A Simple Guide to Retinitis pigmentosa
----------------------------------------------
What is Retinitis pigmentosa?
---------------------------------------
Retinitis pigmentosa is a slow degenerative disease of the retina.
Who is affected by Retinitis pigmentosa?
------------------------------------------------
Retinitis pigmentosa is a genetically determined disease in which abnormal photoreceptors (rods and cones) or the Retinitis pigment epithelium of the retina cause progressive loss of vision.
Initially there is night blindness due to the abnormal photoreceptors.
This is followed by the loss of peripheral visual field known as tunnel
vision which may persist for some years.
Finally the macular region is affected with loss of central vision in the later stages.
In rare cases blindness may occur in childhood.
What is the cause of Retinitis pigmentosa?
------------------------------------------------
The cause is usually in the genes and of the recessive trait.
There is a mild form of dominant trait.
Rarely it is sex linked and can be severe.
What are symptoms and signs of Retinitis pigmentosa?
---------------------------------------------------------
Symptoms:
--------------
1.loss of night vision even in childhood
2.tunnel vision occurs at age of 40-50 for several years or decades
3.loss of central vision usually at 50-60 years of age
Signs:
-----------------
1. In early stage, direct opthalmoscopy show small spidery black spots
2. vessels are sheathed with pigments in some areas
3. Retinal vessels become attenuated (thinned)
4. Optic atrophy(cellophane maculopathy) sets in
5. posterior subcapsular cataracts form at late stage.
How is Retinitis pigmentosa diagnosed?
---------------------------------------------
1. electroretinography (ERG) show progressive loss of photoreceptor function
2.Visual field testing show loss of peripheral vision
3.Flourescin angiography may show dark pigments to establish the presence of Retinitis pigmentosa.
What are the complications of Retinitis pigmentosa?
-------------------------------------------------------
Partial to complete loss of vision.
What is the treatment for Retinitis pigmentosa?
-------------------------------------------------
Retinitis pigmentosa has no cure.
Several methods of treatment aimed at slowing down the progression of loss of vision have been tried:
1.daily intake of 15000 IU of vitamin A palmitate.
2.Retinitis transplants,
3 artificial Retinitis implants,
4.gene therapy,
5.stem cells,
How is Retinitis pigmentosa monitored?
-----------------------------------------
1.regular follow up with the eye doctor.
2.examining the retina for further damage
3.analyzing the visual fields.
What is the prognosis of Retinitis pigmentosa?
----------------------------------------------------
The prognosis is very poor as progression to blindness is the rule.
How can Retinitis pigmentosa be prevented?
-----------------------------------------------
There is no prevention for Retinitis pigmentosa.
The following may help:
1.Genetic counselling
2.Examination of family members for signs of loss of vision
Sunday, September 14, 2008
Friday, September 12, 2008
A Simple Guide to Retinal detachment
A Simple Guide to Retinal detachment
----------------------------------------------
What is Retinal detachment?
---------------------------------------
Retinal detachment is a condition in which there is a separation of the neurosensory retina from the underlying retinal pigment epithelium.
It is a medical emergency.
Who is affected by Retinal detachment?
------------------------------------------------
The following are at risk from Retinal detachment:
1. age above 55 yrs
4. very short sighted (myopia usually above 5-6 diopters)
3. history of serious eye injury (injury to orbits)
4. history of eye cataract surgery
5. Sports activities which can cause injuries to the eye (Boxing, karate etc) or increase pressure in the eye( bunjee jumping, diving etc)
6. family history of Retinal detachment -related to family history of diabetes, sickle cell disease and other underlying condition
What is the cause of Retinal detachment?
------------------------------------------------
There are 2 types of retinal detachment:
Primary:
-------------
There is a hole in the retina which allows the seepage of vitreous humor between the the neurosensory retinal layer and the retinal pigment eipthelium which cause the separation of the 2 layers.
The holes are usually at the periphery.
It is a degenerative condition which can be aggravated by trauma especially in the severe myopic(short sighted) and senile (old) eyes.
Secondary:
---------------
Other eye diseases which can separate the 2 layers are:
1.Choroiditis- inflammation of the choroid cause exudation of serous fluid under the retina layer
2.Toxemic retinopathy - inflammation of the retina cause exudation of serous fluid under the retina layer
3.proliferative diabetic retinopathy - abnormal blood vessels grow within the retina causing the retina to pull away from the wall of the eye
4.vitreous hemorrhage after injury to the orbits - blood clot and fibrovasular tissue developing from the blood clot can cause separation of the nuerosensory retina and pigmented retina layer.
5.Choroidal melanoma(a malignant tumor) - a growth below the layers of the retina can push the layer of retina from the back of the eye
What are symptoms and signs of Retinal detachment?
---------------------------------------------------------
Symptoms:
--------------
1.transient flashes of light
2.a sudden increase of floaters in one eye
3.a ring of floaters at the temporal region of the central vision
4.a feeling of heaviness in the eye
5.presence of cloud in front of the eye so that parts of an object are not seen
6.the sensation of a curtain falling over the central vision of eye
7.Straight lines that become curved
8.Central vision intact at first followed by complete and total loss of vision if untreated
Signs:
-----------------
1. In early stage, direct opthalmoscopy show very little abnormality
2. Indirect opthalmoscopy may show the presence of the detachment.
3. The pale white or grey folds of the detachment can be seen
How is Retinal detachment diagnosed?
---------------------------------------------
1. Indirect opthalmoscopy with slit-lamp examination is the best method to detect early or shallow detachment and to identify the retinal holes.
2.Transillumination and ultrasound may be usefulto detect neoplasm
3.Flourescin angiography may be needed in special cases to establish the presence of retinal detachment.
What are the complications of Retinal detachment?
-------------------------------------------------------
Partial to complete loss of vision.
What is the treatment for Retinal detachment?
-------------------------------------------------
Retinal detachment is a medical emergency.
The most important part of treatment is finding the holes or tears and closing them.
Primary:
--------------
1.Vitrectomy (most common procedure)
Vitrectomy involves the removal of the vitreous gel followed by filling the eye with a gas bubble (SF6 or C3F8 gas).
Side effect is the more rapid progression of a cataract in the operated eye.
2.Cryotherapy and Laser Photocoagulation
Cryotherapy (freezing) and laser photocoagulation are used to create a adhesion around the retinal hole so that fluid cannot enter the hole and accumulate behind the retina resulting in the retinal detachment.
3.Adatomed Silicone Oil
Adatomed Silicone Oil is injected into the eye and mechanically holds the retina in place.
The oil is usually removed within a year.
4.Scleral buckle surgery
The choroid and retina are brought together by buckling the sclera with silicone bands sewn by the eye surgeon to the outside of the eyeball.
The most common side effect of this operation is more short sighted after the operation.
5.Pneumatic retinopexy
This operation is done under local anesthesia by injecting a gas bubble (SF6 or C3F8 gas) into the eye after which laser or freezing treatment is applied to the retinal hole. The patient may have to keep his head tilted for several days to keep the gas bubble in contact with the retinal hole in order to seal the hole..
6.Ignipuncture
Ignipuncture involves cauterization of the retina with a very hot pointed instrument.It is no longer used.
After treatment the results are usually good and vision is regained over a period of a few weeks.
Secondary:
----------------
1.Neoplasm: surgical removal of neoplasm
2.Traction detachment: vitreous surgery, prognosis is poor
3.Others:Fluids usually resorbs as underlying condition is treated.
How is Retinal detachment monitored?
-----------------------------------------
1.regular follow up with the eye doctor.
2.examining the retina for further damage
3.analysing the visual fields.
With proper monitoring and treatment most patients will be less likely to be at risk of blindness.
