A Simple Guide to Salivary Gland Cancer

A Simple Guide to Salivary Gland Cancer
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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.

A Simple Guide to Gynecomastia

A Simple Guide to Gynecomastia
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What is Gynecomastia?
----------------------------


Gynecomastia is unilateral or bilateral enlargement in the glandular tissue of the breast in males.


What causes Gynecomastia?
---------------------------------


The causes of gynecomastia is not completely clear.

It is believed to be caused by an imbalance of sex hormones especially during puberty.

A.Hormonal:
----------------------

1.In male babies 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 boys the development of breasts is due to the increased ratio of free estradiol to free testesterone.

In most cases the breasts may disappear after 1 year.

3.Some cases of Gynecomastia may be due to ingestion of female hormones injected into chicken and ducks

B.Genetic
---------------------

Some cases of male hypogonadism causing reduced testosterone.

C.Liver cirrhosis
---------------------

Failure of metabolism of circulating estrogens can increase the female hormones in the adults and cause Gynecomastia

D.Medications:
---------------------
a.Spironolactone

b.digoxin

c.cimetidine

d.maxolon

E.Tumors
----------------
Testicular or Pituitary Tumors may cause increased estrogen and reduced testesterone and hence increase the production of breasts.


What are the symptoms of Gynecomastia?
---------------------------------------------------


The Symptoms of Gynecomastia are:

1.Pain usually present in all cases except in babies

2.swelling of the breasts or the nipple area in males

Signs:

1.redness of the breast

2.swelling of the breast tissue

3.Local tenderness of swollen area


How is diagnosis of Gynecomastia confirmed?
----------------------------------------------


1. clinical features

2. Endocrine blood tests including HCG levels

3. Liver function tests

4.Ultrasound scan of the breasts


What is the treatment of Gynecomastia?
------------------------------------


1.treat underlying cause

2.Medications causing Gynecomastia should be stopped.

3.cosmetic surgery-liposuction, gland excision, reduction mammoplasty,

4.Tamoxifen if necessary

5.Radiation therapy may prevent gynecomastia in patients with prostate cancer prior to estrogen therapy.


What is the Prognosis of Gynecomastia?
------------------------------------


Most cases has good prognosis.

Aldolescent cases usually regress spontaneously.

A Simple Guide to Acoustic neuroma

A Simple Guide to Acoustic neuroma
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What are Acoustic neuroma ?
------------------------------------------------

Acoustic neuroma is a neurofibroma of the eight nerve.


Who are at risk of Acoustic neuroma?
-------------------------------------

1.Both sexes are equally affected.

2.Acoustic neuroma occurs more in the 50- 60 age group.

3.It forms 5-10% of the intracranial tumors in adults.


What are the different types of Acoustic neuroma?
--------------------------------------------------------

1.Neurofibroma I -
a. Unilateral acoustic neuroma usually
Bilateral acoustic neuromas are not common.

b. occurs in adult life,

c. the tumor involve the 8th nerve,

d. can involve any other cranial nerve or the spinal root.

e.Incidence is usually 90-95%

2.Neurofibroma II -
a. bilateral acoustic neuromas are common

b. occurs before the age of 21.

c. affects the entire nerve

d. autosomal dominant inheritance.

e. Incidence is about 5 to 10%.


What are the Causes of Acoustic neuroma?
------------------------------------------------------

Acoustic neuroma in the adult begins in the Schwann's cells of the vestibular portion of the 8th nerve inside the internal auditory canal.

The tumor grows slowly and can extend into the posterior fossa to occupy the space between the cerebellum and the pons.

Because of its location, it can also compress the 5th, 7th, and less often, the 9th and 10th cranial nerves.

If it grows larger, it may also compress the pons and lateral medulla of the brain, causing blockage of the cerebrospinal fluid and increased intracranial pressure.


What are the symptoms and signs of Acoustic neuroma?
-------------------------------------------------------

Symptoms:
--------------
1.unilateral hearing loss

2.tinnitus with unilateral high-pitched ringing sound

3.loss of sense of balance

4.vertigo

5.nausea and vomiting

6.altered gait

7.pressure in the ear

8.rarely headache and altered consciousness.

Signs:
-------------

1.unilateral facial weakness.

2.sensory impairment of the nerve

3.impairment of glandular secretions

4.loss of taste

5.loss of sensation in one side of the face and mouth

6.rarely altered gag or swallowing reflexes.


