A Simple Guide to Skin Polyp
----------------------------------------------------
What is a Skin Polyp?
---------------------------------------
Skin Polyp is a benign tumor with soft round body rising on a stalk from the skin surface.
They are often called skin tags.
Who is affected by Skin Polyp?
---------------------------------------------------
Skin polyp usually occur in middle age.
Skin Polyp is more common in women than in men.
Polyps can also be found all over the body especially areas where the skin forms creases, such as the neck, armpits and groin.
Some may found on the eyelids.
What is the Cause of Skin Polyp?
-----------------------------------------------------
Skin Polyp is a well encapsulated round swelling rising from the skin on a stalk called the peduncle.
The cause of formation of skin polyps is unknown but may be related to:
1.Age
2.Obesity
3.hereditary
What are the Symptoms and signs of Skin Polyp?
-----------------------------------------------------------
Symptoms :
1.slow growing round soft tissue swelling on a stalk rising from the skin
2.mutiple swellings may also be present.
3.Usually painless
Signs:
1.swelling is well demarcated and rounded
2.there is a stalk or peduncle attached to it.
How do you make the Diagnosis of skin Polyp?
------------------------------------------------------------
1.round well encapsulated swelling
2.soft on palpation
3.there ia a stalk attached to the swelling from the skin
4.Microscopic examination shows the presence of a fibrovascular core together with fat cells and nerve cells covered by skin.
What are the complications of skin Polyp?
---------------------------------------------------
The skin polyp can be irritated by shaving, clothing or jewellery.
There can be :
1. bleeding
2. infection especially in diabetes
What is the treatment of skin Polyp?
---------------------------------------------------
The only treatment is removal of the skin Polyp.
This can be done by :
1.Excision with a scalpel
2.Cauterization: with cautery instrument
3.Cryosurgery (freezing with liquid nitrogen)
4.Ligation with a sterile thread: by cutting off blood supply to the polyp
Small Polyps may left alone if they are slow growing and does not impinge on the nearby organs.
What is the prognosis of skin Polyp?
-----------------------------------------
The prognosis is usually excellent.
Recurrence at the same spot is rare but do occur due to regrowth of the blood vessel supplying the Polyp.
Sunday, August 31, 2008
Thursday, August 28, 2008
A Simple Guide to Squamous Cell Carcinoma(skin)
A Simple Guide to Squamous Cell Carcinoma(skin)
----------------------------------------------------
What is Squamous Cell Carcinoma?
---------------------------------------
Squamous Cell Carcinoma is a progressive neoplastic tumor of the epithelial cells of thee skin which are found mainly in the late middle age and consists of a solitary skin lesion.
Who is affected by Squamous Cell Carcinoma?
---------------------------------------------------
Squamous Cell Carcinoma is more common in :
1.People with fair skin than in those with darker skin.
2.People who spend time outdoors under the sun than those staying indoors.
3.People with skin condition called xeroderma pigmentosa
4.People with autoimmune disease such as systemic lupus erythematosus
5.People with family history of Squamous Cell Carcinoma
What is the Cause of Squamous Cell Carcinoma?
-----------------------------------------------------
A.Sun exposure:
Exposure to the sun is one of the most common causes of Squamous Cell Carcinoma.
Risk factors are:
1.intensity of the sun
2.duration of sun exposure,
3.age when sun exposure takes place
4.degree of skin pigmentation
B.Familial:
1.skin condition called xeroderma pigmentosa (autosomal recessive)
2.family history of Squamous Cell Carcinoma
What are the Symptoms and signs of Squamous Cell Carcinoma?
-----------------------------------------------------------
Squamous Cell Carcinoma presents usually as:
1.single firm lesion
2.raised
3.red
4.indurated
5.scaling
6.ulceration may occur
7.rarely bleeding
8.found in sun exposed areas of body
9.regional lymph nodes may be enlarged
How do you make the Diagnosis of Squamous Cell Carcinoma?
------------------------------------------------------------
Biopsy show malignant epithelial cells with varying degrees of infiltration
What are the complications of Squamous Cell Carcinoma?
-----------------------------------------------------------------
Squamous Cell Carcinoma can spread to the organs and other parts of the body
What is the treatment of Squamous Cell Carcinoma?
---------------------------------------------------
Treatment is simple surgical removal of the skin lesion .
Sometimes the regional lymph nodes are also removed.
If the spread is further, chemotherapy and radiotherapy may be necessary.
What is the prognosis of Squamous Cell Carcinoma?
------------------------------------------------------
The prognosis is good if detected early and there is complete removal of the cancer.
If there is spread to the organs, prognosis is variable depending on the degree of metastases.
What are the preventive measures for Squamous cell carcinoma?
-----------------------------------------------------------------
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats).
Use sunscreens.
2.Good nutrition and healthy lifestyle boost the immune system and helps prevent malignancy.
3.Patients with family history of skin cancer should be reviewed yearly
4.Recently a melanocyte-stimulating hormone called melanotan has been found to provide photo-protection against squamous cell carcinoma of the skin.
----------------------------------------------------
What is Squamous Cell Carcinoma?
---------------------------------------
Squamous Cell Carcinoma is a progressive neoplastic tumor of the epithelial cells of thee skin which are found mainly in the late middle age and consists of a solitary skin lesion.
Who is affected by Squamous Cell Carcinoma?
---------------------------------------------------
Squamous Cell Carcinoma is more common in :
1.People with fair skin than in those with darker skin.
2.People who spend time outdoors under the sun than those staying indoors.
3.People with skin condition called xeroderma pigmentosa
4.People with autoimmune disease such as systemic lupus erythematosus
5.People with family history of Squamous Cell Carcinoma
What is the Cause of Squamous Cell Carcinoma?
-----------------------------------------------------
A.Sun exposure:
Exposure to the sun is one of the most common causes of Squamous Cell Carcinoma.
Risk factors are:
1.intensity of the sun
2.duration of sun exposure,
3.age when sun exposure takes place
4.degree of skin pigmentation
B.Familial:
1.skin condition called xeroderma pigmentosa (autosomal recessive)
2.family history of Squamous Cell Carcinoma
What are the Symptoms and signs of Squamous Cell Carcinoma?
-----------------------------------------------------------
Squamous Cell Carcinoma presents usually as:
1.single firm lesion
2.raised
3.red
4.indurated
5.scaling
6.ulceration may occur
7.rarely bleeding
8.found in sun exposed areas of body
9.regional lymph nodes may be enlarged
How do you make the Diagnosis of Squamous Cell Carcinoma?
------------------------------------------------------------
Biopsy show malignant epithelial cells with varying degrees of infiltration
What are the complications of Squamous Cell Carcinoma?
-----------------------------------------------------------------
Squamous Cell Carcinoma can spread to the organs and other parts of the body
What is the treatment of Squamous Cell Carcinoma?
---------------------------------------------------
Treatment is simple surgical removal of the skin lesion .
Sometimes the regional lymph nodes are also removed.
If the spread is further, chemotherapy and radiotherapy may be necessary.
What is the prognosis of Squamous Cell Carcinoma?
------------------------------------------------------
The prognosis is good if detected early and there is complete removal of the cancer.
If there is spread to the organs, prognosis is variable depending on the degree of metastases.
What are the preventive measures for Squamous cell carcinoma?
-----------------------------------------------------------------
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats).
Use sunscreens.
2.Good nutrition and healthy lifestyle boost the immune system and helps prevent malignancy.
3.Patients with family history of skin cancer should be reviewed yearly
4.Recently a melanocyte-stimulating hormone called melanotan has been found to provide photo-protection against squamous cell carcinoma of the skin.
Wednesday, August 27, 2008
A Simple Guide to Basal cell carcinoma
A Simple Guide to Basal cell carcinoma
----------------------------------------------------
What is Basal cell carcinoma?
---------------------------------------
Basal cell carcinoma is a localized malignant tumor of the basal cells of the skin which seldom spread beyond its location.
It is the most common skin cancer.
It usually occurs in fair skinned people above the age of 50.
It is never life threatening.
Who is affected by Basal cell carcinoma?
---------------------------------------------------
Basal cell carcinoma is more common in :
1.People with fair skin than in those with darker skin.
2.People who spend time outdoors under the sun than those staying indoors.
3.People with a family history of Basal cell carcinoma.
What is the Cause of Basal cell carcinoma?
-----------------------------------------------------
A. Familial:
Familial cases of Basal cell carcinoma with
1.autosomal dominant genes(basal cell nevus) and
2.xeroderma pigmentosum(autosomal recessive)
are more common especially in fair skin people.
B.Sun exposure:
Exposure to the sun is one of the most common causes of Basal cell carcinoma.
The majority of basal cell carcinomas occur on sun-exposed areas of the body.
Risk factors are:
1.intensity of the sun
2.duration of sun exposure,
3.age when sun exposure takes place
4.degree of skin pigmentation
C:Environmental causes:
1.Arsenic exposure in certain occupations(preparation of arsenic products)
2.Exposure to X-ray radiation especially radiotherapy
What are the types of Basal cell carcinoma?
-----------------------------------------------------------
1.Nodular: flesh-colored papule with capillaries which can become ulcerated ( called rodent ulcer )
2.Cystic: less common with a central cystic cavity.
3.Pigmented: pigmented nodular form
4.Sclerosing: looks like a keloid
5.Superficial: a red scaly flat lesion.
What are the Symptoms and signs of Basal cell carcinoma?
-----------------------------------------------------------
Basal cell carcinoma can present as:
1.firm nodule which grows within the skin and below it
2.Color may be like normal skin, dark brown or black.
3.Border is characteristic rolled up edge
4. red, flat, scaling areas similar to a patch of eczema.
How do you make the Diagnosis of Basal cell carcinoma?
------------------------------------------------------------
1.Skin biopsy under local anesthesia
2.small lesions can be totally removed
3.larger ones are biopsied first and surgically removed if there is confirmed malignancy.
What are the complications of Basal cell carcinoma?
--------------------------------------------------------
1.local growth and destruction of neighboring tissues (e.g. nose).
2.Growth into vital structures resulting in the loss of extension or function
3.rarely metastases or cause death.
What is the treatment of Basal cell carcinoma?
---------------------------------------------------
Surgery:
Most basal cell carcinomas are removed by surgical excision with margins of 4-6mm.
Chemotherapy:
local therapy with 5-fluorouracil(a chemotherapy agent) with 70-90% success rate
Radiation:
Radiation therapy may be used in older patients not suitable for surgery.
Cryosurgery:
Cryosurgery can be done for basal cell cancer that invades cartilage.
Mohs surgery:
Mohs micrographic surgery is an outpatient procedure in which the cancer nodule is surgically excised and then immediately examined under a microscope. The base and edges are microscopically examined to confirm no evidence of malignancy before repair is done.
Immunotherapy:
Immunotherapy research indicates that treatment with Euphorbia peplus, a common garden weed, may be effective against Basal cell carcinoma.
What is the prognosis of Basal cell carcinoma?
----------------------------------------------------
Prognosis of majority of cases is good if there is complete removal.
Sclerosing lesions are harder to treat because they invade deeper into the tissues.
What are the preventive measures for Basal cell carcinoma?
-----------------------------------------------------------------
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats). Use sunscreens.
2.Good nutrition and healthy lifestyle boost the immune system and helps prevent malignancy.
3.Patients with family history of skin cancer should be reviewed yearly
----------------------------------------------------
What is Basal cell carcinoma?
---------------------------------------
Basal cell carcinoma is a localized malignant tumor of the basal cells of the skin which seldom spread beyond its location.
It is the most common skin cancer.
It usually occurs in fair skinned people above the age of 50.
It is never life threatening.
Who is affected by Basal cell carcinoma?
---------------------------------------------------
Basal cell carcinoma is more common in :
1.People with fair skin than in those with darker skin.
2.People who spend time outdoors under the sun than those staying indoors.
3.People with a family history of Basal cell carcinoma.
What is the Cause of Basal cell carcinoma?
-----------------------------------------------------
A. Familial:
Familial cases of Basal cell carcinoma with
1.autosomal dominant genes(basal cell nevus) and
2.xeroderma pigmentosum(autosomal recessive)
are more common especially in fair skin people.
B.Sun exposure:
Exposure to the sun is one of the most common causes of Basal cell carcinoma.
The majority of basal cell carcinomas occur on sun-exposed areas of the body.
Risk factors are:
1.intensity of the sun
2.duration of sun exposure,
3.age when sun exposure takes place
4.degree of skin pigmentation
C:Environmental causes:
1.Arsenic exposure in certain occupations(preparation of arsenic products)
2.Exposure to X-ray radiation especially radiotherapy
What are the types of Basal cell carcinoma?
-----------------------------------------------------------
1.Nodular: flesh-colored papule with capillaries which can become ulcerated ( called rodent ulcer )
2.Cystic: less common with a central cystic cavity.
3.Pigmented: pigmented nodular form
4.Sclerosing: looks like a keloid
5.Superficial: a red scaly flat lesion.
What are the Symptoms and signs of Basal cell carcinoma?
-----------------------------------------------------------
Basal cell carcinoma can present as:
1.firm nodule which grows within the skin and below it
2.Color may be like normal skin, dark brown or black.
3.Border is characteristic rolled up edge
4. red, flat, scaling areas similar to a patch of eczema.
How do you make the Diagnosis of Basal cell carcinoma?
------------------------------------------------------------
1.Skin biopsy under local anesthesia
2.small lesions can be totally removed
3.larger ones are biopsied first and surgically removed if there is confirmed malignancy.
What are the complications of Basal cell carcinoma?
--------------------------------------------------------
1.local growth and destruction of neighboring tissues (e.g. nose).
2.Growth into vital structures resulting in the loss of extension or function
3.rarely metastases or cause death.
What is the treatment of Basal cell carcinoma?
---------------------------------------------------
Surgery:
Most basal cell carcinomas are removed by surgical excision with margins of 4-6mm.
Chemotherapy:
local therapy with 5-fluorouracil(a chemotherapy agent) with 70-90% success rate
Radiation:
Radiation therapy may be used in older patients not suitable for surgery.
Cryosurgery:
Cryosurgery can be done for basal cell cancer that invades cartilage.
Mohs surgery:
Mohs micrographic surgery is an outpatient procedure in which the cancer nodule is surgically excised and then immediately examined under a microscope. The base and edges are microscopically examined to confirm no evidence of malignancy before repair is done.
Immunotherapy:
Immunotherapy research indicates that treatment with Euphorbia peplus, a common garden weed, may be effective against Basal cell carcinoma.
What is the prognosis of Basal cell carcinoma?
----------------------------------------------------
Prognosis of majority of cases is good if there is complete removal.
Sclerosing lesions are harder to treat because they invade deeper into the tissues.
What are the preventive measures for Basal cell carcinoma?
-----------------------------------------------------------------
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats). Use sunscreens.
2.Good nutrition and healthy lifestyle boost the immune system and helps prevent malignancy.
3.Patients with family history of skin cancer should be reviewed yearly
Tuesday, August 26, 2008
A Simple Guide to Melonoma
A Simple Guide to Melonoma
----------------------------------------------------
What is Melonoma?