What is the prognosis of Retinal detachment?
----------------------------------------------------
The prognosis varies depending on the the underlying disease.
Prognosis is good if the condition is diagnosed and treated early although visual acuity may not be as good as before.
How can Retina Detachment be prevented?
------------------------------------------
Retinal detachment can be prevented:
1.educating people of the symptoms suggestive of a posterior vitreous detachment.
2.Eye examination to detect retinal tears which can be treated with laser or cryotherapy.
3.Avoid known risk factors for retinal detachment.
a.Cataract surgery
b.Trauma (boxing, kickboxing, karate, etc.)
c.high level of myopia
d.activities that increase pressure in the eye, including diving, skydiving, bungee jumping
----------------------------------------------
What is Retinal detachment?
---------------------------------------
Retinal detachment is a condition in which there is a separation of the neurosensory retina from the underlying retinal pigment epithelium.
It is a medical emergency.
Who is affected by Retinal detachment?
------------------------------------------------
The following are at risk from Retinal detachment:
1. age above 55 yrs
4. very short sighted (myopia usually above 5-6 diopters)
3. history of serious eye injury (injury to orbits)
4. history of eye cataract surgery
5. Sports activities which can cause injuries to the eye (Boxing, karate etc) or increase pressure in the eye( bunjee jumping, diving etc)
6. family history of Retinal detachment -related to family history of diabetes, sickle cell disease and other underlying condition
What is the cause of Retinal detachment?
------------------------------------------------
There are 2 types of retinal detachment:
Primary:
-------------
There is a hole in the retina which allows the seepage of vitreous humor between the the neurosensory retinal layer and the retinal pigment eipthelium which cause the separation of the 2 layers.
The holes are usually at the periphery.
It is a degenerative condition which can be aggravated by trauma especially in the severe myopic(short sighted) and senile (old) eyes.
Secondary:
---------------
Other eye diseases which can separate the 2 layers are:
1.Choroiditis- inflammation of the choroid cause exudation of serous fluid under the retina layer
2.Toxemic retinopathy - inflammation of the retina cause exudation of serous fluid under the retina layer
3.proliferative diabetic retinopathy - abnormal blood vessels grow within the retina causing the retina to pull away from the wall of the eye
4.vitreous hemorrhage after injury to the orbits - blood clot and fibrovasular tissue developing from the blood clot can cause separation of the nuerosensory retina and pigmented retina layer.
5.Choroidal melanoma(a malignant tumor) - a growth below the layers of the retina can push the layer of retina from the back of the eye
What are symptoms and signs of Retinal detachment?
---------------------------------------------------------
Symptoms:
--------------
1.transient flashes of light
2.a sudden increase of floaters in one eye
3.a ring of floaters at the temporal region of the central vision
4.a feeling of heaviness in the eye
5.presence of cloud in front of the eye so that parts of an object are not seen
6.the sensation of a curtain falling over the central vision of eye
7.Straight lines that become curved
8.Central vision intact at first followed by complete and total loss of vision if untreated
Signs:
-----------------
1. In early stage, direct opthalmoscopy show very little abnormality
2. Indirect opthalmoscopy may show the presence of the detachment.
3. The pale white or grey folds of the detachment can be seen
How is Retinal detachment diagnosed?
---------------------------------------------
1. Indirect opthalmoscopy with slit-lamp examination is the best method to detect early or shallow detachment and to identify the retinal holes.
2.Transillumination and ultrasound may be usefulto detect neoplasm
3.Flourescin angiography may be needed in special cases to establish the presence of retinal detachment.
What are the complications of Retinal detachment?
-------------------------------------------------------
Partial to complete loss of vision.
What is the treatment for Retinal detachment?
-------------------------------------------------
Retinal detachment is a medical emergency.
The most important part of treatment is finding the holes or tears and closing them.
Primary:
--------------
1.Vitrectomy (most common procedure)
Vitrectomy involves the removal of the vitreous gel followed by filling the eye with a gas bubble (SF6 or C3F8 gas).
Side effect is the more rapid progression of a cataract in the operated eye.
2.Cryotherapy and Laser Photocoagulation
Cryotherapy (freezing) and laser photocoagulation are used to create a adhesion around the retinal hole so that fluid cannot enter the hole and accumulate behind the retina resulting in the retinal detachment.
3.Adatomed Silicone Oil
Adatomed Silicone Oil is injected into the eye and mechanically holds the retina in place.
The oil is usually removed within a year.
4.Scleral buckle surgery
The choroid and retina are brought together by buckling the sclera with silicone bands sewn by the eye surgeon to the outside of the eyeball.
The most common side effect of this operation is more short sighted after the operation.
5.Pneumatic retinopexy
This operation is done under local anesthesia by injecting a gas bubble (SF6 or C3F8 gas) into the eye after which laser or freezing treatment is applied to the retinal hole. The patient may have to keep his head tilted for several days to keep the gas bubble in contact with the retinal hole in order to seal the hole..
6.Ignipuncture
Ignipuncture involves cauterization of the retina with a very hot pointed instrument.It is no longer used.
After treatment the results are usually good and vision is regained over a period of a few weeks.
Secondary:
----------------
1.Neoplasm: surgical removal of neoplasm
2.Traction detachment: vitreous surgery, prognosis is poor
3.Others:Fluids usually resorbs as underlying condition is treated.
How is Retinal detachment monitored?
-----------------------------------------
1.regular follow up with the eye doctor.
2.examining the retina for further damage
3.analysing the visual fields.
With proper monitoring and treatment most patients will be less likely to be at risk of blindness.
What is the prognosis of Retinal detachment?
----------------------------------------------------
The prognosis varies depending on the the underlying disease.
Prognosis is good if the condition is diagnosed and treated early although visual acuity may not be as good as before.
How can Retina Detachment be prevented?
------------------------------------------
Retinal detachment can be prevented:
1.educating people of the symptoms suggestive of a posterior vitreous detachment.
2.Eye examination to detect retinal tears which can be treated with laser or cryotherapy.
3.Avoid known risk factors for retinal detachment.
a.Cataract surgery
b.Trauma (boxing, kickboxing, karate, etc.)
c.high level of myopia
d.activities that increase pressure in the eye, including diving, skydiving, bungee jumping
Thursday, September 11, 2008
A Simple Guide to Gingivitis
A Simple Guide to Gingivitis
-----------------------------------
What is Gingivitis?
---------------------------
Gingivitis is an acute disease which causes inflammation and infection of the gums with redness, swelling and bleeding.
What are the causes of Gingivitis?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus and Staphphylococcus may be painful and lead to upper respiratory tract infection
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Non-infectious:
------------------
1.malocclusion
2.food impaction
3.dental calculus
4.dental procedures
5.exposure to heavy metals
6.long term phenytoin treatment
7.Oral contraceptive pills
Systemic diseases:
--------------------
1.diabetes mellitus
2.leukemia
3.Debilitating diseases
4.autoimmune diseases
What are Signs and symptoms of Gingivitis?
---------------------------------------------
Symptoms:
1.Pain in the gums
2.Red swollen inflamed gums
3.bleeding in between the gums
4.Fever may be present
Signs:
1.Red swollen inflamed gums around neck of teeth
2.Swelling of papilla between teeth
3.Gum boils or abscess in the gums
4.Gum ulcers
How is the diagnosis of Gingivitis made?
------------------------------------------
1.Symptoms and signs of red, swollen and inflamed gums
2.blood tests (complete blood count, ESR and blood culture)
3.X-rays of teeth
What are the complications of Gingivitis?
-----------------------------------------------
1.damage to root canals
2.cavity in the teeth
3.upper respiratory tract infection
What is the treatment of Gingivitis?