How are diagnosis of Acoustic neuroma made?
------------------------------------------------------------

1.Contrast-enhanced CT will detect almost all acoustic neuromas that are greater than 2.0 cm in diameter

2.MRI with gadolinium enhancement may show even smaller tumors

3.Audiology and vestibular tests are done to check for Nerve versus conduction hearing loss.


What is the Treatment of Acoustic neuroma?
-------------------------------------------

Treatment of acoustic neuroma is usually by surgery and radiotherapy.

Conservative treatment
--------------------------

In some cases because the neuroma grow so slowly, the tumor is monitored by annual MRI to see its growth.

This method is common among patients over 70 years old.

In rare cases, acoustical neuroma have been known to disappear spontaneously.

Acoustic neuroma may result in gradual hearing loss and tinnitus.


Surgery
-----------------

Surgical removal of acoustic neuroma usually involve microsurgery to remove the tumor.

The superior and inferior vestibular nerves are removed at surgery.

This effectively restores balance in the patient.

Radiation treatment
-----------------------

Radiotherapy using gamma knife radiosurgery or fractionated stereotactic radiotherapy does not remove the tumor but is able to slow or stop its growth.


What is the Prognosis of Acoustic neuroma?
-------------------------------------------

Prognosis is good in all early diagnosis and small tumors.

Large tumors may give rise to residual neurolgical damage even afer removal.

A Simple Guide to Ovarian torsion

A Simple Guide to Ovarian torsion
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What is a Ovarian torsion?
---------------------------------------

Ovarian torsion is the twisting of the Ovary either spontaneously or due to another medical condition.

Ovarian torsion occurs usually in only one Ovary at a time.

Both normal or enlarged ovaries can be affected.

Rarely both ovaries may be affected.

It is a medical emergency as gangrene of Ovary may occur.


Who is at risk of Ovarian torsion?
----------------------------------------

Women of all ages can develop this rare condition.

Most cases occur in women under 30 years old.

One fifth of all cases occur in pregnant women.



What is the Cause of Ovarian torsion?
-----------------------------------------------------

Ovarian torsion is caused by

1.congenital and developmental abnormalities

Longer than normal tubes or a missing mesosalpinx will cause ovarian torsion.

2.disease that affects the tube or Ovary resulting in the twisting of the ovarian axis.

a.Spasms or changes in the blood vessels in the mesosalpinx can cause the blood vessels to the ovaries to be congested resulting in torsion of the ovaries.

b.Ovarian cysts or fibromas,

c.tumor of the Ovaries or tubes,

d.Injury to either the ovaries or the tubes


What are the Symptoms and signs of Ovarian torsion?
-----------------------------------------------------------

Symptoms :
--------------

1.sudden onset of extreme lower abdominal pain that radiates to the back, side and thigh.

2.Nausea, vomiting,

3.diarrhea, or constipation

4.fever

5.tachycardia.

Signs:
-------------

1.tenderness of the lower abdomen

2.tenderness of the Ovarian region on vaginal palpation


How do you make the Diagnosis of Ovarian torsion?
------------------------------------------------------------

1.suddenness of lower abdominal pain.

2.pregnancy test.

3. ultrasound and CT scan (computed tomography) can help to visualise the ovarian structures

4.laparoscopy.


What are the complications of Ovarian torsion?
---------------------------------------------------

Damage to the Ovary with gangrene formation due to loss of blood flow.


What is the treatment of Ovarian torsion?
---------------------------------------------------

Surgical repair of the ovarian torsion must done urgently.

For less severe cases laparoscopic surgery can release the torsion

Pain killers such as NSAIDs are given to control pain.


What is the prognosis of Ovarian torsion?
-----------------------------------------

The prognosis is usually good if the ovarian trosion is detected early and treated.

If however the treatment is delayed there is a danger of arterial blood flow into and venous blood flow out of the Ovarian may be compromised resulting in necrosis (death) of the ovarian tissue.

Infertility may be a result of ovarian torsion.

A Simple Guide to Obstructive Sleep Apnea

A Simple Guide to Obstructive Sleep Apnea
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What is Obstructive Sleep Apnea?
--------------------------------------

Obstructive Sleep Apnea (OSA) is the absence of respiratory airflow (for 10 seconds or more) during sleep despite respiratory effort due to upper airway obstruction.

Patients with OSA do not have adequate sleep and may have problem staying awake during the day posing problems in their employment during the day and keeping their family awake at night.

