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Typically affecting the elderly, normal pressure hydrocephalus (NPH) is one of the more difficult conditions to diagnose. In addition to gait difficulty and incontinence, the signs and symptoms include cognitive impairment, which is often characterized as memory loss. The cause of enlarged ventricles, found on CT scans or MRI, is uncertain. However, NPH has been shown experimentally to be associated with decreased absorption of spinal fluid, increased pulse pressure or systolic blood pressure, or both, and brain atrophy.
Neill R. Graff-Radford, M.D., a neurologist at Mayo Clinic in Florida, and his neurosurgical colleague Robert E. Wharen Jr., M.D., have broad experience in treating NPH and assessing factors that may predict outcomes.
After other causes of gait disturbance have been ruled out, patients at Mayo have a test that mimics a temporary shunt to determine whether decreasing cerebrospinal fluid volume improves gait. Typically, 30 cubic centimeters of fluid is removed during a spinal tap, and pre- and post-procedure videos of the patient walking are compared.
Separately, tests for cognitive function are conducted to help determine if memory problems are isolated or are accompanied by other impairments. The presence of aphasia, for example, suggests an additional degenerative pathology that likely will not improve with shunting.
Treatment consists of a neurosurgically placed shunt that drains cerebrospinal fluid into the peritoneal cavity. Dr. Wharen explains that one of the known complications in the past has been overdrainage, which can cause the brain to shrink and may result in subdural hemorrhage or subdural hygroma. The recent introduction of programmable shunt valves, however, has improved outcomes and reduced the need for additional surgical procedures to adjust the rate of drainage.
Dr. Wharen notes that NPH may have a degenerative component. Even in patients with initial success, it may be necessary to adjust the rate of drainage six months to several years later. The programmable valve readily enables such adjustments and has made surgery more viable for more patients.
Not all symptoms improve with treatment. Often, gait and incontinence improve, but memory and cognition may not. Dr. Graff-Radford has long suspected that overlapping conditions may be important to the cognitive decline associated with NPH. The presence of aphasia or even mild naming deficits may signal coexisting pathology, such as vascular disease or Alzheimer's disease (AD).
As Dr. Graff-Radford points out, studies have shown that among people older than 74 years, the brains of more than 30 percent of patients show evidence of AD pathology on autopsy. Cerebrovascular disease is also frequent in this age group because hypertension is common. Several studies show that hypertension is associated with hydrocephalus in animal models and with hydrocephalus in humans.
Dr. Graff-Radford and colleagues presented findings at the American Academy of Neurology meeting in New Orleans in April, from data collected by the Atherosclerosis Risk in Communities (ARIC) Study, a prospective epidemiologic study sponsored by the National Heart, Lung, and Blood Institute (NHLBI).
Looking at the MRI scans of study participants taken 10 years apart, Dr. Graff-Radford and his co-authors found that both increased systolic blood pressure and increased pulse pressure correlated with increased ventricle size. In earlier research, Dr. Graff-Radford and colleagues showed that head size also correlates with increased risk of NPH. Approximately 10 to 20 percent of people with NPH have a head size at or above the 98th percentile. Thus, it may be that people born with a large head have congenital hydrocephalus that becomes symptomatic as they age.
The question of the contribution of head size, vascular disease and underlying AD pathological factors is important to predicting outcomes for surgical shunting. To address these issues, Drs. Graff-Radford and Wharen are initiating a prospective study in which 25 NPH patients who have agreed to shunt surgery will be given a battery of neuropsychological tests and PET imaging to screen for amyloid plaque buildup before surgery. They will also have gait evaluation and neuropsychological testing at one-year follow-up.
The goal of the study is to determine whether the presence of amyloid in the brain influences cognitive outcomes from shunt surgery in NPH. The investigators hope their findings will help physicians in counseling patients about which symptoms may improve with a shunt and whether shunting is a good option.
Original article: http://www.mayoclinic.org/medical-professionals/clinical-updates/neurosciences/predicting-outcomes-normal-pressure-hydrocephalus


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A colorful array of beautiful flowers spring off the canvas of artist Cecelia Webber's creative digital series. From a distance, the flowers look highly realistic, but as one steps closer the truth behind these images is revealed. Each element of the image is created using photographs of nude models in yoga like poses, then they are digitally multiplied and arranged to form a whole. According to her website, she creates the images as a celebration of the human body and nature.
Cecelia's work ranges from humanistic flowers, to modernist paintings, to her own existential webcomic. Find out more at ceceliawebber.com or follow her on twitter @ceceliawebber.
Source: designyourway.net

subset: commoncrawl


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Item #: ACROMONO16:SET
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A different take on their Crossfire line, Ashaway Crossfire Monogut 16 String combines a resilient synthetic gut cross string with their more durable Monogut for the main strings. The co-polyester Monogut provides good durability with more playability than aramid strings while the synthetic gut helps to soften the string bed even more. The result is that Crossfire Monogut provides a more responsive string bed for hard hitters that want a softer feel without sacrificing durability. An improvement over traditional hybrids, Monogut holds its tension exceptionally well for longer-lasting playability. Our testers felt that Crossfire Monogut performed best in the hands of powerful baseline players that did not want to give up the feel necessary for occasional touch shots.
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A great American, John Wayne, passed away many years ago. One of his last public appearances was at a dinner. The purpose of the dinner was to benefit a land purchase for a Scout Reservation called John Wayne Outpost Camp.
At this dinner, Wayne recited the Scout Law. Then he did something unusual, he said the twelve points of the Scout Law are "nice words". "Trouble is" he continued, "we learn them so young we sometimes don't get all the understanding that goes with them. I take care of that in my family. As each boy reaches Scout age, I make sure he learns the Scout Law. Then I break it down for him, with a few things I have picked up in more than half a century since I learned it."
Then Wayne proceeded to explain the importance of the Scout Law, breaking it down for the guests at the dinner; much like he would have for his grandson.
TRUSTWORTHY - The badge of honesty. Having it lets you look any man in the eye. Lacking it he won't look back. Keep this one at the top of your list.
LOYAL - The very word is life itself, for without loyalty we have no love of person or country.
HELPFUL - Part sharing, part caring. By helping each other, we help ourselves, not to mention mankind. Be always full of help -- the dying man's last words.
FRIENDLY - Brotherhood is part of that word. You can take it in a lot of directions - and do - but make sure and start with brotherhood.
COURTEOUS - Allow each person his human dignity which means a lot more than saying, "yes ma'am" and "thank you sir". It reflects an attitude that later in life you wish you had honored more -- earlier in life. Save yourself that problem. Do it now.
- This one word would stop wars and erase hatreds. But its like your bicycle, its just no good unless you get out and use it.OBEDIENT - Starts at home. Practice it in your family. Enlarge it in your friends. Share it with humanity.
CHEERFUL - Anyone can put on a happy face when the going is good. The secret is to wear it as a mask for your problems. It might surprise you how many others do the same thing.
THRIFTY - Means a lot more than putting pennies away, and it is the opposite of cheap. Common sense covers it just about as well as anything.
BRAVE - You don't have to fight to be brave. Millions of good, fine, decent folks show more bravery than heavyweight champs just by getting out of bed every morning, going out to do a good day's work and living the best life they know how against the law of odds. Keep the word handy every day of your life.
CLEAN - Soap and water help a lot on the outside. But it is the inside that counts and don't ever forget it.
REVERENT - Believe in anything that you want to believe in, but keep God at the top of it. With Him, life can be a beautiful experience. Without Him, you are just biding time.
John Wayne then thanked those at the dinner for putting his name on the outpost camp and said, "I would rather see it here than on all the theater marquees the world over."
This text has been posted on the Scouts-L newsgroup several times by several people.
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Semi Hauling Volatile Explosives Wrecks in Okla.
A wreck involving a tractor-trailer carrying volatile explosives shut down westbound traffic of Interstate 40 on Wednesday morning.
The crash happened on Interstate 40 near Scott Street at about 11:15 a.m.
Oklahoma Highway Patrol spokesperson Chris West said the driver of a Rent-A-Center van swerved into the truck, which caused it to hit the side of the bridge.
The driver of the van was transported from the crash by ambulance. The truck's driver was not hurt.
Oklahoma City Fire Chief Cecil Clay said the truck had a 28,000-pound load of highly volatile explosives from the McAlester Ammunition Plant.
The name on the side of the truck was Chalich Trucking -- an approved Department of Defense trucking carrier.
Clay said air space was restricted, but no evacuations were ordered.
I-40 was closed at the Fort Smith junction to all traffic moving westbound as crews worked the scene.
Highway Patrol officials said that anytime a truck carrying hazardous material is involved in a collision it has to stop and be inspected before going any further.
Traffic was detoured onto northbound I-35 while Army officials inspected the cargo and gave the go-ahead for the truck to leave the scene.
Copyright 2011 by koco.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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A to Z Guide to PKD Welcome to the A to Z Guide to PKD, your most comprehensive (and organized) resource for information on PKD! Articles and information in this guide have appeared in PKD Progress magazine, our books or online and are constantly being updated as new information becomes available. To learn more about the medical documents in this section, view our Legal Disclaimer. To further improve this section with new material please send your suggestions to email@example.com.