---------------------------------------
Melanoma is a progressive neoplastic tumor of melanocytes which are found mainly in the skin and can be present in the eye and the intestine.
It is a rare but dangerous cancer because of its rapid growth.
Who is affected by Melonoma?
---------------------------------------------------
Melonoma is more common in :
1.People with fair skin than in those with darker skin.
2.People with multiple atypical nevi(moles)
3.Persons born with giant congenital melanocytic nevi(moles)
4.People who spend time outdoors under the sun than those staying indoors.
5.People with a family history of melanoma
What is the Cause of Melonoma?
-----------------------------------------------------
A. Familial:
Familial cases of melanoma with autosomal dominant genes are more common especially in fair skin people.
B.Sun exposure:
Exposure to the sun is one of the most common causes of melanoma.
Risk factors are:
1.intensity of the sun
2.duration of sun exposure,
3.age when sun exposure takes place
4.degree of skin pigmentation
What are the types of Melanoma?
-------------------------------------
Types of primary melanomas:
1.superficial spreading melanoma
2.nodular melanoma
3.acral lentiginous melanoma
4.lentigo maligna melanoma
Melanomas occuring in non-skin areas:
5.clear cell sarcoma (Soft Parts)
6.mucosal melanoma (Intestines)
7.uveal melanoma (Eye)
What are the Symptoms and signs of Melanoma?
-----------------------------------------------------------
Symptoms & Signs:
--------------------
A skin mole which has the following features:
1.Asymmetrical features
2.Border of the mole is irregular.
3.Color: black, blue or brown with occasional reddish and white areas
4.Diameter: Any mole with a diameter of > 5 mm has a higher chance to become melanomas
5.Elevation: The mole is usually raised above the skin.
Any change in the mole appearance may suggest malignancy
Bleeding and ulcerations are late signs.
Loss of skin markings may be present.
There is rarely pain.
How do you make the Diagnosis of Melanoma?
------------------------------------------------------------
1.Moles that are irregular in color or shape
2.Excision biopsy of the suspected mole.
3.Lactate dehydrogenase (LDH) tests are used to detect metastases
4.chest X-rays - to exclude spread to lungs
4.CT, MRI, PET scans of body to exclude metastases.
What are the complications of Melanoma?
---------------------------------------------------
Metastases or spread of the melanoma can spread through the lymphatic or blood vessels to:
1.lymph nodes - if detected early and removed, survival rate is better
2.skin and lungs - have a better survival rate
3.brain , bone and liver - have the worst survival rates
What is the treatment of Melonoma?
---------------------------------------------------
Surgery is the only treatment for localized cutaneous melanoma.
The skin lesion must be totally removed with an adequate margin of surrounding skin and tissue.
The biopsy will include the epidermal, dermal, and subcutaneous layers of the skin,in order to determine the depth and any infiltration outside the lesion.
The lymph nodes nearest to the lesion are also removed.
Disseminated melanoma (Cancer has spread to other parts of body) requires chemotherapy.
Radiation therapy is also used after surgery for patients with local melanoma or for patients with un-operable distant metastases.
Immuno-therapy with interleukin-2 or interferon has also been used with encouraging good results.
Gene therapy is a new area where the genes are manipulated to help kill the melanoma cells.
What is the prognosis of Melonoma?
-----------------------------------------
Prognosis depends on the following factors:
1.tumor thickness
2.depth related to skin
3.type of melanoma,
4.ulceration presence
5.lymphatic spread
6.tumor infiltrating lymphocytes (if present, prognosis is better),
7.location of lesion,
8.distant metastasis
Early diagnosis, biopsy and surgery usually means better prognosis.
Prognosis also depends on the depth and thickness of the melanoma.
The smaller the thickness of the melanoma the better is the prognosis.
Regional node spread and distant metastases usually suggest poor prognosis.
What are preventive measures for Melanoma?
---------------------------------------------------
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats)
2.Good nutrition and healthy lifestyle boost the immune system and helps prevent malignancy.
3.Patients with family history of skin cancer should be reviewed yearly
4.Israeli scientists from the Oncology Institute of the Hadassa Medical Center in Jerusalem in June 2008 announced the development of a new vaccine which can prevent recurrences and increase survival rates for melanoma patients.
----------------------------------------------------
What is Melonoma?
---------------------------------------
Melanoma is a progressive neoplastic tumor of melanocytes which are found mainly in the skin and can be present in the eye and the intestine.
It is a rare but dangerous cancer because of its rapid growth.
Who is affected by Melonoma?
---------------------------------------------------
Melonoma is more common in :
1.People with fair skin than in those with darker skin.
2.People with multiple atypical nevi(moles)
3.Persons born with giant congenital melanocytic nevi(moles)
4.People who spend time outdoors under the sun than those staying indoors.
5.People with a family history of melanoma
What is the Cause of Melonoma?
-----------------------------------------------------
A. Familial:
Familial cases of melanoma with autosomal dominant genes are more common especially in fair skin people.
B.Sun exposure:
Exposure to the sun is one of the most common causes of melanoma.
Risk factors are:
1.intensity of the sun
2.duration of sun exposure,
3.age when sun exposure takes place
4.degree of skin pigmentation
What are the types of Melanoma?
-------------------------------------
Types of primary melanomas:
1.superficial spreading melanoma
2.nodular melanoma
3.acral lentiginous melanoma
4.lentigo maligna melanoma
Melanomas occuring in non-skin areas:
5.clear cell sarcoma (Soft Parts)
6.mucosal melanoma (Intestines)
7.uveal melanoma (Eye)
What are the Symptoms and signs of Melanoma?
-----------------------------------------------------------
Symptoms & Signs:
--------------------
A skin mole which has the following features:
1.Asymmetrical features
2.Border of the mole is irregular.
3.Color: black, blue or brown with occasional reddish and white areas
4.Diameter: Any mole with a diameter of > 5 mm has a higher chance to become melanomas
5.Elevation: The mole is usually raised above the skin.
Any change in the mole appearance may suggest malignancy
Bleeding and ulcerations are late signs.
Loss of skin markings may be present.
There is rarely pain.
How do you make the Diagnosis of Melanoma?
------------------------------------------------------------
1.Moles that are irregular in color or shape
2.Excision biopsy of the suspected mole.
3.Lactate dehydrogenase (LDH) tests are used to detect metastases
4.chest X-rays - to exclude spread to lungs
4.CT, MRI, PET scans of body to exclude metastases.
What are the complications of Melanoma?
---------------------------------------------------
Metastases or spread of the melanoma can spread through the lymphatic or blood vessels to:
1.lymph nodes - if detected early and removed, survival rate is better
2.skin and lungs - have a better survival rate
3.brain , bone and liver - have the worst survival rates
What is the treatment of Melonoma?
---------------------------------------------------
Surgery is the only treatment for localized cutaneous melanoma.
The skin lesion must be totally removed with an adequate margin of surrounding skin and tissue.
The biopsy will include the epidermal, dermal, and subcutaneous layers of the skin,in order to determine the depth and any infiltration outside the lesion.
The lymph nodes nearest to the lesion are also removed.
Disseminated melanoma (Cancer has spread to other parts of body) requires chemotherapy.
Radiation therapy is also used after surgery for patients with local melanoma or for patients with un-operable distant metastases.
Immuno-therapy with interleukin-2 or interferon has also been used with encouraging good results.
Gene therapy is a new area where the genes are manipulated to help kill the melanoma cells.
What is the prognosis of Melonoma?
-----------------------------------------
Prognosis depends on the following factors:
1.tumor thickness
2.depth related to skin
3.type of melanoma,
4.ulceration presence
5.lymphatic spread
6.tumor infiltrating lymphocytes (if present, prognosis is better),
7.location of lesion,
8.distant metastasis
Early diagnosis, biopsy and surgery usually means better prognosis.
Prognosis also depends on the depth and thickness of the melanoma.
The smaller the thickness of the melanoma the better is the prognosis.
Regional node spread and distant metastases usually suggest poor prognosis.
What are preventive measures for Melanoma?
---------------------------------------------------
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats)
2.Good nutrition and healthy lifestyle boost the immune system and helps prevent malignancy.
3.Patients with family history of skin cancer should be reviewed yearly
4.Israeli scientists from the Oncology Institute of the Hadassa Medical Center in Jerusalem in June 2008 announced the development of a new vaccine which can prevent recurrences and increase survival rates for melanoma patients.
Monday, August 25, 2008
A Simple Guide to Lipoma
A Simple Guide to Lipoma
----------------------------------------------------
What is Lipoma?
---------------------------------------
Lipoma is a benign tumor which consists of well circumscribed fatty tissue.
Who is affected by Lipoma?
---------------------------------------------------
Lipoma is more common in women than in men.
A possible reason is that women has more fatty tissue than men.
Lipomas can also be found all over the body:
1.subcutaneous
2.subfascial
3.subsynovial
4.intrarticular
5.intramuscular
6.perosteal
7.subserous
8.submucous
9.extradural
What is the Cause of Lipoma?
-----------------------------------------------------
Lipoma is a well encapsulated round swelling consisting fats cell which are not distinguishable from normal fat cells.
Possible causes are:
1.hereditary - more common in some families than others
2.injury to fatty tissue - stimulation for the fat cells to grow and accumulate at one site.
What are the Symptoms and signs of Lipoma?
-----------------------------------------------------------
Symptoms :
1.slow growing round soft tissue swelling on the skin
2.mutiple swellings may also be present.
3.painless
Signs:
1.swelling are well demarcated and rounded
2.Soft tissue felt on palpation.
3.May grow to considerable size.
How do you make the Diagnosis of Lipoma?
------------------------------------------------------------
1.round well encapsulated swelling
2.soft on palpation
3.Unlike sebaceous cyst doe not have an central blocked opening
4.Ultrasound may used to confirm the presence of fatty tissue and not a cyst or malignant tumor
5.Biopsy of the swelling will confirm presence of fat cells
What are the complications of Lipoma?
---------------------------------------------------
The lipoma may grow to considerable size over tima and can cause blockage to neighbouring organs:
1.intestinal obstruction at the abdominal area
2.difficulty in breathing especially near the trachea
3.In rare cases lipoma may become malignant liposarcoma
What is the treatment of Lipoma?
---------------------------------------------------
The only treatment is surgical excision of the lipoma.
Small lipomas may left alone if they are slow growing and does not impinge on the nearby organs.
What is the prognosis of Lipoma?
-----------------------------------------
The prognosis is usually excellent.
Recurrence at the smae spot is rare but do occur due to regrowth of the blood vessel supplying the lipoma.
Rarely a lipoma may undergo malignant degeneration and become liposarcoma.
----------------------------------------------------
What is Lipoma?
---------------------------------------
Lipoma is a benign tumor which consists of well circumscribed fatty tissue.
Who is affected by Lipoma?
---------------------------------------------------
Lipoma is more common in women than in men.
A possible reason is that women has more fatty tissue than men.
Lipomas can also be found all over the body:
1.subcutaneous
2.subfascial
3.subsynovial
4.intrarticular
5.intramuscular
6.perosteal
7.subserous
8.submucous
9.extradural
What is the Cause of Lipoma?
-----------------------------------------------------
Lipoma is a well encapsulated round swelling consisting fats cell which are not distinguishable from normal fat cells.
Possible causes are:
1.hereditary - more common in some families than others
2.injury to fatty tissue - stimulation for the fat cells to grow and accumulate at one site.
What are the Symptoms and signs of Lipoma?
-----------------------------------------------------------
Symptoms :
1.slow growing round soft tissue swelling on the skin
2.mutiple swellings may also be present.
3.painless
Signs:
1.swelling are well demarcated and rounded
2.Soft tissue felt on palpation.
3.May grow to considerable size.
How do you make the Diagnosis of Lipoma?
------------------------------------------------------------
1.round well encapsulated swelling
2.soft on palpation
3.Unlike sebaceous cyst doe not have an central blocked opening
4.Ultrasound may used to confirm the presence of fatty tissue and not a cyst or malignant tumor
5.Biopsy of the swelling will confirm presence of fat cells
What are the complications of Lipoma?
---------------------------------------------------
The lipoma may grow to considerable size over tima and can cause blockage to neighbouring organs:
1.intestinal obstruction at the abdominal area
2.difficulty in breathing especially near the trachea
3.In rare cases lipoma may become malignant liposarcoma
What is the treatment of Lipoma?
---------------------------------------------------
The only treatment is surgical excision of the lipoma.
Small lipomas may left alone if they are slow growing and does not impinge on the nearby organs.
What is the prognosis of Lipoma?
-----------------------------------------
The prognosis is usually excellent.
Recurrence at the smae spot is rare but do occur due to regrowth of the blood vessel supplying the lipoma.
Rarely a lipoma may undergo malignant degeneration and become liposarcoma.
Sunday, August 24, 2008
A Simple Guide to Meniere's Disease
A Simple Guide to Meniere's Disease
-----------------------------------------------
What is Meniere's Disease?
------------------------------------
Meniere's Disease is a disease of the inner ear which is characterised by the triad of episodic vertigo(giddiness), tinnitus(buzzing sound in ear) and progressive hearing loss.
It is more common in adults between 30-60years of age and in men more than women.
It usually occurs more in one ear.
What are the causes of Meniere's Disease?
---------------------------------------
The exact cause of Meniere's Disease is unknown.
It is believed to be due to distension of the membranous labyrinth with increased pressure and fluid in the endolymph of the inner ear.
As a result the balance in one ear is affected leading to dizzines
The possible triggers of this condition may be:
1.middle ear infection,
2.head injury
3.upper respiratory tract infection
4.the effect of aspirin,
5.smoking
6.alcohol
7.caffeine
8.salt
Some invetigators believed that there is a link with the herpes zoster virus which is activated when the immune system is low, resulting in inflammation of the eight nerve(hearing).
What are the symptoms and signs of Meniere's Disease?
-------------------------------------------------------------
Symptoms:
-----------
The classical triad of symptoms are:
1.recurrent bouts of vertigo of varying degrees which may last from hours to days.
Recurrences may be as often as 1 week to several years.
2.Slow progressive loss of hearing in one ear or rarely in both ears starting at low pitch sounds first.
3.Unilateral tinnitus (buzzing sound in one ear), sometimes in both ears
Beides these symptoms, there is also :
4.feeling of pressure9fullness) in one or both ears.
5.Nausea and vomiting sometimes occur with the vertigo
6.hypersensitivity to sound
7.nystagmus(uncotrollable jerky eye movements)
8.cognitive performance
How is the diagnosis of Meniere's Disease established?
-------------------------------------------------------------
1.classical history
2.audiometry shows impairment of hearing
3.MRI scan of the head - to exclude a tumour of the eighth cranial nerve (vestibulocochlear nerve)
What is the Treatment of Meniere's Disease?
-------------------------------------------------
Initial treatment:
1.Acute attacks are treated symptomatically with injections of stemetil, maxolon, dimenhydrinate
Other treatments:
1. Oral stemetil, maxolon, dimenhydrinate
2. mild diuretic
3.vitamin B6
4.antihistamines,
5.anticholinergics,
6.corticosteroids orally or injection of steroid medication behind the eardrum
7.Bed rest
8.stress reduction.
9.low-sodium diet.