What are the causes of Obstructive Sleep Apnea?
-----------------------------------------------------

Obstruction causes:
----------------------------

1.Inadequate muscle tone of the palate, tongue and pharynx leads to airway collapse during inspiration during the deep stage sleep.

2.bulky tissue in the upper respiratory airway(adenoids and tonsillar hypertrophy, cysts and tumors)

3.excessive soft palatial tissue or long uvula

4.receding chin resulting in a backward prolapsing tongue

5.anatomical abnormalities in the nose(deviated nasal septum, hypertrophied inferior turbinates) or congested nasal passages (allergies, sinusitis, nasal polyps)

Systemic disorders:
-------------------------

1.Hypothyroidism

2.Acromegaly

3.Alcohol

4.Sedatives

5.Obesity

What are Signs and symptoms of Obstructive Sleep Apnea?
-------------------------------------------------------------

Symptoms:

1.snoring present in 20% of men and 5% of women at age 30-35 years.
At age 60years or more, 60% of men and 40% of women snore habitually

2.unrefreshed sleep

3.daytime sleepiness

4.poor concentration

5.forgetfulness

6.morning headaches

7.dryness of mouth in the morning

8.irritability

9.depression

10.sexual dysfunction

Signs:

1.Enlarged nasal turbinates, polyps , and nasal blockage

2.Enlarged tonsils and adenoids

3.Long uvula

4.large protruding tongue


How is the diagnosis of Obstructive Sleep Apnea made?
--------------------------------------------------------------

A.Symptoms of snoring, nasal congestion and inadequate sleep

B.observation of airway obstruction during sleep

C.Sleep study using monitoring devices such as

1.electroencephalogram(EEG)- brain waves

2 electro-oculogram(EOG) - ocular or eye muscle movement

3.Electro-myogram (EMG) - chin and leg movement

4.Electrocardiogram(ECG) - electrical activity of the heart

5.Blood oxygen studies

6.Body position

7.Nasal and oral airflow

8.Thoracic movement

9.abdominal movement

10.Snoring sounds


What are the complications of Obstructive Sleep Apnea?
-----------------------------------------------

1.higher risk of hypertension

2.cardiovascular disease

3.Congestive heart failure

4.cardiac arrhythmias

5.cerebrovascular accidents

What is the treatment of Obstructive Sleep Apnea?
------------------------------------

Non Surgical treatment:
--------------------------

1.Continuous Positive Airway Pressure(CPAP)
CPAP administered by mask through the nose is the single most effective and least invasive treatment for OSA.
It can improve all the bad effects of OSA.

2.Oral appliances which pushes the mandible forward and prevent it from falling open during sleep

3.Nasal Congestion treatment:
Patients with nasal congestion and blockage should be treated with antihistamine and decongestant

4. Weight reduction:
Any obese patients should have at least 10% of his weight reduced over a 6 months period

Surgical Treatments:
--------------------------

1.Surgery on the upper pharyngeal airway (uvula and palate)

a.Radiofrequency reduction is indicated in simple snorer or mild OSA.

b.Uvulopalatopharyngeal (UPPP) surgery includes uvulectomy, palatal releasing and shortening incisions.

2.Surgery of the Tongue base:
Radiofrequency reduction is done for mild cases.
Advancement of the tongue, hyoid suspension is done under general anesthesia. All these enlarge the posterior airway space.

3.Maxillomandibular Advancement:
This is the most effective surgical procedure for treatment of OSA.
It causes enlargement of the pharyngeal and hypopharyngeal airway by physically expanding the skeletal framework.

What is the prognosis of Obstructive Sleep Apnea ?
--------------------------------------------------------

This depends on the severity of the condition but is generally good.

What are the Preventive measures taken for Obstructive Sleep Apnea ?
---------------------------------------------------------------------

1.Lose weight in obese individual with OSA

2.Healthy lifestyle with balanced diet and exercise.

3.Neck elevation

4.Avoid alcohol

A Simple Guide to Testicular torsion

A Simple Guide to Testicular torsion
----------------------------------------------------


What is a Testicular torsion?
---------------------------------------


Testicular torsion is the twisting of the testis on its cord either spontaneously or following strenuous activity.

It is a medical emergency as gangrene of testis may occur.


