A Simple Guide to Salivary Gland Cancer
----------------------------------------
What is Salivary Gland Cancer?
------------------------------
Salivary Gland Cancer is a malignant disease of the Salivary glands.
Cancers affecting the salivary glands are rare.
They can occur at any age, but are more common in people over 50.
What are the causes of Salivary Gland Cancer?
--------------------------------------------------------
The cause of the cancer is unknown.
Malignant tumours of the salivary glands are rare but there are benign or non-malignant tumours of the salivary glands which are more common.
Cancer of the salivary glands cannot be transmitted to another person through the saliva.
There is no inherited gene and the cancer do not run in families.
What are the symptoms and signs of Salivary Gland Cancer?
----------------------------------------------------------
Symptoms - non-specific and silent.
In the early stage there is no symptoms.
By the the time the symptoms appeared, the cancer may be in the advanced stage.
1.swelling on one side of the face either in front of the ear or under the jaw.
2.numbness and drooping of one side of the face (facial palsy).
3.weight loss
Signs:
palpable mass under the jaw
How do you diagnose Salivary Gland Cancer?
----------------------------------------------
1. full medical history and physical examination
2. blood tests for general screeing including tumor markers
Definite diagnosis requre the following tests:
3.X-rays to show the size and position of the cancer and possible spread.
4.CAT (computerised tomography) scan of the skull and neck to detect the enlarged salivary tumors
5.MRI (magnetic resonance imaging) scan of the skull and neck to detect the enlarged salivary tumors
6.Biopsy of the affected salivary gland for examination under a microscope through a needle or surgical removal.
Salivary Gland Biopsy
-----------------------------
Biopsy of Salivary tumor may be done to determine stage of Salivary cancer:
Stage 1 :
1.Size is < 2cm
2.no spread
Stage 2
1. Size is between 2 and 4cm
2.No spread.
Stage 3
1.Size > 4cm in size
2.There may be spread into nearby soft tissue.
Stage 4a
1.Size can be any size > 4cm
2.spread to the skin, jaw-bone, ear-canal or facial nerves.
Stage 4b
1.Size can be any size > 4cm
2.spread to other nearby bones, the base of the skull or the carotid artery.
Lymph nodes spread
-------------------
Stage 0
1. None of the lymph nodes are affected.
Stage1.
1.spread to one lymph node on the same side of the neck as the tumour.
2.Size of affected node <3cm
Stage 2a
1.spread to one lymph node on the same side of the neck as the tumour.
2.Size of the node is between 3-6cm
Stage 2b
1.spread to >one lymph node on the same side of the neck as the tumour.
2.Size < 6cm in size.
Stage 2c
1.spread to one or more lymph nodes on both sides of the neck.
2.Size < 6cm in size.
Stage3
1.Size of lymph nodes > 6cm in size.
Metastases Stages
---------------------
Stage 0
No spread to other parts of the body.
Stage 1
spread to other parts of the body, such as the lungs.
What is the treatment of Salivary Gland Cancer?
------------------------------------------------
Treatment of Salivary cancer can be
1.surgery
2.chemotherapy
3.radiotherapy
The type of treatment given depend on
1.the position of the cancer,
2.the exact type of cancer,
3.the general health of the patient.
Surgery
Surgery is done to remove the salivary gland tumor.
If necessary, surgery is also done to remove any affected lymph nodes in the neck.
Radiotherapy
Radiotherapy can be used to treat salivary gland cancers.
Radiotherapy can be used in conjunction with surgery especially where there is spread to lymph nodes and other parts of the body.
Chemotherapy
Chemotherapy involve the use of anti-cancer drugs to destroy the cancer cells.
It is however not very effective in treating salivary gland cancers and is used only more for the cancer which has spread to the lungs, bones and other parts of the body.
What is the Prognosis of Salivary Gland cancer?
-------------------------------------------------
The prognosis of Salivary cancer is usually fair
1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.
2.Survival rates are best in the slow growing tumors.
How to prevent Salivary Gland cancer?
------------------------------------
There is no way to prevent salivary gland cancer but proper mouth hygience may hlp to prevent infections and chemicals in the mouth from causing mutations in the salivary gland cells.
Smoking should be avoided if possible.
Friday, November 28, 2008
Tuesday, November 25, 2008
A Simple Guide to Atopic Dermatitis
A Simple Guide to Atopic Dermatitis
----------------------------------------
What is Atopic Dermatitis?
-------------------------------------
Atopic Dermatitis is a common skin condition which presents as a chronic, relapsing, and very itchy rash at some point during childhood.
Atopic Dermatitis clears and often disappears with age.
What causes Atopic Dermatitis?
-------------------------------------
The causes of Atopic Dermatitis is unknown.
However some possible causes are:
1.Genetic
Genes play a part in Atopic Dermatitis as the condition runs in families
2.External causes
a.abnormal response of the body’s immune system play a part in the development of Atopic Dermatitis.
b.damage to the skin barrier may lead to dryness and inflammation of the skin
c.irritating substances overacts, causing itching and scratching.
Atopic Dermatitis is not contagious .
Who is at risk of Atopic Dermatitis?
------------------------------------------
Atopic Dermatitis occurs in both children and adults, but usually appears during infancy.
1.Those who are genetically predisposed
2.Those exposed to environmental triggers
a.rough or coarse materials coming into contact with the skin causes itchiness.
b.feeling too hot and/or sweating will cause an outbreak.
c.certain soaps, detergents, disinfectants,
d.contact with juices from fresh fruits and meats,
e.food allergens in childhood such as cow's milk, hen's egg,peanuts, nuts, shellfish
f.dust mites,
g.animal saliva and faeces may trigger itching.
h.Upper respiratory infections (caused by viruses) may also be triggers.
i.Stress can also sometimes aggravate an existing flare-up.
Many people who have Atopic Dermatitis also suffer from Atopic rhinitis and asthma, or have family members who do.
Atopic Dermatitis affects both sexes equally.
Where does Atopic Dermatitis appear?
------------------------------------------
Atopic Dermatitis can occur on just about any part of the body
In infants, Atopic Dermatitis typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck.
In children and adults, Atopic Dermatitis typically occurs on the face, neck, and the insides of the elbows, knees, and ankles.
In some people, Atopic Dermatitis may "bubble up" and ooze.
In others, the condition may appear more scaly, dry, and red.
Chronic scratching usually make the skin worse taking on a leathery texture because the skin thickens (lichenification).
What are the symptoms and signs of Atopic Dermatitis?
-----------------------------------------------------------
Typical features of Atopic Dermatitis are:
1.dry,
2.red,
3.extremely itchy patches on the skin.
4.Oozing of the rash
5.Thickening of the skin
How is Atopic Dermatitis diagnosed?
-------------------------------------------
1.History and appearance of the rash
2.Screening test for food allergy
3.Blood test for specific antibodies to food substances
How can Atopic Dermatitis be treated?
------------------------------------------
Treatment of an Atopic Dermatitis treatment routine is:
1. prevent scratching.
2. application of lotions or creams to keep the skin as moist as possible after bathing (within three minutes is a common recommendation) so that the moisture from the bath is "locked in."
3.Cold compresses applied directly to itchy skin can also help relieve itching.
4.application of nonprescription corticosteroid creams and ointments to reduce inflammation
if the condition persists, worsens, or does not improve satisfactorily.
Hydrocortisone cream and ointment are preferred to prevent side effects such as skin thinning.
5.For severe flare-ups, your doctor may prescribe oral corticosteroids (this treatment is not recommended for long-term use).
6.topical or oral antibiotics may be needed for the skin infection which may affect the dry inflamed skin.