------------------------------------
1.Rest & fluids
2.Painkiller for pain
3.Antibiotics depending on the organism found:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
4.Oral application of oral antibiotic cream
What is the prognosis of Gingivitis ?
------------------------------------------
Usually very good.
Surgery for abscess and other gum or tooth problem very rarely needed.
What are the Preventive measures taken for Gingivitis ?
--------------------------------------------------------
1.Avoid smoking
2.Healthy lifestyle with balanced diet and exercise.
3.Regular cleaning of gums and teeth by brushing and flossing
4.Gargling of mouth after meals
5.Regular dental checkups
-----------------------------------
What is Gingivitis?
---------------------------
Gingivitis is an acute disease which causes inflammation and infection of the gums with redness, swelling and bleeding.
What are the causes of Gingivitis?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus and Staphphylococcus may be painful and lead to upper respiratory tract infection
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Non-infectious:
------------------
1.malocclusion
2.food impaction
3.dental calculus
4.dental procedures
5.exposure to heavy metals
6.long term phenytoin treatment
7.Oral contraceptive pills
Systemic diseases:
--------------------
1.diabetes mellitus
2.leukemia
3.Debilitating diseases
4.autoimmune diseases
What are Signs and symptoms of Gingivitis?
---------------------------------------------
Symptoms:
1.Pain in the gums
2.Red swollen inflamed gums
3.bleeding in between the gums
4.Fever may be present
Signs:
1.Red swollen inflamed gums around neck of teeth
2.Swelling of papilla between teeth
3.Gum boils or abscess in the gums
4.Gum ulcers
How is the diagnosis of Gingivitis made?
------------------------------------------
1.Symptoms and signs of red, swollen and inflamed gums
2.blood tests (complete blood count, ESR and blood culture)
3.X-rays of teeth
What are the complications of Gingivitis?
-----------------------------------------------
1.damage to root canals
2.cavity in the teeth
3.upper respiratory tract infection
What is the treatment of Gingivitis?
------------------------------------
1.Rest & fluids
2.Painkiller for pain
3.Antibiotics depending on the organism found:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
4.Oral application of oral antibiotic cream
What is the prognosis of Gingivitis ?
------------------------------------------
Usually very good.
Surgery for abscess and other gum or tooth problem very rarely needed.
What are the Preventive measures taken for Gingivitis ?
--------------------------------------------------------
1.Avoid smoking
2.Healthy lifestyle with balanced diet and exercise.
3.Regular cleaning of gums and teeth by brushing and flossing
4.Gargling of mouth after meals
5.Regular dental checkups
Wednesday, September 10, 2008
A Simple Guide to High Cholesterol
A Simple Guide to High Cholesterol
-------------------------------------------
What is High Cholesterol?
------------------------------
High Cholesterol is the presence of raised amount of total cholesterol in the blood( blood total cholesterol above 200mg/dl).
What is the cause of High Cholesterol?
---------------------------------------------
Cholesterol is a fat molecule in the body which is needed for many normal body functions.
It is produced mostly in the liver and is present in the cell walls and membranes of the brain, nerves, muscles, skin, heart ,intestine and of course liver.
Cholesterol is used by the body to make the body's hormones(male and female) and bile acids used to digest fats.
20-30% of the cholesterol comes from the food that is eaten.
Animal Fat:
-------------
1.A diet high in saturated fat mainly animal fat, butter, lard
2.Trans-fatty acids in fast food and processed foods
Animal organs:
------------------
Brains of pigs, sheep, fish are particularly high in lipoproteins and fat
Liver, skin fat, etc
Egg yolk:
----------------
Egg yolk and products containing egg yolk like fish roe, cakes, icecream,
Dairy Products:
------------------
full cream milk
Certain other food:
--------------------
Peanut butter, peanut oils, coconut oil
Genetic factors - Familial hypercholesterolemia has been known for high cholesterol in families
What is the diagnosis of high cholesterol?
----------------------------------------------------
A blood test for lipid profile measures :
1.total cholesterol
2.LDL (low-density lipoprotein [the bad cholesterol]),
3.HDL (high-density lipoprotein [the good cholesterol])
4. triglycerides—another fatty substance in the blood.
High lipid readings are when the
1.total cholesterol in your blood is more than 200mg/dL,
2.LDL cholesterol is more than 130 mg/dL (130-159 is borderline high; 160 is high; 190 is very high).
3.HDL, the "good cholesterol," should be around 40 mg/dL or greater.
With HDL, the higher the number, the better, and 60 mg/dL is protective against heart disease.
4.Triglycerides is more than 200 mg/dL
What is the danger of High Cholesterol?
------------------------------------------
The excess cholesterol will then be deposited in the arterial walls causing narrowing of the arteries and reducing the blood flow to the heart, kidney and the brain.
Therefore any thickening of the arterial wall of blood vessels to the heart, kidney or brain as a result of deposit of cholesterol deposited in the wall of these arteries will reduce the flow of nutrients and oxygen to the heart, kidney or brain resulting in heart attack, kidney failure or stroke.
What is the Treatment of High Cholesterol?
---------------------------------------------------
1.Dietary and lifestyle modification
2. Medications:
1. statins (HMG-CoA reductase inhibitors) has been found to reduce high cholesterol fairly fast especially the more potent ones such as LIpitor and Crestor.
However they also have more side effects particularly damage to the liver(hepatitis) and muscles(myopathy)
2.fibrates is preferred especially if the triglycerides is high or if the patient has liver problem.
Lipanthyl (a fibrate) has been found to be as effective if not more effective than statins.
Side effects are myopathy.
3.Combination treatment of statins and fibrates are more effective but have more side effects such as increased myopathy and rhabdomyolysis in addition to hepatitis.
4.ezetimibe, niacin, bile acid sequestrants, plant sterol-containing products have also been used together with statins for better effect.
Treatment Regime:
--------------------
1. Total cholesterol is less than 250mg/dl: Diet and weight control is sufficient.
2.Total cholesterol is 250-300mg/dl: Diet and weight control is a must.
If associated risk factors such as high blood pressure, diabetes, heart disease, obesity and smoking is present, drug therapy is necessary.
3:Total cholesterol is more than 300mg/dl:
drug therapy together with diet and weight control is required.
How to prevent High Cholesterol?
-----------------------------------------
Diet Control
-----------------
1. Reduce intake of fatty meats
Eat lean meat and poultry
2. Avoid organs of animals especially liver, brain
Eat more beans, peas or bean cursd
3. Avoid seafood especially prawns, crabs, lobsters,squids'
Take more fish
4. Avoid deep fried food
Take more steamed food and non-creamy soups
5. Avoid lard and butter
Take margarine or polyunsaturated vegetable oils
6. Avoid creams, coconut milk, cakes
Eat Fish oils(omega 3) ,garlic
7. Avoid alcohol, excess rice, jams, sugars, sweets
Eat more fruits and vegetables
Weight control:
---------------------
Reduce the calories in food
Mild to strenous exercise
Avoid stress which can sometimes make you eat more.
-------------------------------------------
What is High Cholesterol?
------------------------------
High Cholesterol is the presence of raised amount of total cholesterol in the blood( blood total cholesterol above 200mg/dl).
What is the cause of High Cholesterol?
---------------------------------------------
Cholesterol is a fat molecule in the body which is needed for many normal body functions.
It is produced mostly in the liver and is present in the cell walls and membranes of the brain, nerves, muscles, skin, heart ,intestine and of course liver.
Cholesterol is used by the body to make the body's hormones(male and female) and bile acids used to digest fats.
20-30% of the cholesterol comes from the food that is eaten.