What is the Cause of Testicular torsion?
-----------------------------------------------------


Testicular torsion is caused by

1.incomplete fixation of the epididymis to the testis

2.inadequate attachment of the mesorchium.(testicular body)

3.loose ligaments holding the testis to its cord .

Because of the loose attachment sudden movement of the testis on its cord may cause the testis to be twisted resulting in sudden reduction of blood flow to the testis leading to gangrene of the testis.


What are the Symptoms and signs of Testicular torsion?
-----------------------------------------------------------


Symptoms :

1.Severe pain in the testis

2.nausea and vomiting

3.fever

Signs:

1.scrotal swelling and edema

2.tenderness of the testis on palpation

3.redness and inflammation of the scrotal pouch

4.enlarged scrotal pouch


How do you make the Diagnosis of Testicular torsion?
------------------------------------------------------------


1.Characteristic appearance of the testis

2.Ultrasound examination can detect the obvious torsion


What are the complications of Testicular torsion?
---------------------------------------------------


Damage to the testis with gangrene formation


What is the treatment of Testicular torsion?
---------------------------------------------------


The only treatment is surgical treatment to untangle the torsion and fasten the testis tightly to its attachment.

Removal of the testis (orchidectomy) may be necessary if there is gangrene.


What is the prognosis of Testicular torsion?
----------------------------------------------


The prognosis is usually excellent if treated early.

Gangrenous testis must be removed.


How can Testicular Torsion be prevented?
---------------------------------------------


Avoid strenuous activities

Wear loose underwear

A Simple Guide to Keloid

A Simple Guide to Keloid
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What is a Keloid?
---------------------------------------

Keloid is an overgrowth of fibroplastic tissue which occurs in an area of injured skin.

Sometimes it may occur spontaneously.


Who is affected by Keloid?
---------------------------------------------------

Keloid usually occur in black skin people than in white skin.

Keloid is more common in women than in men.

Keloid may occur after skin injury especially burns.


What is the Cause of keloid?
-----------------------------------------------------

Keloid are dense fibrous tissue which forms scars as a result:

1.Skin injury -cuts and lacerations, even superficial abrasions

2.Burns - from injury to the skin

3.Chemical damage to the skin - cosmetics, sulphuric acid burns,

4.Infections of the skin -acne, abscess, ulcers

5.Surgery - incision scars after operations

6.Postvaccination scarring such a keloids over BCG vaccination

What are the Symptoms and signs of keloid?
-----------------------------------------------------------

Symptoms :

1.raised red fleshy looking irregular swelling of the skin at site of injury

2.smooth and shiny surface

3.Usually painless, mainly itchy

4.may grow bigger

5.multiple swellings may also be present.

Signs:

1.swelling is red, fleshy looking with blood vessels present

2.irregular appearance with shiny smooth surface

3.May occur anywhere on the body

4.Swelling quite hard on palpation

How do you make the Diagnosis of keloid?
------------------------------------------------------------

1.Characteristic appearance at site of injury or surgery

2.Microscopic examination shows the presence of a fibroplastic cells with blood vessels and nerve endings.


What are the complications of keloid?
---------------------------------------------------

The keloid can be irritated by shaving, clothing or jewellery.

There can be :

1. bleeding

2. infection especially in diabetes

What is the treatment of keloid?
---------------------------------------------------

The only treatment is removal of the keloid.

This can be done by :

1.Injection of corticosteroids into the base of keloids

2.Excision followed by corticosteroid injections.

3.Cryosurgery (freezing with liquid nitrogen)

4.Taping of keloid with pressure adhesive tape to prevent growth and flattening of keloids.

Some keloids may resolve spontaneously.

What is the prognosis of keloid?
-----------------------------------------

The prognosis is usually excellent.

Recurrence at the same spot is common due to regrowth of the blood vessel supplying the keloid.

A Simple Guide to Skin Polyp

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.

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.

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

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.

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.





















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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.

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

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.

A Simple Guide to Knee cap Dislocation

A Simple Guide to Knee cap Dislocation
----------------------------------------------------

What is Knee cap Dislocation?
---------------------------------------------------------

Knee cap Dislocation is when the knee cap (patella) moves or slides out of place. This usually occurs on the outer side of the knee.


What are the causes of Knee cap Dislocation?
----------------------------------------------------------------------

1.Dislocated knee caps most often occur in people with loose joint ligaments.

It can occur due to sudden strain on the knee ligaments causing the kneecap to protrude out of its loose ligaments.