10.avoid caffeine, alcohol and cigarettes
Surgery :
is only required if the above treatment does not control the vertigo
1.Decompression of the endolymphatic sac may help to relieve symptoms.
2.Permanent surgical destruction of the balance part of one ear may be done where the disease is severe and affects one ear.
This usually causes permanent deafness.
a.chemical labyrinthectomy: a drug (such as gentamicin) that can cause destruction of the balance portion of the inner ear is injected into the middle ear.
b.vestibular neurectomy where section of the nerve to the balance portion of the inner ear is done surgically
c.surgical removal of the inner ear (labyrinthectomy).
Usually balance returns to normal after sugery but hearing may be permanently damaged in one ear.
3.In the belief that Meniere's disease is caused by herpes virus, acyclovir an antiviral drug is given and has been found to relieve symptoms.
What is the prognosis of Meniere's Disease?
------------------------------------------------
Symptoms may remain the same, worsen or disappear spontaneously.
1.Vertigo symptoms may be worse and more frequent but sometimes disappear spontaneously.
2.Hearing symptoms usually become worse and patients may become deaf in the affected ear.
3.Tinnitus usually is more pronounced with time.
-----------------------------------------------
What is Meniere's Disease?
------------------------------------
Meniere's Disease is a disease of the inner ear which is characterised by the triad of episodic vertigo(giddiness), tinnitus(buzzing sound in ear) and progressive hearing loss.
It is more common in adults between 30-60years of age and in men more than women.
It usually occurs more in one ear.
What are the causes of Meniere's Disease?
---------------------------------------
The exact cause of Meniere's Disease is unknown.
It is believed to be due to distension of the membranous labyrinth with increased pressure and fluid in the endolymph of the inner ear.
As a result the balance in one ear is affected leading to dizzines
The possible triggers of this condition may be:
1.middle ear infection,
2.head injury
3.upper respiratory tract infection
4.the effect of aspirin,
5.smoking
6.alcohol
7.caffeine
8.salt
Some invetigators believed that there is a link with the herpes zoster virus which is activated when the immune system is low, resulting in inflammation of the eight nerve(hearing).
What are the symptoms and signs of Meniere's Disease?
-------------------------------------------------------------
Symptoms:
-----------
The classical triad of symptoms are:
1.recurrent bouts of vertigo of varying degrees which may last from hours to days.
Recurrences may be as often as 1 week to several years.
2.Slow progressive loss of hearing in one ear or rarely in both ears starting at low pitch sounds first.
3.Unilateral tinnitus (buzzing sound in one ear), sometimes in both ears
Beides these symptoms, there is also :
4.feeling of pressure9fullness) in one or both ears.
5.Nausea and vomiting sometimes occur with the vertigo
6.hypersensitivity to sound
7.nystagmus(uncotrollable jerky eye movements)
8.cognitive performance
How is the diagnosis of Meniere's Disease established?
-------------------------------------------------------------
1.classical history
2.audiometry shows impairment of hearing
3.MRI scan of the head - to exclude a tumour of the eighth cranial nerve (vestibulocochlear nerve)
What is the Treatment of Meniere's Disease?
-------------------------------------------------
Initial treatment:
1.Acute attacks are treated symptomatically with injections of stemetil, maxolon, dimenhydrinate
Other treatments:
1. Oral stemetil, maxolon, dimenhydrinate
2. mild diuretic
3.vitamin B6
4.antihistamines,
5.anticholinergics,
6.corticosteroids orally or injection of steroid medication behind the eardrum
7.Bed rest
8.stress reduction.
9.low-sodium diet.
10.avoid caffeine, alcohol and cigarettes
Surgery :
is only required if the above treatment does not control the vertigo
1.Decompression of the endolymphatic sac may help to relieve symptoms.
2.Permanent surgical destruction of the balance part of one ear may be done where the disease is severe and affects one ear.
This usually causes permanent deafness.
a.chemical labyrinthectomy: a drug (such as gentamicin) that can cause destruction of the balance portion of the inner ear is injected into the middle ear.
b.vestibular neurectomy where section of the nerve to the balance portion of the inner ear is done surgically
c.surgical removal of the inner ear (labyrinthectomy).
Usually balance returns to normal after sugery but hearing may be permanently damaged in one ear.
3.In the belief that Meniere's disease is caused by herpes virus, acyclovir an antiviral drug is given and has been found to relieve symptoms.
What is the prognosis of Meniere's Disease?
------------------------------------------------
Symptoms may remain the same, worsen or disappear spontaneously.
1.Vertigo symptoms may be worse and more frequent but sometimes disappear spontaneously.
2.Hearing symptoms usually become worse and patients may become deaf in the affected ear.
3.Tinnitus usually is more pronounced with time.
Friday, August 22, 2008
A Simple Guide to Hydrocoele
A Simple Guide to Hydrocoele
-----------------------------
What is Hydrocoele?
--------------------
Hydrocoele is the excess accumulation of fluid inside the sac containing your testis.
What causes Hydrocoele?
------------------------
The causes of Hydrocoele are mostly due:
A.Congenital:
----------------------
Children are born with with enlarged testicular sac with fluid which communicate with abdominal cavity through a patent duct which should be closed at birth.
B.Infections:
---------------------
Infections of the testicle can cause inflammation of the cavity surrounding the testicle and its appendages.
c. Obstruction to fluid flow:
Obstruction to lymphatic and venous flow in the testicular cavity prevents the fluid in the testicular cavity from being re-absorbed into the general system.
What are the symptoms of Hydrocoele?
-------------------------------------
The Symptoms of Hydrocoele are:
1.heaviness anf fullness of the scrotum
2.enlargement of scrotum usually on 1 side
3.usually painless except when inflammed or infected
Signs:
1.redness and swelling of the scrotum
2.enlargement of the scrotum on 1 side
5.Inguinal lymph nodes may be swollen and painful if there is severe infection(rare)
What are the complications of Hydrocoele?
-----------------------------------------------
1.Abscess formation
2.torsion of the testicle(rare)
How is diagnosis of Hydrocoele confirmed?
------------------------------------------
1. clinical features and trans-illumination of scrotal swelling
3. Ultrasound scan of the scrotal swelling to exclude any tumors of the testicle or torsion.
What is the treatment of Hydrocoele?
------------------------------------
1. Aspiration of the fluid in the scrotal cavity usually helps to reduce swelling but recurrences are common
2.Rest and support of the scrotum with loose underwear
3. surgery with drainage of fluid from scrotum.
The scrotal cavity is opened up and the fluid drained.
If the testicle is normal it should be left alone.
If the testicle is disease and shrunken, it is usually removed.
What is the Prognosis of Hydrocoele?
------------------------------------
Most cases of Hydrocoele usually will recover with surgical treatment.
Aspiration is a temporary measure as recurrences are common.
Congenital cases of Hydrocoele usually resolve spontaneously
What are the Preventive measures for Hydrocoele?
----------------------------------------------------
Avoid too tight underwear which can obstruct the lymphatic or blood vessels of the scrotum.
/span>
-----------------------------
What is Hydrocoele?
--------------------
Hydrocoele is the excess accumulation of fluid inside the sac containing your testis.
What causes Hydrocoele?
------------------------
The causes of Hydrocoele are mostly due:
A.Congenital:
----------------------
Children are born with with enlarged testicular sac with fluid which communicate with abdominal cavity through a patent duct which should be closed at birth.
B.Infections:
---------------------
Infections of the testicle can cause inflammation of the cavity surrounding the testicle and its appendages.
c. Obstruction to fluid flow:
Obstruction to lymphatic and venous flow in the testicular cavity prevents the fluid in the testicular cavity from being re-absorbed into the general system.
What are the symptoms of Hydrocoele?
-------------------------------------
The Symptoms of Hydrocoele are:
1.heaviness anf fullness of the scrotum
2.enlargement of scrotum usually on 1 side
3.usually painless except when inflammed or infected
Signs:
1.redness and swelling of the scrotum
2.enlargement of the scrotum on 1 side
5.Inguinal lymph nodes may be swollen and painful if there is severe infection(rare)
What are the complications of Hydrocoele?
-----------------------------------------------
1.Abscess formation
2.torsion of the testicle(rare)
How is diagnosis of Hydrocoele confirmed?
------------------------------------------
1. clinical features and trans-illumination of scrotal swelling
3. Ultrasound scan of the scrotal swelling to exclude any tumors of the testicle or torsion.
What is the treatment of Hydrocoele?
------------------------------------
1. Aspiration of the fluid in the scrotal cavity usually helps to reduce swelling but recurrences are common
2.Rest and support of the scrotum with loose underwear
3. surgery with drainage of fluid from scrotum.
The scrotal cavity is opened up and the fluid drained.
If the testicle is normal it should be left alone.
If the testicle is disease and shrunken, it is usually removed.
What is the Prognosis of Hydrocoele?
------------------------------------
Most cases of Hydrocoele usually will recover with surgical treatment.
Aspiration is a temporary measure as recurrences are common.
Congenital cases of Hydrocoele usually resolve spontaneously
What are the Preventive measures for Hydrocoele?
----------------------------------------------------
Avoid too tight underwear which can obstruct the lymphatic or blood vessels of the scrotum.
/span>
Thursday, August 21, 2008
A Simple Guide to Inguinal Hernia
A Simple Guide to Inguinal Hernia
-------------------------------------------
What is Inguinal Hernia?
----------------------------------
Inguinal Hernia is protrusion of the part of the viscera(contents in the abdominal cavity) through the inguinal canal which is the tunnel which leads the spermatic duct from the testis to the urethra or seminal vesicles in the abdomen.
What are the different types of Inguinal Hernia?
---------------------------------------------------
1.Indirect:
The abdominal contents such as small intestine enter the the enlarged internal inguinal ring and protrude into the inguinal canal entering the scrotum.
2:Direct:
The abdominal contents find a weak spot in the abdominal wall and enter the the inguinal canal.
What causes Inguinal Hernia?
---------------------------------------
The causes of Inguinal Hernia are mostly due:
A.Congenital :
----------------------
The inguinal canal follows the same route as the descent of the testes from the abdomen out to the scrotum outside the abdomen during the embryonic stage.
If there is partial closure of the internal inguinal ring, then weakness of the of abdominal wall occurs allowing abdominal content to protrude through the inguinal canal.
B.Increased abdominal pressure:
------------------------------------
Increased intra-abdominal pressure can occur as a result of :
1.coughing
2.straining
3.distension
4.obstruction
C.Weakening of the abdominal muscle:
---------------------------------------
1.Obesity
2.muscle wasting diseases
Hernias are more common in men than in women because the inguinal canal is usually closed in women whereas in men the canal carries the spermatic duct.
What are the symptoms of Inguinal Hernia?
------------------------------------------------
Symptoms:
1.Swelling in the groin area which is worse on coughing, straining or standing up
2.swelling of the groin usually disappear on lying down(abdominal contents is returned to the abdominal cavity).
3.Pain or discomfort may be present
Signs:
1.Swelling in the groin can be felt.
If a finger is pressed into the external inguinal ring, coughing can make the swelling feel more palpable
2.There may gurgling sounds of intestinal gas movement on auscultation of the swelling with the stethoscope.
3.Local tenderness of swelling
What are the complications of Inguinal Hernia?
----------------------------------------------------
1.Irreducible hernia may occur when the abdominal contents cannot be returned to the peritoneal cavity due to adhesions of the inguinal canal of the faecal matter stuck in the protruded intestine.
This complication may be serious
2.Strangulated hernia occur when the blood circulation is cut off due to constriction of the neck of the hernial sac resulting in ischemia and gangrene of the gut.
Signs and symptoms of intestinal obstruction then becomes obvious with increased abdominal pain and local tenderness.
This is a medical emergency and should be treated immediately.
3.Peritonitis - burst abdomen as a result of intestinal obstruction
How is diagnosis of Hernia confirmed?
------------------------------------------
1. clinical features of swelling in the inguinal area
2. CT and Ultrasound scan of the inguinal region and scrotum to exclude hydrocoele and tumors
What is the treatment of Hernia?
------------------------------------
1. At the early stage of inguinal hernia, a truss which press against the internal inguinal ring may help to elevate symptoms and prevent the hernia from bulging out.
They are useful in patients with poor general condition who are unable to tolerate full surgery.
They are seldom used now.
2.All inguinal hernia patients should undergo elective (non-emergency) surgery to repair the hernia before complications such as strangulated hernia sets in.
Such surgery called herniorrhaphy or hernioplasty can be done on a day surgery under local anethesia and using laparoscopy.
It usually involved sewing a wire mesh over the inguinal ring to tighten the inguinal ring and prevent the contents of the abdomen from pushing its way out into the inguinal canal.
Patient is usually asked to cough after the surgery to make sure the abdominal wall is tight enough to prevent any intestine to protrude out.
3.Emergency surgery is required if there is any strangulated inguinal hernia or intestinal obstruction.
4.Most congenital hernia may disappear by the end of the first year.
What is the Prognosis of Hernia?
------------------------------------
Most cases of inguinal hernia usually will recover with proper surgical treatment.
Very rarely there may be complications such as postoperative infections or recurrence.
What are the Preventive measures for Hernia?
----------------------------------------------------
Avoid straining at stools, severe coughing.
Avoid carrying heavy weights.
Lose some weight.
-------------------------------------------
What is Inguinal Hernia?
----------------------------------
Inguinal Hernia is protrusion of the part of the viscera(contents in the abdominal cavity) through the inguinal canal which is the tunnel which leads the spermatic duct from the testis to the urethra or seminal vesicles in the abdomen.
What are the different types of Inguinal Hernia?
---------------------------------------------------
1.Indirect:
The abdominal contents such as small intestine enter the the enlarged internal inguinal ring and protrude into the inguinal canal entering the scrotum.
2:Direct:
The abdominal contents find a weak spot in the abdominal wall and enter the the inguinal canal.
What causes Inguinal Hernia?
---------------------------------------
The causes of Inguinal Hernia are mostly due:
A.Congenital :
----------------------
The inguinal canal follows the same route as the descent of the testes from the abdomen out to the scrotum outside the abdomen during the embryonic stage.
If there is partial closure of the internal inguinal ring, then weakness of the of abdominal wall occurs allowing abdominal content to protrude through the inguinal canal.
B.Increased abdominal pressure:
------------------------------------
Increased intra-abdominal pressure can occur as a result of :
1.coughing
2.straining
3.distension
4.obstruction
C.Weakening of the abdominal muscle:
---------------------------------------
1.Obesity
2.muscle wasting diseases
Hernias are more common in men than in women because the inguinal canal is usually closed in women whereas in men the canal carries the spermatic duct.
What are the symptoms of Inguinal Hernia?
------------------------------------------------
Symptoms:
1.Swelling in the groin area which is worse on coughing, straining or standing up
2.swelling of the groin usually disappear on lying down(abdominal contents is returned to the abdominal cavity).
3.Pain or discomfort may be present
Signs:
1.Swelling in the groin can be felt.
If a finger is pressed into the external inguinal ring, coughing can make the swelling feel more palpable
2.There may gurgling sounds of intestinal gas movement on auscultation of the swelling with the stethoscope.
3.Local tenderness of swelling
What are the complications of Inguinal Hernia?