7.sedative antihistamines are sometimes used to reduce the itch
8.Tar treatments can have positive effects; however, tar can be messy.
9.Phototherapy requires special equipment (lights).
10.cyclosporine A, which modifies immune response; however, this is used only in extreme cases because of its association with serious side effects.
How can Atopic Dermatitis be prevented?
---------------------------------------------
Atopic Dermatitis outbreaks can usually be avoided with some simple precautions.
The following suggestions may help to reduce the severity and frequency of flare-ups:
Moisturize frequently
Avoid sudden changes in temperature or humidity
Avoid sweating or overheating
Dress the child in breathable cotton clothes
Reduce stress
Avoid scratchy materials (e.g., wool or other irritants)
Avoid harsh soaps, detergents, and solvents
Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites, and animal dander)
Be aware of any foods that may cause an outbreak and avoid those foods
----------------------------------------
What is Atopic Dermatitis?
-------------------------------------
Atopic Dermatitis is a common skin condition which presents as a chronic, relapsing, and very itchy rash at some point during childhood.
Atopic Dermatitis clears and often disappears with age.
What causes Atopic Dermatitis?
-------------------------------------
The causes of Atopic Dermatitis is unknown.
However some possible causes are:
1.Genetic
Genes play a part in Atopic Dermatitis as the condition runs in families
2.External causes
a.abnormal response of the body’s immune system play a part in the development of Atopic Dermatitis.
b.damage to the skin barrier may lead to dryness and inflammation of the skin
c.irritating substances overacts, causing itching and scratching.
Atopic Dermatitis is not contagious .
Who is at risk of Atopic Dermatitis?
------------------------------------------
Atopic Dermatitis occurs in both children and adults, but usually appears during infancy.
1.Those who are genetically predisposed
2.Those exposed to environmental triggers
a.rough or coarse materials coming into contact with the skin causes itchiness.
b.feeling too hot and/or sweating will cause an outbreak.
c.certain soaps, detergents, disinfectants,
d.contact with juices from fresh fruits and meats,
e.food allergens in childhood such as cow's milk, hen's egg,peanuts, nuts, shellfish
f.dust mites,
g.animal saliva and faeces may trigger itching.
h.Upper respiratory infections (caused by viruses) may also be triggers.
i.Stress can also sometimes aggravate an existing flare-up.
Many people who have Atopic Dermatitis also suffer from Atopic rhinitis and asthma, or have family members who do.
Atopic Dermatitis affects both sexes equally.
Where does Atopic Dermatitis appear?
------------------------------------------
Atopic Dermatitis can occur on just about any part of the body
In infants, Atopic Dermatitis typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck.
In children and adults, Atopic Dermatitis typically occurs on the face, neck, and the insides of the elbows, knees, and ankles.
In some people, Atopic Dermatitis may "bubble up" and ooze.
In others, the condition may appear more scaly, dry, and red.
Chronic scratching usually make the skin worse taking on a leathery texture because the skin thickens (lichenification).
What are the symptoms and signs of Atopic Dermatitis?
-----------------------------------------------------------
Typical features of Atopic Dermatitis are:
1.dry,
2.red,
3.extremely itchy patches on the skin.
4.Oozing of the rash
5.Thickening of the skin
How is Atopic Dermatitis diagnosed?
-------------------------------------------
1.History and appearance of the rash
2.Screening test for food allergy
3.Blood test for specific antibodies to food substances
How can Atopic Dermatitis be treated?
------------------------------------------
Treatment of an Atopic Dermatitis treatment routine is:
1. prevent scratching.
2. application of lotions or creams to keep the skin as moist as possible after bathing (within three minutes is a common recommendation) so that the moisture from the bath is "locked in."
3.Cold compresses applied directly to itchy skin can also help relieve itching.
4.application of nonprescription corticosteroid creams and ointments to reduce inflammation
if the condition persists, worsens, or does not improve satisfactorily.
Hydrocortisone cream and ointment are preferred to prevent side effects such as skin thinning.
5.For severe flare-ups, your doctor may prescribe oral corticosteroids (this treatment is not recommended for long-term use).
6.topical or oral antibiotics may be needed for the skin infection which may affect the dry inflamed skin.
7.sedative antihistamines are sometimes used to reduce the itch
8.Tar treatments can have positive effects; however, tar can be messy.
9.Phototherapy requires special equipment (lights).
10.cyclosporine A, which modifies immune response; however, this is used only in extreme cases because of its association with serious side effects.
How can Atopic Dermatitis be prevented?
---------------------------------------------
Atopic Dermatitis outbreaks can usually be avoided with some simple precautions.
The following suggestions may help to reduce the severity and frequency of flare-ups:
Moisturize frequently
Avoid sudden changes in temperature or humidity
Avoid sweating or overheating
Dress the child in breathable cotton clothes
Reduce stress
Avoid scratchy materials (e.g., wool or other irritants)
Avoid harsh soaps, detergents, and solvents
Avoid environmental factors that trigger allergies (e.g., pollens, molds, mites, and animal dander)
Be aware of any foods that may cause an outbreak and avoid those foods
Wednesday, November 19, 2008
A Simple Guide to Heat Stroke
A Simple Guide to Heat Stroke
----------------------------------------------
What is Heat Stroke?
------------------------------------
Heat Stroke is a disturbance of the heat regulating mechanism of the body which can result in hyperpyrexia (high body temperature), syncope (fainting), convulsions (fits), coma and sometimes death
Who is at risk of Heat Stroke?
----------------------------------------------
1.people staying in hot dry climates (eg. desert)
2.People training under hot temperature (eg. soldiers)
3.During heat waves.
What are the causes of Heat Stroke?
--------------------------------------------------
Most forms of Heat Stroke are due to
genetic conditions:
------------------------
1.Icthyosis
Acquired Heat Stroke
----------------------
1.Body's inability to dissipate body heat
2.Strenuous exercise without sufficient hydration
3.Prolonged exposure to high temperatures especially sunshine especially in desert and heat waves
4.Dehydration and inability to sweat.
5.Medications:
anticholinergics
antidepressants
MAO inhibitors
What are Signs and symptoms of Heat Stroke?
---------------------------------------------
Onset is usually sudden.
Symptoms:
1.feeling of weakness
2.dizziness and nausea
3.headache
4.chest discomfort
5.flushing of face and body
Signs:
1.Fever
2.Flushed skin
3.Muscle twitching
4.cramps
5.tachycardia, raised blood pressure
6.Dilated pupils
7.reduced reflexes
8.Seizures and coma
9.Hyperventilation
10.Cardiac failure
How is the diagnosis of Heat Stroke made?
--------------------------------------------------------
1.History of exposure to high temperature
2.Body temperature
3.Blood electrolytes and acid base
What are the complications of Heat Stroke?
-----------------------------------------------
1.Brain damage
2.Heart damage
3.Kidney damage
What is the treatment of Heat Stroke?
------------------------------------
Heat Stroke is a life threatening emergency.
1.Reduce temperature with ice packs or ice baths
2.Alcohol sponging if ice not available
3.Cooler packs if available
4.Intravenous fluids to correct dehydration and electrolytes
5.Oral fluids and isotonic drinks.
6.Anticonvulsant to prevent seizure or fits
7.Remove drugs which can cause dehydration such as anticholinergics and antidepressants.
What is the prognosis of Heat Stroke ?
------------------------------------------
Prognosis is poor if treatment is delayed.
Treat the condition urgently as it is a life threatening emergency.
What are the Preventive measures taken for Heat Stroke ?
--------------------------------------------------------
Prevention is by
1.frequent drinking of water and
2.avoiding extreme hot temperature.
----------------------------------------------
What is Heat Stroke?