2.Dislocation of the knee cap may also occur due to trauma.

A sudden blow to the medial part of the knee can cause the knee cap to dislocate laterally.

3.People who are prone to dislocated knee caps usually have loose ligaments with hyperflexion of the wrists or flat feet.

This condition is usually inherited and are more common in women than in men.


What are the symptoms and signs of Knee cap Dislocation?
-------------------------------------------------------------------

Symptoms:

1.Knee cap is displaced to the lateral position

2.knee swelling and effusion due to displacement of the knee cap.

3.Knee pain and tenderness is present.

4.The knee is usually held in slight flexion.

5.There is difficulty in lifting the leg

6. Patient usually walks with a limp.

Signs:

1.Tenderness and swelling of the knee

2.Knee cap is displaced to the outside or lateral part of the knee

3.In most cases the knee cap may have returned to the central position of the knee but there is still tenderness and swelling.

4.The knee cap can move excessively from right to left.(hypermobile)

How to investigate the cause of Knee cap Dislocation?
-------------------------------------------------------------

1.examination of the knee would confirm presence of the dislocated knee cap.

There is lateral displacement of the knee cap and swelling of the knee.
Movement of the knee may be painful.

2.A knee x-ray should be done to exclude any fracture especially in the case of injury or in the elderly.

A skyline view of the knee should show the shift of the patella laterally.

3.MRI of the knee can be done to see any damage in the cartilage or meniscus of the knee.


What is the Treatment of Knee cap Dislocation?
----------------------------------------------------------------

Conservative treatment:
-----------------------

1. Most cases of knee dislocation can treated by simple reduction of the dislocated knee cap.

The heel of the leg is lifted to extend the knee and flex the hip thus relaxing the quadriceps muscles(front muscles of the thigh)

Gentle pressure is exerted on the knee cap to place it to its normal position.

The knee is then immobilized for 2-3 weeks.

Quadriceps exercises are begun as soon as possible to build back your muscle strength and improve the knee's range of motion.

Drug Therapy:
-----------------------

1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

2.Muscle relaxant to relax muscles

Surgery:
--------------

Surgery is required if:

1.the knee remains unstable

2.Injury of the knee cap cause a partial rupture of the medial retinaculum and supporting ligaments of the knee cap.
This can cause recurrent episodes of subluxation or dislocation of knee cap.

Surgery is done to stabilize the knee cap.
Reconstruction of the quadriceps extensor muscles is done to tighten the ligaments surrounding the knee cap.


What is the prognosis of Knee cap Dislocation?
----------------------------------------------------------

Prognosis using conservative methods is fair.

Recurrences are quite common.

Preventative measures such as knee guard, quadriceps exercises, avoidance of sudden turns and twisting of the knee may help.

Prognosis after surgery is usually good as there is tightening of the knee cap ligaments and the quadriceps muscles.


What is the Prevention of Knee cap Dislocation?
------------------------------------------------------------

1.proper technique when exercising.

2.Maintain strength and flexibility of the knee by exercising the quadriceps muscles.

3.Wearing a knee guard

A Simple Guide to Frozen Shoulder

A Simple Guide to Frozen Shoulder
----------------------------------------------------

What is Frozen Shoulder?
-----------------------------------------

Frozen Shoulder (also known as adhesive capsulitis) is a disorder of the shoulder characterised by the slow onset of pain and restriction of movement.

It tends to be chronic and full recovery may take several months.

It is more common in women and diabetes.

Incidence is about 2 in a 1000.

What are the causes of Frozen Shoulder?
-----------------------------------------------

The exact cause is unknown but several conditions has been blamed:

1.bicipital tenosynovitis- inflammation of the biceps muscles and tendon limmiting its movements

2.rotator cuff tendonitis - inflammation of the rotator cuff muscles which surrounds the shoulder with resultant adhesions and stiffness causing limitation of movement

3.reflex sympathetic dystrophy- a disturbance in the sympatheic nervous system cause pain ine the shoulder joint and hypersensitivity of the muscles surrounding the joint. There is swelling of the arm followed by atrophy of the muscles

4.trauma - injury to the joint may cause tightening of the injured muscles around the shoulder joint.

5.Surgery of the shoulder, breast and lung may also cause frozen shoulder because of the pain resulting from the movement of the shoulder and hence stiffness of the muscles.