Animal Fat:
-------------
1.A diet high in saturated fat mainly animal fat, butter, lard
2.Trans-fatty acids in fast food and processed foods
Animal organs:
------------------
Brains of pigs, sheep, fish are particularly high in lipoproteins and fat
Liver, skin fat, etc
Egg yolk:
----------------
Egg yolk and products containing egg yolk like fish roe, cakes, icecream,
Dairy Products:
------------------
full cream milk
Certain other food:
--------------------
Peanut butter, peanut oils, coconut oil
Genetic factors - Familial hypercholesterolemia has been known for high cholesterol in families
What is the diagnosis of high cholesterol?
----------------------------------------------------
A blood test for lipid profile measures :
1.total cholesterol
2.LDL (low-density lipoprotein [the bad cholesterol]),
3.HDL (high-density lipoprotein [the good cholesterol])
4. triglycerides—another fatty substance in the blood.
High lipid readings are when the
1.total cholesterol in your blood is more than 200mg/dL,
2.LDL cholesterol is more than 130 mg/dL (130-159 is borderline high; 160 is high; 190 is very high).
3.HDL, the "good cholesterol," should be around 40 mg/dL or greater.
With HDL, the higher the number, the better, and 60 mg/dL is protective against heart disease.
4.Triglycerides is more than 200 mg/dL
What is the danger of High Cholesterol?
------------------------------------------
The excess cholesterol will then be deposited in the arterial walls causing narrowing of the arteries and reducing the blood flow to the heart, kidney and the brain.
Therefore any thickening of the arterial wall of blood vessels to the heart, kidney or brain as a result of deposit of cholesterol deposited in the wall of these arteries will reduce the flow of nutrients and oxygen to the heart, kidney or brain resulting in heart attack, kidney failure or stroke.
What is the Treatment of High Cholesterol?
---------------------------------------------------
1.Dietary and lifestyle modification
2. Medications:
1. statins (HMG-CoA reductase inhibitors) has been found to reduce high cholesterol fairly fast especially the more potent ones such as LIpitor and Crestor.
However they also have more side effects particularly damage to the liver(hepatitis) and muscles(myopathy)
2.fibrates is preferred especially if the triglycerides is high or if the patient has liver problem.
Lipanthyl (a fibrate) has been found to be as effective if not more effective than statins.
Side effects are myopathy.
3.Combination treatment of statins and fibrates are more effective but have more side effects such as increased myopathy and rhabdomyolysis in addition to hepatitis.
4.ezetimibe, niacin, bile acid sequestrants, plant sterol-containing products have also been used together with statins for better effect.
Treatment Regime:
--------------------
1. Total cholesterol is less than 250mg/dl: Diet and weight control is sufficient.
2.Total cholesterol is 250-300mg/dl: Diet and weight control is a must.
If associated risk factors such as high blood pressure, diabetes, heart disease, obesity and smoking is present, drug therapy is necessary.
3:Total cholesterol is more than 300mg/dl:
drug therapy together with diet and weight control is required.
How to prevent High Cholesterol?
-----------------------------------------
Diet Control
-----------------
1. Reduce intake of fatty meats
Eat lean meat and poultry
2. Avoid organs of animals especially liver, brain
Eat more beans, peas or bean cursd
3. Avoid seafood especially prawns, crabs, lobsters,squids'
Take more fish
4. Avoid deep fried food
Take more steamed food and non-creamy soups
5. Avoid lard and butter
Take margarine or polyunsaturated vegetable oils
6. Avoid creams, coconut milk, cakes
Eat Fish oils(omega 3) ,garlic
7. Avoid alcohol, excess rice, jams, sugars, sweets
Eat more fruits and vegetables
Weight control:
---------------------
Reduce the calories in food
Mild to strenous exercise
Avoid stress which can sometimes make you eat more.
A Simple Guide to Bronchitis
A Simple Guide to Bronchitis
-----------------------------------
What is Bronchitis?
---------------------------
Bronchitis is an acute disease which causes inflammation and infection of the trachea, bronchi and bronchioles of the lungs.
The mucous membranes of the bronchi of the lungs becomes inflamed from bacterial or viral infection or irritated by fumes and dust in the air resulting in swelling of the bronchial mucosa with excess mucous discharge causing narrowing of the air passages.
Because of the congestion of the brochi there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .
What are the causes of Bronchitis?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus Bronchitise and Staphphylococcus may be serious and fatal in some cases.
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Viral infections:
--------------------
Influenza, arbovirus, Severe Acute Respiratory Syndrome(SARS) virus, coxsackie virus
Fungal infections:
-----------------------
Cryptococcus neoformans
Non-infectious:
------------------
1.chemicals such as fumes can damage the lungs and cause Bronchitis
2.Othostatic Bronchitis occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs
3.Aspiration Bronchitis occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.
This occurs in comatose patients and people having seizures or stroke.
What are Signs and symptoms of Bronchitis?
---------------------------------------------
Symptoms:
1.cold or runny nose is usually the first symptom
2.Fever may be present
3.cough initially dry, followed by productive purulent sputum which can yellow, green or bloody
4.Breathlessness due to airway obstruction
5.chest pain especially the sides of the chest due to coughing and fever
6.Myalgia (bodyaches) and headache which may be related to the fever
Signs:
1.Moist sounds and wheezing on auscultation with sthetoscope due to narrowing of the airways(bronchi)
2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs
3.Reduced breath sounds - air movement is reduced in the lungs
4.Hyporesonance on percussion of the lungs
5.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.
This will considered as a medical emergency.
Children and babies with Bronchitis may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.
How is the diagnosis of Bronchitis made?
------------------------------------------
1.Symptoms and signs of fever, breathless and productive cough
2.blood tests (complete blood count, ESR and blood culture)
3.Sputum culture to determine the type of micro-organism
4.Chest X-rays to establish site and character of the bronchial infection
5.CT or MRI of the lungs may be done if required especailly if there is suspicion of lung cancer.
What are the complications of Bronchitis?
-----------------------------------------------
1.Pneumonia
2.adult respiratory distress syndrome
3.Emphysema
What is the treatment of Bronchitis?
------------------------------------
1.Rest, fluids and oxygen
2.Bronchidilators such as aminophylline, ventolin, bricanyl
3.Antibiotics depending on the organism found:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
c.Tetracycline or erythromycin for mycoplasma and chlamydia
d.Erythromycin and rifampicin for Legionaire's disease.
3.Antivirals such as Tamiflu for Influeza infection
Acyclovir may be given for herpes virus infection
4.High dosages of antifungals may be given for Fungal Bronchitis for a prolonged period of time
5.corticosteroids is useful to reduce complications
6.Humidifiers and steam inhalations
5.cough mixtures and mucolytic agents such as bisolvon
What is the prognosis of Bronchitis ?
------------------------------------------
This depends on the severity and type of infection.
Most cases if treated early and correctly recovered completely with return of normal lung function.
In elderly and debilitated patients, breathing can be a problem and recurrence can occur.
What are the Preventive measures taken for Bronchitis ?
--------------------------------------------------------
1.Avoid smoking and dusty environment.
2.Healthy lifestyle with balanced diet and exercise.
3.Vaccination against the influenza virus may help.
-----------------------------------
What is Bronchitis?
---------------------------
Bronchitis is an acute disease which causes inflammation and infection of the trachea, bronchi and bronchioles of the lungs.
The mucous membranes of the bronchi of the lungs becomes inflamed from bacterial or viral infection or irritated by fumes and dust in the air resulting in swelling of the bronchial mucosa with excess mucous discharge causing narrowing of the air passages.
Because of the congestion of the brochi there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .
What are the causes of Bronchitis?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus Bronchitise and Staphphylococcus may be serious and fatal in some cases.