A AlcoholAlbuminuriaAllograftAnemiaAneurysmsAnuriaArteriovenous FistulaArteriogramsAutosomal Dominant PKD (ADPKD)Autosomal Recessive PKD (ARPKD) Albuminuria More than normal amounts of a protein called albumin in the urine. Albuminuria may be a sign of kidney disease. Allograft An organ or tissue transplant between two humans. Anemia The condition of having too few red blood cells. Healthy red blood cells carry oxygen throughout the body. If the blood is low on red blood cells, the body does not get enough oxygen. People with anemia may be tired and pale and may feel their heartbeat change. Anemia is common in people with chronic renal failure or those on dialysis. (See also erythropoietin.) Aneurysms An aneurysm is an outpouching in a blood vessel, which can leak or rupture. In these events the symptoms can include sudden severe headache, pain in moving the neck, nausea and vomiting, difficulties with speech or movement, and even loss of consciousness. All such symptoms require immediate medical attention. Intracranial aneurysms occur in the blood vessels of the brain. Recent studies done in the United States have shown that people with ADPKD have about a 5 – 10 percent risk of developing intracranial aneurysms. They also seem to cluster in certain families – that is, if a member of your family has an aneurysm or has ruptured an aneurysm, you may be at a higher risk of having an aneurysm yourself. Because the risk for aneurysm is small, not everyone with ADPKD needs to be tested. However, people who have ADPKD and a family history of aneurysm should be tested, along with those whose job or hobbies would put them or others at risk if they lost consciousness (such as those who fly airplanes or drive buses). It's important to inform your physician if you have a family history of intracranial aneurysms and/or if you have a high-risk occupation or hobby. Magnetic resonance arteriography (MRA) is usually the first test done to screen for cerebral aneurysm, while some centers prefer high-resolution CT Scans. Both of these tests are relatively noninvasive. If there are any areas where an aneurysm is suspected, a cerebral arteriogram is usually performed. This test is more invasive and is done by putting dye directly into the blood vessels and will more clearly show if there is an aneurysm and how large it is. If an aneurysm is found in someone with ADPKD, surgical repair or a therapeutic coil (a device placed in the aneurysm by a neuroradiologist) may be recommended. When and if surgery is performed depends on where the aneurysm is located and how large it is. Many times an aneurysm can be repaired surgically before it leaks or ruptures. People with ADPKD who have had one aneurysm may develop others over time and need periodic follow-up. Recent studies from the University of Colorado and the Mayo Clinic suggest a period of 5-10 years between follow-ups for aneurysms Anuria A condition in which the person stops making urine. Arteriovenous Surgical connection of an artery directly to a vein, usually in the forearm, created in patients who will need hemodialysis (see dialysis). The AV fistula causes the vein to grow thicker, allowing the repeated needle insertions required for hemodialysis. Arteriograms Procedures that utilize contrast dye injected into blood vessels in order to clearly visualize them. When it is suspected that there is an aneurysm on a blood vessel in the brain, an arteriogram is usually done. Autosomal Dominant PKD (ADPKD) Means that if one parent has the disease, there is a 50 percent chance that the disease will pass to a child. At least one parent must have the disease for a child to inherit it. In some rare cases, the cause of autosomal dominant PKD occurs spontaneously in the child soon after conception — in these cases the parents are not the source of this disease. Autosomal Recessive PKD (ARPKD) Parents who do not have the disease can have a child with the disease if both parents carry the abnormal gene and both pass the gene to their baby. The chance of this happening (when both parents carry the abnormal gene) is one in four. If only one parent carries the abnormal gene, the baby cannot get the disease. B BladderBlood TestsBlood Urea Nitrogen (BUN) Bladder The balloon-shaped organ inside the pelvis that holds urine. Blood Tests Creatinine is a measure of kidney function. It is a waste product of muscle metabolism (the work the muscles do). After creatinine leaves the muscles, it enters into the blood, then is filtered by the kidneys and ends up in the urine. There is always some creatinine in the blood and some in the urine. When there is a loss in kidney function, the kidneys do not clear creatinine from the blood as efficiently as they once did. This causes an increase of creatinine in the blood, which can be measured by a simple blood test. Normal blood creatinine is 0.6 to 1.4 mg/dl. When a person's blood creatinine goes up to 2.0 mg/dl, they have lost approximately half of their kidney function. Blood urea nitrogen (BUN) is another measure of kidney function. Urea nitrogen is the waste product of dietary protein. If there is a loss of kidney function, the urea nitrogen builds up in the blood. A number of factors such as diet, protein intake, heart function, and fluid status can affect BUN. Therefore, creatinine is the preferred measure of kidney function. The normal range for BUN is 6 to 15 mg/dl. Liver function tests fall under tests on the blood. Liver function is almost always normal even if there are cysts in the liver. If at some time your liver function tests are not in the normal range, your physician should look for a cause other than ADPKD. Blood Urea Nitrogen (BUN) A waste product in the blood that comes from the breakdown of food protein. The kidneys filter blood to remove urea. As kidney function decreases, the BUN level increases. C CaffeineCalciumCarbohydratesChildren and ADPKDChronicChronic Renal FailureCreatinineCreatinine ClearanceComputed Axial Tomography (CT Scan)Cyst DecorticationCysts Caffeine There is no direct evidence that caffeine damages kidneys in people with ADPKD, however, studies done in test tubes combining ADPKD kidney cysts and caffeine-like substances have resulted in cyst growth. There is no clear relationship between caffeine and cysts in people since our bodies do not need caffeine (some may not agree with this, especially in the morning), it may be best to limit caffeine intake to 200 – 250 mg a day or two – three cups of coffee. Learn more about PKD and caffeine CAFFEINE CONTENT OF BEVERAGES Beverages Serving Size Caffeine (mg) Coffee, drip 5 oz 110-250 Coffee, perk 5 oz 60-125 Coffee, instant 5 oz 40-105 Coffee, decaf 5 oz 2-5 Tea, 5-minute steep 5 oz 40-100 Tea, 3-minute steep 5 oz 20-50 Hot Cocoa 5 oz 2-10 Coca-Cola 12 oz 45 Calcium A mineral that the body needs for strong bones and teeth. Calcium may form stones in the kidney. Children and ADPKD It was once thought that people who inherited the gene for ADPKD did not form cysts or have symptoms until well into adult life. We now know that ADPKD can be diagnosed at a very young age and even before birth. Any diagnostic tests done during pregnancy should be done in conjunction with medical counseling so the results of the test can be completely understood. For example, knowing a fetus carries the ADPKD gene does not predict the course of the disease. The fetus could go on to develop ADPKD in childhood or never have a symptom until much later in life. There seem to be two different groups of children with ADPKD — those who are diagnosed before birth or in the first year of life with large kidneys and/or cysts, and those who are diagnosed after the age of 1. Children who are diagnosed in the first year of life have some special characteristics: Most often the parent with ADPKD is the mother. Most of these children have brothers and/or sisters who are also diagnosed in the first year of life. Most are diagnosed before birth with large kidneys, but often they do not have actual cysts. Most develop high blood pressure in childhood, so this should be watched for and treated. Children who are diagnosed after 1 year of age are: Just as likely to have an affected father as an affected mother. Cysts, even though their kidneys are not necessarily enlarged. Affected with only one cyst in half the children, or just a few cysts. Whereas, in an adult one cyst alone is not enough to diagnose ADPKD because, as a natural part of aging, people often develop a few kidney cysts without having ADPKD. But in children who are a part of an ADPKD family, even one cyst means they are more likely to have the disease. The number of cysts a child has affects his/her signs and symptoms. Just as in adults, children with many cysts are more likely to have back, side or stomach pain and are also more likely to have high blood pressure than children with only a few cysts. Almost all children who are diagnosed after the first year of life have perfectly normal kidney function that seems to stay normal throughout childhood. Most children will maintain normal kidney function until they are into their mid-twenties. Chronic Lasting a long time. Chronic diseases develop slowly. Chronic renal failure may develop over many years and lead to end-stage renal disease. Chronic Renal Failure Slow and progressive loss of kidney function over several years, often resulting in end-stage renal disease. People with end-stage renal disease need dialysis or transplantation to replace the work of the kidneys. Creatinine A measure of kidney function. It is a waste product of muscle metabolism (the work the muscles do). After creatinine leaves the muscles, it enters into the blood, then is filtered by the kidneys and ends up in the urine. There is always some creatinine in the blood and some in the urine. When there is a loss in kidney function, the kidneys do not clear creatinine from the blood as efficiently as they once did. This causes an increase of creatinine in the blood, which can be measured by a simple blood test. Creatinine Clearance A test that measures how efficiently the kidneys remove creatinine and other wastes from the blood. Low creatinine clearance indicates impaired kidney function. Computed Axial Tomography (CT Scan) A sophisticated form of x-ray. CT scan uses radiation and, most often, contrast dye to visualize the organ or blood vessels being studied. This imaging technique is very helpful if complications of ADPKD arise, such as bleeding into a cyst or kidneys stones. High-resolution CT scan is used to visualize the blood vessels in the brain. This type of CT can show if there are any suspicious areas that may be aneurysms before doing more invasive or expensive tests. Cysts A cyst in the kidney begins as an outpouching of the nephron, similar to a blister, and can occur anywhere along the length of the nephron. Although polycystic means many cysts, not every nephron forms cysts — only 5 percent of the nephrons do. The fluid inside the cysts often reflects the area in the nephron from which the cyst began. Approximately 70 percent of cysts detach from the nephron when they are still very small, about 2 mm (1/8 inch) in diameter. Over time, the cysts enlarge and can become filled with clear fluid or fluid that contains blood or white blood cells. Cysts can also form in other organs as well as the kidney, with the most common site being the liver. Current research suggests that liver cysts are associated with the bile ducts or tubules of the liver rather than liver cells themselves and that these cysts do not take the place of functioning liver cells, they merely push liver cells aside. This difference between kidney cysts and liver cysts is the reason why liver cysts don't cause liver failure even though the liver can become quite enlarged due to cysts. The genes that cause ADPKD give an incorrect message and make abnormal polycystins, which in turn, causes some cells in the body to function incorrectly. Research has shown there are at least three components to cyst formation: Cell proliferation (growth) - The cells of a cyst wall reproduce themselves more than do normal kidney cells, making them grow in size. Fluid secretion - Secretion is a