----------------------------------------------------
1.Irreducible hernia may occur when the abdominal contents cannot be returned to the peritoneal cavity due to adhesions of the inguinal canal of the faecal matter stuck in the protruded intestine.
This complication may be serious
2.Strangulated hernia occur when the blood circulation is cut off due to constriction of the neck of the hernial sac resulting in ischemia and gangrene of the gut.
Signs and symptoms of intestinal obstruction then becomes obvious with increased abdominal pain and local tenderness.
This is a medical emergency and should be treated immediately.
3.Peritonitis - burst abdomen as a result of intestinal obstruction
How is diagnosis of Hernia confirmed?
------------------------------------------
1. clinical features of swelling in the inguinal area
2. CT and Ultrasound scan of the inguinal region and scrotum to exclude hydrocoele and tumors
What is the treatment of Hernia?
------------------------------------
1. At the early stage of inguinal hernia, a truss which press against the internal inguinal ring may help to elevate symptoms and prevent the hernia from bulging out.
They are useful in patients with poor general condition who are unable to tolerate full surgery.
They are seldom used now.
2.All inguinal hernia patients should undergo elective (non-emergency) surgery to repair the hernia before complications such as strangulated hernia sets in.
Such surgery called herniorrhaphy or hernioplasty can be done on a day surgery under local anethesia and using laparoscopy.
It usually involved sewing a wire mesh over the inguinal ring to tighten the inguinal ring and prevent the contents of the abdomen from pushing its way out into the inguinal canal.
Patient is usually asked to cough after the surgery to make sure the abdominal wall is tight enough to prevent any intestine to protrude out.
3.Emergency surgery is required if there is any strangulated inguinal hernia or intestinal obstruction.
4.Most congenital hernia may disappear by the end of the first year.
What is the Prognosis of Hernia?
------------------------------------
Most cases of inguinal hernia usually will recover with proper surgical treatment.
Very rarely there may be complications such as postoperative infections or recurrence.
What are the Preventive measures for Hernia?
----------------------------------------------------
Avoid straining at stools, severe coughing.
Avoid carrying heavy weights.
Lose some weight.
A Simple Guide to Pneumothorax
A Simple Guide to Pneumothorax
---------------------------------------
What is Pneumothorax?
-------------------------------------
Pneumothorax is a medical emergency caused by collection of air in the pleural space between the perietal and visceral pleura.
What are the types of pneumothorax?
---------------------------------------
Tension pneumothorax:
-----------------------------
This ia a medical emergency as air builds up in the pleural space with each breath.
The rising intrathoracic pressure pushes the mediastinum away from the affected lung to the other compressing intrathoracic vessels and causing collapse of the lung.
Tension pneumothorax are life threatening.
Non-tension pneumothorax:
-----------------------------
A non-tension pneumothorax is less serious because there is no increasing pressure of air in the thoracic region and hence no increasing pressure on the intrathoracic organs.
Hemopneumothorax:
----------------------
When blood accumulates in the thoracic cavity (hemothorax), there is even more increased pressure in the pleural cavity. This is called a hemopneumothorax and also be life threatening.
What is the causes of pneumothorax?
---------------------------------------------------
It is most commonly due to:
Spontaneous pneumothorax
-----------------------------
This is due to the rupture of superficial air sacs following severe coughing or strenous exercise in:
1.tall young males and in Marfan syndrome
2.Tuberculosis
3.Bronchial obstruction
4.Cancer
Non-spontaneous pneumothorax
--------------------------------
1.penetrating chest wound
2.surgical trauma
3.pleural effusion tap
What are the Signs and symptoms of Pneumothorax?
----------------------------------------------------
Symptoms:
---------------
1.Sudden onset of chest pain, back
2.shortness of breath,
3.dry coughs,
4.cyanosis (turning blue)
5.coma
Signs:
--------------
1.Pale or cyanotic
2.Percussion show resonance at normal lung while none at the pneumothorax lung area
3.Auscultation reveals breath sounds on the normal side but none at the pneumothoracic lung
4.There may be a characteristic clicking sound with respiration.
5.In penetrating chest wounds, there is a typical "sucking" sound of air flowing through the puncture hole .
6.The flopping sound of the punctured lung can sometimes be heard
How is the Diagnosis of Pneumothorax made?
---------------------------------------------------
Physical examination:
a. absence of audible breath sounds through a stethoscope
b. hyperresonance (higher pitched sounds than normal) to percussion of the chest wall is suggestive of the diagnosis.
c.Two coins when tapped on the affected side results in a tinkling resonant sound
Chest X-ray reveals a typical pattern of complete lung collapse with air space surrounding the lung edge.
Medistinal shifts can be seen on inspiratory and expiratory films
CT scan and MRI can revealed a clearer picture of the pneumothorax and even the bubbles on the lung surface which may burst and cause a pneumothorax.
What is the complication of Pneumothorax?
------------------------------------------------
Respiratory failure with circulatory collapse
What is the treatment of Pneumothorax?
--------------------------------------------
All pneumothorax patients are to be admitted to hospital for treatment.
1. Small spontaneous pneumothorax
-------------------------------------
A small spontaneous pneumothorax can be left alone to reabsorb on its own.
The patient is monitored in hospital and given oxygen until the pneumothorax has disappeared.
2.Tension Pneumothorax
-----------------------------
Tension Pneumothorax is a medical emergency.
Any perimedic or doctor attending to the patient should insert a needle immediately into the pleural cavity to allow the air to escape.
Tube drainage can also be done if available. If the tube is not available, immediate evacuation to the hospital should be done for advanced medical care.
The tube should be inserted with underwater seal and suction of the air out of the pleural cavity done using a simple one way valve or vacuum and a water valve device, depending on severity.
The lung should re-expand in the thoracic cavity nad the result is monitored by frequent x-rays
Where rarely the chest tube does not help healing of the lung , surgery may be done to staple the lung closed.
Penetrating wounds:
---------------------
A chest drain is inserted first before any treatment of the wounds is done.
Supprtive treatment:
------------------------
Oxygen therapy
Rest
Antibiotics for infections
Painkillers for pain
Recurrent pneumothorax
------------------------------
1.pleurodesis may be required in recurrent pneumothorax.
2.bullectomy (the removal or stapling of bullae).
3.Chemical pleurodesis uses chemical irritant that leads to adhesion of the lung to the parietal pleura.
4.Mechanical pleurodesis The inside chest wall is roughened so the lung attaches to the peural wall with scar tissues
5.pleurectomy is the removal of the parietal pleura which can be performed using keyhole surgery
What is the prognosis of Pneumothorax?
----------------------------------------------
It is usually good following treatment.
However treatment is always needed to address the cause of the underlying diseases causing the pneumothorax.
---------------------------------------
What is Pneumothorax?
-------------------------------------
Pneumothorax is a medical emergency caused by collection of air in the pleural space between the perietal and visceral pleura.
What are the types of pneumothorax?
---------------------------------------
Tension pneumothorax:
-----------------------------
This ia a medical emergency as air builds up in the pleural space with each breath.
The rising intrathoracic pressure pushes the mediastinum away from the affected lung to the other compressing intrathoracic vessels and causing collapse of the lung.
Tension pneumothorax are life threatening.
Non-tension pneumothorax:
-----------------------------
A non-tension pneumothorax is less serious because there is no increasing pressure of air in the thoracic region and hence no increasing pressure on the intrathoracic organs.
Hemopneumothorax:
----------------------
When blood accumulates in the thoracic cavity (hemothorax), there is even more increased pressure in the pleural cavity. This is called a hemopneumothorax and also be life threatening.
What is the causes of pneumothorax?
---------------------------------------------------
It is most commonly due to:
Spontaneous pneumothorax
-----------------------------
This is due to the rupture of superficial air sacs following severe coughing or strenous exercise in:
1.tall young males and in Marfan syndrome
2.Tuberculosis
3.Bronchial obstruction
4.Cancer
Non-spontaneous pneumothorax
--------------------------------
1.penetrating chest wound
2.surgical trauma
3.pleural effusion tap
What are the Signs and symptoms of Pneumothorax?
----------------------------------------------------
Symptoms:
---------------
1.Sudden onset of chest pain, back
2.shortness of breath,
3.dry coughs,
4.cyanosis (turning blue)
5.coma
Signs:
--------------
1.Pale or cyanotic
2.Percussion show resonance at normal lung while none at the pneumothorax lung area
3.Auscultation reveals breath sounds on the normal side but none at the pneumothoracic lung
4.There may be a characteristic clicking sound with respiration.
5.In penetrating chest wounds, there is a typical "sucking" sound of air flowing through the puncture hole .
6.The flopping sound of the punctured lung can sometimes be heard
How is the Diagnosis of Pneumothorax made?
---------------------------------------------------
Physical examination:
a. absence of audible breath sounds through a stethoscope
b. hyperresonance (higher pitched sounds than normal) to percussion of the chest wall is suggestive of the diagnosis.
c.Two coins when tapped on the affected side results in a tinkling resonant sound
Chest X-ray reveals a typical pattern of complete lung collapse with air space surrounding the lung edge.
Medistinal shifts can be seen on inspiratory and expiratory films
CT scan and MRI can revealed a clearer picture of the pneumothorax and even the bubbles on the lung surface which may burst and cause a pneumothorax.
What is the complication of Pneumothorax?
------------------------------------------------
Respiratory failure with circulatory collapse
What is the treatment of Pneumothorax?
--------------------------------------------
All pneumothorax patients are to be admitted to hospital for treatment.
1. Small spontaneous pneumothorax
-------------------------------------
A small spontaneous pneumothorax can be left alone to reabsorb on its own.
The patient is monitored in hospital and given oxygen until the pneumothorax has disappeared.
2.Tension Pneumothorax
-----------------------------
Tension Pneumothorax is a medical emergency.
Any perimedic or doctor attending to the patient should insert a needle immediately into the pleural cavity to allow the air to escape.
Tube drainage can also be done if available. If the tube is not available, immediate evacuation to the hospital should be done for advanced medical care.
The tube should be inserted with underwater seal and suction of the air out of the pleural cavity done using a simple one way valve or vacuum and a water valve device, depending on severity.
The lung should re-expand in the thoracic cavity nad the result is monitored by frequent x-rays
Where rarely the chest tube does not help healing of the lung , surgery may be done to staple the lung closed.
Penetrating wounds:
---------------------
A chest drain is inserted first before any treatment of the wounds is done.
Supprtive treatment:
------------------------
Oxygen therapy
Rest
Antibiotics for infections
Painkillers for pain
Recurrent pneumothorax
------------------------------
1.pleurodesis may be required in recurrent pneumothorax.
2.bullectomy (the removal or stapling of bullae).
3.Chemical pleurodesis uses chemical irritant that leads to adhesion of the lung to the parietal pleura.
4.Mechanical pleurodesis The inside chest wall is roughened so the lung attaches to the peural wall with scar tissues
5.pleurectomy is the removal of the parietal pleura which can be performed using keyhole surgery
What is the prognosis of Pneumothorax?
----------------------------------------------
It is usually good following treatment.
However treatment is always needed to address the cause of the underlying diseases causing the pneumothorax.
Tuesday, August 19, 2008
A Simple Guide to Infectious Mononucleosis
A Simple Guide to Infectious Mononucleosis
-------------------------------------------------
What is Infectious Mononucleosis?
-------------------------------------------
Infectious Mononucleosis is an infectious disease which typically cause swelling of the lymph nodes of neck, sore throat and fever.
What is the cause of Infectious Mononucleosis?
-------------------------------------------------------
The cause of Infectious Mononucleosis is the Epstein Barr virus which can be spread by droplets and kissing.
It is more common in young adults.
The incubation period (from contact to illness) is 10-15 days.
It is usually sporadic but may be epidemic.
What are Signs and symptoms of Infectious Mononucleosis?
------------------------------------------------------------------
The triad of symptoms which are common to Infectious Mononucleosis are:
1.Neck and axillary lymph nodes are enlarged
2.Fever with headache
3.sore throat with sometimes extensive tonsillar exudates and swelling
Other symptoms are:
4.fatigue
5.bodyaches
6.jaundice(rare)
Signs:
1.Throat is red and inflamed with enlarged tonsils
2.Pinpoint petechiae at junction of hard and soft palate
3.Enlarged lymph nodes are felt below the jaw and neck region; sometimes in the axillary region
4.Swelling of lacrimal glands and eyelids
5.Spleen is enlarged in 50% of cases
6.Generalized maculopapular rash may occur
Onset is usually insidious with mild fever which may becomes worse and lasts for 2 to 21 days.
Disease usually lasts for 2-3 weeks.
How is the diagnosis of Infectious Mononucleosis made?
---------------------------------------------------------------
1.Classical symptoms and signs as above especially lymph nodes enlargement.
2.blood tests (complete blood count, ESR, liver function tests and blood culture).
Blood count usually shows more than 10% atypical mononuclear cells.
3.Blood for Epstein Barr antibody
3.X-rays of chest and abdomen
4.CT Scan or ultrasound of the abdomen to detect presence of other lymph nodes and enlarged spleen.
What are the complications of Infectious Mononucleosis?
---------------------------------------------------------------
1.Obstruction to airway from enlarged lymph nodes
2.thrombopenic purpura
3.myocarditis
4.pericarditis
5.lymphocytic meningitis
6.encephalitis
7.polyneuritis
8.hepatitis
What is the treatment of Infectious Mononucleosis?
------------------------------------------------------------
1.Bed rest in isolation ward
2.Adequate fluids
3.Antipyretic medicines such as paracetamol for fever
3.corticosteroids is useful to reduce complications such as upper airway obstruction and severe hepatitis
4.High-flow oxygen and tracheostomy in airway obstruction
What is the prognosis of Infectious Mononucleosis?
-----------------------------------------------------------
Prognosis of Infectious Mononucleosis is generally good.
Epstein Barr infections has been associated with nasopharyngeal cancer.
What are the Preventive measures taken for Infectious Mononucleosis?
------------------------------------------------------------------------
Isolation of cases at home or in hospital.
Avoid contacts.
-------------------------------------------------
What is Infectious Mononucleosis?
-------------------------------------------
Infectious Mononucleosis is an infectious disease which typically cause swelling of the lymph nodes of neck, sore throat and fever.
What is the cause of Infectious Mononucleosis?
-------------------------------------------------------
The cause of Infectious Mononucleosis is the Epstein Barr virus which can be spread by droplets and kissing.
It is more common in young adults.
The incubation period (from contact to illness) is 10-15 days.
It is usually sporadic but may be epidemic.
What are Signs and symptoms of Infectious Mononucleosis?
------------------------------------------------------------------
The triad of symptoms which are common to Infectious Mononucleosis are:
1.Neck and axillary lymph nodes are enlarged
2.Fever with headache
3.sore throat with sometimes extensive tonsillar exudates and swelling
Other symptoms are:
4.fatigue
5.bodyaches
6.jaundice(rare)
Signs:
1.Throat is red and inflamed with enlarged tonsils
2.Pinpoint petechiae at junction of hard and soft palate
3.Enlarged lymph nodes are felt below the jaw and neck region; sometimes in the axillary region
4.Swelling of lacrimal glands and eyelids
5.Spleen is enlarged in 50% of cases
6.Generalized maculopapular rash may occur
Onset is usually insidious with mild fever which may becomes worse and lasts for 2 to 21 days.
