Spinal disc herniation, also known as a slipped disc, is a medical condition affecting the spine in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion to bulge out beyond the damaged outer rings. Disc herniation is usually due to age-related degeneration of the anulus fibrosus, although trauma, lifting injuries, or straining have been implicated. Tears are almost always postero-lateral in nature owing to the presence of the posterior longitudinal ligament in the spinal canal. This tear in the disc ring may result in the release of inflammatory chemical mediators, which may directly cause severe pain, even in the absence of nerve root compression.

Disc herniations are normally a further development of a previously existing disc “protrusion”, a condition in which the outermost layers of the fibrous ring are still intact, but can bulge when the disc is under pressure. In contrast to a herniation, none of the central portion escapes beyond the outer layers. Most minor herniations heal within several weeks. Anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or disc tear are generally effective. Severe herniations may not heal of their own accord and may require surgery. The condition is widely referred to as a slipped disc, but this term is not medically accurate as the spinal discs are firmly attached between the vertebrae and cannot “slip”.

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Parkinson’s disease (PD), also known as idiopathic or primary parkinsonism, hypokinetic rigid syndrome, or paralysis agitans, is a degenerative disorder of the central nervous system mainly affecting the motor system. The motor symptoms of Parkinson’s disease result from the death of dopamine-generating cells in the substantia nigra, a region of the midbrain. The causes of this cell death are poorly understood. Early in the course of the disease, the most obvious symptoms are movement-related; these include shaking, rigidity, slowness of movement and difficulty with walking and gait. Later, thinking and behavioral problems may arise, with dementia commonly occurring in the advanced stages of the disease, and depression is the most common psychiatric symptom. Other symptoms include sensory, sleep and emotional problems. Parkinson’s disease is more common in older people, with most cases occurring after the age of 50; when it is seen in young adults, it is called young onset PD.

The main motor symptoms are collectively called parkinsonism, or a “parkinsonian syndrome”. The disease can be either primary or secondary. Primary Parkinson’s disease is referred to as idiopathic (having no known cause), although some atypical cases have a genetic origin, while secondary parkinsonism is due to known causes like toxins. Many risks and protective factors have been investigated: the clearest evidence is for an increased risk of PD in people exposed to certain pesticides and a reduced risk in tobacco smokers. The pathology of the disease is characterized by the accumulation of proteins into Lewy bodies in neurons, and insufficient formation and activity of dopamine in certain parts of the midbrain. Where the Lewy bodies are located is often related to the expression and degree of the symptoms of an individual. Diagnosis of typical cases is mainly based on symptoms, with tests such as neuroimaging being used for confirmation.

Treatments, typically the antiparkinson medications L-DOPA and dopamine agonists, improve the early symptoms of the disease. As the disease progresses and dopaminergic neurons continue to be lost, these drugs eventually become ineffective whilst at the same time produce a complication marked by involuntary writhing movements. Diet and some forms of rehabilitation have shown some effectiveness at improving symptoms. Surgery and deep brain stimulation have been used to reduce motor symptoms as a last resort in severe cases where drugs are ineffective. Research directions include investigations into new animal models of the disease and of the potential usefulness of gene therapy, stem cell transplants and neuroprotective agents. Medications to treat non-movement-related symptoms of PD, such as sleep disturbances and emotional problems, also exist.

In 2013 PD resulted in about 103,000 deaths globally, up from 44,000 deaths in 1990. The disease is named after the English doctor James Parkinson, who published the first detailed description in An Essay on the Shaking Palsy in 1817. Several major organizations promote research and improvement of quality of life of those with the disease and their families. Public awareness campaigns include Parkinson’s disease day (on the birthday of James Parkinson, 11 April) and the use of a red tulip as the symbol of the disease. People with parkinsonism who have increased the public’s awareness of the condition include actor Michael J. Fox, Olympic cyclist Davis Phinney, and professional boxer Muhammad Ali.

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Irritable bowel syndrome (IBS) or spastic colon is a symptom-based diagnosis. It is characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits. Diarrhea or constipation may predominate, or they may alternate (classified as IBS-D, IBS-C, or IBS-A, respectively).

As a functional gastrointestinal disorder (FGID), IBS has no known organic cause; however, excessive mast cell activation has a central pathophysiological role in the disorder. IBS is a disorder of the gut?brain axis. Onset of IBS is more likely to occur after infections (postinfectious IBS-PI), or a stressful life event, but varies little with age. For at least some individuals, abnormalities in the gut flora occur, and it has been theorised that these abnormalities result in inflammation and altered bowel function.

A diagnosis of IBS may be made on the basis of symptoms, in the absence of worrisome features such as age of onset greater than 50 years, weight loss, bloody stool, signs of infection or colitis, or family history of inflammatory bowel disease. Routine testing yields no abnormalities, although the bowels may be more sensitive to certain stimuli, such as balloon insufflation testing. Several conditions may present similarly, including coeliac disease, non-celiac gluten sensitivity, fructose malabsorption, mast cell activation disorders, parasitic infections, inflammatory bowel disease, bile acid malabsorption, functional chronic constipation, small intestinal bacterial overgrowth, and chronic functional abdominal pain.

Although no cure for IBS is known, treatments to relieve symptoms exist. This including dietary adjustments, medication, and psychological interventions. Patient education and good doctor?patient relationships are also important. Dietary measures that have been found to be effective include increasing soluble fiber intake. IBS has no direct effect on life expectancy. IBS also does not harm intestines. It is, however, a source of chronic pain, fatigue, and other symptoms, and contributes to work absenteeism. It is common and its effects on quality of life make it a disease with a high social cost. Psychiatric disorders such as anxiety and major depression are common in IBS.

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