way of making fluid. To form a cyst, the cells themselves must secrete fluid. If there were no fluid produced to fill the cyst, there would merely be a ball of cells. Abnormal basement membrane - As its name implies, the basement membrane is a very thin layer of tissue the cystic cells sit on. In ADPKD, this layer is thicker than usual and is also incorrectly formed. Research continues on other complex factors that affect cyst formation and growth. In general, cysts cause problems because of their size and the space they occupy. Many of the symptoms people with ADPKD have are dependent on how large their liver and kidneys are. For example: People with kidneys over 15 cm (6 inches) are more likely to have pain than people with smaller kidneys People with ADPKD who also have high blood pressure have bigger kidneys than those with normal blood pressure People with ADPKD who have bleeding into their urine have bigger kidneys than those who don't People with large kidneys have more loss of renal function than people with smaller kidneys D DiagnosisDialysateDialysisDialyzerDiverticulaDwell Time Diagnosis A physician is alerted to the possibility of ADPKD in three different settings: When someone reports there is a family history of ADPKD When there are signs and symptoms that commonly occur in ADPKD When a test is done for some other reason and cysts are found in the kidney About 70 percent of the time, there is a family history of ADPKD. Family history helps to see who is at-risk for developing cysts. In general, the signs and symptoms of ADPKD are not specific enough to permit a doctor to know if a person has the disease or not. For example, although some people with ADPKD have back pain and/or high blood pressure, so do many other people who do NOT have ADPKD. However, if a person goes to the doctor with these signs or symptoms and the doctor also feels enlarged kidneys or liver during an examination, he/she will likely think about ADPKD and order an ultrasound test. Ultrasound is currently the most practical screening test for ADPK. Ultrasound can detect cysts in nearly all people with the ADPKD gene who are over age 30. It does not use dyes or radiation and is relatively inexpensive. Ultrasound may be negative prior to the age of 30 in 20 percent of patients who carry the ADPKD gene. For that reason it is important to remember that a negative ultrasound test before age 30 does not exclude the condition actually being present. CT scans or magnetic resonance imaging (MRI) can increase the sensitivity for diagnosis somewhat, but these tests are more expensive. The CT scan also uses x-ray dye which may potentially damage kidney tissue and both of these tests still have a false-negative rate of 15 percent before age 30. CT scans are sometimes used in patients with ADPKD to diagnose complications like bleeding into a cyst or the presence of kidney stones. The limitations of all these methods are that the cysts have to be large enough to be seen. Many patients, particularly those with ADPKD2, do not have cysts large enough to see until they are 30 years of age or older. Genetic testing of a patient's DNA is available. This testing scans the individual's DNA isolated from a blood sample and looks for mutations in the PKD gene. However, this test is extremely expensive and mutations are found in only 60 – 70 percent of samples again giving us a high false-negative rate. Dialysate A cleansing liquid used in the two major forms of dialysis — hemodialysis and peritoneal dialysis. Dialysis The process of cleaning wastes from the blood artificially. This job is normally done by the kidneys. If the kidneys fail, the blood must be cleaned artificially with special equipment. The two major forms of dialysis are hemodialysis and peritoneal dialysis. Hemodialysis The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. Peritoneal Dialysis Cleaning the blood by using the lining of the belly (abdomen) as a filter. A cleansing solution, called dialysate, is drained from a bag into the belly. Fluids and wastes flow through the lining of the belly and remain "trapped" in the dialysate. The dialysate is then drained from the belly, removing the extra fluids and wastes from the body. There are three types of peritoneal dialysis: Continuous Ambulatory Peritoneal Dialysis (CAPD) - The most common type of peritoneal dialysis. It needs no machine. With CAPD, the blood is always being cleaned. The dialysate passes from a plastic bag through the catheter and into the abdomen. The dialysate stays in the abdomen with the catheter sealed. After several hours, the person using CAPD drains the solution back into a disposable bag. Then the person refills the abdomen with fresh solution through the same catheter, to begin the cleaning process again. Continuous Cyclic Peritoneal Dialysis (CCPD) - A form of peritoneal dialysis that uses a machine. This machine automatically fills and drains the dialysate from the abdomen. A typical CCPD schedule involves three to five exchanges during the night while the person sleeps. During the day, the person using CCPD performs one exchange with a dwell time that lasts the entire day. Nocturnal Intermittent Peritoneal Dialysis (NIPD) - A machine-aided form of peritoneal dialysis. NIPD differs from CCPD in that six or more exchanges take place during the night, and the NIPD patient does not perform an exchange during the day. Learn more about dialysis Dialyzer A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. Diverticula Diverticula are outpouchings on the large intestine (colon). It seems that people with ADPKD who are on dialysis or have had a transplant have diverticula more often and also have more complications from diverticula, including infection, than people who have other kidney diseases. At the present time, we are not recommending any routine evaluation for this possible symptom. Dwell Time In peritoneal dialysis, the amount of time a bag of dialysate remains in the patient's abdominal cavity during an exchange. E EchocardiogramEdemaElectrolytesEnd-Stage Renal Disease (ESRD)ErythropoietinExchangeExercise Echocardiogram An ultrasound of the heart. One of the uses of an echocardiogram is to image the valves of the heart. Your physician may order this test if he or she suspects you have mitral valve prolapse (MVP). Edema Swelling caused by too much fluid in the body. Electrolytes Chemicals in the body fluids that result from the breakdown of salts, including sodium, potassium, magnesium, and chloride. The kidneys control the amount of electrolytes in the body. When the kidneys fail, electrolytes get out of balance, causing potentially serious health problems. Dialysis can correct this problem. End-Stage Renal Disease (ESRD) When normal kidney function declines and needs to be replaced by dialysis or transplant. At this point kidneys can no longer balance electrolytes and acids in the blood or remove the wastes and excess water. These imbalances will result in your not feeling as well as you are used to. The progression to end-stage renal failure is usually gradual for people with ADPKD. Symptoms that some people experience during this time are: Decreased energy Weakness Shortness of breath Weight loss Nausea and/or vomiting Metallic taste in the mouth Mild to moderate depression Decreased ability to think problems through It's important to keep you doctor informed of your symptoms so she/he can help you decide when it's time to start therapy. Blood tests will show that your blood urea nitrogen (BUN) and creatinine are not being eliminated by the kidneys and are building up in the blood. These tests may also show that your electrolytes and pH are out of balance. In many centers, planning for kidney replacement therapy (dialysis) is done when there is about 25 percent of kidney function still left. If a person waits until he/she is very sick (uremic), it will take much longer to recover and may require more and longer hospitalizations. Erythropoietin A hormone made by the kidneys to help form red blood cells. Lack of this hormone may lead to anemia. Exchange A cycle in peritoneal dialysis in which the patient fills the abdominal cavity with dialysate, carries it for a specified dwell time, and then empties the dialysate from the abdomen in preparation for a fresh bag of dialysate. F FatsFinancial Aid Financial Aid In general, Medicare covers a significant amount of the cost of dialysis and transplantation. To be eligible, a person must have earned Social Security benefits or be the spouse or dependent of someone who has. About 93 percent of those with end-stage kidney disease are eligible. For more detailed information regarding Medicare and payment of costs associated with dialysis and transplant, call your local Social Security Medicare office or write to the U.S. Department of Health and Human Services for the Medicare Handbook. Another good source of information for Medicare coverage and kidney replacement therapy is your local transplant unit and The National Kidney Foundation also published a booklet on these issues. Those who do not qualify for Medicare may be covered by Medicaid for the indigent. A social worker or financial counselor in the dialysis unit or transplant program will help you work through the financial issues. G Graft Graft A transplanted organ or tissue. H Health InsuranceHematocritHematuriaHemodialysisHerniasHigh Blood Pressure/HypertensionHormone Hematocrit A measure that tells how many red blood cells are present in a blood sample. Low hematocrit suggests anemia or massive blood loss. Hematruia Blood in the urine, which can be a sign of a kidney stone, glomerulonephritis, or other kidney problem. Hemodialysis A procedure that removes extra fluid, electrolytes and wastes using a dialysis machine. This can be done in three different settings: Home hemodialysis - Done at home with an assistant and your own dialysis machine. In-center, self-care hemodialysis - Done in a center with you doing as much as possible with the assistance of staff at the dialysis center. In-center hemodialysis - Done in a center with the staff providing all of the care. Hernias Both inguinal and umbilical hernias are more common in those with ADPKD. Inguinal hernias are outpouchings in the area of the groin and umbilical hernias are outpouchings at or near the navel. These should be surgically repaired if they are large or are causing other problems, just as they would be in someone who does not have ADPKD. High Blood Pressure/Hypertension Blood pressure is a measurement of the force of the blood as it flows through the body. The pressure depends on the amount of blood and fluid in the body, how much blood the heart pumps each second (cardiac output), and the degree in which blood vessels are constricted or dilated. This is similar to the force it takes to get water through a garden hose. The pressure depends on how much water is going through the faucet and how narrow the hose is. Blood pressure measurements have two parts, recorded as millimeters of mercury (mm Hg) – for example 120/80 mm/Hg. The top number or systolic blood pressure measures the pressure when the heart is actually pumping and the bottom number or diastolic pressure is the measurement of the pressure when the heart is relaxing between beats. High blood pressure or hypertension affects about 60 – 70 percent of people with ADPKD and begins early in the course of the disease. Fully half of the people with ADPKD who have normal kidney function already have hypertension and is more common in men than in women. Twenty to thirty percent of children with ADPKD also have high blood pressure as compared to other children their age. Many times, the increase in blood pressure will be the first sign of ADPKD and is the primary reason a person gets tested. People with ADPKD and high blood pressure have more and larger cysts than do people with normal blood pressure. A great deal of research has been done trying to understand how hypertension occurs. In general, there is either an increase in cardiac output or constriction of the blood vessels. In ADPKD, it seems the more likely of these two processes is the constricting of the blood vessels. This is thought to be