Disease usually lasts for 2-3 weeks.
How is the diagnosis of Infectious Mononucleosis made?
---------------------------------------------------------------
1.Classical symptoms and signs as above especially lymph nodes enlargement.
2.blood tests (complete blood count, ESR, liver function tests and blood culture).
Blood count usually shows more than 10% atypical mononuclear cells.
3.Blood for Epstein Barr antibody
3.X-rays of chest and abdomen
4.CT Scan or ultrasound of the abdomen to detect presence of other lymph nodes and enlarged spleen.
What are the complications of Infectious Mononucleosis?
---------------------------------------------------------------
1.Obstruction to airway from enlarged lymph nodes
2.thrombopenic purpura
3.myocarditis
4.pericarditis
5.lymphocytic meningitis
6.encephalitis
7.polyneuritis
8.hepatitis
What is the treatment of Infectious Mononucleosis?
------------------------------------------------------------
1.Bed rest in isolation ward
2.Adequate fluids
3.Antipyretic medicines such as paracetamol for fever
3.corticosteroids is useful to reduce complications such as upper airway obstruction and severe hepatitis
4.High-flow oxygen and tracheostomy in airway obstruction
What is the prognosis of Infectious Mononucleosis?
-----------------------------------------------------------
Prognosis of Infectious Mononucleosis is generally good.
Epstein Barr infections has been associated with nasopharyngeal cancer.
What are the Preventive measures taken for Infectious Mononucleosis?
------------------------------------------------------------------------
Isolation of cases at home or in hospital.
Avoid contacts.
Monday, August 18, 2008
A Simple Guide to Pneumonia
A Simple Guide to Pneumonia
-----------------------------------
What is Pneumonia?
---------------------------
Pneumonia is a serious medical disease which causes inflammation and infection of the lung tissues of one or both lungs.
The alveoli of the lungs are filled with exudates and white blood cells sent by the body to contain the infection.
Because of the congestion of the lungs there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .
It is one of the top causes of death in the world.
What are the causes of Pneumonia?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus pneumoniae and Staphylococcus may be serious and fatal in some cases.
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Mycobacterium tuberculosis pneumonia are more common in developing countries and in people whose immune systems are impaired(e.g. AIDS) and are preceded by active tuberculosis infections elsewhere.
Viral infections:
--------------------
Influenza, arbovirus, Severe Acute Respiratory Syndrome(SARS) virus, coxsackie virus
Fungal infections:
-----------------------
Cryptococcus neoformans
Non-infectious:
------------------
1.chemicals such as asbestos can damage the lungs and cause pneumonia
2.Othostatic pneumonia occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs
3.Aspiration pneumonia occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.
This occurs in comatose patients and people having seizures or stroke.
What are Signs and symptoms of pneumonia?
---------------------------------------------
Symptoms:
1.cold or runny nose is usually the first symptom
2.Fever is usually high
3.cough with productive purulent sputum which can yellow, green or bloody
4.Breathlessness due to congestion of the lungs
5.chest pain especially the sides of the chest due to coughing and fever
6.Myalgia (bodyaches) and headache which may be related to the fever
7.abdominal discomfort
8.lethargy especially in small children
Signs:
1.creptitation sounds on auscultation with stethoscope due to large amount of phlegm in the alveoli of the lungs
2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs
3.Reduced breath sounds - air movement is reduced in the lungs
4.Hyporesonance on percussion of the lungs
5.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.
This will considered as a medical emergency.
Children and babies with pneumonia may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.
Elderly people also do not have much symptoms except for fever and breathlessness
How is the diagnosis of Pneumonia made?
------------------------------------------
1.Symptoms and signs of fever, breathless and productive cough
2.blood tests (complete blood count, ESR and blood culture) including viral and legionaire's disease
3.Sputum culture to determine the type of micro-organism
4.Chest X-rays to establish site and character of the lung infection
5.Pleural tap may be necessary if there is pleural effusion. The pleural aspirate is then sent for culture and microscopic examination.
6.CT or MRI of the lungs may be done if required especailly if there is suspicion of lung cancer.
What are the complications of Pneumonia?
-----------------------------------------------
1.Pleural effusion
2.septic shock,
3.adult respiratory distress syndrome
4.seizures also more in children
5.Emphysema
6.Pericarditis
What is the treatment of pneumonia?
------------------------------------
1.Hospitalization should be immediate as pneumonia can be a life threatening condition.
2.Antibiotics depending on the organism found:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
c.Tetracycline or erythromycin for mycoplasma and chlamydia
d.Erythromycin and rifampicin for Legionaire's disease.
3.Antivirals such as Tamiflu for Influenza infection
Acyclovir may be given for herpes virus infection
4.High dosages of anti-fungals may be given for Fungal pneumonia for a prolonged period of time
3.corticosteroids is useful to reduce complications
4.High-flow oxygen
5.intravenous fluids
What is the prognosis of pneumonia ?
------------------------------------------
This depends on the severity and type of infection.
Most cases if treated early and correctly recovered completely.
The elderly, babies and bedridden has a higher mortality.
What are the Preventive measures taken for pneumonia ?
--------------------------------------------------------
Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of pneumonia.
Pneumococcal vaccine against Streptococcus pneumoniae has been given to newborns to prevent pneumonia.
Vaccinations are recommended in:
Adults age 65 or older
Patient over two years of age
1. with diseased lungs, heart, liver, or kidneys
2. health problems like diabetes, alcoholism, AIDS
3. taking any medications or therapy that can affect the body's immune system
e.g chemotherapy
-----------------------------------
What is Pneumonia?
---------------------------
Pneumonia is a serious medical disease which causes inflammation and infection of the lung tissues of one or both lungs.
The alveoli of the lungs are filled with exudates and white blood cells sent by the body to contain the infection.
Because of the congestion of the lungs there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .
It is one of the top causes of death in the world.
What are the causes of Pneumonia?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus pneumoniae and Staphylococcus may be serious and fatal in some cases.
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Mycobacterium tuberculosis pneumonia are more common in developing countries and in people whose immune systems are impaired(e.g. AIDS) and are preceded by active tuberculosis infections elsewhere.
Viral infections:
--------------------
Influenza, arbovirus, Severe Acute Respiratory Syndrome(SARS) virus, coxsackie virus
Fungal infections:
-----------------------
Cryptococcus neoformans
Non-infectious:
------------------
1.chemicals such as asbestos can damage the lungs and cause pneumonia
2.Othostatic pneumonia occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs
3.Aspiration pneumonia occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.
This occurs in comatose patients and people having seizures or stroke.
What are Signs and symptoms of pneumonia?
---------------------------------------------
Symptoms:
1.cold or runny nose is usually the first symptom
2.Fever is usually high
3.cough with productive purulent sputum which can yellow, green or bloody
4.Breathlessness due to congestion of the lungs
5.chest pain especially the sides of the chest due to coughing and fever
6.Myalgia (bodyaches) and headache which may be related to the fever
7.abdominal discomfort
8.lethargy especially in small children
Signs:
1.creptitation sounds on auscultation with stethoscope due to large amount of phlegm in the alveoli of the lungs
2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs
3.Reduced breath sounds - air movement is reduced in the lungs
4.Hyporesonance on percussion of the lungs
5.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.
This will considered as a medical emergency.
Children and babies with pneumonia may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.
Elderly people also do not have much symptoms except for fever and breathlessness
How is the diagnosis of Pneumonia made?
------------------------------------------
1.Symptoms and signs of fever, breathless and productive cough
2.blood tests (complete blood count, ESR and blood culture) including viral and legionaire's disease
3.Sputum culture to determine the type of micro-organism
4.Chest X-rays to establish site and character of the lung infection
5.Pleural tap may be necessary if there is pleural effusion. The pleural aspirate is then sent for culture and microscopic examination.
6.CT or MRI of the lungs may be done if required especailly if there is suspicion of lung cancer.
What are the complications of Pneumonia?
-----------------------------------------------
1.Pleural effusion
2.septic shock,
3.adult respiratory distress syndrome
4.seizures also more in children
5.Emphysema
6.Pericarditis
What is the treatment of pneumonia?
------------------------------------
1.Hospitalization should be immediate as pneumonia can be a life threatening condition.
2.Antibiotics depending on the organism found:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
c.Tetracycline or erythromycin for mycoplasma and chlamydia
d.Erythromycin and rifampicin for Legionaire's disease.
3.Antivirals such as Tamiflu for Influenza infection
Acyclovir may be given for herpes virus infection
4.High dosages of anti-fungals may be given for Fungal pneumonia for a prolonged period of time
3.corticosteroids is useful to reduce complications
4.High-flow oxygen
5.intravenous fluids
What is the prognosis of pneumonia ?
------------------------------------------
This depends on the severity and type of infection.
Most cases if treated early and correctly recovered completely.
The elderly, babies and bedridden has a higher mortality.
What are the Preventive measures taken for pneumonia ?
--------------------------------------------------------
Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of pneumonia.
Pneumococcal vaccine against Streptococcus pneumoniae has been given to newborns to prevent pneumonia.
Vaccinations are recommended in:
Adults age 65 or older
Patient over two years of age
1. with diseased lungs, heart, liver, or kidneys
2. health problems like diabetes, alcoholism, AIDS
3. taking any medications or therapy that can affect the body's immune system
e.g chemotherapy
Sunday, August 17, 2008
Normal Pressure Hydrocephalus
A Simple Guide to Normal Pressure Hydrocephalus
---------------------------------------------------------
What is Normal Pressure Hydrocephalus?
--------------------------------------------
Normal Pressure Hydrocephalus(NPH) is an abnormal accumulation of cerebrospinal fluid in the cavities of the brain.
Who is at risk of getting Normal Pressure Hydrocephalus?
-------------------------------------------------------------
Normal Pressure Hydrocephalus occurs in adults of 55 years old and above.
The accumulation of cerebrospinal fluid is gradual leading to enlargement of the cavities in the brain called ventricles.
This in turn stretches the nerve tissues of the brain giving rise to 3 main neurological disturbances in the brain which is characteristic of NPH.
What are the causes of Normal Pressure Hydrocephalus?
------------------------------------------------------------
In most cases the cause is unknown.
In the remaining cases, the secondary causes can be found:
1. Brain infection can cause damage to brain tissues and the resulting cell damage can increase fluid in the brain
2. Stroke may damage brain cells resulting in damaged brain tissues and increase fluid in the brain
3. Trauma and head injury may damage brain cells similar to above
4. Brain tumors are another cause of increased fluid in the brain
What are the Symptoms of Normal Pressure Hydrocephalus?
----------------------------------------------------------------
Onset is slow and gradual but typically the following symptoms are present:
Gait disturbance
-----------------
Difficulty in walking or balancing
Cognitive impairment
---------------------------
mild dementia
Urinary Incontinence
---------------------
Problems with bladder control and hence incontinence
How is the diagnosis of Normal Pressure Hydrocephalus confirmed?
------------------------------------------------------------------------
1.History of the above 3 symptoms
2.Physical examination shows the neurological deficits:
difficulty in walking
mild dementia
urinary incontinence
3.MRI of brain shows the presence of enlarged ventricles in the brain
What is the Treatment of Normal Pressure Hydrocephalus?
-------------------------------------------------------------------
NPH cannot be cured but its symptoms can be controlled.
Treatment is by surgery using a shunt to divert the excessive fluid in the brain to the peritoneal cavity.
What are the complications of Normal Pressure Hydrocephalus?
-------------------------------------------------------------------
1. Dementia
2. Disabilty
3. Disturbed urinary and bowel function.
What is the prognosis of Normal Pressure Hydrocephalus?
------------------------------------------------------------------------
With early diagnosis and treatment, symptoms can be partially or fully reversed leading to resumption of a normal life.
With the use of the shunt, symptoms may disappear within days or at most a few months.
There is dramatic improvement in the first week in mild cases.
Some adjustments of the valve are often needed before the correct setting is obtained for the individual.
---------------------------------------------------------
What is Normal Pressure Hydrocephalus?
--------------------------------------------
Normal Pressure Hydrocephalus(NPH) is an abnormal accumulation of cerebrospinal fluid in the cavities of the brain.
Who is at risk of getting Normal Pressure Hydrocephalus?
-------------------------------------------------------------
Normal Pressure Hydrocephalus occurs in adults of 55 years old and above.
The accumulation of cerebrospinal fluid is gradual leading to enlargement of the cavities in the brain called ventricles.
This in turn stretches the nerve tissues of the brain giving rise to 3 main neurological disturbances in the brain which is characteristic of NPH.
What are the causes of Normal Pressure Hydrocephalus?
------------------------------------------------------------
In most cases the cause is unknown.
In the remaining cases, the secondary causes can be found:
1. Brain infection can cause damage to brain tissues and the resulting cell damage can increase fluid in the brain
2. Stroke may damage brain cells resulting in damaged brain tissues and increase fluid in the brain
3. Trauma and head injury may damage brain cells similar to above
4. Brain tumors are another cause of increased fluid in the brain
What are the Symptoms of Normal Pressure Hydrocephalus?
----------------------------------------------------------------
Onset is slow and gradual but typically the following symptoms are present:
Gait disturbance
-----------------
Difficulty in walking or balancing
Cognitive impairment
---------------------------
mild dementia
Urinary Incontinence
---------------------
Problems with bladder control and hence incontinence
How is the diagnosis of Normal Pressure Hydrocephalus confirmed?
------------------------------------------------------------------------
1.History of the above 3 symptoms
2.Physical examination shows the neurological deficits:
difficulty in walking
mild dementia
urinary incontinence
3.MRI of brain shows the presence of enlarged ventricles in the brain
What is the Treatment of Normal Pressure Hydrocephalus?
-------------------------------------------------------------------
NPH cannot be cured but its symptoms can be controlled.
Treatment is by surgery using a shunt to divert the excessive fluid in the brain to the peritoneal cavity.
What are the complications of Normal Pressure Hydrocephalus?
-------------------------------------------------------------------
1. Dementia
2. Disabilty
3. Disturbed urinary and bowel function.
What is the prognosis of Normal Pressure Hydrocephalus?
------------------------------------------------------------------------
With early diagnosis and treatment, symptoms can be partially or fully reversed leading to resumption of a normal life.
With the use of the shunt, symptoms may disappear within days or at most a few months.
There is dramatic improvement in the first week in mild cases.
Some adjustments of the valve are often needed before the correct setting is obtained for the individual.
Friday, August 15, 2008
A Simple Guide to Meningitis
A Simple Guide to Meningitis
-----------------------------------
What is Meningitis?
---------------------------
Meningitis is a serious medical disease which causes inflammation and infection of the meninges which are the protective lining of the spinal cord and brain.
What are the causes of Meningitis?
----------------------------------------
The causes of Meningitis may be divided into:
Infections:
------------
1.viral infections are the most common and are usually mild
(enterovirus, herpes simplex virus 2 and mumps) except for Hand mouth and foot disease(enterovirus EV7)which can cause fatality in children
2.bacterial infections such as meningoccocus (Neisseria meningitidis) and pneumococcus (Streptococcus pneumoniae) can be serious and fatal in some cases.