------------------------------------
Heat Stroke is a disturbance of the heat regulating mechanism of the body which can result in hyperpyrexia (high body temperature), syncope (fainting), convulsions (fits), coma and sometimes death
Who is at risk of Heat Stroke?
----------------------------------------------
1.people staying in hot dry climates (eg. desert)
2.People training under hot temperature (eg. soldiers)
3.During heat waves.
What are the causes of Heat Stroke?
--------------------------------------------------
Most forms of Heat Stroke are due to
genetic conditions:
------------------------
1.Icthyosis
Acquired Heat Stroke
----------------------
1.Body's inability to dissipate body heat
2.Strenuous exercise without sufficient hydration
3.Prolonged exposure to high temperatures especially sunshine especially in desert and heat waves
4.Dehydration and inability to sweat.
5.Medications:
anticholinergics
antidepressants
MAO inhibitors
What are Signs and symptoms of Heat Stroke?
---------------------------------------------
Onset is usually sudden.
Symptoms:
1.feeling of weakness
2.dizziness and nausea
3.headache
4.chest discomfort
5.flushing of face and body
Signs:
1.Fever
2.Flushed skin
3.Muscle twitching
4.cramps
5.tachycardia, raised blood pressure
6.Dilated pupils
7.reduced reflexes
8.Seizures and coma
9.Hyperventilation
10.Cardiac failure
How is the diagnosis of Heat Stroke made?
--------------------------------------------------------
1.History of exposure to high temperature
2.Body temperature
3.Blood electrolytes and acid base
What are the complications of Heat Stroke?
-----------------------------------------------
1.Brain damage
2.Heart damage
3.Kidney damage
What is the treatment of Heat Stroke?
------------------------------------
Heat Stroke is a life threatening emergency.
1.Reduce temperature with ice packs or ice baths
2.Alcohol sponging if ice not available
3.Cooler packs if available
4.Intravenous fluids to correct dehydration and electrolytes
5.Oral fluids and isotonic drinks.
6.Anticonvulsant to prevent seizure or fits
7.Remove drugs which can cause dehydration such as anticholinergics and antidepressants.
What is the prognosis of Heat Stroke ?
------------------------------------------
Prognosis is poor if treatment is delayed.
Treat the condition urgently as it is a life threatening emergency.
What are the Preventive measures taken for Heat Stroke ?
--------------------------------------------------------
Prevention is by
1.frequent drinking of water and
2.avoiding extreme hot temperature.
Thursday, November 13, 2008
A Simple Guide to Kidney Cancer
A Simple Guide to Kidney Cancer
----------------------------------------
What is Kidney Cancer?
------------------------------
Kidney Cancer is a malignant disease of the kidney.
What are the causes of Kidney Cancer?
-----------------------------------------
1.Hereditary- hereditary kidney cancer is related to the Von Lindau syndrome.
2.Smoking. cigarettes smoke chemicals has been known to damage the Kidney cells
3.Uncontrolled hypertension-damage to kidney cells may contribute to Kidney cancer
4.Obesity has been found to have some causal effect
5.Age - more common in in 50-70 age group
6.Long term dialysis for kidney failure.
What are the symptoms and signs of Kidney Cancer?
-------------------------------------------------------
Symptoms - non-specific and silent.
In the early stage there is no symptoms.
By the the time the symptoms appeared, the cancer is usually in the advanced stage.
1.painless hematuria or blood in urine
2.pain in the renal flanks
3.Fever
4.weight loss
Signs:
1.tenderness in renal area of backs
2.palpable mass in the side of abdomen
How do you diagnose Kidney Cancer?
----------------------------------------------
Diagnosis can usually be made by :
History
-----------
1.hematuria
2.Renal flank pain
3.Weight loss
Liver function tests
---------------------
may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels) in the absence of liver disease.
Ultrasound or abdominal CT
------------------------------
may be used to identify tumors.
Kidney Biopsy
---------------
biopsy of kidney may be done to determine types of Kidney cancer:
Clear Cell Type: 75%
Papillary type: 20%
Chromophole type: 4%
Others: 1%
What is the treatment of Kidney Cancer?
------------------------------------------------
Treatment of Kidney cancer can be
surgery
chemotherapy
radiotherapy
immunotherapy
biological targeted therapy
depending on the stage of the cancer.
Surgery
--------------
If the cancer is localized within the kidney , then it is surgically resectable and curable.
No treatment after surgery has been proven to prevent recurrence.
Depending on the size of the cancer, the recurrence rate varies from
10% in Stage I
60% in Stage III
Once recurrence occur then the cancer is considered as a Stage IV cancer and therefore incurable.
The aim of treatment then is palliative with emphasis to improve overall survival rates and quality of life.
Immunotherapy
-----------------
High dose immunotherapy such as interleukin may be able to cure less than 5% of the kidney cancer patients.
It is however toxic and potentially life threatening and is used for patients not suitable for surgery.
Low dose immunotherapy such as interferon is better in that it can relieve symptoms and improve quality of life for an average of 3-6 month in 15% of cases treated.
Despite its low dose the side effects can also affects the treatment of the patients such as fever, chills and loss of appetite.
Biological targeted therapy
-------------------------------------
These drugs target the growth of the cancer cells by suppressing the cellular pathways which stimulates the growth of the abnormal tumor blood vessels and the tumor cells .
These treatments have been proven to better in terms of better response and length of the disease control compared to interferon and interleukin.
There has also being an improved overall survival rate with a reduced risk of death by 28%.
Side effects are hypertension, ischemia of heart, fatigue, loss of appetite, diarrhea and loss of weight.
The approved drugs are sorafenib, sumitinib and tensirolimus.
Chemotherapy and radiotherapy
-----------------------------
Chemotherapy and radiotherapy have been found to be ineffective for renal cancer treatment.
What is the Prognosis of Kidney cancer?
-------------------------------------------------
The prognosis of Kidney cancer is poor
1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.
2.Median survival from diagnosis is around 1 year
3.5-year survival is lower than 5%.
4.Kidney cancer has one of the highest mortality of all the cancers.
How to prevent Kidney cancer?
------------------------------------
Avoid smoking
Reduce weight in obese patients
Control high blood pressure to prevent damage to the kidney
Avoid taking toxic substances which may damage or injure the cells of the kidney.
----------------------------------------
What is Kidney Cancer?
------------------------------
Kidney Cancer is a malignant disease of the kidney.
What are the causes of Kidney Cancer?
-----------------------------------------
1.Hereditary- hereditary kidney cancer is related to the Von Lindau syndrome.
2.Smoking. cigarettes smoke chemicals has been known to damage the Kidney cells
3.Uncontrolled hypertension-damage to kidney cells may contribute to Kidney cancer
4.Obesity has been found to have some causal effect
5.Age - more common in in 50-70 age group
6.Long term dialysis for kidney failure.
What are the symptoms and signs of Kidney Cancer?
-------------------------------------------------------
Symptoms - non-specific and silent.
In the early stage there is no symptoms.
By the the time the symptoms appeared, the cancer is usually in the advanced stage.
1.painless hematuria or blood in urine
2.pain in the renal flanks
3.Fever
4.weight loss
Signs:
1.tenderness in renal area of backs
2.palpable mass in the side of abdomen
How do you diagnose Kidney Cancer?
----------------------------------------------
Diagnosis can usually be made by :
History
-----------
1.hematuria
2.Renal flank pain
3.Weight loss
Liver function tests
---------------------
may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels) in the absence of liver disease.
Ultrasound or abdominal CT
------------------------------
may be used to identify tumors.
Kidney Biopsy
---------------
biopsy of kidney may be done to determine types of Kidney cancer:
Clear Cell Type: 75%
Papillary type: 20%
Chromophole type: 4%
Others: 1%
What is the treatment of Kidney Cancer?
