolism.

3rd degree

Body weight exceeds normal indicators by 50% or more. Obesity is difficult to bear, a person suffers from shortness of breath and does not tolerate physical activity well. Complications arise - arthrosis of the joints, strokes, heart attacks.

BMI corresponds to 36.0–40.9 for people 25 years of age and older, and 35.0–39.9 for over young(18–25 years old).

Normal body weight is a weight that corresponds to a certain height of a person, taking into account his physique.

4th degree

Weight more than normal 2 times or more. This stage is rare because patients simply do not live to see it. They usually do not leave the bed, cannot move, and suffer from shortness of breath even at rest. Often the body shape takes on a monstrous character; a person resembles a monster with a shapeless body, consisting of mountains of fat.

A BMI will show 40.0 or higher for 18-25 year olds and 41.0 or higher for older people.

Causes of obesity

There are many reasons that cause this disease, from overeating to hormonal disorders. Therefore, there are two main groups of obesity:

Exogenous

Types of exogenous obesity:

• Alimentary-constitutional obesity. The main reasons are physical inactivity, food cult (overeating, poor nutrition, passion for fast food), stress, depression. It refers to family diseases. In these families, usually all household members have one degree of obesity. This type is also typical for women, especially women who have crossed the 40-year mark. There is a violation of the energy balance. All the energy that enters the body is not completely consumed, but is deposited in the form of adipose tissue.
• Exogenous-constitutional obesity. It is progressive in nature. People with sedentary work and fast food lovers. But it differs from the previous one in that it is not hereditary and is not the result of any disease.
• Visceral obesity. Adipose tissue is not deposited in the subcutaneous layer, but is localized around internal organs. Both men and women are susceptible to it. “Beer belly” refers to this type. It is more difficult to treat and provokes diabetes, since it is associated with metabolic disorders in the body.

Visceral obesity can be determined by measuring your waist circumference. The norm is considered to be a waist circumference of up to 80 cm for women, and no more than 95 cm for men. If the values ​​are higher than these values, then it’s time to take action.

Endogenous

Endogenous types of obesity are as follows:

• Cerebral obesity. It occurs as a result of trauma, inflammation and neoplasms (malignant and benign) of the brain. It is not a hereditary disease.
• Endocrine obesity. Occurs against a background of dysfunction hormonal system, for diseases of the pituitary gland, hypofunction of the thyroid and gonads. It is also not hereditary.

These two types of obesity are difficult to cure because it must be treated together with the underlying disease causing this disease.

Obesity treatment

The approach to treating obesity depends on the severity of the disease.

Obesity 1st degree

To treat grade 1 obesity, a set of measures is used:

• Diet. Reduce daily calorie content diet, reduce the intake of carbohydrates and lipids. They eat small meals, replacing animal fats with vegetable oil.
• Physical exercise. Regularity is important here - you can’t let yourself be lazy. Select a set of exercises and start with 3-5 repetitions, gradually increasing the number of repetitions and exercises. The process of losing weight will take a long time, quick result It's not worth hoping.
• Ethnoscience. Traditional medicine will also help restore normal weight. For example, they drink ginger infusion every day. Take 50 g fresh root ginger, chop it and pour 1 liter of boiling water. Add half a lemon, cut into slices, and a little fresh mint. Leave to brew and drink 1 glass before meals.

It is important to note that for obesity, it is prescribed by a doctor therapeutic diet- table No. 8, which can be seen in the video:

Obesity 2 degrees

For 2nd degree obesity the following is also prescribed:

• Diet therapy, but it will be more strict. A nutritionist will select a low-calorie diet, in which the main products will be vegetables and fruits.
• Daily physical exercise, a specialist can refer you to physical therapy, taking into account the age and health status of the patient.
• Herbal medicine. They use herbs that create a satiating effect and reduce appetite, as they swell in the stomach. These are flax seeds or angelica officinalis. Diuretics are also effective - lingonberry leaf, parsley root.

IN advanced cases appoint medications, which are aimed at reducing appetite and removing excess fluid from the body. The doctor selects the medications for each patient individually.

Obesity 3 degrees

With 3 degrees of obesity, they first undergo an examination - they donate blood for hormones and sugar and, with the help of a doctor, identify the cause that provokes the increase. excess weight. Apply:

• Diet and fasting days, limit carbohydrates and sugar in the diet. They eat fractionally, reducing portions.
• Physical exercise. They are performed at a moderate pace at the initial stage. Start with morning exercises, walking short distances. They become more active when they have lost significant weight.
• Drug treatment. Drug treatment is prescribed only by a specialist.

With stage 3 obesity, the patient cannot cope on his own and only in tandem with a doctor will he achieve positive effect from treatment.