Meningococcal meningitis can cause outbreaks(spread easily).
E.coli, Group B streptococus and Pseudomonas infection are common in neonates.
Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae are common in infants and children
Streptococcus pneumoniae, N. meningitidis, Mycobacteria are more common in adults.
Mycobacterium tuberculosis meningitis are more common in developing countries and in people whose immune systems are impaired(eg. AIDS) and are preceded by active tuberculosis infections elsewhere.
3.fungi
Cryptococcus neoformans is the most common cause of fungal meningitis
Non-infectious:
------------------
Non infectious causes usually irritates the meninges through inflammation and auto immune reactions:
1.cancers,
2.systemic lupus erythematosus
3.drugs.
4.head injury
5.post neurosurgical procedures
What are Signs and symptoms of Meningitis?
---------------------------------------------
The triad of symptoms which often defines meningitis are:
1.Severe headache
2.Neck rigidity (unable to flex the neck forward),
A positive Kernig's sign means that the neck will painful when one hip is flexed to 90 degrees and the knee flexed to 90 degrees in a patient lying supine.
3.vomiting
Other symptoms are:
4.high fever
5.mental confusion.
6.Malaise
7.photo-phobia (inability to tolerate bright light),
8.phono-phobia (inability to tolerate loud noises),
9.irritability especially in small children
10.seizures .
11.swelling of the fontanelle may be present in infants
12.rash with numerous small, irregular red spots on the body, lower legs, soles of feet, palms
13.ulcers of the mouth (present in hand,mouth and foot disease).
How is the diagnosis of Meningitis made?
------------------------------------------
1.Classical symptoms and signs as above especially neck rigidity
2.blood tests (complete blood count, ESR and blood culture)
3.X-rays of chest and brain
4.cerebrospinal fluid (CSF) analysis via lumbar puncture is examined for white blood cells, red blood cells, protein content, glucose level and micro-organisms.
This test should not be done if there is suspected cerebral mass lesion or raised intracranial pressure (head injury, localizing neurological signs)
A pressure of over 180 mm suggests bacterial meningitis.
5.CSF glucose is low,protein high and cells high in bacterial meningitis,
CSF glucose is normal,protein normal and cells high in viral meningitis
CSF glucose is low,protein high and cells high in fungal meningitis
6.CT or MRI of the brain and spine with MRI preferred over CT because it can detect more easily areas of cerebral edema,tumors, ischemia, and meningeal inflammation.
What are the complications of Meningitis?
-----------------------------------------------
1.Neurological deficits
2.deafness
3.learning disorders in children
4.brain infarction,
5.septic shock,
6.adult respiratory distress syndrome
7.seizures also more in children
8.pneumonia especially in the elderly
What is the treatment of Meningitis?
------------------------------------
1.Hospitalization should be immediate as meningitis is an life threatening condition.
2.Antibiotics such as cephalosporin, ampicillin, chloramphenicol, intravenous vancomycin to be started even before doing lumbar puncture.
Acyclovir may be given for herpes virus infection
High dosages of anti-fungals may be given for Fungal meningitis for a prolonged period of time
3.corticosteroids is useful to reduce complications
4.High-flow oxygen
5.intravenous fluids
What is the prognosis of Meningitis?
------------------------------------------
This depends on the severity and type of infection.
Viral infections except for enterovirus EV7 usually recover quickly.
Bacterial infections such as meningococcus and pneumococcus are more dangerous.
What are the Preventive measures taken for Meningitis?
--------------------------------------------------------
Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of meningitis.
Vaccines against type A and C Neisseria meningitidis are used to prevent these types of meningitis especially in those who travel abroad.
Vaccines against type B Neisseria meningitidis have yet to be produced athough a drug company is doing research on the production of this vaccine.
Pneumococcal vaccine against Streptococcus pneumoniae has been given to newborns to prevent pneumococcal meningitis.
Mumps vaccination as part of Measles, mumps and rubella vaccine(MMR) has reduced the incidence of mumps related form of meningitis
-----------------------------------
What is Meningitis?
---------------------------
Meningitis is a serious medical disease which causes inflammation and infection of the meninges which are the protective lining of the spinal cord and brain.
What are the causes of Meningitis?
----------------------------------------
The causes of Meningitis may be divided into:
Infections:
------------
1.viral infections are the most common and are usually mild
(enterovirus, herpes simplex virus 2 and mumps) except for Hand mouth and foot disease(enterovirus EV7)which can cause fatality in children
2.bacterial infections such as meningoccocus (Neisseria meningitidis) and pneumococcus (Streptococcus pneumoniae) can be serious and fatal in some cases.
Meningococcal meningitis can cause outbreaks(spread easily).
E.coli, Group B streptococus and Pseudomonas infection are common in neonates.
Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae are common in infants and children
Streptococcus pneumoniae, N. meningitidis, Mycobacteria are more common in adults.
Mycobacterium tuberculosis meningitis are more common in developing countries and in people whose immune systems are impaired(eg. AIDS) and are preceded by active tuberculosis infections elsewhere.
3.fungi
Cryptococcus neoformans is the most common cause of fungal meningitis
Non-infectious:
------------------
Non infectious causes usually irritates the meninges through inflammation and auto immune reactions:
1.cancers,
2.systemic lupus erythematosus
3.drugs.
4.head injury
5.post neurosurgical procedures
What are Signs and symptoms of Meningitis?
---------------------------------------------
The triad of symptoms which often defines meningitis are:
1.Severe headache
2.Neck rigidity (unable to flex the neck forward),
A positive Kernig's sign means that the neck will painful when one hip is flexed to 90 degrees and the knee flexed to 90 degrees in a patient lying supine.
3.vomiting
Other symptoms are:
4.high fever
5.mental confusion.
6.Malaise
7.photo-phobia (inability to tolerate bright light),
8.phono-phobia (inability to tolerate loud noises),
9.irritability especially in small children
10.seizures .
11.swelling of the fontanelle may be present in infants
12.rash with numerous small, irregular red spots on the body, lower legs, soles of feet, palms
13.ulcers of the mouth (present in hand,mouth and foot disease).
How is the diagnosis of Meningitis made?
------------------------------------------
1.Classical symptoms and signs as above especially neck rigidity
2.blood tests (complete blood count, ESR and blood culture)
3.X-rays of chest and brain
4.cerebrospinal fluid (CSF) analysis via lumbar puncture is examined for white blood cells, red blood cells, protein content, glucose level and micro-organisms.
This test should not be done if there is suspected cerebral mass lesion or raised intracranial pressure (head injury, localizing neurological signs)
A pressure of over 180 mm suggests bacterial meningitis.
5.CSF glucose is low,protein high and cells high in bacterial meningitis,
CSF glucose is normal,protein normal and cells high in viral meningitis
CSF glucose is low,protein high and cells high in fungal meningitis
6.CT or MRI of the brain and spine with MRI preferred over CT because it can detect more easily areas of cerebral edema,tumors, ischemia, and meningeal inflammation.
What are the complications of Meningitis?
-----------------------------------------------
1.Neurological deficits
2.deafness
3.learning disorders in children
4.brain infarction,
5.septic shock,
6.adult respiratory distress syndrome
7.seizures also more in children
8.pneumonia especially in the elderly
What is the treatment of Meningitis?
------------------------------------
1.Hospitalization should be immediate as meningitis is an life threatening condition.
2.Antibiotics such as cephalosporin, ampicillin, chloramphenicol, intravenous vancomycin to be started even before doing lumbar puncture.
Acyclovir may be given for herpes virus infection
High dosages of anti-fungals may be given for Fungal meningitis for a prolonged period of time
3.corticosteroids is useful to reduce complications
4.High-flow oxygen
5.intravenous fluids
What is the prognosis of Meningitis?
------------------------------------------
This depends on the severity and type of infection.
Viral infections except for enterovirus EV7 usually recover quickly.
Bacterial infections such as meningococcus and pneumococcus are more dangerous.
What are the Preventive measures taken for Meningitis?
--------------------------------------------------------
Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of meningitis.
Vaccines against type A and C Neisseria meningitidis are used to prevent these types of meningitis especially in those who travel abroad.
Vaccines against type B Neisseria meningitidis have yet to be produced athough a drug company is doing research on the production of this vaccine.
Pneumococcal vaccine against Streptococcus pneumoniae has been given to newborns to prevent pneumococcal meningitis.
Mumps vaccination as part of Measles, mumps and rubella vaccine(MMR) has reduced the incidence of mumps related form of meningitis
Wednesday, August 13, 2008
A Simple Guide to Mastitis
A Simple Guide to Mastitis
-----------------------------
What is Mastitis?
--------------------
Mastitis is inflammation or infection of the breasts, resulting in pain and swelling.
What causes Mastitis?
------------------------
The causes of Mastitis are mostly due:
A.Hormonal:
----------------------
1.In babies whether male or female, the painless swelling of the breast may occur due to the effects of the mother's female hormones.The swelling usually subsides after a few weeks.
2.At Puberty for girls the development of breasts may cause some pain and swelling. It may occur first on one side and then subsequently on the side.
The nipples may be red and tender andthis may cause worry for the adlolescent girl and her mother.
3.Premenstrual pain and swelling of breasts may occur
B.Infections:
---------------------
Infections of the breasts may occur due to
1.poor skin hygiene
2.Injuries or wounds allowing microganism to enter the wound
3.Breastfeeding as a result of the baby sucking the nipple incorrectly or as a result of blockage of the milk ducts. In either case bacteria can enter through the injured nipple or the inflammation of the blocked milk ducts may cause suppuration and abscess formation.
4.Mastitis may occur as a rare complication of mumps.
5.Most common bacteria infection is staphyloccus aures.
6.Other rare causes of mastitis are tuberculosis, syphlis or actinomycosis
What are the symptoms of Mastitis?
-------------------------------------
The Symptoms of Mastitis are:
1.Pain usually present in all cases except in babies
2.swelling of the breasts or the nipple area
3.Pus discharge from the nipple
Signs:
1.redness of the nipple or areola
2.red, warm swelling of the breast tissue may indicate presence of formation of abscess.
3.Local tenderness of inflammed area
4.Fever and genral malaise
5.Axillary lymph nodes may be swollen and painful
What are the complications of Mastitis?
------------------------------------
1.Abscess formation
2.Cystic formation
3.Chronic mastitis or fibroadenosis
How is diagnosis of Mastitis confirmed?
------------------------------------------
1. clinical features
2. Mammograms to exclude malignant tumors
3. Ultrasound scan of the breasts
What is the treatment of Mastitis?
------------------------------------
1. antibiotics are given to cure the infections.
The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.
2. Painkillers may be given if there is pain
3.Rest and support of the breasts with soft bras
4.Warm water bottle to apply to areas of inflmmation due to blocked milk to soften the milk and induce flow.
5. surgery with drainage of abscess if antibiotic do not work.
Aspiration of cysts may also be nessary
6.Reassurance in hormonal cases of mastitis
What is the Prognosis of Mastitis?
------------------------------------
Most cases of mastitis usually will recover with proper treatment.
What are the Preventive measures for Mastitis?
----------------------------------------------------
Practice good personal and skin hygiene
Wash hands frequently
Clean the beasts properly before and after breastfeeding
Patients should be taught to do breast self examination and to do it frequently
-----------------------------
What is Mastitis?
--------------------
Mastitis is inflammation or infection of the breasts, resulting in pain and swelling.
What causes Mastitis?
------------------------
The causes of Mastitis are mostly due:
A.Hormonal:
----------------------
1.In babies whether male or female, the painless swelling of the breast may occur due to the effects of the mother's female hormones.The swelling usually subsides after a few weeks.
2.At Puberty for girls the development of breasts may cause some pain and swelling. It may occur first on one side and then subsequently on the side.
The nipples may be red and tender andthis may cause worry for the adlolescent girl and her mother.
3.Premenstrual pain and swelling of breasts may occur
B.Infections:
---------------------
Infections of the breasts may occur due to
1.poor skin hygiene
2.Injuries or wounds allowing microganism to enter the wound
3.Breastfeeding as a result of the baby sucking the nipple incorrectly or as a result of blockage of the milk ducts. In either case bacteria can enter through the injured nipple or the inflammation of the blocked milk ducts may cause suppuration and abscess formation.
4.Mastitis may occur as a rare complication of mumps.
5.Most common bacteria infection is staphyloccus aures.
6.Other rare causes of mastitis are tuberculosis, syphlis or actinomycosis
What are the symptoms of Mastitis?
-------------------------------------
The Symptoms of Mastitis are:
1.Pain usually present in all cases except in babies
2.swelling of the breasts or the nipple area
3.Pus discharge from the nipple
Signs:
1.redness of the nipple or areola
2.red, warm swelling of the breast tissue may indicate presence of formation of abscess.
3.Local tenderness of inflammed area
4.Fever and genral malaise
5.Axillary lymph nodes may be swollen and painful
What are the complications of Mastitis?
------------------------------------
1.Abscess formation
2.Cystic formation
3.Chronic mastitis or fibroadenosis
How is diagnosis of Mastitis confirmed?
------------------------------------------
1. clinical features
2. Mammograms to exclude malignant tumors
3. Ultrasound scan of the breasts
What is the treatment of Mastitis?
------------------------------------
1. antibiotics are given to cure the infections.
The antibiotics may need to be taken for 10 days by mouth.
They must not be stopped just because the discomfort stops, or the infection will NOT be cured.
2. Painkillers may be given if there is pain
3.Rest and support of the breasts with soft bras
4.Warm water bottle to apply to areas of inflmmation due to blocked milk to soften the milk and induce flow.
5. surgery with drainage of abscess if antibiotic do not work.
Aspiration of cysts may also be nessary
6.Reassurance in hormonal cases of mastitis
What is the Prognosis of Mastitis?
------------------------------------
Most cases of mastitis usually will recover with proper treatment.
What are the Preventive measures for Mastitis?
----------------------------------------------------
Practice good personal and skin hygiene
Wash hands frequently
Clean the beasts properly before and after breastfeeding
Patients should be taught to do breast self examination and to do it frequently
Tuesday, August 12, 2008
A Simple Guide to Hypothyroidism
A Simple Guide to Hypothyroidism
-----------------------------------
What is Hypothyroidism (Underactive Thyroid) ?
------------------------------------------------
Hypothyroidism is a condition caused by insufficient production of the thyroid hormones, usually more common in females.
What are the causes of Hypothyroidism?
-------------------------------------------
Primary causes:
1.Congenital:
Aplasia(no thyroid), Hypoplasia(small thyroid), ectopic(not at normal site) thyroid gland
2.Autoimmune Thyroiditis(hashimoto thyroiditis):
inflammation cause insuffient production of thyroid hormones
3.Iodine deficiency can cause less production of thyroxine
Secondary Causes:
1.Radioactive iodine reduces production of thyroid hormones
2.Excess removal of thyroid gland causes reduced production of thyroid hormones.
3.Hypothyroidism during or after pregnancy.
These women develop antibodies to their own thyroid gland resulting in underproduction of thyroid hormones.