related to excess activity of the renin-angiotensin-aldosterone system. Renin is a hormone produced in the kidneys and acts on angiotensinogen, a substance in the blood that forms yet another hormone called angiotensin. This hormone is a powerful constrictor of blood vessels and also stimulates the production of aldosterone, leading to salt retention and potassium loss. In ordinary circumstances, the kidneys make renin when blood pressure is low and the kidneys sense they need a stronger flow of blood — in other words, a protective mechanism. In ADPKD, cysts can press on blood vessels in the kidney, resulting in decreased blood flow to some parts of the kidney. Sensors in the nephron react as though the blood pressure in the kidney was low, triggering the secretion of renin, which in turn generates angiotesin, constricting the blood vessels, and causing high blood pressure. Whatever the initial cause of high blood pressure, it needs to be treated aggressively. If not treated, hypertension causes further damage to the kidneys, enlarges and thickens the heart muscle, and increases the risk for strokes and other cardiovascular events. Hypertension in ADPKD is often treated by a group of drugs called angiotensin converting enzyme inhibitors (ACE inhibitors) or angiotensin receptor blockers (ARBs). These two classes of drugs are usually the first drug of choice because of the role of angiotensin in high blood pressure in ADPKD. In general, both types of drugs are safe and effective, however, in some patients with large kidneys and decreased kidney function, these drugs can make kidney function rapidly worse. Regardless of what kind of blood pressure medication is used, the most important thing is to have you blood pressure in or near the normal range, below 120/80 and the lower the better. There are many different, very good medications to treat high blood pressure. Work with your doctor to find the right one for you. Remember, a blood pressure medicine only works if you take it, so try to have a regular time to take your medicine so that you don't forget. Although drugs are important in treating blood pressure, in some individuals certain non-drug treatments can also lower blood pressure. Some of these non-drug therapies include weight loss, exercise, and a low-salt/high potassium diet. Even though these treatments have not been studied specifically in ADPKD patients, they are worth trying since they also improve a person's overall health. WEIGHT LOSS - Weight loss in some people who are overweight can lower or eliminate entirely the need for blood pressure medications. EXERCISE - In some people regular exercise can decrease blood pressure and improves muscle strength and heart function in everyone. ALCOHOL - People who drink more than three ounces of alcohol a day tend to have higher blood pressures than those who are nondrinkers or light drinkers. SALT - Even though salt intake has not been shown to be the cause of hypertension in ADPKD, a low salt diet may be helpful, particularly if certain drugs are being used. POTASSIUM - Although it has not been examined in ADPKD, in other causes of hypertension potassium can lower blood pressure. Therefore, a diet that is high in potassium is probably a good idea (see diet) but only if your kidney function is in the normal range. Talk with your doctor before making any changes in your diet. When kidneys start to fail they can't excrete the potassium properly, which could cause serious problems. CALCIUM/MAGNESIUM - In non-ADPKD settings, a deficiency of calcium and magnesium has been associated with high blood pressure. Dietary calcium and magnesium are best provided by dairy products with low-fat dairy products a good choice in maintaining normal mineral balance as part of healthy diet. Studies in high blood pressure patients without PKD have shown that the so-called DASH diet (Dietary Approach to Stopping Hypertension) which consists of lots of fruits and vegetables combined with low-fat dairy by itself lowers blood pressure substantially and a diet based on these guidelines would also seem appropriate for patients with ADPKD TOBACCO - Smoking increases the risk of heart disease and stroke, and when paired with hypertension these risks increase dramatically. There is a close correlation between poor blood pressure control and progressive loss of kidney function with ADPKD. If you have ADPKD, you should have your own blood pressure cuff and monitor and keep a log of blood pressures away from the doctor's office. This will give your physician a better picture of your blood pressure over time. Hormone A natural chemical produced in one part of the body and released into the blood to trigger or regulate particular functions of the body. The kidney releases three hormones: erythropoietin, renin, and an active form of vitamin D that helps regulate calcium for bones. I Immune SystemImmunosuppressantInheritance Immune System The body's system for protecting itself from viruses and bacteria or any "foreign" substances. Immunosuppressant A drug given to suppress the natural responses of the body's immune system. Immunosuppressants are given to transplant patients to prevent organ rejection and to patients with autoimmune diseases like lupus. Inheritance Every person has 23 pairs of chromosomes, making a total of 46. Twenty-two pairs are called autosomes, and one pair is specifically devoted to determining the gender of an individual. Because the ADPKD genes are on an autosome, men and women have an equal chance of inheriting this disorder. During reproductions, the chromosome pairs split in the formation of female eggs and male sperm. The woman donates 23 of her chromosomes to the baby and the man donates 23 in the sperm. In this way, when the egg is fertilized by the sperm, it will have the normal complement of chromosomes. There are four possible ways the egg and the sperm of parents where one has ADPKD can combine. Two will contain the chromosome with the gene for ADPKD and two will not. Therefore, each child of a parent who has ADPKD has a 50 percent possibility of inheriting the affected chromosome. K KidneysKidney FailureKidney StoneKt/V Kidneys Each person is born with two kidneys located in the back of the body on each side of the spine, tucked under the rib cage. The kidneys are about 5 1/2 inches long (14 cm), 3 inches wide (8 cm), and 2 inches thick (5 cm) and they weigh 10 – 12 ounces (280 – 340 grams). Both kidneys are affected when a person has ADPKD. There may be just a few cysts or many, and the cysts may range in size from a pinhead to a grapefruit. If there are many cysts, the kidneys can more than double in size and weight. Each kidney contains about 1 million tiny tubes called nephrons. Almost a quarter of the blood your heart pumps every second is filtered through the filters in the nephrons called glomerulus. Red blood cells, white blood cells, and large substances like protein don't normally pass through the glomerulus, but rather stay in the body. The fluid that goes through the filter is made up of water, electrolytes and other small substances, and is about 180 liters (approx. 47 gallons) of fluid per day. This fluid passes through the glomerulus and the long tube of the nephron. All except 1 – 2 liters (a quart to a half-gallon) is reabsorbed back into the body; the rest ends us as urine. The process of filtering and reclaiming fluid along the nephron enables the normal kidney to perfectly maintain the body's fluid composition. The kidneys are also a regulating system. They make sure your electrolytes such as sodium, potassium, calcium, phosphorus, and other chemicals are in balance and help regulate the pH of your bodily fluids so they are not too acidic or alkaline. The kidneys filter and excrete the waste products your body produces each day. Blood Urea Nitrogen (BUN) and creatinine are two waste products removed by the kidneys. In particular, creatinine is removed so efficiently that an estimate of kidney function can be made by the level of this substance in the blood. Your doctor can calculate approximately how much actual kidney function you have with a blood test for creatinine, a 24-hour urine collection, along with your height and weight. This is called creatinine clearance and is approximately equal to the true glomerular filtration rate (GFR) of your kidneys which can be measured precisely for research purposes. The creatinine clearance tells your doctor the approximate percent of "normal" kidney function you have. The kidneys make several essential hormones. One of these is renin, an enzyme that facilitates the production of other hormones such as angiotensin (help regulate blood pressure) and aldosterone (aids in the body's handling of salt and potassium). Another hormone made in the kidneys is erythropoietin, commonly known as EPO. This hormone tells the bone marrow to make red blood cells. If a person's kidneys are surgically removed or if they fail because of a kidney disease, EPO is no longer produced and blood transfusions must be given to the person every five or six weeks. The exact gene that codes for the protein erythropoietin was discovered several years ago. There is now a genetically manufactured form of EPO that a person can take, which has all but eliminated the need for transfusions. The kidneys are also required to change vitamin D to its active form, which helps the body absorb calcium from the diet. In this way, the kidneys help control calcium and bone formation. Because the kidneys perform all these essential functions, they are vital to keeping a person healthy. Kidney Failure Although everyone with the ADPKD gene develops kidney cysts, not everyone progresses to kidney failure, and if they do it's rarely before age 40. Several recent large studies have shown that about 70 percent of those with ADPKD have not progressed to kidney failure by age 50. These studies also showed that about 50 percent were not in kidney failure even at age 60, and 23 percent were not by age 70. There is a high probability that many people with a very mild form of ADPKD are unaware of their status and thus are never diagnosed. Although we still don't know exactly how kidney failure happens in ADPKD, we do know some of the factors that increase the rate of progression to kidney failure. These include: Having the ADPKD1 gene as opposed to the ADPKD2 gene Male Diagnosed with cysts at a young age High blood pressure Large kidneys Multiple episodes of blood in the urine Urinary tract infections in men Being a woman with high blood pressure and four or more pregnancies Kidney Stone A stone that develops from crystals that form in urine and build up on the inner surfaces of the kidney, in the renal pelvis, or in the ureters. Kt/V A measurement of dialysis dose. The measurement takes into account the efficiency of the dialyzer, the treatment time, and the total volume of urea in the body. See also URR. L Liver CystsLiving-Related Donor (LDR)Living-Unrelated Donor Liver Cysts Over ninety percent of people with ADPKD have cysts in the liver during their lifetime. Liver cysts occur in those under the age of 30 but they are small and often detectable only by sensitive MRI scanning. The liver can remain normal in size with few cysts or become enlarged. Even though there is an increase in liver size, the amount of functional liver tissue remains fairly constant. Therefore, rather than have cysts take the place of normal tissue as occurs in the kidney, cysts in the liver seem to push good tissue aside. This appears to be the reason that normal liver function continues even with many cysts and enlarged liver size. Liver cysts occur more often in women than men; women have liver cysts at a younger age and more and larger cysts than men. Women who have been pregnant are more likely to have liver cysts; and the cysts are also more numerous and larger in women who have been pregnant compared to women who have not been pregnant. This suggests that female hormones may influence the development of liver cysts. For this reason researchers are looking at the effect of estrogen in post-menopausal ADPKD women. Because estrogen may be a factor in liver cyst growth, the benefits of