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Viral infections:
--------------------
Influenza, arbovirus, Severe Acute Respiratory Syndrome(SARS) virus, coxsackie virus
Fungal infections:
-----------------------
Cryptococcus neoformans
Non-infectious:
------------------
1.chemicals such as fumes can damage the lungs and cause Bronchitis
2.Othostatic Bronchitis occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs
3.Aspiration Bronchitis occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.
This occurs in comatose patients and people having seizures or stroke.
What are Signs and symptoms of Bronchitis?
---------------------------------------------
Symptoms:
1.cold or runny nose is usually the first symptom
2.Fever may be present
3.cough initially dry, followed by productive purulent sputum which can yellow, green or bloody
4.Breathlessness due to airway obstruction
5.chest pain especially the sides of the chest due to coughing and fever
6.Myalgia (bodyaches) and headache which may be related to the fever
Signs:
1.Moist sounds and wheezing on auscultation with sthetoscope due to narrowing of the airways(bronchi)
2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs
3.Reduced breath sounds - air movement is reduced in the lungs
4.Hyporesonance on percussion of the lungs
5.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.
This will considered as a medical emergency.
Children and babies with Bronchitis may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.
How is the diagnosis of Bronchitis made?
------------------------------------------
1.Symptoms and signs of fever, breathless and productive cough
2.blood tests (complete blood count, ESR and blood culture)
3.Sputum culture to determine the type of micro-organism
4.Chest X-rays to establish site and character of the bronchial infection
5.CT or MRI of the lungs may be done if required especailly if there is suspicion of lung cancer.
What are the complications of Bronchitis?
-----------------------------------------------
1.Pneumonia
2.adult respiratory distress syndrome
3.Emphysema
What is the treatment of Bronchitis?
------------------------------------
1.Rest, fluids and oxygen
2.Bronchidilators such as aminophylline, ventolin, bricanyl
3.Antibiotics depending on the organism found:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
c.Tetracycline or erythromycin for mycoplasma and chlamydia
d.Erythromycin and rifampicin for Legionaire's disease.
3.Antivirals such as Tamiflu for Influeza infection
Acyclovir may be given for herpes virus infection
4.High dosages of antifungals may be given for Fungal Bronchitis for a prolonged period of time
5.corticosteroids is useful to reduce complications
6.Humidifiers and steam inhalations
5.cough mixtures and mucolytic agents such as bisolvon
What is the prognosis of Bronchitis ?
------------------------------------------
This depends on the severity and type of infection.
Most cases if treated early and correctly recovered completely with return of normal lung function.
In elderly and debilitated patients, breathing can be a problem and recurrence can occur.
What are the Preventive measures taken for Bronchitis ?
--------------------------------------------------------
1.Avoid smoking and dusty environment.
2.Healthy lifestyle with balanced diet and exercise.
3.Vaccination against the influenza virus may help.
Monday, September 8, 2008
A Simple Guide to Thyroid Nodules
A Simple Guide to Thyroid Nodules
-----------------------------------
What are Thyroid Nodules ?
------------------------------------------------
Thyroid nodules are abnormal swellings in the thyroid gland which occurs when the thyroid tissues starts to proliferate in one part of the thyroid gland.
Who are at risk of thyroid nodule?
-------------------------------------
1.Thyroid nodules are more common in females than in male.
2.However the thyroid nodule in males are more prone to malignancy than in females
3.Thyroid nodules occurs more in the 30- 60 age group.
What are the different types of Thyroid Nodules?
--------------------------------------------------------------
1.solid - solid thyroid nodules which may or not feel hard
2.cystic - the nodules is filled with fluid.
3.benign - non malignant
4.malignant - cancerous
What are the symptoms and signs of Thyroid Nodules?
-------------------------------------------------------
In mild cases there is usually no obvious symptoms.
In moderate or severe cases of thyroid nodules:
Symptoms:
--------------
1.Obvious swelling in the thyroid gland
2.Neck swelling -suuggest presence of spread to the lymph node
3.Hoarseness of voice may occur if there is pressure on the vocal cord or recurrent nerve to vocal cord
4.Dyspnea or breathlessness if there is pressure on the trachea
5.Dysphagia or difficuly in swallowing due to pressure on the oesophagus
Signs:
-------------
1.Thyroid nodules are felt only if they are more than 1.5 to 2cm in diameter.
2.Cystic nodules may feel hard while solid nodules may be soft to firm.
3. The vocal cords should always be examined to exclude lesions in the vocal cords causing hoarseness.
4.Malignant thyroid nodules present similarly to benign nodules but can spread to other parts of the body.
How are diagnosis of Thyroid Nodules made?
------------------------------------------------------------
1.blood test for thyroxine and TSH levels
2.fine needle aspiration biopsy is a simple way to determine if a nodule is benign or malignant.
The biopsied material is then sent to the lab for tests to look for any malignant cells.
3.ultrasound scans are done to differentiate between solid and cystic nodules,
4.thyroid scans which help to show if a nodule is producing excessive thyroid hormone(hot) or not.
5.CT Scan or MRI are not routine to thyroid nodules investigation except where there is suspected compression of teachea.
What is the Treatment of Thyroid Nodules?
-------------------------------------------
Benign lumps can be monitored by doctors at regular intervals.
If there are symptoms of compressing a neighbouring organ or the nodule is cancerous, surgery is required.
Patients who has symptoms of hyperthyroidism are advised to go for radioactive iodine treatment or surgery.
What is the Prognosis of Thyroid Nodules?
-------------------------------------------
Prognosis is good in all benign cases.
Malignant thyroid nodules will depend on any spread to other organs.
-----------------------------------
What are Thyroid Nodules ?
------------------------------------------------
Thyroid nodules are abnormal swellings in the thyroid gland which occurs when the thyroid tissues starts to proliferate in one part of the thyroid gland.
Who are at risk of thyroid nodule?
-------------------------------------
1.Thyroid nodules are more common in females than in male.
2.However the thyroid nodule in males are more prone to malignancy than in females
3.Thyroid nodules occurs more in the 30- 60 age group.
What are the different types of Thyroid Nodules?
--------------------------------------------------------------
1.solid - solid thyroid nodules which may or not feel hard
2.cystic - the nodules is filled with fluid.
3.benign - non malignant
4.malignant - cancerous
What are the symptoms and signs of Thyroid Nodules?
-------------------------------------------------------
In mild cases there is usually no obvious symptoms.
In moderate or severe cases of thyroid nodules:
Symptoms:
--------------
1.Obvious swelling in the thyroid gland
2.Neck swelling -suuggest presence of spread to the lymph node
3.Hoarseness of voice may occur if there is pressure on the vocal cord or recurrent nerve to vocal cord
4.Dyspnea or breathlessness if there is pressure on the trachea
5.Dysphagia or difficuly in swallowing due to pressure on the oesophagus
Signs:
-------------
1.Thyroid nodules are felt only if they are more than 1.5 to 2cm in diameter.
2.Cystic nodules may feel hard while solid nodules may be soft to firm.
3. The vocal cords should always be examined to exclude lesions in the vocal cords causing hoarseness.
4.Malignant thyroid nodules present similarly to benign nodules but can spread to other parts of the body.
How are diagnosis of Thyroid Nodules made?
------------------------------------------------------------
1.blood test for thyroxine and TSH levels
2.fine needle aspiration biopsy is a simple way to determine if a nodule is benign or malignant.
The biopsied material is then sent to the lab for tests to look for any malignant cells.
3.ultrasound scans are done to differentiate between solid and cystic nodules,
4.thyroid scans which help to show if a nodule is producing excessive thyroid hormone(hot) or not.
5.CT Scan or MRI are not routine to thyroid nodules investigation except where there is suspected compression of teachea.