Other rarer causes include
4. radiation treatment for cancers of the head and neck,
5.pituitary problems
What are the symptoms and signs of Hypothyroidism?
-------------------------------------------------------
Symptoms
Congenital Hypothyroidism:
---------------------------
1.puffy face
2.enlarged protruberant tongue
3.hypotonia
4.sluggish reflexes
5.enlarged fontanelle
6.retardation of development
Adult Hypothyroidism:
------------------------
1.Slowness of movement
2.slowness of thought
3.unexplained weight gain
4.cold intolerance
5.dry coarse skin
6.hair loss
7.puffy face
8.menorrhagia
9.constipation
10.depression
11.husky voice
12.bradycardia(slow heart beats)
How is the diagnosis of Hypothyroidism made?
-----------------------------------------------
1.blood test is done for TSH (thyroid stimulating hormone) levels.
TSH is usually high for Hypothyroidism
2.blood test for T4 and T3 levels.
Low levels of T4 and T3 usually means HYpothyroidism
3.Thyroid ultrasound scan for ectopic and congenital hyothyroids
What is the Treatment of Hypothyroidism?
-------------------------------------------
1.Hormone replacement with daily doses of synthetic thyroxine
2.Blood is taken regularly to test the level of TSH.
3.thyroxine dosage is adjusted until there is a normal TSH level.
4.Life long treatment of patients with thyroid hormones
What is the Prognosis of Hypothyroidism?
-------------------------------------------
Dramatic response and very good reaction to treatment occurs in most cases.
Mental retardation and slow physical development occurs in congenital hypothyroidism
-----------------------------------
What is Hypothyroidism (Underactive Thyroid) ?
------------------------------------------------
Hypothyroidism is a condition caused by insufficient production of the thyroid hormones, usually more common in females.
What are the causes of Hypothyroidism?
-------------------------------------------
Primary causes:
1.Congenital:
Aplasia(no thyroid), Hypoplasia(small thyroid), ectopic(not at normal site) thyroid gland
2.Autoimmune Thyroiditis(hashimoto thyroiditis):
inflammation cause insuffient production of thyroid hormones
3.Iodine deficiency can cause less production of thyroxine
Secondary Causes:
1.Radioactive iodine reduces production of thyroid hormones
2.Excess removal of thyroid gland causes reduced production of thyroid hormones.
3.Hypothyroidism during or after pregnancy.
These women develop antibodies to their own thyroid gland resulting in underproduction of thyroid hormones.
Other rarer causes include
4. radiation treatment for cancers of the head and neck,
5.pituitary problems
What are the symptoms and signs of Hypothyroidism?
-------------------------------------------------------
Symptoms
Congenital Hypothyroidism:
---------------------------
1.puffy face
2.enlarged protruberant tongue
3.hypotonia
4.sluggish reflexes
5.enlarged fontanelle
6.retardation of development
Adult Hypothyroidism:
------------------------
1.Slowness of movement
2.slowness of thought
3.unexplained weight gain
4.cold intolerance
5.dry coarse skin
6.hair loss
7.puffy face
8.menorrhagia
9.constipation
10.depression
11.husky voice
12.bradycardia(slow heart beats)
How is the diagnosis of Hypothyroidism made?
-----------------------------------------------
1.blood test is done for TSH (thyroid stimulating hormone) levels.
TSH is usually high for Hypothyroidism
2.blood test for T4 and T3 levels.
Low levels of T4 and T3 usually means HYpothyroidism
3.Thyroid ultrasound scan for ectopic and congenital hyothyroids
What is the Treatment of Hypothyroidism?
-------------------------------------------
1.Hormone replacement with daily doses of synthetic thyroxine
2.Blood is taken regularly to test the level of TSH.
3.thyroxine dosage is adjusted until there is a normal TSH level.
4.Life long treatment of patients with thyroid hormones
What is the Prognosis of Hypothyroidism?
-------------------------------------------
Dramatic response and very good reaction to treatment occurs in most cases.
Mental retardation and slow physical development occurs in congenital hypothyroidism
Monday, August 11, 2008
A Simple Guide to Hyperthyroid Disease
A Simple Guide to Hyperthyroid Disease
------------------------------------------
What is Hyperthyroid Disease?
---------------------------------
Hyperthyroid disease is a condition when the thyroid gland produces too much thyroid hormones resulting in all the symptoms of excessive metabolism.
What is the cause of Hyperthyroid Disease ?
---------------------------------------------------
Hyperthyroid disease is caused by conditions that increases the output of thyroid hormones:
too much thyroid hormone.
1.Graves' disease - diffuse goiter(enlarged thyroid) caused by autoimmune antibodies stimulation of the thyroid gland to produce more thyroid hormones.
Graves' disease is more common in young women.
2.Plummer's Disease (Toxic nodular thyroid)
Hyperactive thyroid nodules produce excess thyroid hormones especially in older women.
3.Hashimoto's Disease (Thyroiditis) inflammation of the thyroid gland causes production of excess thyroid hormones.
4.Idiopathic Hyperthyroid Disease is caused by ingestion of too much thyroid hormones.
What are the Symptoms of Hyperthyroid Disease?
------------------------------------------------------------
Symptoms:
1.anxiety, shaking, feeling nervous or irritated
2.fast heartbeat or palpitations
3.feeling hot all the time
4.Excess sweating
5.increased appetite
6.loss of weight
7.fatigue, exhaustion
8.increased frequency of bowel movements
9.changes in menstrual periods
10.eye irritation
11.bulging of the eyes
12.double vision
13.blurred vision
Signs:
1. Enlarged thyroid gland -diffuse or nodular
2. Bruit or blood flow sounds may be heard over the thyroid
3. Skin warm and sweaty
4. fine brittle nails
5. fine hair
6. Tachycardia -heart beat may be above 100/min , wide difference between systolic and diastolic pressure
7. Fine tremors of hands
8. Eye : bulging, peri-orbital edema, lid lag
How is diagnosis of Hyperthyroidism made?
-------------------------------------------------------
1. blood test is done for presence of high thyroid hormones(T3 and T4) and low TSH (thyroid stimulating hormone) levels.
2. Blood for thyroid antibodies(thyroiditis)
3. Ultrasound of the thyroid gland
What is the Treatment of Hyperthyroidism?
--------------------------------------------------
1.Anti-thyroid drugs
-------------------------
reduce the production of excess thyroid hormones
The drugs of choice are carbimazole and propylthiouracil initially on high doses then reducing down to a maintenance dose which has to be taken for 1-2 years depending on the severity of the condition.
Symptoms usually improve after 2 months but blood tests are needed to monitor the effect of the drugs.
Side effects include lowering of white cell count and concomitant infection of the throat.
Relapse after 1-2 years treatment are quite common.
2.Radioactive iodine therapy
--------------------------------
is more suitable for older patients and those who do not respond to anti-thyroid drugs and women who do not intend to have pregnancy.
The side effect of radioactive iodine is often radiation side effects which may lead to cancer of the bones 20 years down the road.
The other danger is the destruction of the thyroid producing cells which lead to hypothyroid disease later on.
The patient will then be required to take thyroxine for the rest of her life.
3.Surgery
may be required if the hyperthyroid condition did not improve with anti-thyroid
drugs or if there is frequent recurrences.
It is also done for women who do not wish to go for radioactive iodine therapy and who wishes to have a child later on.
A subtotal thyroidectomy is done.
Usually three quarters of the glands are removed.
Dangers of surgery and anesthesia are as usual rare however there may be removal of too much thyroid gland resulting in hypothyroidism or removal of parathyroid glands resulting in low calcium.
Patient will then need to take thyroxine and calcium replacement tablets for life.
4. Supportive treatment:
a.Propanolol and other beta blockers can slow down the fast heart beats caused by the excess thyroid hormones
b.tranquillizers such as ativan, xanax can help soothe the anxiety or stress in a person with hyperthyroid disease.
Most hyperthyroid disease patients have their excessive thyroid hormones production triggered off by stress and anxiety.
c.rest and a healthy lifestyle may help to prevent an onset or recurrence of hyperthyroid disease.
What is the prognosis of Hyperthyroid Disease?
---------------------------------------------------
Most cases of patients treated with surgery and radioactive iodine recovered quite well although many can developed hypothyroidism later on in life when the thyroid hormones production is reduced.
Many cases on anti-thyroid medication usually have recurrence especially if the basic cause of stress and anxiety remains in their work or home life.
What are the prevention measures for hyperthyroid Disease?
--------------------------------------------------------------
Rest and a healthy lifestyle may help to prevent an onset or recurrence of hyperthyroid disease.
Avoid stress and anxiety.
------------------------------------------
What is Hyperthyroid Disease?
---------------------------------
Hyperthyroid disease is a condition when the thyroid gland produces too much thyroid hormones resulting in all the symptoms of excessive metabolism.
What is the cause of Hyperthyroid Disease ?
---------------------------------------------------
Hyperthyroid disease is caused by conditions that increases the output of thyroid hormones:
too much thyroid hormone.
1.Graves' disease - diffuse goiter(enlarged thyroid) caused by autoimmune antibodies stimulation of the thyroid gland to produce more thyroid hormones.
Graves' disease is more common in young women.
2.Plummer's Disease (Toxic nodular thyroid)
Hyperactive thyroid nodules produce excess thyroid hormones especially in older women.
3.Hashimoto's Disease (Thyroiditis) inflammation of the thyroid gland causes production of excess thyroid hormones.
4.Idiopathic Hyperthyroid Disease is caused by ingestion of too much thyroid hormones.
What are the Symptoms of Hyperthyroid Disease?
------------------------------------------------------------
Symptoms:
1.anxiety, shaking, feeling nervous or irritated
2.fast heartbeat or palpitations
3.feeling hot all the time
4.Excess sweating
5.increased appetite
6.loss of weight
7.fatigue, exhaustion
8.increased frequency of bowel movements
9.changes in menstrual periods
10.eye irritation
11.bulging of the eyes
12.double vision
13.blurred vision
Signs:
1. Enlarged thyroid gland -diffuse or nodular
2. Bruit or blood flow sounds may be heard over the thyroid
3. Skin warm and sweaty
4. fine brittle nails
5. fine hair
6. Tachycardia -heart beat may be above 100/min , wide difference between systolic and diastolic pressure
7. Fine tremors of hands
8. Eye : bulging, peri-orbital edema, lid lag
How is diagnosis of Hyperthyroidism made?
-------------------------------------------------------
1. blood test is done for presence of high thyroid hormones(T3 and T4) and low TSH (thyroid stimulating hormone) levels.
2. Blood for thyroid antibodies(thyroiditis)
3. Ultrasound of the thyroid gland
What is the Treatment of Hyperthyroidism?
--------------------------------------------------
1.Anti-thyroid drugs
-------------------------
reduce the production of excess thyroid hormones
The drugs of choice are carbimazole and propylthiouracil initially on high doses then reducing down to a maintenance dose which has to be taken for 1-2 years depending on the severity of the condition.
Symptoms usually improve after 2 months but blood tests are needed to monitor the effect of the drugs.
Side effects include lowering of white cell count and concomitant infection of the throat.
Relapse after 1-2 years treatment are quite common.
2.Radioactive iodine therapy
--------------------------------
is more suitable for older patients and those who do not respond to anti-thyroid drugs and women who do not intend to have pregnancy.
The side effect of radioactive iodine is often radiation side effects which may lead to cancer of the bones 20 years down the road.
The other danger is the destruction of the thyroid producing cells which lead to hypothyroid disease later on.
The patient will then be required to take thyroxine for the rest of her life.
3.Surgery
may be required if the hyperthyroid condition did not improve with anti-thyroid
drugs or if there is frequent recurrences.
It is also done for women who do not wish to go for radioactive iodine therapy and who wishes to have a child later on.
A subtotal thyroidectomy is done.
Usually three quarters of the glands are removed.
Dangers of surgery and anesthesia are as usual rare however there may be removal of too much thyroid gland resulting in hypothyroidism or removal of parathyroid glands resulting in low calcium.
Patient will then need to take thyroxine and calcium replacement tablets for life.
4. Supportive treatment:
a.Propanolol and other beta blockers can slow down the fast heart beats caused by the excess thyroid hormones
b.tranquillizers such as ativan, xanax can help soothe the anxiety or stress in a person with hyperthyroid disease.
Most hyperthyroid disease patients have their excessive thyroid hormones production triggered off by stress and anxiety.
c.rest and a healthy lifestyle may help to prevent an onset or recurrence of hyperthyroid disease.
What is the prognosis of Hyperthyroid Disease?
---------------------------------------------------
Most cases of patients treated with surgery and radioactive iodine recovered quite well although many can developed hypothyroidism later on in life when the thyroid hormones production is reduced.
Many cases on anti-thyroid medication usually have recurrence especially if the basic cause of stress and anxiety remains in their work or home life.
What are the prevention measures for hyperthyroid Disease?
--------------------------------------------------------------
Rest and a healthy lifestyle may help to prevent an onset or recurrence of hyperthyroid disease.
Avoid stress and anxiety.
Wednesday, August 6, 2008
A Simple Guide to Pterygium
A Simple Guide to Pterygium
----------------------------------------------------
What is Pterygium?
---------------------------------------
Pterygium is a fleshy tissue that grows in on the inner corner of the eye
towards the pupil.
It may also appear on the outer corner.
It is usually triangular in shape.
Who is affected by Pterygium?
---------------------------------------------------
Pterygium is more common in people who spend time outdoors than indoor
What is the Cause of Pterygium?
-----------------------------------------------------
The exact cause of Pterygium is not known.
1. Long-term exposure to sunlight, especially ultraviolet (UV) rays
2. chronic eye irritation
3. dusty conditions
4. dry eye may contribute to pterygium as well.
What are the Symptoms and signs of Pterygium?
-----------------------------------------------------------
Symptoms varies from mild to severe:
1.discomfort in the eye
2.Conjunctival congestion
3.Tearing -excess tears from irritation
Signs:
1.fleshy growth on the conjunctiva on inner side of eye growing towards pupils
2.increased dilated blood vessels in the fleshy growth
How do you make the Diagnosis of Pterygium?
------------------------------------------------------------
The presence of fleshy growth with blood vessels on the conjunctiva on inner side of eye growing towards pupils
What are the complications of Pterygium?
---------------------------------------------------
1.Partial blindness if the pterygium covers the cornea
2.Recurrent irritation and conjunctivitis of eyes.
3.Severe infection of the eye - rare
What is the treatment of Pterygium?
---------------------------------------------------
Treatment depends on the severity:
1.Mild:
Eye drops with anti congestion and anti-inflammatory properties may shrink the blood vessels which provide nourishment for the growth of the pterygium.
2.Severe:
Once the pterygium reaches the cornea and may cover the cornea, surgical resection of the pterygium may be necessary otherwise the eye sight may be compromised.
Surgical resection may also be done if the pterygium is unsightly.
What is the prognosis of Pterygium?
-----------------------------------------
The prognosis is usually good.
Recurrence is rare but do occur due to regrowth of the blood vessel supplying the pterygium.
This occurs more in younger people.
How is pterygium prevented?
---------------------------------
Wearing UV protective sunglasses
Avoid dry and dusty conditions
Use of artificial tear eye drops
----------------------------------------------------
What is Pterygium?