estrogen replacement therapy and the risk of liver cystic disease must be carefully weighed. A recent nurses' health study has disproved any benefit of estrogen to prevent cardiovascular disease, however estrogen replacement therapy is protective against osteoporosis and decreases vasomotor instability — a cause of hot flashes in post-menopausal women. Thus, the quandary is to balance increases in the size of the liver cysts against the benefits of estrogen for post-menopausal symptoms and osteoporosis. Work with your doctor in determining what would be the best course for you. Women with ADPKD who do make the decision to take estrogen after menopause should have a baseline ultrasound of their liver before they start estrogen replacement therapy (ERT) and every two years thereafter. This will help your doctor evaluate if liver cysts are increasing in number and/or size. It is unclear at this time if it is better to take ERT in pill form or by skin patch, but theoretically, the patch would be a better choice since oral therapy provides high concentrations of estrogen directly to the liver. There have been reports of cysts in the liver becoming infected, with symptoms of liver cyst infection ranging from fever to pain in the abdomen on the upper right side. These symptoms need to be reported to your doctor as soon as possible. Treatment of an infected liver cyst usually requires drainage and antibiotic therapy. Although not common, if the liver becomes much enlarged and pain is disabling, decompression of cysts may be indicated. When there are a few large cysts, they can be drained by inserting a needle through the skin. When there are more cysts and greater liver involvement, a surgical procedure can be performed to "unroof" the cysts and/or take a section of the liver itself out — a major procedure that is rarely required. If it is needed, surgery should be done by a physician skilled in the procedure since it can be accompanied by complications. Living-Related Donor (LDR) A family member who donates a kidney, part of a lung, liver, or pancreas to another family member. Example: a brother and a sister, or a parent and a child. Living Unrelated Donor A person who is not related by blood, who donates a kidney, part of a lung, liver, or pancreas to another person (such as a husband and wife). M Magnetic Resonance Arteriogram (MRA)Magnetic Resonance Imaging (MRI)MatchMitral Valve Prolapse (MVP) Magnetic Resonance Arteriogram (MRA) Used to visualize the blood vessels in the brain for screening of aneurysms. This is similar to high-resolution CT, but does not use contrast dyes or radiation. MRA is used when people are allergic to contrast dyes and/or iodine, or if they have lost kidney function. Magnetic Resonance Imaging (MRI) Takes pictures of the body using a magnet that puts a certain spin on particles that exist in a person's body and does not require contrast dyes or radiation. Cysts are easily visualized with MRI and appear much better than ultrasonography in following the course of ADPKD. Match The compatibility between the donor and the recipient. The more closely they match, the greater the chance that the transplant will be successful. Mitral Valve Prolapse (MVP) Mitral valve prolapse (MVP) is a condition where the valve separating the top and the bottom of the left side of the heart does not close properly. Sometimes this causes blood to leak back to the top part of the heart. This is called regurgitation and can be heard during an examination of the heart as a heart murmur. Symptoms that can be associated with MVP are palpitations, a feeling that the heart is running away or that there are extra beats in the heart, and chest pain that is not associated with exercise or exertion. MVP occurs in approximately 26 percent of the people who have ADPKD compared to 2 – 3 percent of the general population. The majority of people with MVP never experience any major problems. MVP is usually confirmed with an ultrasound of the heart valves called an echocardiogram. If MVP is present and causing palpitations that are bothersome, they can be treated with medications that can also treat high blood pressure at the same time. Stopping the use of caffeine, alcohol and cigarettes may be enough to decrease or stop the palpitations in many cases. Rarely, an infection of a heart valve can occur as a complication of MVP. Although not a common occurrence, it can lead to destruction of the heart valve. Therefore, if you have MVP and a heart murmur, inform all physicians who care for you. To protect your heart valve from infection, antibiotics prior to certain surgical or dental procedures may be prescribed. N NephrectomyNephrologistNephronNephrotic SyndromeNuclear ScanNutrition Nephrectomy Surgical removal of a kidney. Nephrologist A doctor who treats patients with kidney problems or hypertension. Learn how to choose a good nephrologist Nephron A tiny part of the kidneys. Each kidney is made up of about 1 million nephrons, which are the working units of the kidneys, removing wastes and extra fluids from the blood. Nephrotic Syndrome A collection of symptoms that indicate kidney damage. Symptoms include high levels of protein in the urine, lack of protein in the blood, and high blood cholesterol. Nuclear Scan A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. O Organ DonationOrgan ProcurementOxalate Organ Procurement The removal or retrieval of organs and tissues for transplantation. Oxalate A chemical that combines with calcium in urine to form the most common type of kidney stone (calcium oxalate stone). P Pain ManagementPanel Reactive Antibody (PRA)Peritoneal DialysisPolycystic Kidney Disease (PKD)Polycystic Liver Disease (PLD)PotassiumPregnancyPregnancy NutritionProcurementProteinProteinuria Panel Reactive Antibody (PRA) The percentage of cells from a panel of donors with which a potential recipient's blood serum reacts. The more antibodies in the recipient's blood, the more likely the recipient will react against the potential donor. The higher the PRA, the less chance of receiving an organ that will not be rejected. A patient with a PRA of 80% means that they will reject 80% of donor kidneys. Patients with a high PRA have priority on the waiting list. Paritoneal Dialysis A type of dialysis that removes extra fluid, electrolytes and wastes using the lining of the abdominal cavity (peritoneum). There are two ways to do peritoneal dialysis: Continuous ambulatory peritoneal dialysis (CAPD) - Done on a continuous basis with exchanges four times a day. <strongContinuous cyclic peritoneal dialysis (CCPD) Done during the night using a machine to make the exchanges while you sleep. The basic principle of dialysis is to have the blood flow on one side of a natural or artificial membrane, with special fluid on the other side. This membrane permits molecules that have built up in the blood to pass into the special fluid and be removed. Polycystic Kidney Disease (PKD) An inherited disorder characterized by many grape-like clusters of fluid-filled cysts that make both kidneys larger over time. These cysts take over and destroy working kidney tissue. PKD may cause chronic renal failure and end-stage renal disease. Polycystic Liver Disease (PLD) Polycystic liver disease (PLD) is the development of multiple cysts in the liver. PLD cysts may cause pain, but they usually do not affect liver function. Most people with PLD also have polycystic kidney disease (PKD). Potassium Potassium is essential to all living cells and is important for muscle and nerve functions in the body. It is found in most foods, such as legumes, whole grains, fruits, green vegetables, potatoes, meats, milk and yogurt. Although potassium is vital to the body, it is not wise to take potassium supplements in pill or liquid form without consulting your physician. Pregnancy The diagnosis of ADPKD is no longer only made years after a person has had a family. The use of noninvasive ultrasonography has made the testing for ADPKD safe for all ages. Thus, screening specifically for ADPKD or finding evidence of ADPKD while doing an ultrasound for other reasons has made early diagnosis a more common occurrence. As the age of diagnosis is lower, an understanding of the risks of pregnancy in women with ADPKD is important. The fertility rates of both men and women who have ADPKD are no different than they are for the general population. However, when you factor in end-stage renal disease and dialysis, there is a loss of both libido and fertility. Although most women do not get pregnant while on dialysis, they are not sterile. If a patient has a transplant, the libido more often returns to what it was prior to the loss of kidney function. Generally, women with ADPKD who have normal blood pressure and normal kidney function have uneventful pregnancies and deliver healthy babies. Risk factors associated with pregnancy and ADPKD are due to increased blood pressure. Some women with ADPKD will develop hypertension during their pregnancy and are more likely to have continued elevations in their blood pressure after delivery. Women who have high blood pressure prior to becoming pregnant have the risk of further elevations in their blood pressure while pregnant and women with complications in their first pregnancy are more likely to have complications in future pregnancies. It is important for a woman with ADPKD to be closely monitored during pregnancy whether she has hypertension or not. Increases in blood pressure as well as protein in the urine could herald a serious complication of pregnancy called pre-eclampsia — a condition where the placenta can be prevented from getting enough blood. If the placenta doesn't get enough blood, the baby gets less air and food, which can cause low birth weight, premature birth, and other problems for the baby. Most women with preeclampsia still deliver healthy babies. Pregnancy does not seem to affect the growth of cysts in the kidney. But there appears to be a mild long-term loss of kidney function in women who have hypertension and have had four or more pregnancies, compared to ADPKD women with hypertension who have fewer than four pregnancies. The decision to have children is a very personal one. Both parents need to discuss both the risks involved and the joys associated with having a child. With an affected parent, there is a 50 percent probability of having a child who has inherited the gene for ADPKD. All alternatives and risks, including attitudes on termination of pregnancy, should be addressed with the couple. Learn more about PKD and pregnancy Procurement The act of recovering a donated organ or tissue. Proteinuria The presence of protein in the urine, indicating that the kidneys are not working properly. R RecoverRejectionRenalRenal CystsRenin Recover The act of surgically removing an organ or tissue for transplantation; formerly referred to as "harvest". Rejection Rejection occurs when the body tries to destroy a transplanted organ or tissue because it sees the organ or tissue as a foreign object and produces antibodies to destroy it. Anti-rejection (immunosuppressive) drugs help prevent rejection. Renal Of the kidneys. A renal disease is a disease of the kidneys. Renal failure means the kidneys have stopped working properly. Renal Cysts Abnormal fluid-filled sacs in the kidney that range in size from microscopic to much larger. Many simple cysts are harmless, while other types can seriously damage the kidneys. Renin A hormone made by the kidneys that helps regulate the volume of fluid in the body and blood pressure. S SaltSensitizedSigns and SymptomsSodiumSpontaneous Mutation Sensitized When a potential recipient has antibodies in their blood, usually because of pregnancy, blood transfusions, or previous rejection of an organ transplant. Sensitization is measured by panel reactive antibody (PRA). Highly sensitized patients are less likely to match with a suitable donor and more likely to reject an organ than non-sensitized patients. Signs and Symptoms High Blood Pressure Blood pressure is a measurement of the force of the blood as it flows through the body. The pressure depends on the amount of blood and fluid in the body, how much blood the heart pumps