Obesity 4 degrees

At grade 4, treatment is carried out under the supervision of the attending physician. In addition to diet, exercise, and treatment of concomitant diseases, surgical intervention is used:

• Liposuction- remove excess adipose tissue if the patient’s life is in danger. As a result of the operation, the load on vital organs is reduced.
• Vertical gastroplasty- vertically divide the stomach into two parts. After operation top part The stomach becomes smaller in volume, and therefore fills with food faster and satiation occurs sooner.
• Gastrobypass surgery, in which a small part of the stomach is isolated. As a result, the patient receives less food, but after surgery it is necessary to consume vitamins and minerals throughout life.
• Biliopancreatic bypass. Part of the stomach is removed. And just like in the previous case, you need to take vitamins and minerals throughout your life.

Drug treatment for grade 4 is rarely prescribed, since the body is in in serious condition. A person with this stage is considered seriously ill, in whom all vital organs are affected.

Fatty liver and its treatment

Fatty hepatosis is one of the common diseases of this type, in which the liver tissue degenerates into fatty tissue.

Causes

The main reasons are:

• abuse fatty foods and alcohol;
• violation of metabolic processes;
• lack of vitamins and proteins in the diet;
• chronic poisoning with substances.

Development of hepatosis

On early stages development of the disease, especially those caused by endocrine disorders, may not manifest itself for a long time. Patients usually complain of indigestion, nausea, and vomiting. With a progressive disease, jaundice is observed, which is accompanied by itching of the skin. In patients, the liver becomes enlarged.

Since the initial symptoms are characteristic of a variety of diseases gastrointestinal tract, you should definitely visit a specialist and undergo an examination to determine accurate diagnosis and prescribing the optimal treatment option.

The main task is to find the factor that provoked fatty hepatosis. Therefore, the patient must be prepared to refuse bad habits or leave hazardous work.

During treatment, as well as after it, a person must adhere to strict diet. All fatty foods are excluded from the diet - meat, fish, dairy, as well as canned food, smoked meats, baked goods and fried foods. And, of course, you should forget about any use alcoholic drinks.

In addition to the diet, the doctor may prescribe a vitamin course or drug therapy. In some cases, take medicines will have to for the rest of my life. And also pay Special attention lipid metabolism, if necessary, correct it with anticholesterol drugs.

If treatment is not started in a timely manner, hepatosis can develop into chronic hepatitis or cirrhosis of the liver.

Treatment of fatty liver with folk remedies

In folk medicine there are several recipes that help the liver get rid of fatty tissue:

• Rosehip infusion. 100 g of dry rose hips are poured into a thermos and poured with boiling water, left for 8 hours. Drink 200 ml infusion 3 times a day.
• Apricot kernels. Eat no more than 6 apricot kernels per day; they prevent the accumulation of fat in the liver. However, you should not get carried away with them, as they contain Not a large number of cyanide.
• Lemon seeds. Promotes the restoration of liver cells. To do this, they need to be crushed and mixed with an equal amount of honey. Take 1 teaspoon on an empty stomach.

Obesity prevention

Obesity - dangerous disease, so it’s better to warn him than to fight him for a long time. This is especially true for people at risk. This:

• people whose parents suffer from excess body weight;
• people leading little active image life due to profession;
• lovers of good food;
• people with diseases of the endocrine system and gastrointestinal tract;
• people taking medications - hormonal, contraceptives and psychotropic drugs.

Preventive measures:

• Limit consumption table salt, easily digestible carbohydrates. Monitor the amount of food consumed.
• Limit the consumption of alcoholic beverages, which stimulate appetite and reduce the sensitivity of satiety.
• Lead an active lifestyle that helps burn calories.
• Improve psycho-emotional state. Because stress, depression, negative emotions a person usually “binges” on food.
• Treat concomitant diseases in a timely manner - diabetes, thyroid dysfunction.

Excess body weight can lead to serious consequences: diabetes mellitus, sleep disorders, osteoarthritis, heart disease, increased blood levels, problems, hypertension, cholelithiasis and even cancer or colon.

The first thing you should do is see a doctor for advice. A specialist will help identify the real reason obesity, as well as possible complications. The doctor will prescribe drug therapy and an appropriate diet. Very often, with excess body weight, the patient requires the help of an endocrinologist and nutritionist. A psychiatrist will help change eating behavior (often a person cannot control how much and when he eats). The therapist will check your health and be able to determine whether you have the resources to exercise.

Recently, doctors are increasingly using cold procedures to improve metabolic processes (contrast baths, wet rubdowns, dousing and cool shower). Harmonization nervous system– another integral part of the treatment of obesity. It is depression and stress that aggravate the situation, and sometimes are the main cause of the development of the disease. Psychologists will help you regain a sense of inner comfort and peace of mind, and increase your productivity. Trust your health to professionals, qualified specialists will help you find reliable way fix the problem.

Lifestyle and nutrition changes do not always lead to weight loss. Some patients require medication support. Available wide choose various teas and tablets, but they may be unsafe for human health. Part food additives includes laxative and diuretic herbs, trace elements and vitamins that do not affect tissue mass. Therefore, proven and high-quality medications should only be prescribed by a doctor.