What is the natural progression of frozen shoulder in most cases?
-----------------------------------------------------------------------

Frozen shoulder is a disabiliting disease which can last from 5 months to 4 years.

There is chronic inflammation of the muscles surrounding the joint with adhesios formed between joint and muscles causing restriction of movement of the joint.

There is also reduced fluid in the joint further restricting movement.

Stage one("freezing" or painful stage):
There is a slow onset of pain which becomes worse and stiffening of the joint occurs.

This lasts 5 weeks to 9 months.

Stage two("frozen" or adhesive stage):
There is a slow but steady improvement in pain, but the stiffness persists.

This lasts 4 -9 months.

Stage three("thawing" or recovery):
There is a gradual return to normalcy in the shoulder motion.

This lasts 5 -26 months.

What are the symptoms and signs of Frozen Shoulder?
-------------------------------------------------------------------

Symptoms:

1.Pain in the shoulder radiating down the deltoid muscle and anterior aspect of the arm

2.Pain usually is worse at night especially lying on the affected shoulder

3.Certain movements makes the pain worse

4.Pain is described as constant, dull and aching

5.complaints of stiffness of the shoulder

6.inability to wear a shirt or blouse because of restricted movements

Signs:

1.apprehensive patient who holds the arm protectively

2.Generalised tenderness of rotator cuff and biceps muscles

3.Limited shoulder movement

4.Range of muscle movement is reduced in all directions

5.Arthrogram or MRI of shoulder can be done to confirm the diagnosis and exclude a posterior shoulder dislocation..

What is the Treatment of Frozen Shoulder?
----------------------------------------------------------------

Conservative treatment:
-----------------------
Initial phase:
1.rest of the shoulder

2.moist heat

3.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

4.Muscle relaxant to relax muscles

5.injection of local anesthetic and long acting steroid into the rotator cuff muscle may help to relieve pain.

Mobilisation phase:
1.Physiotherapy such as traction, shortwave diathermy

2.gradual mobilisation and exercises to loosen the tight muscles surrounding the shoulder

Maintenance phase:
1.Continual exercises of the shoulder muscles

2.Avoidance of strain on the muscles of the shoulder

Manipulation of the frozen shoulder may be done under anaethesia to break the adhesions and restore some movement.

Surgery is usually not indicated in frozen shoulder.
Rarely surgery is used to cut the adhesions.

What is the prognosis of Frozen Shoulder?
----------------------------------------------------------

Prognosis depends on the underlying cause.

In most cases frozen shoulder may resolve itself with time

A Simple Guide to Prolapsed Intervertebral Disc

A Simple Guide to Prolapsed Intervertebral Disc
---------------------------------------------------------------

What is Prolapsed Intervertebral Disc?
-------------------------------------------------------

Prolapsed Intervertebral Disc is the prolapse of the intervertebral disc(which is the disc between 2 vertebrae) as a result of protrusion of the nucleus pulposus out of its weakened ligamentous ring(annulus fibrosus).

It may protrude in a posterior or postero-lateral direction causing pressure to the nerve roots especially at S1, L5 and L4 vertebrae.

What are the causes of Prolapsed Intervertebral Disc?
---------------------------------------------------------------

1.Degeneration of the posterior longitudal ligaments and annulus fibrosus occurs with age resulting in the disc being pushed out between the weakened ligaments.

2.Trauma -direct injury to disc, heavy lifting, sneezing can cuse the disc to pop out of the weakened ligaments and prolapse partially or completely.

3.Spinal tumour rarely pushes the disc out of its intervertebral space

What are the symptoms and signs of Prolapsed Intervertebral Disc?
-----------------------------------------------------------------------------

Symptoms:
1.Low Backache with pain in the lumbar region

2.Sciatica or pain shooting down 1 leg

3.Pain usually follows
severe bending
lifting heavy objects
injury
sneezing or coughing

4.Pain may so bad that the person cannot stand erect.

5.pain is worse when sitting

6.weakness, numbness, difficulty in moving the leg

Signs:
1.Muscle spasm especially spinal extensor muscles

2.Movement of the back and affected led painful and restricted

3.Patient tend to stand stiffly or with slight sciatic scoliosis on the affected side

4.Straight leg raising test is usually restricted on the affected side.

5.Neurological signs such as paraesthesia commonly present on the affected side.