------------------------------------------------
Treatment of Kidney cancer can be
surgery
chemotherapy
radiotherapy
immunotherapy
biological targeted therapy
depending on the stage of the cancer.
Surgery
--------------
If the cancer is localized within the kidney , then it is surgically resectable and curable.
No treatment after surgery has been proven to prevent recurrence.
Depending on the size of the cancer, the recurrence rate varies from
10% in Stage I
60% in Stage III
Once recurrence occur then the cancer is considered as a Stage IV cancer and therefore incurable.
The aim of treatment then is palliative with emphasis to improve overall survival rates and quality of life.
Immunotherapy
-----------------
High dose immunotherapy such as interleukin may be able to cure less than 5% of the kidney cancer patients.
It is however toxic and potentially life threatening and is used for patients not suitable for surgery.
Low dose immunotherapy such as interferon is better in that it can relieve symptoms and improve quality of life for an average of 3-6 month in 15% of cases treated.
Despite its low dose the side effects can also affects the treatment of the patients such as fever, chills and loss of appetite.
Biological targeted therapy
-------------------------------------
These drugs target the growth of the cancer cells by suppressing the cellular pathways which stimulates the growth of the abnormal tumor blood vessels and the tumor cells .
These treatments have been proven to better in terms of better response and length of the disease control compared to interferon and interleukin.
There has also being an improved overall survival rate with a reduced risk of death by 28%.
Side effects are hypertension, ischemia of heart, fatigue, loss of appetite, diarrhea and loss of weight.
The approved drugs are sorafenib, sumitinib and tensirolimus.
Chemotherapy and radiotherapy
-----------------------------
Chemotherapy and radiotherapy have been found to be ineffective for renal cancer treatment.
What is the Prognosis of Kidney cancer?
-------------------------------------------------
The prognosis of Kidney cancer is poor
1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.
2.Median survival from diagnosis is around 1 year
3.5-year survival is lower than 5%.
4.Kidney cancer has one of the highest mortality of all the cancers.
How to prevent Kidney cancer?
------------------------------------
Avoid smoking
Reduce weight in obese patients
Control high blood pressure to prevent damage to the kidney
Avoid taking toxic substances which may damage or injure the cells of the kidney.
Tuesday, November 11, 2008
A Simple Guide to Pleural effusion
A Simple Guide to Pleural effusion
-------------------------------------
What is Pleural effusion?
----------------------------
Pleural effusion is excess fluid collection in the pleural space between the parietal and visceral layers of the pleural cavity.
Excessive fluid can limit the expansion of the lungs and cause breathing difficulty.
What the types of Pleural effusions and their causes?
------------------------------------------------------------------
There are 4 types of pleural effusion which can occur in the pleural space:
1.Serous fluid (hydrothorax)
This is essentially passive collection of extracellular fluid with a specific gravity of <1.015 and protein < 2-3g/dl.
It is translucent in color.
It occur as part of :
a.generalized edema
b.left heart failure
c.liver cirrhosis giving rise to hydrothorax
2.Pus (pyothorax or empyema)
This consists of inflammatory or neoplastic fluid with high protein content.
It is usually yellow or orange in color.
There may be cells or pus or bacteria.
Causes include:
a.bacterial and viral infections such as pneumonia
b.tuberculosis
c.intra-abdominal abscess
d.autoimmune diseases like SLE, rheumatoid arthritis
e.neoplasm(cancer of the lung)
3.Blood (hemothorax)
The exudate is typically blood stained.
Causes are:
a.pulmonary embolism and infarction
b.neoplasm especially with secondaries to lungs
4.Chyle (chylothorax)
Here the exudate arise from the leakage of thoracic duct.
It is milky in appearance.
Causes are:
a.Trauma including chest and heart surgery
b.filariasis in the tropics
What are the symptoms and signs of Pleural effusion?
-----------------------------------------------------------
Symptoms:
-----------
1.Breathless
2.Side Chest pain
3.dry cough
Signs:
----------
1.Dullness to percussion
2.Faint or absent breath sounds
3.Decreased movement of the chest
4.Decreased vocal resonance
5.Fremitus
6.pleural friction rub
How do you made a Diagnosis of Pleural effusion?
----------------------------------------------------
Pleural effusion is usually diagnosed on:
1.medical history and physical exam,
2.chest x-ray.
Chest films with the patient lying on their side are more accurate and can show fluid level as low as 50 ml of fluid.
Upright chest films can show fluid level of at least 300ml of pleural effusion
In large effusion there may be tracheal deviation away from the effusion.
3.CT scan of chest showing left sided pleural effusion.
Effusion fluid often settles at the lowest space due to gravity;
4.Pleural tap or thoracentesis.
A needle is inserted through the back of the chest wall in sixth, seventh or eight intercostal space in midaxillary line, into the pleural space.
The fluid may then be evaluated for the following:
Chemical composition including
protein,
lactate dehydrogenase (LDH),
albumin,
amylase,
pH and
glucose
Gram stain and culture to identify possible bacterial infections
Cell count and differential white cell count
Cytology to identify cancer cells
Cytology to identify some infective organisms
Other tests :
lipids,
fungal culture,
viral culture,
specific immunoglobulins
5.Thoracoscopy
If cytology does not show cancer but cancer is still suspected, then a thoracoscopy, or needle biopsy of the pleura may be done to exclude cancer.
What is the Treatment of Pleural Effusion?
------------------------------------------
1.Pleural Aspiration is done for relief of chest discomfortand breathlessness.
The Chest Drainage Device is usually connected to an underwater seal below the level of the chest.
Air or pleural fluid is allowed to escape from the pleural space but nothing is allowed to return to the pleural cavity.
Larger effusions may need insertion of an intercostal drain .
2.Treatment depends on the underlying cause of the pleural effusion.
a.Therapeutic aspiration may be sufficient in some cases of trauma and leakage.
b.Installation of antibiotics( eg.bleomycin, tetracycline/doxycycline) in pleural cavity
c.Installation of chemotherapy drugs for cancer into the pleural cavity.
d.treatment of filariasis cases with anti-parasitic drugs
e.surgical pleurodesis- here the parietal and visceral pleural surfaces are made to adhere to each other to prevent accumulation of fluid.
What is the Prognosis of Pleural Effusion?
------------------------------------------
Recovery of patient from the pleural effusion after appropriate treatment of the underlying disease is the rule.
Recurrence from returning cancer or infections may be common.
-------------------------------------
What is Pleural effusion?
----------------------------
Pleural effusion is excess fluid collection in the pleural space between the parietal and visceral layers of the pleural cavity.
Excessive fluid can limit the expansion of the lungs and cause breathing difficulty.
What the types of Pleural effusions and their causes?
------------------------------------------------------------------
There are 4 types of pleural effusion which can occur in the pleural space:
1.Serous fluid (hydrothorax)
This is essentially passive collection of extracellular fluid with a specific gravity of <1.015 and protein < 2-3g/dl.
It is translucent in color.
It occur as part of :
a.generalized edema
b.left heart failure
c.liver cirrhosis giving rise to hydrothorax
2.Pus (pyothorax or empyema)
This consists of inflammatory or neoplastic fluid with high protein content.
It is usually yellow or orange in color.
There may be cells or pus or bacteria.
Causes include:
a.bacterial and viral infections such as pneumonia
b.tuberculosis
c.intra-abdominal abscess
d.autoimmune diseases like SLE, rheumatoid arthritis
e.neoplasm(cancer of the lung)
3.Blood (hemothorax)
The exudate is typically blood stained.
