MRI

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A magnetic resonance imaging (MRI) scan is a common procedure used by hospitals around the world. MRI uses a strong magnetic field and radio waves to create detailed images of the organs and tissues within the body.

The development of MRI revolutionized the medical world. Since its discovery, doctors and researchers have refined techniques so as to use MRI scans to not only assist in medical procedures but also aid in research
What is an MRI scan?
An MRI scan uses a large magnet, radio waves, and a computer to create a detailed cross-sectional image of the patient's internal organs and structures.

The scanner itself typically resembles a large tube with a table in the middle, allowing the patient to slide into the tunnel.

An MRI scan differs from CT scans and X-rays because it does not use ionizing radiation that can be potentially harmful to a patient.1

Background of the MRI scanner
The first full-body MRI scanner was created by Prof. Raymond Damadian in 1977 and took nearly 5 hours to produce the first ever full body scan of a human. Dr. Ramadan nicknamed the first MRI scanner the "Indomitable" and it is currently housed in the Smithsonian Institute.2

The idea for MRI was initially conceived by Damadian in 1971 after he recognized that under nuclear magnetic resonance certain mouse tumors would display elevated relaxation times compared with normal tissues in vitro.
How does an MRI scan work?An MRI Scanner.
An MRI scanner can be found in most hospitals and is an important tool to analyze body tissues.
An MRI scanner contains two powerful magnets, which represent the most critical part of the equipment.

The human body is largely made of water molecules, which are comprised of hydrogen and oxygen atoms. At the center of each atom lies an even smaller particle called a proton, which serves as a magnet and is sensitive to any magnetic field.

Normally the water molecules in our bodies are randomly arranged, but upon entering an MRI scanner, the first magnet causes the body's water molecules to align in one direction, either north or south.

The second magnetic field is then turned on and off in a series of quick pulses, causing each hydrogen atom to alter its alignment and then quickly switch back to its original relaxed state when switched off. The magnetic field is created by passing electricity through gradient coils, which also causes the coils to vibrate, resulting in a knocking sound inside the scanner.

Although the patient cannot feel these changes, the scanner can detect them and, in conjunction with a computer, can create a detailed cross-sectional image for the radiologist to interpret.

What are MRI scans used for?
The development of the MRI scan represents a huge milestone for the medical world, as doctors, scientists and researchers are now able to examine the insides of the human body accurately using a non-invasive tool.

The following are just some of the examples where an MRI scan is used:

Abnormalities of the brain and spinal cord
Tumors, cysts, and other abnormalities in various parts of the body
Injuries or abnormalities of the joints, such as back pain
Certain types of heart problems
Diseases of the liver and other abdominal organs
Causes of pelvic pain in women (e.g. fibroids, endometriosis)
Suspected uterine abnormalities in women undergoing evaluation for infertility.

What happens before an MRI scan?
There is little to no preparation required for patients before an MRI scan. On arrival at the hospital, doctors may ask you to change into a gown. As magnets are used, it is critical that no metal objects are in the scanner, meaning that you will be asked to remove any metal jewelry or accessories that may interfere with the machine.

Sometimes, patients will be injected with intravenous (IV) contrast liquid to improve the appearance of a certain body tissue.

The radiologist will then talk you through the MRI scanning process and answer any questions you may have on the procedure.

Once you have entered the scanning room, you will be helped onto the scanner to lie down. Staff will try to ensure that you are as comfortable as possible by providing blankets or cushions. You will also be offered earplugs or headphones to block out the loud noises of the scanner. The latter is very popular with children as they can listen to music to calm any anxiety.

What happens during an MRI scan?
Once in the MRI scanner, the doctor will speak to you to via the intercom to ensure you are comfortable. They will not start the scan unless you are ready.

During the scan, it is imperative you try your best to stay still. Any movement will disrupt the images created, much like a camera trying to take a picture of a moving object. You will hear some loud noises coming from the scanner, which is perfectly normal.

If you feel uncomfortable during the procedure, you can speak to the doctor via the intercom and request the scan be stopped.

What happens after an MRI scan?
After the scan, a radiologist will examine your images to check whether any further images are required. If the radiologist is satisfied, you can simply get changed and go. The radiologist will prepare a short report for your doctor, who will make an appointment with you to discuss the results.

What is a functional MRI scan?
Functional magnetic resonance imaging or functional MRI (fMRI) uses MRI technology to measure brain activity by monitoring blood flow in the brain. This gives an insight into the activity of neurons in the brain as blood flow increases in areas where neurons are active.