---------------------------------------
Pterygium is a fleshy tissue that grows in on the inner corner of the eye
towards the pupil.
It may also appear on the outer corner.
It is usually triangular in shape.
Who is affected by Pterygium?
---------------------------------------------------
Pterygium is more common in people who spend time outdoors than indoor
What is the Cause of Pterygium?
-----------------------------------------------------
The exact cause of Pterygium is not known.
1. Long-term exposure to sunlight, especially ultraviolet (UV) rays
2. chronic eye irritation
3. dusty conditions
4. dry eye may contribute to pterygium as well.
What are the Symptoms and signs of Pterygium?
-----------------------------------------------------------
Symptoms varies from mild to severe:
1.discomfort in the eye
2.Conjunctival congestion
3.Tearing -excess tears from irritation
Signs:
1.fleshy growth on the conjunctiva on inner side of eye growing towards pupils
2.increased dilated blood vessels in the fleshy growth
How do you make the Diagnosis of Pterygium?
------------------------------------------------------------
The presence of fleshy growth with blood vessels on the conjunctiva on inner side of eye growing towards pupils
What are the complications of Pterygium?
---------------------------------------------------
1.Partial blindness if the pterygium covers the cornea
2.Recurrent irritation and conjunctivitis of eyes.
3.Severe infection of the eye - rare
What is the treatment of Pterygium?
---------------------------------------------------
Treatment depends on the severity:
1.Mild:
Eye drops with anti congestion and anti-inflammatory properties may shrink the blood vessels which provide nourishment for the growth of the pterygium.
2.Severe:
Once the pterygium reaches the cornea and may cover the cornea, surgical resection of the pterygium may be necessary otherwise the eye sight may be compromised.
Surgical resection may also be done if the pterygium is unsightly.
What is the prognosis of Pterygium?
-----------------------------------------
The prognosis is usually good.
Recurrence is rare but do occur due to regrowth of the blood vessel supplying the pterygium.
This occurs more in younger people.
How is pterygium prevented?
---------------------------------
Wearing UV protective sunglasses
Avoid dry and dusty conditions
Use of artificial tear eye drops
Tuesday, August 5, 2008
A Simple Guide to Entropion
A Simple Guide to Entropion
----------------------------------------------------
What is Entropion?
---------------------------------------
Entropion is an inversion(rolling inwards) of the eyelid
Who is affected by Entropion?
---------------------------------------------------
Entropion is more common in women than in men.
What is the Cause of Entropion?
-----------------------------------------------------
The causes of Entropion can divided into 2 type:
Spasm of Orbicularis muscle:
1. Degeneration of the peripheral connective tissue of the eye
2. Occurs in old age
3. Occurs also after removal of eyeball
4. Primarily affects the lower eyelid.
Cicatricial:
1. Scarring of the eyelid muscle to connective tissue as a result of injury, trauma, burns
2.retraction of the connective tissue of eyelid from infections such as trachoma, chronic infections
3.Congenital disease
4. May affect either upper or lower eyelid
What are the Symptoms and signs of Entropion?
-----------------------------------------------------------
Symptoms varies from mild to severe due to rubbing of eyelashes against the cornea or conjunctiva:
1.Irritation of the conjunctiva
2.Conjunctival congestion - increased blood flow through irritated eye shows up the blood vessels
3.Tearing -excess tears from irritation
Signs:
1.Erosions, opacities and vasculisation of the cornea
2.increased dilated blood vessels of conjunctiva present due to irritation
3.The presence of inward turning eyelids and eyelashes
How do you make the Diagnosis of Entropion?
------------------------------------------------------------
The presence of inward direction of the eyelashes and eyelid can be seen using a slit lamp microscope.
What are the complications of Entropion?
---------------------------------------------------
1.Recurrent corneal ulcers
2.Recurrent irritation and conjunctivitis of eyes.
3.Severe infection of the eye - rare
What is the treatment of Entropion?
---------------------------------------------------
Treatment depends on the type of Entropion:
Spastic:
1.Eversion of eyelid especially lower eyelid with adhesive plaster or tape for temporary relief together with lubricating eye
drops
2.Surgery - by removal of inturning eyelashes using laser
- eversion of eyelid by surgery as below
Cicatricial:
Surgery to tighten the eyelid muscle is usually required:
1.Quickert procedure: 2 to 3 strategically placed stitches are used under local anesthesia to evert the eyelid.
Recurrence is common.
This is useful for patients who are not suitable for surgery and can be followed the full repair surgery later on when the patient is better.
2.Repair of inverted eyelid is done by incision above and below the eyelids and removal of connective tissue or scarred tissue and tightening of the eyelid muscle.
This is usually done on an outpatient basis and under local anesthesia.
Post-operatively the wounds are protected by antibiotic creams and dressings.
Healing usually occurs within 1 week.
Antibiotics are also given for any infections of the conjunctiva and cornea.
What is the prognosis of Entropion?
-----------------------------------------
The prognosis is usually good.
Recurrence is rare but do occur especially due to weakening of eye muscles from age.
----------------------------------------------------
What is Entropion?
---------------------------------------
Entropion is an inversion(rolling inwards) of the eyelid
Who is affected by Entropion?
---------------------------------------------------
Entropion is more common in women than in men.
What is the Cause of Entropion?
-----------------------------------------------------
The causes of Entropion can divided into 2 type:
Spasm of Orbicularis muscle:
1. Degeneration of the peripheral connective tissue of the eye
2. Occurs in old age
3. Occurs also after removal of eyeball
4. Primarily affects the lower eyelid.
Cicatricial:
1. Scarring of the eyelid muscle to connective tissue as a result of injury, trauma, burns
2.retraction of the connective tissue of eyelid from infections such as trachoma, chronic infections
3.Congenital disease
4. May affect either upper or lower eyelid
What are the Symptoms and signs of Entropion?
-----------------------------------------------------------
Symptoms varies from mild to severe due to rubbing of eyelashes against the cornea or conjunctiva:
1.Irritation of the conjunctiva
2.Conjunctival congestion - increased blood flow through irritated eye shows up the blood vessels
3.Tearing -excess tears from irritation
Signs:
1.Erosions, opacities and vasculisation of the cornea
2.increased dilated blood vessels of conjunctiva present due to irritation
3.The presence of inward turning eyelids and eyelashes
How do you make the Diagnosis of Entropion?
------------------------------------------------------------
The presence of inward direction of the eyelashes and eyelid can be seen using a slit lamp microscope.
What are the complications of Entropion?
---------------------------------------------------
1.Recurrent corneal ulcers
2.Recurrent irritation and conjunctivitis of eyes.
3.Severe infection of the eye - rare
What is the treatment of Entropion?
---------------------------------------------------
Treatment depends on the type of Entropion:
Spastic:
1.Eversion of eyelid especially lower eyelid with adhesive plaster or tape for temporary relief together with lubricating eye
drops
2.Surgery - by removal of inturning eyelashes using laser
- eversion of eyelid by surgery as below
Cicatricial:
Surgery to tighten the eyelid muscle is usually required:
1.Quickert procedure: 2 to 3 strategically placed stitches are used under local anesthesia to evert the eyelid.
Recurrence is common.
This is useful for patients who are not suitable for surgery and can be followed the full repair surgery later on when the patient is better.
2.Repair of inverted eyelid is done by incision above and below the eyelids and removal of connective tissue or scarred tissue and tightening of the eyelid muscle.
This is usually done on an outpatient basis and under local anesthesia.
Post-operatively the wounds are protected by antibiotic creams and dressings.
Healing usually occurs within 1 week.
Antibiotics are also given for any infections of the conjunctiva and cornea.
What is the prognosis of Entropion?
-----------------------------------------
The prognosis is usually good.
Recurrence is rare but do occur especially due to weakening of eye muscles from age.
Sunday, August 3, 2008
A Simple Guide to Corneal Ulcer
A Simple Guide to Corneal Ulcer
----------------------------------------------------
What is Corneal ulcer?
---------------------------------------
Corneal ulcer is a inflammatory disease of the surface of the cornea which causes local destruction of the superficial layer of the cornea resulting in ulcers.
Corneal ulcers can be infectious(due to infection) or non infectious(due to injury or autoimmune disease)
Who is affected by corneal ulcer?
---------------------------------------------------
Corneal ulcers may be present more frequently in patients with :
Vitamin A deficiency
autoimmune disease
neurological disorders like facial palsy
What is the Cause of corneal ulcer?
-----------------------------------------------------
The causes of Corneal ulcers can divided into 2 type:
Infections:
1. Bacterial infection such as Streptococci, Staphhylococci, pneumococci, pseudomonas
2. Viral infections such as herpes simplex, herpes zoster,
3. Fungal infection
Non-infection:
1.Injury due to hard contact lens, abrasions from trauma, accidental scratch
2.autoimmune disease
3.Systemic disease
What are the Symptoms and signs of corneal ulcer?
-----------------------------------------------------------
Symptoms varies from mild to severe:
1.Severe pain in the eye or around the eye and eyebrow especially with infectious causes. Non-infectious causes may not give rise to pain.
2.Red eye - increased blood flow through inflamed eye shows up the blood vessels
3.Tearing -excess tears from inflammation
4.Discharge -may be pus discharge from eyes especially in the morning
5.Light sensitivity - sensitive to bright lights
Signs:
1.White spot on the cornea, that depending on the severity of the ulcer, may not be visible with the naked eye
2.increased dilated blood vessels present due to inflammation
How do you make the Diagnosis of corneal ulcer?
------------------------------------------------------------
The presence of a corneal ulcer can be seen using a slit lamp microscope.
Sometimes a dye fluorescein may be dropped into the eye making it more visible and easier to detect.
What investigation are necessary in Corneal ulcer?
-----------------------------------------------------
If the patient is suspected to have infection(pus discharge from the eyes), a tissue culture of the corneal cells(gently scraped from the ulcer) may be necessary to determine the type of micro-organism infecting the eye.
What are the complications of corneal ulcer?
---------------------------------------------------
The complication is always the risk of :
1.Severe infection of the eye especially with pseudomonas infection causing infection of the anterior chamber of the eye and then spreading to the rest of eye resulting in loss of an eye.
2.Scarring of the corneal ulcer resulting in partial loss of vision
What is the treatment of corneal ulcer?
---------------------------------------------------
Treatment depends on the type of corneal ulcer:
Infection:
1.Bacterial infection requires more intense treatment with oral antibiotics and antibiotic eye drops (given every 15 minutes)
2.Viral infections are usually treated with acyclovir tablets orally and acyclovir eye cream
3.Fungal infections are less common but are usually treated with antifungal medicine and eye drops.
In all infection cases, corticosteroid medications are not given.
Painkillers such as paracetamol can be given for pain
Non-infection:
1.Corticosteroid eye drops are usually given to reduce the inflammation
2.Antibiotic are also given to prevent infections of the ulcer.
In all cases the eye should be covered with eye pad until the epithelium of the ulcer heals about 10-14 days.
What is the prognosis of corneal ulcer?
-----------------------------------------
The prognosis depends on the severity of the disease
Most cases can be healed if detected early.
There may be minimum scarring of the cornea with possible loss of some vision.
Rarely the eye may be lost if there is severe infection and no treatment.
What are preventive measures in corneal ulcer?
-----------------------------------------------------
1. A nutritious diet with vitamin supplements can strengthen the body resistance against illness.
2.Avoid the use of infected contact lens lotion
3.A soft lens are more prone to eye infection. Always wash the hands before using any contact lens.
4.Avoid rubbing the eyes with dirty hands or tissues
5.A healthy lifestyle with less stress and mild exercise is always good for the body.
----------------------------------------------------
What is Corneal ulcer?
---------------------------------------
Corneal ulcer is a inflammatory disease of the surface of the cornea which causes local destruction of the superficial layer of the cornea resulting in ulcers.
Corneal ulcers can be infectious(due to infection) or non infectious(due to injury or autoimmune disease)
Who is affected by corneal ulcer?
---------------------------------------------------
Corneal ulcers may be present more frequently in patients with :
Vitamin A deficiency
autoimmune disease
neurological disorders like facial palsy
What is the Cause of corneal ulcer?
-----------------------------------------------------
The causes of Corneal ulcers can divided into 2 type:
Infections:
1. Bacterial infection such as Streptococci, Staphhylococci, pneumococci, pseudomonas
2. Viral infections such as herpes simplex, herpes zoster,
3. Fungal infection
Non-infection:
1.Injury due to hard contact lens, abrasions from trauma, accidental scratch
2.autoimmune disease
3.Systemic disease
What are the Symptoms and signs of corneal ulcer?
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Symptoms varies from mild to severe:
1.Severe pain in the eye or around the eye and eyebrow especially with infectious causes. Non-infectious causes may not give rise to pain.
2.Red eye - increased blood flow through inflamed eye shows up the blood vessels
3.Tearing -excess tears from inflammation
4.Discharge -may be pus discharge from eyes especially in the morning
5.Light sensitivity - sensitive to bright lights
Signs:
1.White spot on the cornea, that depending on the severity of the ulcer, may not be visible with the naked eye
2.increased dilated blood vessels present due to inflammation
How do you make the Diagnosis of corneal ulcer?
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The presence of a corneal ulcer can be seen using a slit lamp microscope.
Sometimes a dye fluorescein may be dropped into the eye making it more visible and easier to detect.
What investigation are necessary in Corneal ulcer?
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If the patient is suspected to have infection(pus discharge from the eyes), a tissue culture of the corneal cells(gently scraped from the ulcer) may be necessary to determine the type of micro-organism infecting the eye.
What are the complications of corneal ulcer?
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The complication is always the risk of :
1.Severe infection of the eye especially with pseudomonas infection causing infection of the anterior chamber of the eye and then spreading to the rest of eye resulting in loss of an eye.
2.Scarring of the corneal ulcer resulting in partial loss of vision
What is the treatment of corneal ulcer?
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Treatment depends on the type of corneal ulcer:
Infection:
1.Bacterial infection requires more intense treatment with oral antibiotics and antibiotic eye drops (given every 15 minutes)
2.Viral infections are usually treated with acyclovir tablets orally and acyclovir eye cream
3.Fungal infections are less common but are usually treated with antifungal medicine and eye drops.
In all infection cases, corticosteroid medications are not given.
Painkillers such as paracetamol can be given for pain
Non-infection:
1.Corticosteroid eye drops are usually given to reduce the inflammation
2.Antibiotic are also given to prevent infections of the ulcer.
In all cases the eye should be covered with eye pad until the epithelium of the ulcer heals about 10-14 days.
What is the prognosis of corneal ulcer?
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The prognosis depends on the severity of the disease
Most cases can be healed if detected early.
There may be minimum scarring of the cornea with possible loss of some vision.
Rarely the eye may be lost if there is severe infection and no treatment.
What are preventive measures in corneal ulcer?
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1. A nutritious diet with vitamin supplements can strengthen the body resistance against illness.
2.Avoid the use of infected contact lens lotion
3.A soft lens are more prone to eye infection. Always wash the hands before using any contact lens.
4.Avoid rubbing the eyes with dirty hands or tissues
5.A healthy lifestyle with less stress and mild exercise is always good for the body.
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