6.Sensory and motor deficit may be present in the affected side

7.Loss of reflex and weakness may help to localise the site of prolapse:
L4 root:
Pain in the medial buttock, lateral thigh, medial tibia and big toe
weakness of big toe and foot dorsiflexion
patella jerk is diminished

L5 root:
Pain in hip, groin,posterolateral thigh, lateral calf and dorsal surface of foot
weakness of the big toe and foot dorsiflexion
no change in patella or ankle reflexes

S1 root:
pain in posterior part of thigh, lower calf border and sole of foot
weakness of knee flexors and plantar flexors
ankle jerk is diminished


How to investigate the cause of Prolapsed Intervertebral Disc?
----------------------------------------------------------------------------

1.Full medical history especially of injuries, type of work, onset of pain,radiation to legs,

2. Full medical examination especially of movement of the back ,any deformity of the spine, straight leg raising test

3. X-ray of the Spine: to exclude osteoarthritis, injury, narrowing of disc space, bone tumor,

4.MRI of spine for slipped disc

5.bone scan for osteoporosis

A definite diagnosis can then be made and the cause of the pain treated.


What is the Treatment of Prolapsed Intervertebral Disc?
----------------------------------------------------------------------------------

Conservative treatment:
-----------------------
Initial phase:
1.Bed rest with a hard board below the mattress- straighten the back
2.Physiotherapy such as traction, shortwave diathermy

Mobilisation phase:
1.Wearing a corset to strengthen the back and help the traction of the spinal bones
2.gradual mobilisation and exercises to strengthen the spinal extensor muscles

Maintenance phase:
1.Exercises to strengthen the back muscles.
2.Wear a corset
3.Avoidance of postural strain on the back

Drug Therapy:
-----------------------
1.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain
2.Muscle relaxant to relax muscles
3.Extradural injection of local anesthetic and long acting steroid may help to relieve the pain

Surgery:
--------------
Surgery is required if there are:
1.persistent pain and neurological symptoms remain after conservative treatment
2.progressive neurological symptoms
3.Disc has protruded more than 75% out of its intervertebral space as seen on MRI

Surgery consists of:
1.laminectomy - removal of the disc and prolapsed material.
2.microdiscectomy- insertion of a titanium disc to replace the removed prolapsed disc

Finally treatment of the underlying cause(eg.space occupying spinal tumors) is important.

What is the prognosis of Prolapsed Intervertebral Disc?
-------------------------------------------------------------------------

Prognosis depends on the underlying cause.

Preventative measures are important in preventing recurrences of the prolapse of the intervertebral disc.

What is the Prevention of Prolapsed Intervertebral Disc?
----------------------------------------------------------------

Avoidance of postural strain on the back

Wear a corset

Exercises to strengthen the back muscles.

A Simple Guide to Cervical Spondylosis

A Simple Guide to Cervical Spondylosis
---------------------------------------------

What is Cervical Spondylosis?
----------------------------------

Cervical Spondylosis is a degenerative disease of the joints of the cervical spine(neck), causing pain in the neck and nerve root irritation.

Who get Cervical Spondylosis?
-------------------------------------

Every one can get Cervical Spondylosis.
The age of onset is usually in the late 40 or early 50.
It is also more common in men than women.
It is worst in the lower cervical spine.

What are the causes of Cervical Spondylosis?
-----------------------------------------------

The causes of Cervical Spondylosis are:

1.Age Degeneration of the cervical spine due to usage such as bending the head to read or write.
The weight of the skull also serves to compress the vertebrae of the cervical spine as well as the intervertebral discs causing narrowing of disc space and bone protrusions called osteophytes which becomes worse with age.

2.Trauma and injury such as whip lash injury, head injuries can also indirectly injure the vertebra of the neck and cause intervertebral disc protrusions.

3. Congenital abnormality of the cervical spine such as incomplete formation of the vertebra and disc.

What are the Symptoms of Cervical Spondylosis?
-------------------------------------------------------

1.The onset is usually gradual with occasional neck pain over weeks or months.

2.There may be a history of trauma to the neck or prolonged neck strain.

3.Early morning neck stiffness and pain may occur,then wears off during the day.

4.The pain may radiate to the shoulder or upper limb.
Pain can be persistent in some cases.

5.Numbness, paresthesia even weakness of the arm and hands may occur due to compression of the neck nerve root.

6.Headaches may be common due to pressure on the neck muscles giving rise to pain to the occiptal region.

7.Neck movements may be restricted in all directions. There may be creaking sounds of the neck on movement.