Start leading an active lifestyle. Climb the stairs on foot, walk as often as possible fresh air. Try aerobics (with an experienced instructor), swimming or water gymnastics. Buy an exercise bike and pedal at (if there are no contraindications). Start eating a balanced diet, include foods low in fat and sugar, but with high amount fiber (legumes, fruits, herbs, vegetables, grains). The goal of obesity is not just weight loss, but also maintaining results achieved. Collaboration between patient and doctor will definitely lead to success.

Video on the topic

Sources:

• obesity and how to treat it in 2019

Fatty hepatosis is the deposition of fat in the liver. Most common cause This disease is obesity, in which fat is deposited not only in subcutaneous tissue, but also in internal organs. The main method of treating this type of hepatosis is to reduce excess body weight. Hepatosis can also be caused by the death of liver cells due to increased load at her, natural aging, inflammation, alcohol and drug abuse, exposure to toxic substances.

You will need

• - birch buds, rose hips, mint leaves, immortelle flowers, corn silk;
• - pine nuts;
• - sunflower oil;
• - bran;
• - natural bear bile with holmovaya solyanka and milk thistle oil;
• - Omega-3 preparations.

Instructions

Fatty liver was first classified as a disease no more than 90 years ago and is still considered a “young” disease. Most often discovered by chance - when ultrasound examination internal organs. As a rule, the attending physician will order a series of blood tests and research aimed at finding out how much the function is impaired. liver. If, then in addition to following a diet that limits the intake of animal fats, as well as fried, hot and spicy foods, alcohol does not include any special restrictions.

If the function liver is violated, which is determined by the results of ultrasound and tests, treatment is prescribed depending on the main one. There are many very effective medications for the treatment of obesity. liver. These are lipotropic drugs "Choline-", vitamin B12 C folic acid, lipoic acid, hydrolysates and extracts liver. All medications have their own characteristics of use, so only a doctor can choose treatment tactics.

In this article we will look at the treatment of obesity folk remedies at home.

General information

Obesity- increase in body weight due to excess accumulation adipose tissue in the body, characterized by an increased body mass index of more than 30 kg/m2 or excess body weight of more than 20% of normal.
Obesity can be primary, caused by heredity, excess nutrition, lack of exercise, and secondary, being a symptom of endocrine diseases. In addition, weight gain, especially moderate weight gain, is not always a consequence of excessive fat deposition. It can be caused by fluid retention in the body due to certain diseases of the kidneys, heart and other reasons. Therefore, to confirm the expected diagnosis, in addition to measuring total body weight, the amount of adipose tissue in the body is determined.

Depending on the location of fat deposits, there are:

• abdominal obesity, when excess fat is located mainly in the abdomen and upper torso, as well as in abdominal cavity, which is most typical for men;
• Gluteofemoral obesity, when excess fat is located mainly on the hips, buttocks and lower torso, which is most typical for women.

Abdominal obesity, even with slight excess weight, worsens morbidity and mortality, mainly due to cardiovascular diseases. This type of obesity increases the likelihood of atherosclerosis and coronary disease, as well as its three main risk factors: arterial hypertension, diabetes mellitus and violations fat metabolism- hyperlipidemia.
For diagnostics abdominal obesity determine the waist/hip index - the ratio of the smallest waist circumference (measured below chest above the navel) to the largest circumference of the hips (measured at the level of the buttocks). If the waist/hip index is more than 0.85 in women and more than 0.95 in men, this indicates abdominal obesity.
It is permissible to measure only the waist circumference, which is measured at the end of a normal exhalation. It is recognized that the risk of developing metabolic disorders and diabetes mellitus increases moderately with a waist circumference of 80 cm or more in women, 94 cm or more in men, and increases sharply with a waist circumference of 88 cm or more in women, 102 cm or more in men. more.

Depending on the body mass index (BMI), overweight and various degrees severity (severity) of obesity.

• BMI 25 - 29.9 kg/m2 - overweight bodies,
• BMI 30 - 34.9 kg/m2 - I degree obesity (mild),
• BMI 35 - 39.9 kg/m2 - II degree obesity (moderate),
• BMI 40 or more kg/m2 - obesity III degree(heavy).

Obesity symptoms

Overweight and obesity I degree

• Moderate weight gain, which is easily corrected by diet and exercise.

Obesity II degree

• Excess body weight is manifested by pronounced fat deposits, sometimes in the form of skin folds.
• Shortness of breath appears during physical activity, pain in the joints and lower back is possible, headaches due to increased blood pressure etc.
• It is at this stage that the diseases are most effective existing methods conservative treatment of obesity (diet, exercise, medications). If they are not applied, further progression of the disease becomes possible.

Obesity III degree

• Excess body weight is extremely pronounced and is manifested by significant fat deposits like “skin aprons” on the abdomen and thighs, attached inflammatory changes skin.
• Worries include shortness of breath at the slightest physical exertion and even at rest, swelling of the extremities, headaches, etc.
• Efficiency is sharply reduced, patients often have difficulty caring for themselves at home.
• At this stage of the disease conservative treatment is ineffective and the method of choice is surgery.