each second (cardiac output), and the degree in which blood vessels are constricted or dilated. This is similar to the force it takes to get water through a garden hose. The pressure depends on how much water is going through the faucet and how narrow the hose is. Blood pressure measurements have two parts, recorded as millimeters of mercury (mm Hg) — for example 120/80 mm/Hg. The top number or systolic blood pressure measures the pressure when the heart is actually pumping and the bottom number or diastolic pressure is the measurement of the pressure when the heart is relaxing between beats. High blood pressure or hypertension affects about 60 – 70 percent of people with ADPKD and begins early in the course of the disease. Fully half of the people with ADPKD who have normal kidney function already have hypertension and is more common in men than in women. Twenty to thirty percent of children with ADPKD also have high blood pressure as compared to other children their age. Many times, the increase in blood pressure will be the first sign of ADPKD and is the primary reason a person gets tested. People with ADPKD and high blood pressure have more and larger cysts than do people with normal blood pressure. A great deal of research has been done trying to understand how hypertension occurs. In general, there is either an increase in cardiac output or constriction of the blood vessels. In ADPKD, it seems the more likely of these two processes is the constricting of the blood vessels. This is thought to be related to excess activity of the renin-angiotensin-aldosterone system. Renin is a hormone produced in the kidneys and acts on angiotensinogen, a substance in the blood that forms yet another hormone called angiotensin. This hormone is a powerful constrictor of blood vessels and also stimulates the production of aldosterone, leading to salt retention and potassium loss. In ordinary circumstances, the kidneys make renin when blood pressure is low and the kidneys sense they need a stronger flow of blood — in other words, a protective mechanism. In ADPKD, cysts can press on blood vessels in the kidney, resulting in decreased blood flow to some parts of the kidney. Sensors in the nephron react as though the blood pressure in the kidney was low, triggering the secretion of renin, which in turn generates angiotesin, constricting the blood vessels, and causing high blood pressure. Pain Pain can be acute, signaling a sudden new problem like bleeding into a cyst, infection or a kidney stone and it can also be a lingering problem, and then it is described as chronic. Chronic pain is one of the most common problems for people with ADPKD. The pain is usually in the back or the side and occasionally in the stomach area. It can be intermittent and mild requiring only occasional mild pain medicine such as acetaminophen. However, in a small number of people, the pain can be constant and quite severe. For these few people, cyst decompression (drainage) can be very helpful. If there are a few big cysts that seem to be causing the pain, they can be emptied. This is done by using ultrasonography which allows the doctor to insert a needle into the cysts, drain the fluid, and then coat the cyst wall with alcohol so the cyst doesn't secrete more fluid. If there are a great many small cysts causing the pain, surgical decompression can be done. Pain is a very subjective feeling. There is no way pain can be measured accurately except by the person who is experiencing it. It is also important to remember that pain frequency and tolerance vary greatly among individuals. Pain tolerance appears to be influenced by a person's cultural background, expectations, behaviors, and physical and emotional health. For this reason, pain clinics that utilize biofeedback and support groups can be very helpful to some people in managing their pain. Blood in the Urine Close to 50 percent of those with ADPKD have had or will have blood in their urine (hematuria) at some point. The urine may look pink, red or brown. Passing small amounts of red blood cells in the urine that can only be seen under a microscope may also occur. This is called microscopic hematuria. Hematuria is more common in an individual with large kidneys and high blood pressure. It is thought that the rupture of cysts or the small blood vessels around them is the cause, along with kidney and bladder infections and kidney stones as other probable sources of blood in the urine. Blood in the urine can last for less than a day or the bleeding may go on for days. Notify your physician as soon as possible if you see blood in the urine. Strict bed rest, increased fluid intake, and acetaminophen (if there is pain) are the usual treatments if the bleeding is prolonged. Avoid taking nonsteroidal anti-inflammatory medications such as aspirin or ibuprofen as they may prolong the bleeding. If the bleeding is directly into a cyst, there may not be the presence of blood in the urine; however the pain can be severe. There is a direct association between multiple episodes of hematuria and decreasing kidney function. Therefore, if a particular activity is generally associated with blood in the urine, it would be best to avoid that activity. Urinary Tract Infection Urinary tract infection, commonly called UTI, is an infection caused by bacteria that have reached the bladder, kidneys or the cysts themselves. Other names used for UTI are cystitis for bladder infection and pyelonephritis when the infection is in the kidney but not a cyst. The infection usually starts in the bladder when, if not treated, can progress up the ureters (the tubes from the kidneys to the bladder) into the kidneys. Although both men and women have UTIs, they are far more common in women, due to women having a very short urethra (the tube that goes from the bladder to the outside). UTIs are quite common in the general population, but they may be more frequent in those with ADPKD. There is an association between frequent UTIs and worsening kidney function. Both males and females with ADPKD are more likely to have an infection after a catheter is placed into the bladder. The most common symptom of UTI, particularly if the infection is in the bladder, is pain or burning with urination and/or an urgent need to urinate even though only a small amount of urine passed. When the infection is in the kidney or in a cyst, there may be a sudden onset of fever, chills and back or flank pain. Your physician should be notified if any of these symptoms occur so that treatment can be started as soon as possible. Usually a urine sample will be taken for a culture to see what kidney of bacteria is causing the infection, and the appropriate antibiotic can be prescribed. Women who have frequent bladder infections may decrease or eliminate the rate of recurrence by: Wiping from front to back after urinating or a bowel movement. This prevents dragging bacteria from the anus and vagina to the urethral opening. Drinking fluid prior to intercourse and urinating afterward. This may help flush out any bacteria that may have entered the urethra. For those who have frequent UTIs, antibiotics may be prescribed on a daily basis to prevent recurring infections. Kidney Stones Kidney stones occur in about 20 – 30 percent of people who have ADPKD as compared to one to two percent of the general population. One reason kidney stones are more common may be due to cysts blocking the tubules, preventing normal drainage. When the urine stays in one area longer than it should, crystals can form and cause kidney stones. Uric acid and calcium oxalate are the two most common types of crystals that lead to stones. Another reason that stones may form in some people with ADPKD is that there is a decrease in urine citrate. Urine citrate is a substance that prevents formation of kidney stones. The symptoms of kidney stones are severe pain in the back, side or into the groin. Often there will be blood in the urine when passing a kidney stone. Kidney stones are treated the same way they would if a person did not have ADPKD. Sometimes a machine using sound waves, called a lithotriptor, may be used to break the stones into smaller pieces so they can be passed. Approximately 10 percent of the people diagnosed with PKD have no family history of the disease, with PKD developing as a spontaneous (new) mutation. Once they have it, they have a 50 percent chance of passing it on to each of their children. T Tissue TypingTransplantTransplant Diet Tissue Typing A blood test done to evaluate how closely the tissues of the donor match those of the recipient (done before the transplant). Done on all donors and recipients in kidney transplants to help match the donor to the most suitable recipient. Transplant Replacement of a diseased organ with a healthy one. Kidney transplant may come from a living donor, usually a relative, or from someone who has just died. Learn more about transplantation U UltrasonographyUreaUremiaUretersUrethraUrinalysisUrinary TractUrine Tests Ultrasonography A test done with sound waves. Ultrasonography does not require the use of radiation or contrast dye to be injected into a person. Because it's so safe and accurate, ultrasonography is the most common imaging test done to screen for ADPKD and can be done safely in pregnant women. Urea A waste product found in the blood and caused by the normal breakdown of protein in the liver. Urea is normally removed from the blood by the kidneys and then excreted in the urine. Urea accumulates in the body of people with renal failure. Uremia The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. Ureters Tubes that carry urine from the kidneys to the bladder. Urethra The tube that carries urine from the bladder to the outside of the body. Urinalysis A test of a urine sample that can reveal many problems of the urinary system and other body systems. The sample may be observed for color, cloudiness, concentration; signs of drug use; chemical composition, including sugar; the presence of protein, blood cells, or germs; or other signs of disease. Urinary Tract The system that takes wastes from the blood and carries them out of the body in the form of urine. The urinary tract includes the kidneys, renal pelvises, ureters, bladder, and urethra. Urine Tests White blood cells (WBC) in urine WBCs normally are present only in small numbers in the urine. Some people with ADPKD do pass a few more, however, large numbers of WBCs in the urine suggest a urinary tract infection. If this happens, your doctor will culture your urine to determine if and what types of bacteria are present and from those results, plan a course of action. Red blood cells (RBC) in the urine Only a few RBCs are normally found in the urine. As with white blood cells, some people with ADPKD also pass a few RBCs. Sometimes with an episode of bleeding, there are so many RBCs that they color the urine pink, red or brown (see hematuria). Protein in the urine Protein is normally found in the urine only in small amounts. About one-third of those with ADPKD pass protein into the urine, but it is usually less than a gram in 24 hours. If protein loss is greater than one gram in 24 hours, there may be another problem occurring in the kidney along with ADPKD. 24-hour urine collection This test is done in combination with the blood creatinine test to determine kidney function, called creatinine clearance or glomerular filtration rate (GFR). V Vitamins Vitamins A person who eats a fairly regular diet usually does not need extra vitamins. Unlike food, vitamins are needed only in tiny amounts. Excess amounts of vitamins A, D and E can accumulate in the body and cause medical problems. Generally, if you feel you need extra vitamins, a one-a-day generic brand of vitamin is sufficient. Consult your physician before taking extra vitamins of any kind. Because there is an increase incidence of calcium kidney stones in individuals with ADPKD, women with ADPKD should discuss with their doctor the proper amount of calcium needed. Low calcium diets do not prevent kidney stones in non-PKD patients and the beneficial effects of dairy product intake on skeletal and cardiovascular systems have already been established.