This technique has revolutionized brain mapping by allowing researchers to assess the brain and spinal cord without need for invasive procedures or injections of drugs. fMRI helps researchers learn about the function of a normal, diseased or injured brain.

Functional MRI is also used in clinical practice as, unlike standard MRI scans which are useful for detecting structural anomalies in tissues, a functional MRI scan can help detect anomalous activity in those tissues. As such, it is used to assess the risks posed by brain surgery by helping a surgeon to identify the regions of the brain involved in critical functions such as speaking, moving, sensing, or planning.

Functional MRI can also be used to determine the effects of tumors, stroke, head and brain injury, or neurodegenerative diseases such as Alzheimer's.

MRI frequently asked questions
How long will an MRI scan take?
MRI scans vary from 15-60 minutes depending on what part of the body is being analyzed and how many images are required. If, after the first MRI scan, the images are not clear enough for the radiologist, you may be asked to undergo a second scan straight away.

I have braces/filings, should I still undergo the scan?
Although braces and fillings are unaffected by the scan, they still may distort the image. Consult your doctor and radiographer beforehand. The MRI scan may take longer if additional images are required.

Can I move while I am in the MRI tunnel?
No, you will be asked to remain as still as possible while in the MRI scanner. Any movement will distort the scanner and, therefore, the images produced will be blurry. In cases when you have a particularly long MRI scan, the doctor may give you a short break halfway through the procedure.

A male patient about to undergo an MRI scan.
Some may find the idea of an MRI scan claustrophobic. Your radiologist will be able to answer any questions you may have. I am claustrophobic, what can I do?
You should speak to the doctor and radiologist beforehand. They will be able to talk you through the whole procedure and address any anxieties you may have. Open MRI scanners are available in some locations to help with patients suffering from claustrophobia.

Do I need an injection of contrast before my MRI scan?
You may need to have a contrast agent injected before your MRI scan if your doctor feels it is necessary to improve diagnostic accuracy by highlighting certain issues, such as inflammation.

Can I have the MRI scan if I am pregnant?
Unfortunately, there is not a straight answer to the question above. If you are pregnant, you should inform your doctor before the scan. There has been relatively little research on the effect of MRI scans on pregnancy. However, guidelines published in 2014 have shed more light on the issue.

It is recommended that MRI scans should be restricted during the first trimester unless the information is deemed "clinically imperative." MRI scans taken during the second and third trimester are safe at 3.0 tesla or less.

The guidelines also state that inadvertent exposure to MRI during the first trimester has not been associated with long-term consequences and should not raise clinical concern.

Stages of Alzheimer

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7 Stages of Alzheimer's Disease
You can help support your loved one with Alzheimer's by learning more about how the condition unfolds.

The stages don't always fall into neat boxes, and the symptoms might vary -- but they can be a guide and help you plan for your friend or relative's care.

Stage 1: Normal Outward Behavior
When your loved one is in this early phase, he won't have any symptoms that you can spot. Only a PET scan, an imaging test that shows how the brain is working, can reveal whether he's got Alzheimer's
As he moves into the next 6 stages, your friend or relative with Alzheimer's will see more and more changes in his thinking and reasoning.

Stage 2: Very Mild Changes
You still might not notice anything amiss in your loved one's behavior, but he may be picking up on small differences, things that even a doctor doesn't catch. This could include forgetting a word or misplacing objects.

At this stage, subtle symptoms of Alzheimer's don't interfere with his ability to work or live independently.

Keep in mind that these symptoms might not be Alzheimer's at all, but simply normal changes from aging.

Stage 3: Mild Decline
It's at this point that you start to notice changes in your loved one's thinking and reasoning, such as:

1.Forgets something he just read
2.Asks the same question over and over
3.Has more and more trouble making plans or organizing
4.Can't remember names when meeting new people
5.You can help by being your loved one's "memory" for him, making sure he pays bills and gets to appointments on time. You can also suggest he ease stress by retiring from work and putting his legal and financial affairs in order.

Stage 4: Moderate Decline
During this period, the problems in thinking and reasoning that you noticed in stage 3 get more obvious, and new issues appear. Your friend or family member might:

1.Forget details about himself
2.Have trouble putting the right date and amount on a check
3.Forget what month or season it is
4.Have trouble cooking meals or even ordering from a menu
5.You can help with everyday chores and his safety. Make sure he isn't driving anymore, and that someone isn't trying to take advantage of him financially.