What is the Treatment of Thyroid Nodules?
-------------------------------------------
Benign lumps can be monitored by doctors at regular intervals.
If there are symptoms of compressing a neighbouring organ or the nodule is cancerous, surgery is required.
Patients who has symptoms of hyperthyroidism are advised to go for radioactive iodine treatment or surgery.
What is the Prognosis of Thyroid Nodules?
-------------------------------------------
Prognosis is good in all benign cases.
Malignant thyroid nodules will depend on any spread to other organs.
Sunday, September 7, 2008
A Simple Guide to Otitis media
A Simple Guide to Otitis media
----------------------------------------------------
What is Otitis media?
---------------------------------------
Otitis media is acute or chronic inflammation of the middle ear.
Otitis media occurs in the area between the ear drum (the end of the outer ear) and the inner ear, including a duct known as the Eustachian tube.
Who is affected by Otitis media?
---------------------------------------------------
1.childhood, usually related to viral upper respiratory tract infection
2.family history of middle ear disease.
What are the Causes of Otitis media?
-----------------------------------------------------
Bacterial infections:
1.Streptococcus pneumoniae
2.Haemophilus influenzae
3.staphylococcus aureus
4.Moraxella catarrhalis, a gram-negative diplococcus.
5.Mycobacterium tuberculosis.
6.E.coli
Viral infections:
1.common cold.
2.measles
What is the Types of Otitis Media?
-----------------------------------------------------
1. Acute otitis media
Acute otitis media ia an acute infection of the middle ear which usually occurs as a result of viral upper respiratory tract infection that can occur at least twice a year
2.Chronic otitis media
Chronic otitis media occurs following acute otitis media with chronic infection of the middle ear and ear perforation.
3.Otitis media with effusion:
Otitis media with effusion occurs when fluid occurs in the middle ear due to blockage of the eustachian tube.
What are the complications of Otitis media?
---------------------------------------------------
1.mastoiditis
2.labrynthitis
3.facial nerve palsy
4.meningitis,
5.brain abscess,
6.febrile seizures.
7.death if a severe infection goes untreated long enough
What are the Symptoms and signs of Otitis media?
-----------------------------------------------------------
1. cold: stuffy nose
2. earache - The pain lasts a day or two.
3. high fever - may cause seizures if very high
4. discharging pus from the ruptured eardrum
Usually the ruptured drum will usually heal spontaneously
5.Eustachian tube becomes blocked resulting in hearing loss
Signs:
1.Ear drum (tympanic membrane) inflamed and bulging with loss of normal outline
2.Decreased or displaced light reflex of ear drum
3.perforation of ear drum
4.mucopurulent discharge from ear after perforation
How is diagnosis of Otitis media made?
-----------------------------------------------
1.Inflamed ear drum with loss of normal outline, decreased light reflex, bulging and perforation and purulent discharge.
2.Culture and sensitivity of pus swab
3.Nasal and pharyngeal swabs my also be done
4.X-rays or MRI of the mastoid air cells
5.Audiogram for hearing loss
What is the treatment of Otitis media?
---------------------------------------------------
Acute otitis media
1. Antibiotics may be commenced if fever is high or the culture showed bacterial infections.
2.Fever and pain may be treated with paracetamol
3.Antihistamines may be given for rhinitis or runny nose.
4.Decogestants may be necessary for blockage of eustachian tube
5.Bed rest and Fluids
6.Myringoplasty -Puncture of bulging ear drum if painful and aspiration of pus or fluid in the middle ear.
7.Tympanoplasty for eardrum whose perforation does not heal.
8.Mastoidectomy to remove cholesteatoma(growing of skin into middle ear cavity) in chronic otitis media with mastoiditis.
What is the prognosis of Otitis media?
-----------------------------------------
Prognosis with appropriate treatment is generally good.
Ear drum perforation usually heal spontaneously in most cases.
What are Preventive measures for Otitis media?
----------------------------------------------------
Avoid swimming and diving.
Proper ear hygiene.
----------------------------------------------------
What is Otitis media?
---------------------------------------
Otitis media is acute or chronic inflammation of the middle ear.
Otitis media occurs in the area between the ear drum (the end of the outer ear) and the inner ear, including a duct known as the Eustachian tube.
Who is affected by Otitis media?
---------------------------------------------------
1.childhood, usually related to viral upper respiratory tract infection
2.family history of middle ear disease.
What are the Causes of Otitis media?
-----------------------------------------------------
Bacterial infections:
1.Streptococcus pneumoniae
2.Haemophilus influenzae
3.staphylococcus aureus
4.Moraxella catarrhalis, a gram-negative diplococcus.
5.Mycobacterium tuberculosis.
6.E.coli
Viral infections:
1.common cold.
2.measles
What is the Types of Otitis Media?
-----------------------------------------------------
1. Acute otitis media
Acute otitis media ia an acute infection of the middle ear which usually occurs as a result of viral upper respiratory tract infection that can occur at least twice a year
2.Chronic otitis media
Chronic otitis media occurs following acute otitis media with chronic infection of the middle ear and ear perforation.
3.Otitis media with effusion:
Otitis media with effusion occurs when fluid occurs in the middle ear due to blockage of the eustachian tube.
What are the complications of Otitis media?
---------------------------------------------------
1.mastoiditis
2.labrynthitis
3.facial nerve palsy
4.meningitis,
5.brain abscess,
6.febrile seizures.
7.death if a severe infection goes untreated long enough
What are the Symptoms and signs of Otitis media?
-----------------------------------------------------------
1. cold: stuffy nose
2. earache - The pain lasts a day or two.
3. high fever - may cause seizures if very high
4. discharging pus from the ruptured eardrum
Usually the ruptured drum will usually heal spontaneously
5.Eustachian tube becomes blocked resulting in hearing loss
Signs:
1.Ear drum (tympanic membrane) inflamed and bulging with loss of normal outline
2.Decreased or displaced light reflex of ear drum
3.perforation of ear drum
4.mucopurulent discharge from ear after perforation
How is diagnosis of Otitis media made?
-----------------------------------------------
1.Inflamed ear drum with loss of normal outline, decreased light reflex, bulging and perforation and purulent discharge.
2.Culture and sensitivity of pus swab
3.Nasal and pharyngeal swabs my also be done
4.X-rays or MRI of the mastoid air cells
5.Audiogram for hearing loss
What is the treatment of Otitis media?
---------------------------------------------------
Acute otitis media
1. Antibiotics may be commenced if fever is high or the culture showed bacterial infections.
2.Fever and pain may be treated with paracetamol
3.Antihistamines may be given for rhinitis or runny nose.
4.Decogestants may be necessary for blockage of eustachian tube
5.Bed rest and Fluids
6.Myringoplasty -Puncture of bulging ear drum if painful and aspiration of pus or fluid in the middle ear.
7.Tympanoplasty for eardrum whose perforation does not heal.
8.Mastoidectomy to remove cholesteatoma(growing of skin into middle ear cavity) in chronic otitis media with mastoiditis.
What is the prognosis of Otitis media?
-----------------------------------------
Prognosis with appropriate treatment is generally good.
Ear drum perforation usually heal spontaneously in most cases.
What are Preventive measures for Otitis media?
----------------------------------------------------
Avoid swimming and diving.
Proper ear hygiene.
Friday, September 5, 2008
A Simple Guide to Skin warts
A Simple Guide to Skin warts
----------------------------------------------------
What are Skin warts?
---------------------------------------
Skin warts are benign epithelial hyperplasia raised swellings on the skin caused by one of the human papilloma viruses.
They are infectious by direct contact or indirect contact through contaminated surfaces from one person to the other.
It is the one of the common skin condition.