8.Muscle weakness of the upper and/or lower limb with muscle wasting

Pain may be aggravated by stress, poor general health, prolonged period of the neck in one position.

How is Cervical Spondylosis diagnosed?
-----------------------------------------

Confirmation is usually by an xray of the cervical spine which may show:
Typical cervical vertebra degeneration,
Disc space narrowing
Osteophytic changes
Narrowing of the exit foramina
Subluxations of the vertebra
Sclerosis of the vertebral margins
Lordosis of the spine

How to treat Cervical Spondylosis?
------------------------------------

Not every patient suffer the same degree of symptoms

1. mild requiring only exercises or mild pain killers.

2. more severe require:

a.Neck collars

b.physiotherapy -cervical traction, shortwave diathermy, neck exercises

c.NSAIDs painkillers

d.surgery for cord compression,intractable root symptoms,vertebral artery compression,weakness of arms or legs

3. All cases require:

protection of neck from muscle strain

avoidance of excessive bending and turning of neck

maintenance of good posture

avoidance of emotional stress

What is the prognosis of Cervical Spondylosis?
------------------------------------------------

Symptoms comes and go.

With exercise and NSAIDS, pain is reduced and flexibility of the spine is improved especially with regular exercise and proper posture.

Injury and stress can aggravate the condition.

There is no cure.

A Simple Guide to Obesity Part 2

A Simple Guide to Obesity Part 2
--------------------------------------

What is the Treatment of Obesity?
----------------------------------------

Motivation:
---------------

Motivation is the key to weight control.

Knowing the dangers of obesity will help to motivate a person to lose weight.

Set realistic goals for losing weight eg. reduce 10% in 6 months
Gradually reduce weight and maintain it at a healthy weight.

Even if you fail to reach your targeted healthy weight, any reduction helps your health and prevents diseases associated with obesity.

Regular Exercise:
-------------

Regular exercise daily, or at least three times a week is good for the body.
It helps to improve blood circulation and breathing.

Start with a regime of walking or cycling or swimming.
Slowly increase the level of activity to more intense physical exercise like jogging.

Lead an active lifestyle.
Do not sit and watch TV all the time.

Diet Control:
-------------

Choose a healthy diet with with reduced calories and which is nutritionally balanced

Take plenty of vegetables and fruits.
Eat less food which is high in fat and sugar

Low Fat and high carbohydrate diets may reduce the weight but may have long term bad effect on your health.

A combination of diet and exercise is more effective in reducing than either one alone.

Medication:
-----------------

Two main types of medications are available to help control weight:

1.Appetite suppressants:
-----------------------------
help promote weight loss by reducing appetite or increase the sensation of being full.
They increase serotonin or catecholamine - brain chemicals that affect mood and appetite.

They also help by increasing metabolism thus burning away the fat.
They may have limited effect on weight loss as the patient's weight loss level off after 4 to 6 months.

They have the side effects of irritability, insomnia, palpitations and tachycardia.
They should be avoided in heart disease, anxiety, insomnia, pregnency.

They should be used for short term (6-12 months) as there is also a danger of dependency.

2.Fat absorption suppressant:
------------------------------------
prevents the absorption of fats by interfering with the enzymes which dissolves the fat and absorbs the fat into the body.

Instead the fat is not absorbed into the body and passes out in the stools undigested.
The fat in the body is then used up to provide energy and production of hormones.
Less fat is available for putting on weight.

They should be avoided in malabsorrption syndrome, liver disease or pregnancy.
The side effects of these medicines are usually diarrhoea due to the fat passed out in the stools.

They can be taken for a longer peroid of 2 years.

Surgery:
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Surgical treatment may be required for the severely obese (those with a BMI of 40 or greater) or with other health problems.

Surgery should be used only drug therapy, diet, exercise have failed.

Minor surgery may involve liposuction (sucking out the fats in the abdominal wall,under the chin, buttocks and other obvious parts of the body.

Lapband surgery is done for the very obese when other methods have failed and there is a risk of obesity related disease.
A band is placed over the middle of the stomach making it narrow and not capable of taking much food.

Surgery has some complications such as infections.

How do you prevent recurrence of Obesity?
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Many studies showed that most people will regain weight within 5 years.

You can maintain your weight by
1.eating a low calorie diet, low in fats

2.maintaining a healthy exercise regime

3.maintaining motivation and self esteem

4.monitoring your weight food intake and exercise