Causes are:
a.pulmonary embolism and infarction
b.neoplasm especially with secondaries to lungs
4.Chyle (chylothorax)
Here the exudate arise from the leakage of thoracic duct.
It is milky in appearance.
Causes are:
a.Trauma including chest and heart surgery
b.filariasis in the tropics
What are the symptoms and signs of Pleural effusion?
-----------------------------------------------------------
Symptoms:
-----------
1.Breathless
2.Side Chest pain
3.dry cough
Signs:
----------
1.Dullness to percussion
2.Faint or absent breath sounds
3.Decreased movement of the chest
4.Decreased vocal resonance
5.Fremitus
6.pleural friction rub
How do you made a Diagnosis of Pleural effusion?
----------------------------------------------------
Pleural effusion is usually diagnosed on:
1.medical history and physical exam,
2.chest x-ray.
Chest films with the patient lying on their side are more accurate and can show fluid level as low as 50 ml of fluid.
Upright chest films can show fluid level of at least 300ml of pleural effusion
In large effusion there may be tracheal deviation away from the effusion.
3.CT scan of chest showing left sided pleural effusion.
Effusion fluid often settles at the lowest space due to gravity;
4.Pleural tap or thoracentesis.
A needle is inserted through the back of the chest wall in sixth, seventh or eight intercostal space in midaxillary line, into the pleural space.
The fluid may then be evaluated for the following:
Chemical composition including
protein,
lactate dehydrogenase (LDH),
albumin,
amylase,
pH and
glucose
Gram stain and culture to identify possible bacterial infections
Cell count and differential white cell count
Cytology to identify cancer cells
Cytology to identify some infective organisms
Other tests :
lipids,
fungal culture,
viral culture,
specific immunoglobulins
5.Thoracoscopy
If cytology does not show cancer but cancer is still suspected, then a thoracoscopy, or needle biopsy of the pleura may be done to exclude cancer.
What is the Treatment of Pleural Effusion?
------------------------------------------
1.Pleural Aspiration is done for relief of chest discomfortand breathlessness.
The Chest Drainage Device is usually connected to an underwater seal below the level of the chest.
Air or pleural fluid is allowed to escape from the pleural space but nothing is allowed to return to the pleural cavity.
Larger effusions may need insertion of an intercostal drain .
2.Treatment depends on the underlying cause of the pleural effusion.
a.Therapeutic aspiration may be sufficient in some cases of trauma and leakage.
b.Installation of antibiotics( eg.bleomycin, tetracycline/doxycycline) in pleural cavity
c.Installation of chemotherapy drugs for cancer into the pleural cavity.
d.treatment of filariasis cases with anti-parasitic drugs
e.surgical pleurodesis- here the parietal and visceral pleural surfaces are made to adhere to each other to prevent accumulation of fluid.
What is the Prognosis of Pleural Effusion?
------------------------------------------
Recovery of patient from the pleural effusion after appropriate treatment of the underlying disease is the rule.
Recurrence from returning cancer or infections may be common.
Friday, November 7, 2008
A Simple Guide to Fibromyalgia II
A Simple Guide to Fibromyalgia II
----------------------------------
What are the investigations needed in assessment of Fibromyalgia?
-------------------------------------------------------------------------------------
These criteria for diagnosis of Fibromyalgia:
1.history of widespread pain lasting more than three months-affecting all four quadrants of the body, i.e., both sides, and above and below the waist.
2.Tender points-there are 18 designated tender or trigger points
During diagnosis, four kilograms-force is exerted at each of the 18 points
The patient must feel pain at 11 or more of these points for fibromyalgia to be diagnosed.
3.fibromyalgia patients show sensitivity to pressure, heat, cold, electrical and chemical stimulation.
4.hyperactivity of the sympathetic nervous system
lower heart rate variability,
sympathetic hyperactivity,
5.laboratory blood testing appears normal
6.Cerebrospinal fluid abnormalities
cerebrospinal fluid levels of substance P, a putative nociceptive neurotransmitter, is raised.
Metabolites for monoamine neurotransmitters serotonin, norepinephrine, and dopamine are lower,
Nerve growth factor, a substance known to participate in structural and functional plasticity of nociceptive pathways within the dorsal root ganglia and spinal cord, is higher
Excitatory amino acid release within cerebrospinal fluid is higher
7.Brain imaging studies
Abnormal brain involvement in fibromyalgia has been provided via functional neuroimaging
decreased blood flow within the thalamus and elements of the basal ganglia and mid-brain.
Hippocampal disruption is shown by reduced brain metabolite ratios
Normal age-related brain atrophy occur with areas of reduced gray matter located in the cingulate cortex, insula and parahippocampal gyrus.
Dopamine synthesis in the brainstem is reduced.
What is the treatment for Fibromyalgia?
-------------------------------------------
There is no cure for fibromyalgia,
B.Medical treatment:
-------------------------
1.corticosteroid seems to help especially to those with adrenal dysfunction and low blood pressure.
Injection of steroids with local anethestics at trigger points or nodules can help relieve pain.
2.Analgesics are able to relieve pain:
a.NSAID medications
b.COX-2 inhibitors,
c.tramadol
3.Muscle relaxants
Muscle relaxants, such as cyclobenzaprine or tizanidine to treat the muscle pain associated with the disorder.
4.Tricyclic antidepressants
Low doses of sedating antidepressants (e.g. amitriptyline and trazodone) help to reduce the sleep disturbances associated with fibromyalgia
Amitriptyline is often favoured as it can also have the effect of providing relief from neuralgenic or neuropathic pain.
5.Anti-seizure medication
Anti-seizure drugs are also sometimes used, such as gabapentin and pregabalin
Pregabalin, originally used for the nerve pain suffered by diabetics, has been approved for treatment of fibromyalgia.
6.Dopamine agonists
Dopamine agonists (e.g. pramipexole (Mirapex) and ropinirole(ReQuip)) have been studied for use in the treatment of fibromyalgia with good results
7.Combination therapy
A combination of amitriptyline and fluoxetine appeared to be more effective in relieving pain.
8.Central nervous system stimulants
Cognitive dysfunction in fibromyalgia may be treated with low doses of central nervous system (CNS) stimulants such as modafinil, adderall or methylphenidate.
Stimulants may be habit forming and can have other serious side effects
9. Cannabis and cannabinoids
Cannabis is used therapeutically to treat symptoms of the disorder.
Cannabinoid agonists can also help in the treatment of chronic pain conditions
B.Non-drug treatment
------------------------
1. regular floatation tank sessions substantially improves sleep patterns leaving users more optimistic and with reduced nervousness, tension and pain.
Relaxing in a weightless state in the silent warmth of a floatation tank activates the body's own system for recuperation and healing
2..Whirlpool therapy is very beneficial.
C.Psychological therapies
------------------------------
1.Cognitive behavioral therapy has help to improve quality of life
2.Neurofeedback has also shown to provide temporary and long-term relief
3.Biofeedback and self-management techniques such as pacing and stress management can help ,
D. Healthy lifestyle
--------------------------
1. Stop smoking in smokers.
2. Reduce weight in the obese
3. Exercise to improve blood flow can improve symptoms(sleep , pain and fatigue)
4..heat to painful areas.
5. physical therapy, massage, or acupuncture
6. reduce intake of monosodium glutamate
E Surgical treatment:
---------------------------
Surgery is only indicated in severe cases with limb-threatening ischemia or lifestyle-limiting claudication.
F.Investigational treatments
------------------------------
a.Milnacipran, a serotonin-norepinephrine reuptake inhibitor (SNRI) has help patients in Europe.
b.Dextromethorphan is an over-the-counter cough medicine with activity as an NMDA receptor antagonist.
What is the prognosis for Fibromyalgia?