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The Secret Is Out
Just in case you thought the only balls secret policemen held were the ones they'd severed from unfortunate prisoners, here come two world premieres of the latest episodes in the long-running and deeply respected Secret Policeman's Ball live concert film series. Tonight's debut sees Neil Innes and co-creator Martin Lewis introducing the cycle, which includes Remember the Secret Policeman's Ball (dir. Margaret Kinmonth, 2004, BBC/Amnesty International), commemorating the 25th anniversary of the series itself. Previously the province of incessant airings on cable along with WarGames, Bill Cosby: Himself and First Blood this latest installment is a retrospective that has Monty Python's John Cleese, Terry Gilliam, Terry Jones and Michael Palin, Rowan Atkinson, Bob Geldof and Sting reminiscing about what it was all about to begin with namely, Amnesty International's research and prevention of human rights abuses around the world, not just in former colonies of the British Empire. Bob Geldof went on to spread the meme through the larger rock community with Live Aid, which begat Band-Aid, which begat Farm Aid, and scads of other benefit concerts working on the same principle. Also showing: The Secret Policeman Rocks (2009, Amnesty International), celebrating the series' 30th anniversary, so expect the usual perfunctory brilliance from Jeff Beck, Peter Gabriel, David Gilmour, Phil Collins and Kate "Let's Not Beat Around The" Bush. Charity fatigue? Not with this lot rocking the way that they do.
Thu., June 11, 9:30 p.m., 2009
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A Louisiana man is facing burglary charges after police say he forgot a crucial part of his break-in plan'his disguise. Slidell Police say Richard Boudreaux went out Tuesday night dressed in camouflage, gloves, and burglary tools to steal from his former employer. Officers say he forgot the Seafood restaurant where he used to work had security cameras, so he put a bucket on his head.
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text: Many 18-year-olds might hesitate before risking their lives to wade into a rip tide to help a stranger. But for Oxford resident Kyle Christopherson, it wasn't even a question. "I guess I really didn't think about it too much," said Christopherson humbly, of saving the life of 47-year-old Daniel Broaddus last July. Christopherson, an all-state varsity swimmer and now a 19-year-old junior at the University of Georgia, was vacationing with his family that fateful day at Daytona Beach Shores, Fla. While at the pool of a condominium complex next to the beach, he noticed a man flailing in the ocean and yelling and a woman on shore yelling. Broaddus had been wading in the waters when a powerful rip tide pulled him from the shore. As he struggled to make it back to land, he became exhausted. He was about 150 feet from the shore when Christopherson plunged into the choppy waters. "The water was really strong that day," remembered the teen. He had been caught in a rip tide once before and had learned first-hand the unpredictable power of the ocean. When he reached Broaddus, Christopherson felt the bottom beneath his feet and realized there was a submerged sandbar nearby. He pulled the Ohio man onto the sandbar so they could both rest for a moment, then took a hold of Broaddus, who was nearly unconscious, and headed back to shore. It was slow going, said Christopherson, swimming with one arm in a diagonal direction to avoid the current. After about 10 minutes, they reached the shore, where there was a lifeguard waiting. Broaddus was given oxygen and recovered. For his actions that day, Christopherson was awarded the Carnegie Medal – an honor bestowed by the Carnegie Hero Fund on "those who risk their lives to an extraordinary degree while saving or attempting to save the lives of others." The Newton County native was one of 25 civilians around the country and in Canada recently recognized for their heroism. Since the fund's inception in 1904, a total of 9,224 people have been recognized, according to the commission. "I am very proud," said his mother, Kathy Christopherson, who witnessed the incident along with her husband, Keith. "We were proud when it happened and scared as well." "It's just an honor," Kyle said. He and his family were thrilled and excited when they received the call that he had won the award, he said. The Christophersons had applied for the award six months ago but hadn't heard anything for a while until several weeks ago when the commission interviewed the family as well as other witnesses. Along with the medal, Kyle, a pre-med biology major and 2006 graduate of George Walton Academy, was awarded $6,000 in scholarship money.


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I've been sick for a week, and it seems like everyone I know is sick too. Does anyone know if this H3N2 strain is the same one that was included in the 2012 flu vaccine?
Thousands of Canadians celebrated the holiday season feeling a bit feverish, knocked off their feet by a strain of influenza that's hurried across the country earlier than in years past.
Emergency rooms in Montreal, Quebec City and Saguenay have all reported they are operating 50 or 60 per cent above capacity, in part due to the impact of the nasty flu season
Originally posted by Cosmic911
Anyone here who is a nurse working in the Emergency Department will tell you it isn't propaganda.edit on 4-1-2013 by Cosmic911 because: (no reason given)
Originally posted by stars15k
Not every sickness is the flu. I have a horrible cough and produced brown and green phlegm for a few days, with fever, chills, and sore throat, but I have a cold. The cold virus is not included in flu shots. So sick people who got a flu shot most likely do not have the flu. That's not propaganda, that a fact.
If you don't want a flu shot, fine. If and when you get the flu, you will be held accountable for your choice. But the usual response to this is just another layer of conspiracy....
A cold has mild symptoms. You usually do not have fever. And if you do have fever, it's a low-grade 100, 101. You have runny nose, cough, but they're mild. And you don't usually have severe body aches. You can usually continue your daily routine functions.


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These four steps will help you get the salary you deserve when taking a new job.
The healing of the job market has been frustratingly slow. ManpowerGroup CEO Jeff Joerres says this recovery is different.
The economy added 227,000 new jobs in February, according to a report released this morning. That's not bad but not as good as January, when 284,000 new jobs were added. The unemployment rate held steady at 8.3 percent, which is the lowest level it has reached in three years. If you are one of the
The headlines will all scream about the drop in the unemployment rate to 9.4 percent. But job growth was a middling 103,000, powered by private sector hiring of 113,000. Those numbers are not enough to pull the unemployment rate lower, and certainly not to the extent that it dropped. So if hiring isn't bringing the
The November jobs report came in well short of expectations. November saw just 39,000 new jobs and 50,000 in the private sector, compared to expectations in the 130,000-175,000 neighborhood. The revisions that make September and October appear slightly better are no consolation. Yes, the November figures will be revised twice more, but it won't be enough to
Working longer seems like a simple way to stretch retirement resources, but a lot of people obviously find this an unacceptable retirement planning option. At least, it appears that way based on a very unscientific measurement: the number of posted comments and e-mails I get every time I suggest it. Richard Johnson, senior fellow at


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As.com | 12/01/2013
Jordi Roura, Tito Vilanova's second-in-command, confirmed today that his boss will be on the bench at La Rosaleda tomorrow to lead his team against Málaga in the first of three matches the two teams will dispute in the space of two weeks, one in the Liga, two in the Copa.
Roura acknowleged that the players are affected by Tito's situation, and that his presence in Málaga is a fantastic piece of news for the group: "Tito is very strong and he's really up for it. It's a boost for everyone; it's really important that he's there."
The match against Málaga concludes the first half of the season for a Barcelona who could make history: so far they've beaten everybody with the exception of a draw in the Clásico. Roura admits it's an exciting prospect for the team, but says they won't lose sight of the main objective: "When the players prepare for a match they don't think about that, just about winning. But it's true it's an extra motivation and a challenge. It's not something that's changing our approach in any way but it would be nice to achieve it."
Despite the fact the confidence is currently sky high at the Camp Nou, Roura said that his players are aware they won't win everything, and a slip will eventually come. "It's inevitable: one day we'll lose, and statistically speaking that day is always coming closer. We just focus on this match and nothing else. We're thinking about winning this one without bearing in mind all the ones gone by. One day we'll lose, but we want it to be as far away as possible."
Regarding the opponents, the assistant coach had words of praise for Málaga's team and their coach, Manuel Pellegrini: "I know they had financial problems and I don't know what shape the club is in but I do know it doesn't show on the pitch. They're having an extraordinary campaign under the guidance of a special coach. We know they'll be tough opponents and it'll be a really difficult match." He also affirmed that Barça aren't expecting special marking for Xavi despite the fact Pellegrini marked out the midfielder as "the cog the team's game spins around."
Finally, he confirmed that Villa has felt a resurgence of the muscular problems that stopped him finishing the match against Córdoba, and he had words of praise for Pedro, who is approaching the fifth anniversary of his first team debut. "He's one of the academy players who's come on the most. He went from playing in Barça B to being a world champion. He's scored a lot of important goals and been a champion of Europe; it's all been said. He's an example for all players at the club and in the academy for his performances and also his attitude."
Monitor finances, choose your signings wisely, select the best strategy, and face off friends to become the best manager in the world.


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Shahram Nazeri
Shahram Nazeri | |
Background information | |
Native name | Kurdish: شارام نازری Persian: شهرام ناظری |
Born | 1951 (age 63–64) Kermanshah, Iran |
Origin | Kurdish Iranian[1] |
Genres | Iranian music |
Occupation(s) | Singer, Composer |
Instruments | Setar |
Years active | 1958–present |
Shahram Nazeri (in Kurdish شارام نازری, Persian شهرام ناظری; born 1951) is a contemporary Iranian tenor from Kermanshah who sings classical. He has been accompanied by some of the authorities of Iranian traditional music such as Jalil Shahnaz, Alizadeh, Jalal Zolfonoun and Payvar. He often works with his son Hafez Nazeri, a composer.