When to see a doctor?

If you have unsuccessful attempts to lose weight on your own and have a strong desire to get rid of excess weight, you should consult a doctor. Progressive weight gain and extreme forms of obesity require mandatory consultation with a doctor to determine the causes of this condition and appropriate treatment.

Obesity screening

A preliminary diagnosis of primary obesity in most cases is established during a general medical examination with mandatory measurement of body weight, height, waist and hip circumference, and calculation of body mass index. In addition, to determine the amount of fatty tissue in the body, doctors use:

• underwater weighing;
• special compass (caliper, adipometer) for measuring the thickness of skin folds;
• adipose tissue analyzers (fat analyzers) for ultrasonic location or measuring the electrical conductivity of body tissue, etc.

If secondary obesity due to disease is suspected thyroid gland, adrenal glands, pituitary gland and other glands internal secretion, additional examinations are required. Their appointment is the competence of the endocrinologist, and the list of techniques used is strictly individual, for example:

• determination of concentrations of thyroid and pituitary hormones in the blood, adrenal hormones in the blood and urine;
• ultrasound examination of the adrenal glands;
• radiography or CT scan skulls, etc.

When treating primary obesity, it is necessary to eliminate physical inactivity (increased physical activity, physical exercise), control of blood pressure and blood sugar levels, diet. According to indications, doctors prescribe medications that suppress appetite (anorexigenic), reduce fat absorption (lipase inhibitors), sugar substitutes, and herbal products.

Diet for obesity

In modern medical science Using a wealth of factual material, scientists from many countries have already quite clearly defined the basic principles of diet therapy for obese patients.
The use of a diet of reduced energy value (calorie content) - up to 1500 - 2000 kcal - due to fats and carbohydrates, but containing all the essential nutrients. Diets of very low energy value (800 kcal per day or less) are advisable only as component course of diet therapy, and not as the entire course.
Physiologically normal or slightly increased content protein in the diet: at least 1 g per 1 kg normal weight the patient's body, on average - 70-80 g per day. This prevents the loss of tissue protein, increases energy expenditure for the absorption of protein foods, and creates a feeling of satiety. The diet should contain about 400 g per day of protein products such as meat, fish, cottage cheese (all low-fat), eggs, and non-fish seafood.
Limiting dietary fat, mainly rich in saturated fatty acids. The fat content in the diet can be 0.7 g per 1 kg of normal body weight, on average 40-50 g per day. Long-term, sharper restriction of fat consumption is undesirable, since fat supplies polyunsaturated fats that are essential for the body. fatty acid, fats are involved in the absorption of fat-soluble vitamins and a number of minerals. The diet should contain about 15 g vegetable oils, preferably for adding to salads, vinaigrettes and other dishes.

• Limit foods with a high amount of fat - cream and sour cream with a fat content of more than 10%, cheese, fatty pork, ducks, geese, smoked and semi-smoked sausages, sprats (canned food), chocolate, cakes, halva.
• Give preference to low-fat foods - skim milk And fermented milk drinks, low-fat and semi-fat cottage cheese, milk ice cream, veal, rabbit meat, chicken meat and lean beef, etc.
• Do not fry for cooking, especially with a lot of fat. In the best ways culinary processing are boiling, steaming and baking.
• Trim visible fat from meat before cooking.
• Use the bird after removing the skin, which contains 2-3 times more fat than in meat.
• Since vegetables absorb fat, do not stew them with meat; It is better to stew vegetables in meat broth or broth, and not with added fat.

Limit the amount of carbohydrates to 200-250 g per day. Drastically reduce or eliminate sugar intake, confectionery, sweet drinks, ice cream and other sugar-containing products, honey; limit or exclude bakery products from premium and 1st grade flour, pasta and flour products, rice, semolina, sago
If it is necessary to further reduce the energy value (calorie content), the diet should limit or exclude other cereals, as well as potatoes. Reducing the carbohydrate content of the diet below 100 g per day is not recommended.
Limitation table salt up to 6-8 g, especially in the presence of high blood pressure.
Sharp limitation of appetite-stimulating foods and dishes (spices and seasonings, strong broths and sauces from meat, fish, mushrooms, smoked meats, pickles).
Avoiding alcoholic beverages, which weaken self-control over food consumption, increase appetite and are themselves a source of energy.
Compliance with a regimen of 5-6 meals a day with a sufficient amount of food to ensure a feeling of fullness and with consumption between main meals raw vegetables and fruits. Frequent appointments food “interrupts” the appetite and reduces the feeling of hunger.

Treatment of obesity with drugs

For oral administration
Anorexigenic drugs:
Dietrin (Phenylpropanolamine) Sibutramine (Meridia) Fepranon (Amphepranone).
Lipase inhibitors:
Orlistat (Xenical).
Sugar substitutes:
Aspartame (Surel, Shugafri) Xylitol Saccharin (Sukrazit, Susli) Sorbitol Fructose.
Herbal products:
Dietplast Novafigura Sveltform Citrimax.