------------------------------------------------------
Fibromyalgia is not degenerative or fatal,
the chronic pain associated with fibromyalgia is pervasive and persistent.
Fibromyalgia can severely curtail social activity and recreation,
Some with fibromyalgia are unable to maintain full-time employment.
It rarely affects activities of daily living.
How can Fibromyalgia be prevented?
-----------------------------------------------------
1.Stop smoking
2.Reduce weight
3.Exercise
4.Avoid monosodium glutamate in diet
5.Avoid stress and depression
6.Live a healthy lifestyle
----------------------------------
What are the investigations needed in assessment of Fibromyalgia?
-------------------------------------------------------------------------------------
These criteria for diagnosis of Fibromyalgia:
1.history of widespread pain lasting more than three months-affecting all four quadrants of the body, i.e., both sides, and above and below the waist.
2.Tender points-there are 18 designated tender or trigger points
During diagnosis, four kilograms-force is exerted at each of the 18 points
The patient must feel pain at 11 or more of these points for fibromyalgia to be diagnosed.
3.fibromyalgia patients show sensitivity to pressure, heat, cold, electrical and chemical stimulation.
4.hyperactivity of the sympathetic nervous system
lower heart rate variability,
sympathetic hyperactivity,
5.laboratory blood testing appears normal
6.Cerebrospinal fluid abnormalities
cerebrospinal fluid levels of substance P, a putative nociceptive neurotransmitter, is raised.
Metabolites for monoamine neurotransmitters serotonin, norepinephrine, and dopamine are lower,
Nerve growth factor, a substance known to participate in structural and functional plasticity of nociceptive pathways within the dorsal root ganglia and spinal cord, is higher
Excitatory amino acid release within cerebrospinal fluid is higher
7.Brain imaging studies
Abnormal brain involvement in fibromyalgia has been provided via functional neuroimaging
decreased blood flow within the thalamus and elements of the basal ganglia and mid-brain.
Hippocampal disruption is shown by reduced brain metabolite ratios
Normal age-related brain atrophy occur with areas of reduced gray matter located in the cingulate cortex, insula and parahippocampal gyrus.
Dopamine synthesis in the brainstem is reduced.
What is the treatment for Fibromyalgia?
-------------------------------------------
There is no cure for fibromyalgia,
B.Medical treatment:
-------------------------
1.corticosteroid seems to help especially to those with adrenal dysfunction and low blood pressure.
Injection of steroids with local anethestics at trigger points or nodules can help relieve pain.
2.Analgesics are able to relieve pain:
a.NSAID medications
b.COX-2 inhibitors,
c.tramadol
3.Muscle relaxants
Muscle relaxants, such as cyclobenzaprine or tizanidine to treat the muscle pain associated with the disorder.
4.Tricyclic antidepressants
Low doses of sedating antidepressants (e.g. amitriptyline and trazodone) help to reduce the sleep disturbances associated with fibromyalgia
Amitriptyline is often favoured as it can also have the effect of providing relief from neuralgenic or neuropathic pain.
5.Anti-seizure medication
Anti-seizure drugs are also sometimes used, such as gabapentin and pregabalin
Pregabalin, originally used for the nerve pain suffered by diabetics, has been approved for treatment of fibromyalgia.
6.Dopamine agonists
Dopamine agonists (e.g. pramipexole (Mirapex) and ropinirole(ReQuip)) have been studied for use in the treatment of fibromyalgia with good results
7.Combination therapy
A combination of amitriptyline and fluoxetine appeared to be more effective in relieving pain.
8.Central nervous system stimulants
Cognitive dysfunction in fibromyalgia may be treated with low doses of central nervous system (CNS) stimulants such as modafinil, adderall or methylphenidate.
Stimulants may be habit forming and can have other serious side effects
9. Cannabis and cannabinoids
Cannabis is used therapeutically to treat symptoms of the disorder.
Cannabinoid agonists can also help in the treatment of chronic pain conditions
B.Non-drug treatment
------------------------
1. regular floatation tank sessions substantially improves sleep patterns leaving users more optimistic and with reduced nervousness, tension and pain.
Relaxing in a weightless state in the silent warmth of a floatation tank activates the body's own system for recuperation and healing
2..Whirlpool therapy is very beneficial.
C.Psychological therapies
------------------------------
1.Cognitive behavioral therapy has help to improve quality of life
2.Neurofeedback has also shown to provide temporary and long-term relief
3.Biofeedback and self-management techniques such as pacing and stress management can help ,
D. Healthy lifestyle
--------------------------
1. Stop smoking in smokers.
2. Reduce weight in the obese
3. Exercise to improve blood flow can improve symptoms(sleep , pain and fatigue)
4..heat to painful areas.
5. physical therapy, massage, or acupuncture
6. reduce intake of monosodium glutamate
E Surgical treatment:
---------------------------
Surgery is only indicated in severe cases with limb-threatening ischemia or lifestyle-limiting claudication.
F.Investigational treatments
------------------------------
a.Milnacipran, a serotonin-norepinephrine reuptake inhibitor (SNRI) has help patients in Europe.
b.Dextromethorphan is an over-the-counter cough medicine with activity as an NMDA receptor antagonist.
What is the prognosis for Fibromyalgia?
------------------------------------------------------
Fibromyalgia is not degenerative or fatal,
the chronic pain associated with fibromyalgia is pervasive and persistent.
Fibromyalgia can severely curtail social activity and recreation,
Some with fibromyalgia are unable to maintain full-time employment.
It rarely affects activities of daily living.
How can Fibromyalgia be prevented?
-----------------------------------------------------
1.Stop smoking
2.Reduce weight
3.Exercise
4.Avoid monosodium glutamate in diet
5.Avoid stress and depression
6.Live a healthy lifestyle
A Simple Guide to Fibromyalgia I
A Simple Guide to Fibromyalgia I
-----------------------------------------------------
What are Fibromyalgia?
---------------------------------------------
Fibromyalgia is a common nonspecific group of syndrome characterised by diffuse chronic pain, felt in and over muscle masses with focal trigger points or tender points in muscles, joints, tendons and ligaments.
Who is at risk of Fibromyalgia?
-----------------------------------------------------------------
1.genetically predisposed.
2.more females than males, with a ratio of 9:1
3.individuals between the ages of 20 and 50
4.Increased psychosocial stress
5.Excessive physical exertion
6.Lack of slow-wave sleep
7.Changes in humidity and barometric pressure
8.Lack of normal energy
What are the causes of Fibromyalgia?
-------------------------------------------------------
The exact cause of fibromyalgia is unknown.
Fibromyalgia is almost always a combination of several disorders:
1.Genetic predisposition
There is a polygenic predisposition to Fibromyalgia with high aggregation of Fibromyalgia in families
2. Stress
Stress can affect cortisol levels in the body leading to widespread pain.
3.Sleep disturbance
People with fibromyalgia has short wave sleep that do not reach stage four sleep .
4.Dopamine abnormality
Dopamine is a catecholamine neurotransmitter which can cause schizophrenia, Parkinson's disease and addiction.
Abnormality in dopamine cause increased pain perception and analgesia.
5.Serotonin
Serotonin is a neurotransmitter important in regulating sleep patterns, mood, feelings of well-being, concentration and descending inhibition of pain.
Poor uptake of serotonin can cause pain and poor sleep.
6. Human growth hormone
Stress-induced problems in the hypothalamus may lead to reduced sleep and reduced production of human growth hormone during slow-wave sleep.
People with fibromyalgia has low levels of HGH.
Treatment with exogenous HGH or growth hormone secretagogue reduces fibromyalgia related pain and restores slow wave sleep.