Stage 5: Moderately Severe Decline
Your loved one might start to lose track of where he is and what time it is. He might have trouble remembering his address, phone number, or where he went to school. He could get confused about what kind of clothes to wear for the day or season.

You can help by laying out his clothing in the morning. It can help him dress by himself and keep a sense of independence.

If he repeats the same question, answer with an even, reassuring voice. He might be asking the question less to get an answer and more to just know you're there.

Even if your loved one can't remember facts and details, he might still be able to tell a story. Invite him to use his imagination at those times.


Stage 6: Severe Decline
As Alzheimer's progresses, your loved one might recognize faces but forget names. He might also mistake a person for someone else, for instance, thinking his wife is his mother. Delusions might a set in, such as thinking he needs to go to work even though he no longer has a job.

You might need to help him go to the bathroom.

It might be hard to talk, but you can still connect with him through the senses. Many people with Alzheimer's love hearing music, being read to, or looking over old photos.

Stage 7: Very Severe Decline
Many basic abilities in a person with Alzheimer's, such as eating, walking, and sitting up, fade during this period. You can stay involved by feeding your loved one with soft, easy-to-swallow food, helping him use a spoon, and making sure he drinks. This is important, as many people at this stage can no longer tell when they're thirsty.

Psikosomatis

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Apabila Anda atau kerabat Anda mengalami hal ini: sakit pada suatu bagian tubuh yang berulang, sementara pada pemeriksaan fisik maupun penunjang (laboratorium klinis, radiologi dsb) tidak diketemukan adanya kelainan, besar kemungkinan yang Anda atau kerabat Anda alami adalah gangguan psikosomatis.

Psikosomatis berasal dari kata psycho (jiwa) dan soma (tubuh, jasad)yang merujuk kepada keterkaitan antara adanya ketidakberesan dalam keseimbangan jiwa dengan kemunculan gejala sakit yang dirasakan oleh tubuh. Sudah kita kenal istilah mens sana in corpore sano, bukan? Jiwa yang sehat terdapat pada tubuh yang sehat. Ternyata juga berlaku sebaliknya, tubuh yang sehat dimiliki oleh jiwa yang juga sehat. Ini adalah masalah mind and body connection.

Psikosomatis merupakan salah satu gangguan kesehatan atau penyakit yang ditandai oleh bermacam-macam keluhan fisik. Berbagai keluhan tersebut acapkali berpindah-pindah. Sebagai contoh dalam waktu beberapa hari terjadi keluhan pada pencernaan, disusul gangguan pernafasan pada hari-hari berikutnya. Atau kadang keluhan tersebut menetap hanya pada satu sistem saja, misal hanya pada sistem pencernaan (gangguan lambung). Kondisi inilah yang seringkali menjadi sebab berpindah-pindahnya penderita dari satu dokter ke dokter yang lain ("doctor shopping"). Ada sebagian pasien yang kemudian jatuh pada perangkap medikalisasi, yakni upaya atau tindakan dengan berbagai teknik dan taktik, yang membuat mereka terkondisi dalam keadaan sakit dan memerlukan pemeriksaan maupun pengobatan.

Padahal gangguan psikosomatis ini sebenarnya justru disebabkan dan berkaitan erat dengan masalah psikis/psikososial. Alhasil, dapat terjadi gangguan fisik pada seluruh sistem di tubuh manusia mulai dari sistem kardiovaskular, sistem pernafasan, sistem pencernaan, kulit, saluran urogenital (saluran kencing) dan sebagainya.

GEJALA YANG TAMPAK

Manifestasi klinis psikosomatis yang banyak dijumpai di masyarakat berupa gejala sakit kepala, mudah pingsan, banyak berkeringat, jantung berdebar-debar, sesak nafas, gangguan pada lambung, diare, mudah gatal-gatal dan sebagainya dengan frekuensi yang berulang-ulang.

Dalam ilmu kedokteran jiwa (Psikiatri) kasus semacam ini seringkali ditemukan dengan ciri khas khusus. Yakni penderita merasa yakin bahwa gangguan-gangguan yang dialaminya merupakan rangkaian gejala penyakit tertentu. Penderita merasa kecewa karena meskipun telah melalui konsultasi dan mendapat pemeriksaan dokter ternyata secara medis/fisik tidak ditemukan suatu kelainan. Karena tidak puas, penderita cenderung mengambil inisiatif penyembuhan sendiri yaitu dengan sering berpindah-pindah dokter. Biasanya penderita penyakit psikosomatis menyangkal dan menolak untuk membahas serta mengutarakan problem atau konflik dalam kehidupan yang dialaminya ketika berhadapan dengan dokter. Meskipun sudah didapatkan gejala ansietas (kecemasan) dan depresi pada dirinya.