Master Shahram Nazeri is an undisputed icon of Kurdish and Persian classical and Sufi music.[citation needed] Born in a Kurdish family[citation needed], He was the first vocalist to set Rumi's poetry to Persian music thirty-five years ago, thus establishing a tradition of Sufi music within both Persian classical music and Kurdish music and his music was instrumental in introducing Western musical audiences to both Sufism and to the poetry of Rumi. The New York Times has dubbed him the "Persian Nightingale" and the Christian Science Monitor has called him "Iran's Pavarotti". Most recently he was awarded with Chevalier des Arts et Lettres medal from The government of France for his lifetime achievements in Iranian traditional music. Also Asia Society has awarded him by Lifetime Cultural Heritage Award. Master Nazeri has released over forty recordings to date; His "The One Hundred Leaf Flower" (Gol'eh Sad Barg) recording has held the record for the highest selling album of Persian classical music and Sufi music in the history. His musical talents were first nurtured by his mother at a very young age. Throughout his childhood, he was under the tutelage of the most renowned masters of Persian music including Abdollah Davami, Nourali Boroumand, and Mahmood Karimi. At eleven, he performed on television for the first time. By twenty-nine, he had gained a loyal fan base. He has continued to perform in Iran and abroad over the course of the last two decades. He has performed at major venues worldwide, including The Festival of Aix-en-Provence, The festival of Avignon, Theâtre de la Ville in Paris, The Tokyo Summer festival, The Kodak Theatre (Oscar ceremony) in Los Angeles, and the Royal Albert Hall, the Festa delPopolo in Italy, The Beiteddine Festival in Lebanon, the Kölner Philharmonic in Germany, Asia Society, World Music Instituted and Brooklyn Academy of Music BAM in New York, the Roma Europa Festival in Rome, São Paulo Music Festival in Brazil and Fes Festival of World Sacred Music in Morocco and many others.[citation needed] From early on, Master Nazeri began to sing and compose music to the works of Mawlana Jalal ad-Din Rumi, Iran's most cherished Sufi poet. Nazeri was also pioneering in assimilating contemporary Persian poetry into the classical repertoire. His progressive approach to music has led to collaborative new projects with his son, Composer and singer Hafez Nazeri. In year 2000 they performed Hafez's new composition in Iran which has hold the record for the most highly attended concert 140.000 in entire Middle East. In year 05/06 Master Nazeri along with his son's new Rumi ensemble launched "In the Path of Rumi," a highly successful North American tour which performed record-breaking sold-out concerts, to rave reviews. The venues, included Los Angeles' Kodak theater (12/11/05), - the most highly attended Persian classical music concert outside of Iran.
Some of his albums are[citation needed]:
- Amir Kabir 2011, composed and led by Pejman Taheri
- The Passion of Rumi 2008 (Live recording from Tehran, 2001), composed by Shahram Nazeri, arranged by Hafez Nazeri
- The Book of Austerity 2007, with Farrokhzad Layegh
- Mythical Chant 2002, also called Naghme-haye Sassani (Songs from Sassanid era), with Bashipour and Hafez Nazeri
- Loulian 2001, with Dastan ensemble, composed by Shahram Nazeri and Hamid Motebassem
- Shahram Nazeri & the Dastan Ensemble, 2001, Live in France, arranged by Kayhan Kalhor
- Avaze Asatir, Kurdish Shahnameh, 2000, Daf by Hafez Nazeri, Tanboor by Alireza Feiz Bashi Pour
- Safar be Digar Sou 1998, Live in Washington, D.C., (Through Eternity), composed by Shahram Nazeri, arranged by Dastan ensemble
- 98's Concert 1998, Live in Shiraz on Hafez' Anniversary, with Kamkars and Hafez Nazeri
- Nowruz 1990, Live in Cologne, Germany, performed by Aref and Shayda Ensemble, composed by Hossein Alizadeh plus some Persian folk songs
- Les Maitres de la Musique Traditionnelle: Nazeri & Tala'i 1980s, Live at the Théâtre de la Ville
- Gol-e Sadbarg 1984, (One hundred-petalled flower), composed by Jalal Zolfonoun, Shahram Nazeri & Reza Ghassemi
- Atashi Dar Neyestan 1980s, (A Fire in the Reed-Bed), composed by Jalal Zolfonoun & Shahram Nazeri
- Layli & Majnoun 1990, (the Beloved and the Lover), with masters of Persian music composed by Faramarz Payvar
- Concert of the Masters of Persian Music 1989, Faramarz Payvar, Ali-Asghar Bahari, Jalil Shahnaz, Mohammad Mousavi and Mohammad Esmaili
- Del-e Shayda 1990s, (Enchanted Heart), performed by masters of Persian music, composed by Faramarz Payvar
- Chashm Be-raah 1990s, (Kept Awaiting), with Atta Jangouk
- Mystified 1990s, (Heyrani), performed by Shams Ensemble, composed by Kaykhosro Pournazeri
- Mahtab-rou 1990s, (as beautiful as the moon), performed by Shams Ensemble, composed by Kaykhosro Pournazeri
- Voice of Endearment 1970s, (Sedaye Sokhan-e Eshgh), performed by Shams Ensemble, composed by Kaykhosro Pournazeri
- Shour-Angiz 1980s, (Joy-giver), composed by Hossein Alizadeh, performed by Aref and Shayda Ensemble
- Yadegar-e doust (In remembrance of a friend), composed by Kambiz Roshanravan
- Baharan-e Abidar 1980s (Springtime in Abidar [a mountain around Sanandaj / Iran]), with Kamkars group
- Beshno az Ney 1980s (Listen to the Reed), with Fereydoun Shahbazian
- Dar Golestaneh 1980s, (In Golestaneh [a village around Kashan / Isfahan province]),composed by Hooshang Kamkar
- Laleh Bahar 1970s, (Spring Tulip), with Aref Ensemble, composed by Parviz Meshkatian
- Bi Gharar 1980s, composed by Jalil Andalibi
- Kish-e mehr 1980s, (Manner of Affection) composed by Jalil Andalibi
- Benmay Rokh 1970s, (Show me your Face), composed by Jalil Andalibi
- Chavoush (4 Volumes) 1970s, performed by Shayda Ensembe, composed by Mohammad-Reza Lotfi
His international appeal led to several invitations to speak at various media outlets, including radio stations such as NPR in the United States, BBC, a live appearance on the Fox Channel (3/10/06), and an exclusive on ABC NEWS, following a recent New York performance. Master Nazeri's performances have garnered critical acclaim worldwide and won him awards at music festivals around the world. In 1975, he won First Prize at the Concours de Musique Traditionelle, the first competition to showcase Iran's great performers. More recently, the Ministry of Culture in Iran named him the Best Singer of Classical Persian and Sufi Music. UCLA has honored Shahram Nazeri with the Living Legend Award. The United Nations has honored Nazeri with are cognition award for his legendary contribution to the revival of Kurdish and Iranian Classical Music. The Irvine City Hall Award of Distinction in Persian music was given to Shahram Nazeri for his contributions in spreading Rumi's spiritual message of peace through the language of music. February 25, 2006 was named "SHAHRAM NAZERI DAY" in San Diego County by the Mayor and the Chairman of San Diego's Board of Supervisors. Soon after this date Shahram Nazeri also received arecognition award from the Congress of the United States and was invited to perform and lecture at Stanford University, Columbia University, University of California Berkeley, University of California Los Angeles UCLA, Emory University in Atlanta and Harvard University where he was recognized for his pioneering efforts in introducing Rumi to the West as well as for his innovations in Persian music. Shahram Nazeri awarded France's Chevalier des Arts et Lettres medal on September 2007. Persian Nightingale achieved this award because of his efforts in Iranian classical music and introduces it to the western countries during these 3 decades. He also received the Lifetime Cultural Heritage Award at the Annual Dinner of the Asia Society of New York on November 6, 2007.
On 19 June 2014, it was announced that Nazari will received France's National Order of Merit.
See also[edit]
External links[edit]
- Shahram Nazeri's official website
- Shahram Nazeri at Allmusic
- Shahram Nazeri's performance at 800th anniversary of Rumi (BBC Persian)
- Légion d'honneur for Shahram Nazeri (BBC Persian)
- France to Award Iran's Pavarotti (Fars News Agency)
- Official MySpace page
- 1951 births
- Grammy Award-winning artists
- Living people
- Iranian classical vocalists
- Iranian humanitarians
- Légion d'honneur recipients
- Iranian male singers
- Iranian musicians
- Music educators
- People from Kermanshah
- Musicians from Kermanshah
- Persian classical musicians
- Chevaliers of the Ordre des Arts et des Lettres
- Kurdish male singers
- Kurdish classical vocalists
- Kurdish artists
- Kurdish Music


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Find the best surf spots |
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Datum: WGS84 [ Help ] |
Latitude: 48° 41.869' N |
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From Brest city, take road N12, exit at Morlaix and follow direction Lanmeur on road D786. Turn left direction D64 toward Locquirec. BE AWARE of other drivers, this road may be dangerous : locals drive slowly, there's not much place to overrun and farming engines can surprise you at any turn or crossroad ! Once you are at Locquirec, take city center, follow the coastal road toward "Les Sables Blancs" cove, which will be on your right. DistanceTake a car WalkInstant access (< 5min) Easy to find?Easy to find Public access?Public access Special accessPaddle > 20mn or Boat |
Wave qualityRegional Classic
ExperiencePros or kamikaze only...
FrequencySometimes break
BottomReef (coral, sharp rocks etc..)
PowerFast, Powerful
Normal lengthShort (< 50m)
Good day lengthNormal (50 to 150m)
Good swell directionNorthWest, West
Good wind directionSouthWest, South, SouthEast
Swell sizeStarts working at 2m-2.5m / 6ft-8ft and holds up to 5m / 16 ft and over
Best tide positionLow tide only
Best tide movementRising tide
Week crowdEmpty
Week-end crowdEmpty
- Rocks
you need quite experience to ride this wave. be carefull the rocks is under than 50 cm of your board!
Author: Antoine Contributors (2) They surfed this spot ! (2)
By POINTBOY , 24-05-2004
does look like box - this wave does look like the box in W.A.,but so does a hundred other breaks around the world when when they're firing
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