7.Chronic fatigue syndrome patients has been known to develop fibromyalgia between onset and the second year of illness
8.Irritable bowel syndrome is found at high frequency in fibromyalgia.
9.Deposition disease
Fibromyalgia is an inherited disorder which cause gradual phosphate build-up in cells but can be accelerated by trauma or illness.
10.Other causes:
a.viral causes such as the Epstein-Barr Virus,
b.disease affecting the hypothalamus gland,
c.immune response to intestinal bacteria
d.neurotransmitter disruptions in the central nervous system
What are the symptoms of Fibromyalgia?
----------------------------------------------
Symptoms can have a slow onset
Many patients have mild symptoms beginning in childhood.
Pain:
1.Onset of pain may be sudden
2.chronic, widespread pain and tenderness to light touch
3.muscle aches(especially lower back, gluteal, neck, chest wall)
4.prolonged muscle spasms,
5.nerve pain,
6.needle-like tingling of the skin,
Fatigue:
7.moderate to severe fatigue,
8.weakness in the limbs,
Psychosomatic disturbances:
9.functional bowel disorders
10.chronic sleep disturbances.
11.cognitive dysfunction
12.impaired concentration,
13.impaired speed of performance,
14.inability to multi-task,
15.diminished attention span
16.anxiety and depressive symptoms
Eye:
17.eye pain,
18.sensitivity to light
19.blurred vision,
20.fluctuating visual clarity,
-----------------------------------------------------
What are Fibromyalgia?
---------------------------------------------
Fibromyalgia is a common nonspecific group of syndrome characterised by diffuse chronic pain, felt in and over muscle masses with focal trigger points or tender points in muscles, joints, tendons and ligaments.
Who is at risk of Fibromyalgia?
-----------------------------------------------------------------
1.genetically predisposed.
2.more females than males, with a ratio of 9:1
3.individuals between the ages of 20 and 50
4.Increased psychosocial stress
5.Excessive physical exertion
6.Lack of slow-wave sleep
7.Changes in humidity and barometric pressure
8.Lack of normal energy
What are the causes of Fibromyalgia?
-------------------------------------------------------
The exact cause of fibromyalgia is unknown.
Fibromyalgia is almost always a combination of several disorders:
1.Genetic predisposition
There is a polygenic predisposition to Fibromyalgia with high aggregation of Fibromyalgia in families
2. Stress
Stress can affect cortisol levels in the body leading to widespread pain.
3.Sleep disturbance
People with fibromyalgia has short wave sleep that do not reach stage four sleep .
4.Dopamine abnormality
Dopamine is a catecholamine neurotransmitter which can cause schizophrenia, Parkinson's disease and addiction.
Abnormality in dopamine cause increased pain perception and analgesia.
5.Serotonin
Serotonin is a neurotransmitter important in regulating sleep patterns, mood, feelings of well-being, concentration and descending inhibition of pain.
Poor uptake of serotonin can cause pain and poor sleep.
6. Human growth hormone
Stress-induced problems in the hypothalamus may lead to reduced sleep and reduced production of human growth hormone during slow-wave sleep.
People with fibromyalgia has low levels of HGH.
Treatment with exogenous HGH or growth hormone secretagogue reduces fibromyalgia related pain and restores slow wave sleep.
7.Chronic fatigue syndrome patients has been known to develop fibromyalgia between onset and the second year of illness
8.Irritable bowel syndrome is found at high frequency in fibromyalgia.
9.Deposition disease
Fibromyalgia is an inherited disorder which cause gradual phosphate build-up in cells but can be accelerated by trauma or illness.
10.Other causes:
a.viral causes such as the Epstein-Barr Virus,
b.disease affecting the hypothalamus gland,
c.immune response to intestinal bacteria
d.neurotransmitter disruptions in the central nervous system
What are the symptoms of Fibromyalgia?
----------------------------------------------
Symptoms can have a slow onset
Many patients have mild symptoms beginning in childhood.
Pain:
1.Onset of pain may be sudden
2.chronic, widespread pain and tenderness to light touch
3.muscle aches(especially lower back, gluteal, neck, chest wall)
4.prolonged muscle spasms,
5.nerve pain,
6.needle-like tingling of the skin,
Fatigue:
7.moderate to severe fatigue,
8.weakness in the limbs,
Psychosomatic disturbances:
9.functional bowel disorders
10.chronic sleep disturbances.
11.cognitive dysfunction
12.impaired concentration,
13.impaired speed of performance,
14.inability to multi-task,
15.diminished attention span
16.anxiety and depressive symptoms
Eye:
17.eye pain,
18.sensitivity to light
19.blurred vision,
20.fluctuating visual clarity,
Sunday, November 2, 2008
A Simple Guide to Pericarditis
A Simple Guide to Pericarditis
---------------------------------------------
What is Pericarditis?
---------------------------------
Pericarditis is a heart condition where there is inflammation of the pericardiac sac surrounding the heart and roots of the great vessels coming from the heart.
Who is at risk of Pericarditis?
-----------------------------------------
1.most common of all pericardial condition
2.more common in females than males
What is the cause of Pericarditis?
---------------------------------------------------
Pericarditis is caused by:
A.Infections
---------
1.Bacterial- streptococcus
2.Viral - adenovirus, enterovirus, cytomegalovirus, influenza virus, hepatitis B virus, and herpes simplex virus
3.mycotic
4.tuberculosis
B.Non- infection:
--------------------
1.Autoimmune diseases include:
a.Rheumatic fever
b.rheumatoid arthritis
c.systemic lupus erythrematosis
d.drug induced
2.Neoplastic
3.Uremia
4.myxedema
5.trauma
6.myocardial infarction
7.myocarditis,
8.dissecting aortic aneurysm,
9.radiation
What are the Symptoms of Pericarditis?
------------------------------------------------------------
Symptoms:
---------------------
1.Chest pain of sudden onset in the anterior chest
2.Pain is sharp and becomes worse with inspiration due to pleural inflammation.
3.Pain is relieved with sitting up and leaning forward and become worse on lying down
4.Pericardial rub is a diagnostic sign of acute pericarditis.
Absence of this sign does not mean that it is not pericarditis.
This rub is best heard at the left sternal border as a squeaky or scratching sound using the diaphragm of the stethoscope.
The pericardial rub is due to the friction generated by the two inflamed layers of the pericardium.
5.Fever may be present.
How is diagnosis of Pericarditis made?
-------------------------------------------------------
1. History and physical examination
chest pain, Pericarditis episodes
2.Blood tests:
a. A Complete Blood Count may show an elevated white count.
b. serum C-reactive protein may be elevated.
c.increase in serum creatine kinase MB and cardiac troponin I ( both of which are also markers for myocardial injury.
3.Electrocardiogram
ECG changes in acute pericarditis show inflammation of the epicardium (the layer directly surrounding the heart).
Typical ECG changes in acute pericarditis are:
stage 1 -- diffuse, positive, ST elevations with reciprocal ST depression in aVR and V1.
stage 2 -- normalization of ST and PR deviations
stage 3 -- diffuse T wave inversions
stage 4 -- ECG becomes normal OR T waves may be indefinitely inverted
4.Echocardiography
Usually normal in acute pericarditis.
It can reveal pericardial effusion, the presence of which supports the diagnosis.
5. Chest X-ray
Chest X-ray is generally only performed if a pulmonary cause of Pericarditis is suggested.
It is normal in acute pericarditis, but can reveal cardiomegaly (enlarged heart) if the pericardial effusion is more than 200 mL.
6.Cardiac catherisation -Coronary angiography in those patients should indicated normal vascular perfusion.
7. Pericardial fluid examination and biopsy- rarely done except for confirmation of neoplasm and tuberculosis.
What is the Complications of Pericarditis?