It is never life threatening.
Who is affected by Skin warts?
---------------------------------------------------
Skin warts is more common in :
1.children than in adults
2.contact with a person with warts
3.families with a patient having warts
What is the Cause of Skin warts?
-----------------------------------------------------
The human papilloma virus is the cause of skin warts.
There are 100 types of HPV which has been identified as causing skin or mucosal infections.
What are the types of Skin warts?
-----------------------------------------------------------
Common wart:
--------------
Common warts are benign swellings in the skin that are caused by human papillomavirus (HPV) infection.
1.Periungual wart
Periungual warts are common warts around or under the fingernail and toenail.
2.Plantar warts
Plantar warts are found on the pressure areas of the foot.
The presure causes inward growth.
They can be single, seedling or mosaic.
3.Mosaic warts
Mosaic warts are plagues of closely set plantar warts
4.Plane warts
Plane warts are flat-topped smooth papules, light brown or skin flesh in color present on the face, legs, and hands often occuring in large numbers.
5.Filiform warts
Filiform warts appear as a single long narrow growth often on the eyelid or face
What are the Symptoms and signs of Skin warts?
-----------------------------------------------------------
Skin warts can present as:
1.round or irregular raised swelling
2.Color may be like normal skin or light brown.
3.Surface is rough(may look like califlower) or smooth
4.Border is sharply demarcated
5.Size varies from 2-10mm in diameter.
5.They are usually found on the fingers, elbows, knees, feet, scalp and face.
How do you make the Diagnosis of Skin warts?
------------------------------------------------------------
1.Skin biopsy under local anesthesia
2.small lesions can be totally removed
3.larger ones are biopsied first and surgically removed later on
What are the complications of Skin warts?
--------------------------------------------------------
If skin warts are transmitted to the genital area, there is a risk of genital warts which can cause cervical cancer in women
What is the treatment of Skin warts?
---------------------------------------------------
Many warts resolve spontaneously.
For those that persists or grow bigger, other treatments may be used:
1.Surgery:
Skin warts are removed by surgical excision.
2.Chemical treatment:
a.local therapy with Salicylic-acid preparations which dissolves the protein forming most of both the wart and the thick layer of dead skin above it.
b. 5-fluorouracil(a chemotherapy agent)
3.Cautery:
Electrotherapy by cautery of the warts kills the virus and destroy the tisues underneath which allow them to grow.
4.Cryosurgery:
Aerosol wart treatments freeze warts at a temperature of minus 57 C.
This can kill the virus.
Dermatologists use liquid nitrogen which is considerably colderminus 196 C.
What is the prognosis of Skin warts?
----------------------------------------------------
Prognosis of majority of cases is good if there is complete removal.
Recurrences are common
What are the preventive measures for Skin warts?
-----------------------------------------------------------------
Avoid direct or indirect contact through contaminated surfaces with people having warts
----------------------------------------------------
What are Skin warts?
---------------------------------------
Skin warts are benign epithelial hyperplasia raised swellings on the skin caused by one of the human papilloma viruses.
They are infectious by direct contact or indirect contact through contaminated surfaces from one person to the other.
It is the one of the common skin condition.
It is never life threatening.
Who is affected by Skin warts?
---------------------------------------------------
Skin warts is more common in :
1.children than in adults
2.contact with a person with warts
3.families with a patient having warts
What is the Cause of Skin warts?
-----------------------------------------------------
The human papilloma virus is the cause of skin warts.
There are 100 types of HPV which has been identified as causing skin or mucosal infections.
What are the types of Skin warts?
-----------------------------------------------------------
Common wart:
--------------
Common warts are benign swellings in the skin that are caused by human papillomavirus (HPV) infection.
1.Periungual wart
Periungual warts are common warts around or under the fingernail and toenail.
2.Plantar warts
Plantar warts are found on the pressure areas of the foot.
The presure causes inward growth.
They can be single, seedling or mosaic.
3.Mosaic warts
Mosaic warts are plagues of closely set plantar warts
4.Plane warts
Plane warts are flat-topped smooth papules, light brown or skin flesh in color present on the face, legs, and hands often occuring in large numbers.
5.Filiform warts
Filiform warts appear as a single long narrow growth often on the eyelid or face
What are the Symptoms and signs of Skin warts?
-----------------------------------------------------------
Skin warts can present as:
1.round or irregular raised swelling
2.Color may be like normal skin or light brown.
3.Surface is rough(may look like califlower) or smooth
4.Border is sharply demarcated
5.Size varies from 2-10mm in diameter.
5.They are usually found on the fingers, elbows, knees, feet, scalp and face.
How do you make the Diagnosis of Skin warts?
------------------------------------------------------------
1.Skin biopsy under local anesthesia
2.small lesions can be totally removed
3.larger ones are biopsied first and surgically removed later on
What are the complications of Skin warts?
--------------------------------------------------------
If skin warts are transmitted to the genital area, there is a risk of genital warts which can cause cervical cancer in women
What is the treatment of Skin warts?
---------------------------------------------------
Many warts resolve spontaneously.
For those that persists or grow bigger, other treatments may be used:
1.Surgery:
Skin warts are removed by surgical excision.
2.Chemical treatment:
a.local therapy with Salicylic-acid preparations which dissolves the protein forming most of both the wart and the thick layer of dead skin above it.
b. 5-fluorouracil(a chemotherapy agent)
3.Cautery:
Electrotherapy by cautery of the warts kills the virus and destroy the tisues underneath which allow them to grow.
4.Cryosurgery:
Aerosol wart treatments freeze warts at a temperature of minus 57 C.
This can kill the virus.
Dermatologists use liquid nitrogen which is considerably colderminus 196 C.
What is the prognosis of Skin warts?
----------------------------------------------------
Prognosis of majority of cases is good if there is complete removal.
Recurrences are common
What are the preventive measures for Skin warts?
-----------------------------------------------------------------
Avoid direct or indirect contact through contaminated surfaces with people having warts
Thursday, September 4, 2008
A Simple Guide to Lichen Planus
A Simple Guide to Lichen Planus
-----------------------------------------------
What is Lichen Planus?
----------------------------------
Lichen Planus is a chronic inflammatory disease of the skin which typically consists of red small papules that joined together to from rough scaly patches.
It is often associated with lesions of the mucosal membranes.
What are the types of Lichen Planus?
--------------------------------
There are 2 main types:
1.Skin Lichen Planus is the most common type of Lichen Planus.
About 80% of people have red small papules that joined together to from rough scaly patches.
The skin usually grows very more quickly and are thicker than usual.
2.Mucosal Lichen Planus (small, red papular lesion of the mouth and mucous membranes)
Who Gets Lichen Planus?
-----------------------
Lichen Planus occurs more in females than in males.
It is also more common in the middle ages.
It is rare in children
What causes Lichen Planus?
-------------------------------------
The cause of Lichen Planus is unknown.
1.allergic reactions to medications for high blood pressure(methyl dopa) and arthritis (chloroquine and salicylates),arsenic, gold.
2.chronic hepatitis C virus infection
3.stress aggravate the condition
4.Allergic reactions to amalgam and gold filling can cause oral lesions
What are the symptoms of Lichen Planus?
-------------------------------------------------
Onset is sudden or gradual.
They may last weeks or months and be recurrent.
Frequently they become chronic.
The typical rash of lichen planus is well-defined :
1.pruritic,
2.planar,
3.purple,
4.polygonal
5.papules.
When seen under the microscope the papules have characteristic network of white lines(Wickham's striae)
Lesions are symmetrical, usually on flexor surfaces of the arm near the wrist and the ankle.
Nails are frequently involved with pitting and thinning of the nail plate.