Treatment of obesity with surgical methods

Surgical methods of treatment (reducing the volume of the stomach or excluding the area from digestion small intestine) are used only for extreme forms of obesity (BMI 40 or more kg/m2), according to strict indications, in cases where the correction overweight Any other means are not effective.
The safest intervention for obesity is the insertion of a silicone balloon into the stomach. This method is intended for short-term use when treatment with diet and medications is ineffective.

Treatment of obesity at home

Treatment of obesity: traditional medicine recipes for internal use

• Wood mallow flowers - 5 g, stinging nettle leaf - 15 g, lavender officinalis flowers - 5 g, senna flowers and leaves - 15 g, smoke grass - 25 g.
  1 tbsp. l. of the collection, pour 1 cup of boiling water, leave in a thermos for 2-3 hours, take the chilled infusion 1/2 cup 3 times a day 20-30 minutes before meals.
• Buckthorn bark - 10 g, coriander fruit - 5 g, leaf walnut— 5 g.
  1 tsp. collection, pour 1 cup of boiling water, leave in a thermos for 1-2 hours, take 1/2 cup 2 times a day 20-30 minutes before meals.
• To reduce appetite, a decoction of corn silk is recommended. To prepare it, pour 10 g of stigmas with 1 glass of water and boil for 30 minutes over low heat in a saucepan under a closed lid, cool, strain and take 3 tbsp. l. 4 times a day.
• Boil 2 tbsp. l. oats in 1 liter of water until tender, leave overnight, strain, take 1/2 cup 3 times a day.
• Corn stalks with silks - 50 g, buckthorn bark - 20 g, yarrow grass - 20 g, common juniper fruits - 10 g.
  2 tbsp. l. collection, pour 0.5 liters of boiling water into a thermos. Leave for 10-12 hours, strain and take 150 ml 3 times a day 20-30 minutes before meals.
• If you can tolerate lemon, you can get rid of excess weight with chamomile tea with lemon. Brew 2 tsp in the evening. chamomile flowers 1 cup boiling water, add 1/2 lemon, cut into slices, leave until morning, strain and drink on an empty stomach. A course of treatment of up to 25-30 days will provide you with a loss of 3-4 kg.
• Once a week, carry out fasting fasting days: for 24 hours, drink only water and freshly squeezed fruit and vegetable juices(from oranges, grapefruits, pears, apples, lingonberries, cherries, lemons, celery, pumpkins, zucchini, tomatoes).
• To improve metabolism: dissolve 1-2 drops of lemon balm essential oil in a glass mineral water. Take 1-2 times a day.
• Ginger tea is widely used in oriental medicine, including for the treatment of obesity: 5 tsp. finely chopped fresh ginger root, pour a glass of boiling water, leave for 15 minutes, then add 5 tsp. honey The drink can be based on an infusion of green tea, which will also help you lose weight.

Treatment of obesity: traditional medicine recipes for external use

• Rinse the intestines from Esmarch's mug with a 5-7% infusion of chamomile or yarrow (2 tablespoons of raw material, pour 200 ml of boiling water, leave for 30 minutes, add to water to rinse the intestines). The optimal number of washes is 7. Do washes at intervals of two days. For one wash, you need to take 1-2 liters of infusion, heated to 36-37 °C. Best time carrying out the procedure - before breakfast.
• Once a week, carry out “blind” probes with a 10-12% infusion of corn silk, apple juice or melt water - 200 ml warm infusion drink juice or melt water on an empty stomach and lie down for 30 minutes with a heating pad on your right side.
• Complete the course of treatment water procedures— wrapping in the form of a shawl every other day, 7 procedures. Wrapped as if in a shawl, in a sheet moistened with cold water, lie on a woolen blanket for an hour and a half, covered with a feather bed or warm blankets. After the procedure, you must wear warm underwear and stay at home.

Traditional and alternative medicine offer a large number of drugs and prescriptions for the treatment of obesity. However, before you start treating obesity with folk remedies at home, it is advisable to consult a doctor. He will tell you which remedy is suitable specifically for your case. Be healthy!

Spinal cord cancer is much less common than brain cancer. It accounts for five cases out of a thousand when diagnosing tumors. A favorable prognosis for this disease is possible. It all depends on how quickly the diagnosis was made and treatment started. A feature of spinal neoplasms is their ability to rapidly progress.

Primary and secondary tumors

Spinal cord tumors are divided into two types: benign and malignant. In turn, they are divided into primary and secondary.

Primary are those that are formed directly from spinal cells. They are initially considered malignant. Secondary spinal cord cancer is metastasis from foci of other organs: lungs, mammary glands, prostate gland, kidney.

Brain cancer - more common age-related disease. Medicine does not have scientifically proven facts about the reasons for its appearance. But, like every disease, there are prerequisites. One of the main ones is genetic predisposition. In second place is the state of immunodeficiency, and in third place is a history of leukemia.