------------------------------------------------------
Cardiac tamponade is accumulation of fluid in the pericardial space to cause blockage to the inflow of blood to the heart.
Cardiac tamponade is an emergency and must be treated urgently.
What is the Treatment of Pericarditis?
------------------------------------------------------
Patients with uncomplicated acute pericarditis can be treated by a heart specialist on outpatient basis.
Those with high risk factors will need to be admitted to hospital:
1.sudden onset
2.high fever
3.leukocytosis
4.presence of cardiac tamponade
5.large pericardial effusion (echo-free space > 20 mm) resistant to NSAID treatment
6.low immunity
7.oral anticoagulation therapy
8.acute trauma
Remove the pericardial fluid
----------------------------
Pericardiocentesis is done to remove the fluid in a pericardial effusion through a needle.
It is performed under the following conditions:
moderate or severe cardiac tamponade
diagnosis of suspected purulent, tuberculosis, or neoplastic pericarditis
persistent pericardial effusion
viral or idiopathic pericarditis.
Treatment of underlying cause
--------------------------------------------
a.In idiopathic or viral pericarditis, NSAID(ibuprofen) is the mainstay treatment.
Goal of therapy is to reduce pain and inflammation.
Failure to respond to NSAIDs within one week (indicated by persistence of fever, worsening of condition, new pericardial effusion, or continuing chest pain) indicate the cause is not viral or idiopathic.
Colchicine can be used alone or in conjunction with NSAIDs in prevention of recurrent pericarditis and treatment of recurrent pericarditis.
b.Anti tuberculous treatment must be given to Tuberculous patients.
c.Chemotherapy is given for cancer patients.
d.Autoimmune disease:
Systemic corticosteroids are usually reserved for those with autoimmune disease.
Surgery
---------------------
Pericardial window or removal of pericardium is done especially when there is possiblity of cardiac tamponade.
Proteolytic enzymes:
--------------------------
Proteolytic enzymes is used to dissolve the fluid in the pericardial sac.
What is the prognosis of Pericarditis?
---------------------------------------------------
Most cases of patients have recurrent pericarditis and become chronic after acute episode.
Response to surgery may not be very satisfactory especially with long standing chronic pericarditis.
What are the prevention measures for Pericarditis?
--------------------------------------------------------------
Rest and a healthy lifestyle may help to prevent an onset or recurrence of Pericarditis.
Avoid stress and anxiety.
---------------------------------------------
What is Pericarditis?
---------------------------------
Pericarditis is a heart condition where there is inflammation of the pericardiac sac surrounding the heart and roots of the great vessels coming from the heart.
Who is at risk of Pericarditis?
-----------------------------------------
1.most common of all pericardial condition
2.more common in females than males
What is the cause of Pericarditis?
---------------------------------------------------
Pericarditis is caused by:
A.Infections
---------
1.Bacterial- streptococcus
2.Viral - adenovirus, enterovirus, cytomegalovirus, influenza virus, hepatitis B virus, and herpes simplex virus
3.mycotic
4.tuberculosis
B.Non- infection:
--------------------
1.Autoimmune diseases include:
a.Rheumatic fever
b.rheumatoid arthritis
c.systemic lupus erythrematosis
d.drug induced
2.Neoplastic
3.Uremia
4.myxedema
5.trauma
6.myocardial infarction
7.myocarditis,
8.dissecting aortic aneurysm,
9.radiation
What are the Symptoms of Pericarditis?
------------------------------------------------------------
Symptoms:
---------------------
1.Chest pain of sudden onset in the anterior chest
2.Pain is sharp and becomes worse with inspiration due to pleural inflammation.
3.Pain is relieved with sitting up and leaning forward and become worse on lying down
4.Pericardial rub is a diagnostic sign of acute pericarditis.
Absence of this sign does not mean that it is not pericarditis.
This rub is best heard at the left sternal border as a squeaky or scratching sound using the diaphragm of the stethoscope.
The pericardial rub is due to the friction generated by the two inflamed layers of the pericardium.
5.Fever may be present.
How is diagnosis of Pericarditis made?
-------------------------------------------------------
1. History and physical examination
chest pain, Pericarditis episodes
2.Blood tests:
a. A Complete Blood Count may show an elevated white count.
b. serum C-reactive protein may be elevated.
c.increase in serum creatine kinase MB and cardiac troponin I ( both of which are also markers for myocardial injury.
3.Electrocardiogram
ECG changes in acute pericarditis show inflammation of the epicardium (the layer directly surrounding the heart).
Typical ECG changes in acute pericarditis are:
stage 1 -- diffuse, positive, ST elevations with reciprocal ST depression in aVR and V1.
stage 2 -- normalization of ST and PR deviations
stage 3 -- diffuse T wave inversions
stage 4 -- ECG becomes normal OR T waves may be indefinitely inverted
4.Echocardiography
Usually normal in acute pericarditis.
It can reveal pericardial effusion, the presence of which supports the diagnosis.
5. Chest X-ray
Chest X-ray is generally only performed if a pulmonary cause of Pericarditis is suggested.
It is normal in acute pericarditis, but can reveal cardiomegaly (enlarged heart) if the pericardial effusion is more than 200 mL.
6.Cardiac catherisation -Coronary angiography in those patients should indicated normal vascular perfusion.
7. Pericardial fluid examination and biopsy- rarely done except for confirmation of neoplasm and tuberculosis.
What is the Complications of Pericarditis?
------------------------------------------------------
Cardiac tamponade is accumulation of fluid in the pericardial space to cause blockage to the inflow of blood to the heart.
Cardiac tamponade is an emergency and must be treated urgently.
What is the Treatment of Pericarditis?
------------------------------------------------------
Patients with uncomplicated acute pericarditis can be treated by a heart specialist on outpatient basis.
Those with high risk factors will need to be admitted to hospital:
1.sudden onset
2.high fever
3.leukocytosis
4.presence of cardiac tamponade
5.large pericardial effusion (echo-free space > 20 mm) resistant to NSAID treatment
6.low immunity
7.oral anticoagulation therapy
8.acute trauma
Remove the pericardial fluid
----------------------------
Pericardiocentesis is done to remove the fluid in a pericardial effusion through a needle.
It is performed under the following conditions:
moderate or severe cardiac tamponade
diagnosis of suspected purulent, tuberculosis, or neoplastic pericarditis
persistent pericardial effusion
viral or idiopathic pericarditis.
Treatment of underlying cause
--------------------------------------------
a.In idiopathic or viral pericarditis, NSAID(ibuprofen) is the mainstay treatment.
Goal of therapy is to reduce pain and inflammation.
Failure to respond to NSAIDs within one week (indicated by persistence of fever, worsening of condition, new pericardial effusion, or continuing chest pain) indicate the cause is not viral or idiopathic.
Colchicine can be used alone or in conjunction with NSAIDs in prevention of recurrent pericarditis and treatment of recurrent pericarditis.
b.Anti tuberculous treatment must be given to Tuberculous patients.
c.Chemotherapy is given for cancer patients.
d.Autoimmune disease:
Systemic corticosteroids are usually reserved for those with autoimmune disease.
Surgery
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Pericardial window or removal of pericardium is done especially when there is possiblity of cardiac tamponade.
Proteolytic enzymes:
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Proteolytic enzymes is used to dissolve the fluid in the pericardial sac.
What is the prognosis of Pericarditis?
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Most cases of patients have recurrent pericarditis and become chronic after acute episode.
Response to surgery may not be very satisfactory especially with long standing chronic pericarditis.
What are the prevention measures for Pericarditis?
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Rest and a healthy lifestyle may help to prevent an onset or recurrence of Pericarditis.
Avoid stress and anxiety.
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