Keadaan ini tentu sangat merugikan bagi penderita, karena selain terganggu dengan keluhan yang dideritanya, biaya berobat dan biaya pemeriksaan-pemeriksan penunjang lain yang biasanya termasuk dalam rangkaian pengobatan dapat melonjak sangat tinggi. Bahkan secara signifikan hasil penelitian dalam kurun waktu terakhir menunjukkan bahwa hampir 80 % pasien yang datang berobat adalah penderita kasus psikosomatis. Ironisnya, jumlah ini kian bertambah sejalan dengan membengkaknya biaya hidup di segala sektor. Tentunya kita akan berada dalam kondisi yang lebih baik apabila kasus psikosomatis ini dapat ditangani dengan lebih tepat.

Dalam pengertian awam istilah stres sering disalahartikan sebagai suatu penyakit atau gejala yang berhubungan dengan masalah psikis/kejiwaan. Padahal, makna stres itu sendiri-- jika ditinjau dari sudut ilmu kedokteran dan psikologi - adalah respon normal tubuh yang bersifat adaptif terhadap perubahan di lingkungan atau luar tubuh, sebagai stresor, yang menimbulkan perubahan atau mekanisme pertahanan tubuh. Respon tubuh terhadap stresor atau penyebab stres dapat berupa perubahan fisik atau emosi.

Ditinjau dari ilmu Kedokteran dan Psikologi, gejala psikosomatis, menurut awam sering disebut stres, muncul ketika tubuh sudah tidak dapat lagi mengatasi stresor. Peristiwa ini sering juga disebut sebagai Kondisi Distress. Pada tahap inilah biasanya penderita psikosomatis datang ke dokter dengan gejala-gejala sebagaimana disebut di awal tulisan ini.

CARA PENANGANAN

Perkembangan dalam terapi ilmu kedokteran dewasa ini-- sesuai dengan definisi WHO tahun 1994 tentang "konsep sehat"-- adalah sehat secara fisik, psikologis, sosial, dan spiritual, maka terapi pun seyogyanya dilakukan secara holistik. Maksudnya, tidak hanya gejala fisik saja yang ditangani tetapi pemeriksaan pada faktor-faktor psikis yang biasanya sangat mendominasi penderita psikosomatis pun menjadi prioritas. Seorang dokter seyogyanya mampu menyakinkan dan menenangkan penderita penyakit psikosomatis ini sehingga mereka tidak terlalu memikirkan kondisi penyakitnya. Berempati dalam mendengarkan segala keluhan penderita yang berkaitan dengan masalah kehidupan yang dihadapinya sebagai salah satu cara terapi (ventilasi) juga menjadi salah satu tugas dokter dalam menangani penyakit ini. Dengan demikian penderita akan lebih merasa tenang.

Berikutnya adalah re-edukasi dan re-assurance. Ini dimaksudkan untuk meyakinkan dan menjamin penderita bahwa segala masalah yang dihadapi dapat diatasi. Biasanya pada tahap ini peran dokter/psikiater atau rohaniwan sangat membantu.

Selanjutnya berupa anjuran untuk memperbaiki kondisi lingkungan dalam keluarga, sosial ekonomi, dan juga di lingkungan pekerjaannya. Sebab, tidak jarang penyebab masalah psikis adalah orang-orang terdekat di sekitar penderita.

Karena itu, masyarakat wajib memahami sungguh-sungguh masalah psikosomatis ini. Lebih-lebih para praktisi medis. Mereka harus lebih proaktif dan bertindak profesional sehingga masyarakat/pasien tidak (di)-jatuh-(kan) pada pemaksaan terselubung alias medikalisasi.

Karena jelas bahwa psikosomatik adalah masalah gangguan berdasarkan mind and body connection, maka penanganannya harus holistik (terpadu). Hipnoterapi diharapkan mampu menjembatani hubungan antara penyebab psikis di bawah sadar dengan manifestasi klinis pada tubuh.

Apabila ada di antara Anda atau kerabat Anda yang memiliki masalah gangguan psikosomatis / psychosomatic dysorder, mengunjungi dokter yang memahami hipnoterapi adalah keputusan yang tepat.