Primary spinal cord cancer is divided according to location:

1. Intradural. With lesions in the meninges (neurofibroma, meningioma, hemangioma) or spinal roots (neurinoma) This is a benign cancer.
2. Intramedullary, developing directly from spinal cells (ependymoma, astrocytoma, glioma) with different degrees of malignancy.
3. Extradural (80% of cases). Beyond the Solid meninges with damage to bone tissue in the spine (osteosarcoma, myeloma). This cancer is considered the most malignant. Reasons: most often these are metastases from other organs: lungs, mammary glands in women.
4. Lymphoma. Lymphocytic tumor, which is provoked by neoplasms in the spine.

How many stages does cancer have? Like others malignant neoplasms, the defeat process goes through four stages.

At the first stage, the oncological focus is not large sizes, not extending beyond the spinal cord. There are no metastases.

On the second cancer cells grow into neighboring tissues. There are no metastases.

At the third stage, spinal cord cancer is of significant size, with single metastases.

The fourth is a large tumor, multiple metastases in the spine or metastases in other organs, with intoxication of the whole body.

Metastases to spinal tissue are a relatively rare phenomenon. It accounts for no more than 5% of the total number of metastases in the central nervous system.

General clinical picture

Spinal cord cancer does not show itself in any way for a very long time and does not produce symptoms. The sick person may feel constant fatigue and loss of strength without cause within two years before diagnosis.

As the tumor grows, symptoms begin to increase. If the cancer affects the nervous tissue, there are neurological symptoms: shooting pains in the lower and middle third of the back, limited movement. By the later stages, the pain becomes constant and unbearable, which can only be relieved with narcotic drugs.

Characteristic symptoms are tingling, crawling, numbness with loss of sensation in the upper and lower extremities.

An intramedullary (in the spinal substance) tumor gives symptoms of myelopathy in the form of loss of sensitivity in certain parts of the body, partial or complete paralysis, shutdown of the functions of the genitourinary and intestinal systems in the form of incontinence or delay.

Important symptoms of spinal cancer are changes in cerebrospinal fluid. Signs of growth of the lesion are visible by partial or complete blockage of the spinal cerebrospinal fluid space. Disruption of cerebrospinal fluid circulation and blood flow spreads down the spinal canal, below the site of compression. Venous stagnation together with prolonged mechanical compression gives degenerative changes in nerve cells.

Clinical picture by location levels

The spinal cord with the cervical, thoracic, lumbar, sacral and coccygeal parts gives its own signs, depending on the location of the tumor.

For example, symptoms of tumors cervical region: sensory disorders of the limbs, movement disorders, diaphragmatic disorders in the form of hiccups, shortness of breath, coughing and sneezing.

Outbreaks in thoracic region give symptoms in the form of girdle pain, simulating diseases of the gastrointestinal tract (cholecystitis, pancreatitis), sensitivity disorders and motor functions upper limbs No.

Symptoms of a lesion in the lumbar and sacral region: radicular pain, atrophy of the femoral muscles, pelvic disorders ( involuntary urination with defecation). The pain radiates to the buttock and thigh, intensifies when coughing or sneezing. The patient feels more pain lying down than standing. Motor disorders in the form of paresis and paralysis.

Forecast

How long people with this diagnosis live depends on the histological features, stage of the disease, whether there are metastases, and the degree of malignancy. Benign tumors are treated quite successfully. In malignant forms, about 60% of patients overcome the five-year survival threshold. Recovery depends on age and the body's ability to resist the disease. If the patient seeks help in the initial stage of the disease, he will live a long life.

Video on the topic

3) Common trunk of the basilar artery

4) Posterior cerebral artery

4. Cerebrovascular diseases. Classification. Strokes. Classification. Ischemic stroke. Etiology, pathogenesis, pathological anatomy, clinical picture, differential diagnosis, treatment.

5. Cerebrovascular diseases. Classification. Strokes. Classification. Hemorrhagic stroke. Etiology, pathogenesis, pathological anatomy, clinical picture, differential diagnosis, treatment.

6. Cerebrovascular diseases. Classification. Subarachnoid hemorrhage. Etiology, clinic, examination, treatment

Question 8. Cerebrovascular diseases. Classification. Social significance of the problem, risk factors. Issues of primary and secondary prevention.

9. Cerebrovascular diseases. Differential diagnosis of ischemic and hemorrhagic strokes

10. Cerebrovascular diseases. Undifferentiated and differentiated treatment of ischemic and hemorrhagic strokes.

35. Parkinson's disease. Etiology, pathogenesis, clinical picture, treatment, prognosis.

36. Symptomatic (secondary) parkinsonism. Etiology, pathogenesis, clinical picture, treatment.

37. Parkinsonism. Classification. Manganese parkinsonism.

2. Pathogenetic treatment.

3. Symptomatic treatment:

38. Huntington's chorea. Etiology, clinical picture, treatment. Genetic and ethical aspects of the disease.

39. Hepatocerebral dystrophy (Wilson's disease). Etiology, pathological anatomy, clinic, treatment.

40. Progressive muscular dystrophies (myopathies). Etiology, genetic aspects, clinical characteristics, diagnosis, treatment (page 467)

42. Brain tumors. Classification, clinical picture, diagnosis, differential diagnosis, treatment (page 442 textbook)

43. Pituitary tumors. Diagnostics, clinic, treatment

44. Spinal cord tumors. Classification, clinic, diagnosis, treatment (page 452)

45. Classification of traumatic brain injury. Fractures of the vault and base of the skull. Clinic, diagnosis, differential diagnosis, treatment. Complications and consequences of traumatic brain injury (page 410)

44. Spinal cord tumors. Classification, clinic, diagnosis, treatment (page 452)

In relation to the spinal cord and its membranes, tumors are divided into

Intramedullary (intravertebral 20%)

Extramedullary-intradural (52%)

extradural (28%)

According to the level of tumor location, there are cervical (18%), thoracic (66%), lumbar (15%), sacral (1%).

Based on their histological structure, they distinguish between neuromas (20-30%), meningiomas (20%), gliomas (17%), malignant extradural tumors (15%) and other tumors (heterotopic) (5-10%)

Clinical picture

The most common and early symptom spinal tumors - pain. It is observed as the first symptom of the disease in 70% of cases. The pain wears local character, however, it can radiate along the affected root. It usually gets worse when lying down. As a rule, the pain is long-lasting, several months or years. It is important to know that pain can be caused not only by extramedullary, but also by intradural tumors (60%).

In the clinical picture extramedullary Tumors are divided into three stages of the disease, which are not always clearly represented.

■ I - radicular stage, lasts several months or years. The appearance of pain is characteristic according to the area of ​​innervation of a certain root; pain is most often expressed as a feeling of encircling or compression. Koreshkovy pain syndrome often causes erroneous diagnostic conclusions. People most often mistakenly think about dry pleurisy, cholecystitis, heart disease, appendicitis, osteochondrosis, radiculitis, etc.

■ II - Brown-Sequard stage or syndrome of damage to half the diameter of the spinal cord. It happens quite quickly and sometimes unnoticed. This stage is characterized by the presence on the side of the tumor of central paresis, disturbances in muscle-joint sense, tactile, vibration, and two-dimensional spatial sensitivity. Contralaterally, hypoesthesia of pain, temperature and, to a lesser extent, tactile sensitivity is found.

■ III - paraplegic stage - damage to the entire diameter of the spinal cord; usually the longest. The average duration for extramedullary tumors is 2-3 years, sometimes it can be up to 10 years or more. This stage is characterized by tetraparesis or lower paraparesis with conduction-type sensitivity disorders from the corresponding level. Appearance of dysfunction pelvic organs(urination and defecation).

Intramedullary

A differential diagnosis between extra- and intramedullary tumor localization is made based on the law of eccentric arrangement of long conductors, which explains the peculiarities of the dynamics of conduction sensitivity disorders.

With an extramedullary tumor, parasthesia and loss of sensitivity occur first in distal sections lower limb, after some time their border gradually expands, reaching the level corresponding to the localization of the lesion.

Radicular pain, as well as Brown-Séquard syndrome, most often occurs with extramedullary neoplasm.

When the tumor is intramedullary, sensory disturbances first occur in the area of ​​the corresponding segment and then spread in a downward direction.

In patients with intramedullary tumors, segmental paresis of the limbs is more diffuse than paresis of radicular origin in patients with extramedullary tumors. This is due to the fact that in the anterior horns of the spinal cord the bodies of motor neurons are distributed in separate groups for the extensor and flexor muscles various departments limbs (Fig. 6-19), and in the root the axons of all these motor neurons are located compactly in one bundle, and when they are compressed by the tumor, the function of the entire myotome is switched off at once.

When the tumor affects mainly back surface Sensitive ataxia develops early in the spinal cord due to a violation of the muscular-articular sense, and the vibration and two-dimensional sense is also lost.

With posterolateral localization of extramedullary tumors, early onset of radicular pain is characteristic, which serves as the first symptom.

With tumors of anterior (premedullary) localization, radicular pain syndrome is absent at the onset of the disease and occurs much later. Myotomal and conductive paresis occur first; sensory disturbances develop only after a long period of time. Symptoms of the spinous process (pain when percussing it) and cerebrospinal fluid push (pain in the spine when coughing) are not pronounced.

Often, with this localization, the first dysfunction of the spinal cord occurs acutely or subacutely, like a spinal stroke. This is due to the fact that a tumor of premedullary localization first compresses the anterior spinal artery, which leads to the development of ischemia in its blood supply, i.e., in the ventral half of the diameter of the spinal cord. Clinically, this is expressed by Preobrazhensky syndrome: lower central or mixed paraparesis, dissociated conductive parahypesthesia, impaired function of the pelvic organs. Sometimes, with such a tumor, Brown-Séquard syndrome initially even occurs due to ischemia of only one half of the ventral part of the diameter of the spinal cord due to compression of the sulcocommissural (sulco) artery (Fig. 6-20).