Dissociative Identity Disorder (Multiple Personality Disorder)

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Dissociative Identity Disorder, formerly referred to as Multiple Personality Disorder, is a condition wherein a person's identity is fragmented into two or more distinct personalities. Sufferers of this rare condition are usually victims of severe abuse.
Definition

Dissociative Identity Disorder (DID) is a severe condition in which two or more distinct identities, or personality states, are present in—and alternately take control of—an individual. The person also experiences memory loss that is too extensive to be explained by ordinary forgetfulness.

DID is a disorder characterized by identity fragmentation rather than a proliferation of separate personalities. The disturbance is not due to the direct psychological effects of a substance or of a general medical condition, yet as this once rarely reported disorder has become more common, the diagnosis has become controversial.

Some believe that because DID patients are easily hypnotized, their symptoms are iatrogenic, that is, they have arisen in response to therapists' suggestions. Brain imaging studies, however, have corroborated identity transitions in some patients. DID was called Multiple Personality Disorder until 1994, when the name was changed to reflect a better understanding of the condition—namely, that it is characterized by a fragmentation, or splintering, of identity rather than by a proliferation, or growth, of separate identities.

DID reflects a failure to integrate various aspects of identity, memory and consciousness in a single multidimensional self. Usually, a primary identity carries the individual's given name and is passive, dependent, guilty and depressed. When in control, each personality state, or alter, may be experienced as if it has a distinct history, self-image and identity. The alters' characteristics—including name, reported age and gender, vocabulary, general knowledge, and predominant mood—contrast with those of the primary identity. Certain circumstances or stressors can cause a particular alter to emerge. The various identities may deny knowledge of one another, be critical of one another or appear to be in open conflict.

Symptoms

1.The individual experiences two or more distinct identities or personality states (each with its own enduring pattern of perceiving, relating to, and thinking about the environment and self).
2.The reported range of identities is from 2 to more than 100. Half of the reported cases include individuals with 10 or fewer.
3.At least two of these identities or personality states recurrently take control of the person's behavior. Each may exhibit its own distinct history, self-image, behaviors, and, physical characteristics, as well as possess a separate name.
4.Particular identities may emerge in specific circumstances. Alternative identities are experienced as taking control in sequence, one at the expense of the other, and may deny knowledge of one another, be critical of one another or appear to be in open conflict. Transitions from one identity to another are often triggered by psychosocial stress.
5.Frequent gaps are found in memories of personal history, including people, places, and events, for both the distant and recent past. Different alters may remember different events, but passive identities tend to have more limited memories whereas hostile, controlling or protective identities have more complete memories.
6.Symptoms of depression, anxiety, passivity, dependence and guilt may be present.
7.In childhood, problem behavior and an inability to focus in school are common.
8.Self-destructive and/or aggressive behavior may take place.
9.Visual or auditory hallucinations may occur.
9.The average time that elapses from the first symptom to diagnosis is six to seven years.
10.The disturbance is not due to the direct psychological effects of a substance or of a general medical condition.

Causes

Why some people develop DID is not entirely understood, but they frequently report having experienced severe physical and sexual abuse, especially during childhood. Though the accuracy of such accounts is disputed, they are often confirmed by objective evidence. Individuals with DID may also have post-traumatic symptoms (nightmares, flashbacks, and startle responses) or Post-Traumatic Stress Disorder. Several studies suggest that DID is more common among close biological relatives of persons who also have the disorder than in the general population. As this once rarely reported disorder has grown more common, the diagnosis has become controversial. Some believe that because DID patients are highly suggestible, their symptoms are at least partly iatrogenic— that is, prompted by their therapists' probing. Brain imaging studies, however, have corroborated identity transitions.

Treatments

The primary treatment for DID is long-term psychotherapy with the goal of deconstructing the different personalities and uniting them into one. Other treatments include cognitive and creative therapies. Although there are no medications that specifically treat this disorder, antidepressants, anti-anxiety drugs or tranquilizers may be prescribed to help control the mental health symptoms associated with it.

Parkinson's Disease

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• ·         Bergetarnya tangan, lengan, kaki, rahang dan wajah
• ·         Kekakuan pada lengan, kaki dan badan
• ·         Pergerakan yang lambat
• ·         Kordinasi dan keseimbangan yang buruk.

Perkembangan Mikroskop dan Manfaatnya dalam Ilmu Kedokteran

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DNA

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