This ischemic Brown-Séquard syndrome differs from a purely compression syndrome by the preservation of the function of the posterior cord on the side of the central paresis of the lower limb.

TO intramedullary tumors are classified as ependymoma. It accounts for about 20% of all spinal tumors and originates from the ependyma of the walls of the central canal. Astrocytoma grows from the stroma of the spinal cord. Cysts can form in the tissue of such a tumor.

Rarely, medulloblastoma (single or multiple) is encountered, usually a metastasis of the same cerebellar tumor.

Among intramedullary tumors there are epidermoid, teratoma, hemangioblastoma, hemangiosarcoma.

EXTRAMEDULLARY-INTRADURAL TUMORS

Among such tumors, neuromas are the most common. This tumor arises from Schwann cells of the dorsal roots. It can spread extramedullary-intradurally, as well as extradurally and extravertebrally, penetrating through the enlarged intervertebral foramen into the neck, chest or abdominal cavities (hourglass tumor, Fig. 6-21).

Meningioma develops from the arachnoid endothelium of the spinal cord meninges and can be located on the anterior, lateral or posterior surfaces of the spinal cord. The initial matrix, as a rule, is quite wide, which makes radical tumor removal difficult.

Ganglioneuromas arise from the spinal nodes of the dorsal root, as well as from the nodes of the paravertebral sympathetic chain. Growing into the spinal canal, ganglioneuroma causes symptoms of an extramedullary tumor. Less common are chordoma, lipoma, cholesteatoma, sarcoma. EXTRADURAL TUMORS

Most of these tumors are metastases or primary malignant tumors of the epidural tissue. Spinal metastases most often occur from tumors of the breast, lung, kidney and prostate. Primary malignant tumors include bone sarcoma, chondrosarcoma, lymphosarcoma, and melanoblastoma.

Differential diagnosis of spinal cord tumors and multiple sclerosis should be carried out ( spinal form): in multiple sclerosis, disturbances are observed mainly in the pyramidal system. Sensory disorders are completely absent or there are only moderately severe symptoms of dysfunction of the posterior cords of the spinal cord in the form of shortening or absence of vibration sensitivity. There is no radicular pain in multiple sclerosis. The function of the pelvic organs is not impaired. In the cerebrospinal fluid of patients with multiple sclerosis, the protein content does not exceed the upper limit of normal, and normal patency of the subarachnoid spaces is characteristic. Particularly great difficulties arise when carrying out differential diagnosis with spinal cicatricial adhesions (the so-called arachnoiditis). However, subacute onset, frequent remissions, predominance of motor disorders

pain over the sensitive ones, the extent of the lesion, the absence or insignificant severity of pelvic disorders, the absence or presence of slight radicular pain, almost always bilateral - all this is more characteristic of arachnoiditis.

A similar clinical picture occurs with vascular malformation in the spinal canal (arterial, arteriovenous aneurysm). With this pathology, the symptom of arterial impulse according to Skoromets is pathognomonic: with the patient lying on his back, the doctor applies compression abdominal aorta at the level of the navel on the left to the anterolateral surface of the spine. After the aortic pulsation disappears, compression is continued for another 10-15 s or less if pain appears in a certain area of ​​the spine or shooting pain of a radicular nature (in the dermatome area). The pain disappears soon after the compression of the aorta stops. Often, against the background of such pain or without it, during compression of the aorta, paresthesia occurs in the legs or back (numbness, tingling, vibration, feeling of cold, etc.). With compression of the abdominal aorta, the vascular system of the spine and spinal cord provides collateral blood flow under elevated blood pressure, and the present vascular malformations increase sharply and cause local or radicular pain, conductive posterior funicular paresthesia (due to overflow of blood into the venous system of the posterior surface of the spinal cord).

In cases of varicose veins of the spinal veins of various etiologies (with arteriovenous aneurysm, compression of the radicular veins by a tumor, cicatricial adhesions, infiltration, herniated intervertebral disc, fragment of a spinal fracture, etc.), another phenomenon is positive - the symptom of venous impulse according to Skoromets: the appearance of a local pain along the lower half of the spine and conduction-segmental paresthesia in the lower half of the body with compression of the inferior vena cava at the level of the umbilicus on the left. The patient lies on his back, the doctor stands to his right. When the inferior vena cava is compressed to the anterolateral surface of the spine (exposure up to 15 s), venous outflow from spinal canal, and in the presence of a vascular malformation (epidural, subdural, intramedullary), it increases and begins to manifest itself clinically. If symptoms of an arterial or venous impulse are detected, it is necessary to perform selective spinal angiography or contrast myelography and MRI to clarify the structure and localization of the vascular malformation to determine treatment tactics.

Establishing a diagnosis of a spinal cord tumor is an absolute indication for surgical intervention; a laminectomy (removal of the vertebral arch) is performed, followed by removal of the tumor. In case of metastasis to the spine with compression of the spinal cord, surgery can only be performed for a single metastasis followed by radiation treatment and chemotherapy.