Oral lichen planus occurs in 50% of patients:
1. reticular form - most common rash, occurs as white streaks on the mucosa (known as Wickham's striae) or papules with small raised area .
The lesions are present on the gums, the tongue, palate and lips.
The lesions are present on both sides of the mouth
2. bullous form - fluid-filled vesicles
3. erosive form - erythematous (red) areas which are ulcerated.
This form may become malignant.
Microscopic appearance is typical of lichen planus:
1.Hyperparakeratosis or thickening of the granular cell layer
There is a typical saw-tooth appearance of the rete pegs
2.Degenerated basal cell layer
3.Inflammatory cells present in subepithelial layer of connective tissue
Lichen planus may involve the glan penis and vulvovaginal mucosa
Lichen planus rarely involve the eosophagus where it can cause erosive esophagitis and stricturing.
How does Lichen Planus affects the Patient?
-----------------------------------------
All types of Lichen Planus can affect a person’s quality of life.
Itching, soreness, and ulcers of the mouth are common.
What is the Treatment of Lichen Planus?
-----------------------------------
Treatment depends on the severity and type of Lichen Planus.
1. mild cases may not require any treatment
2.severe Lichen Planus have lesions that affects most of the body and hospitalization is required.
3.Most cases of Lichen Planus lie in between.
Treatments:
1.Topical Medicines include:
topical steroids.
tar lotions, ointments, creams, and shampoo
2.Systemic therapy (oral drugs that affect the whole body system):
cyclosporins, methotrexate
immunosuppressant medications
Oral retinoids
Oral corticosteroids
hydroxychloroquine
tacrolimus
dapsone
3.Phototherapy (with ultraviolet B, psoralen with ultraviolet A, radiation)
4.Combined therapy are frequently used.
5.new therapies such as the biologic agents has improved the condition
At the present moment there is no known cure for lichen planus.
Medicines have been able to reduce the severity of inflammation and improve the quality of life.
Other medicines are used to treat symptoms:
1.Antihistamines for itch
2.Oral topical steroids for mouth ulcers
What is the Prognosis of Lichen Planus?
-----------------------------------------------
There is generally no cure for lichen planus.
Lichen planus may become dormant after being treated.
Recurrences are common even years after being dormant.
Lifelong treatment may be necessary to control signs and symptoms.
-----------------------------------------------
What is Lichen Planus?
----------------------------------
Lichen Planus is a chronic inflammatory disease of the skin which typically consists of red small papules that joined together to from rough scaly patches.
It is often associated with lesions of the mucosal membranes.
What are the types of Lichen Planus?
--------------------------------
There are 2 main types:
1.Skin Lichen Planus is the most common type of Lichen Planus.
About 80% of people have red small papules that joined together to from rough scaly patches.
The skin usually grows very more quickly and are thicker than usual.
2.Mucosal Lichen Planus (small, red papular lesion of the mouth and mucous membranes)
Who Gets Lichen Planus?
-----------------------
Lichen Planus occurs more in females than in males.
It is also more common in the middle ages.
It is rare in children
What causes Lichen Planus?
-------------------------------------
The cause of Lichen Planus is unknown.
1.allergic reactions to medications for high blood pressure(methyl dopa) and arthritis (chloroquine and salicylates),arsenic, gold.
2.chronic hepatitis C virus infection
3.stress aggravate the condition
4.Allergic reactions to amalgam and gold filling can cause oral lesions
What are the symptoms of Lichen Planus?
-------------------------------------------------
Onset is sudden or gradual.
They may last weeks or months and be recurrent.
Frequently they become chronic.
The typical rash of lichen planus is well-defined :
1.pruritic,
2.planar,
3.purple,
4.polygonal
5.papules.
When seen under the microscope the papules have characteristic network of white lines(Wickham's striae)
Lesions are symmetrical, usually on flexor surfaces of the arm near the wrist and the ankle.
Nails are frequently involved with pitting and thinning of the nail plate.
Oral lichen planus occurs in 50% of patients:
1. reticular form - most common rash, occurs as white streaks on the mucosa (known as Wickham's striae) or papules with small raised area .
The lesions are present on the gums, the tongue, palate and lips.
The lesions are present on both sides of the mouth
2. bullous form - fluid-filled vesicles
3. erosive form - erythematous (red) areas which are ulcerated.
This form may become malignant.
Microscopic appearance is typical of lichen planus:
1.Hyperparakeratosis or thickening of the granular cell layer
There is a typical saw-tooth appearance of the rete pegs
2.Degenerated basal cell layer
3.Inflammatory cells present in subepithelial layer of connective tissue
Lichen planus may involve the glan penis and vulvovaginal mucosa
Lichen planus rarely involve the eosophagus where it can cause erosive esophagitis and stricturing.
How does Lichen Planus affects the Patient?
-----------------------------------------
All types of Lichen Planus can affect a person’s quality of life.
Itching, soreness, and ulcers of the mouth are common.
What is the Treatment of Lichen Planus?
-----------------------------------
Treatment depends on the severity and type of Lichen Planus.
1. mild cases may not require any treatment
2.severe Lichen Planus have lesions that affects most of the body and hospitalization is required.
3.Most cases of Lichen Planus lie in between.
Treatments:
1.Topical Medicines include:
topical steroids.
tar lotions, ointments, creams, and shampoo
2.Systemic therapy (oral drugs that affect the whole body system):
cyclosporins, methotrexate
immunosuppressant medications
Oral retinoids
Oral corticosteroids
hydroxychloroquine
tacrolimus
dapsone
3.Phototherapy (with ultraviolet B, psoralen with ultraviolet A, radiation)
4.Combined therapy are frequently used.
5.new therapies such as the biologic agents has improved the condition
At the present moment there is no known cure for lichen planus.
Medicines have been able to reduce the severity of inflammation and improve the quality of life.
Other medicines are used to treat symptoms:
1.Antihistamines for itch
2.Oral topical steroids for mouth ulcers
What is the Prognosis of Lichen Planus?
-----------------------------------------------
There is generally no cure for lichen planus.
Lichen planus may become dormant after being treated.
Recurrences are common even years after being dormant.
Lifelong treatment may be necessary to control signs and symptoms.
Wednesday, September 3, 2008
A Simple Guide to Keloid
A Simple Guide to Keloid
----------------------------------------------------
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.
----------------------------------------------------
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.
Sunday, August 31, 2008
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.
----------------------------------------------------
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.
Thursday, August 28, 2008
A Simple Guide to Squamous Cell Carcinoma(skin)
A Simple Guide to Squamous Cell Carcinoma(skin)
----------------------------------------------------
What is Squamous Cell Carcinoma?
---------------------------------------
Squamous Cell Carcinoma is a progressive neoplastic tumor of the epithelial cells of thee skin which are found mainly in the late middle age and consists of a solitary skin lesion.
Who is affected by Squamous Cell Carcinoma?
---------------------------------------------------
Squamous Cell Carcinoma is more common in :
1.People with fair skin than in those with darker skin.
2.People who spend time outdoors under the sun than those staying indoors.
3.People with skin condition called xeroderma pigmentosa
4.People with autoimmune disease such as systemic lupus erythematosus
5.People with family history of Squamous Cell Carcinoma
What is the Cause of Squamous Cell Carcinoma?
-----------------------------------------------------
A.Sun exposure:
Exposure to the sun is one of the most common causes of Squamous Cell Carcinoma.
Risk factors are:
1.intensity of the sun
2.duration of sun exposure,
3.age when sun exposure takes place
4.degree of skin pigmentation
B.Familial:
1.skin condition called xeroderma pigmentosa (autosomal recessive)
2.family history of Squamous Cell Carcinoma
What are the Symptoms and signs of Squamous Cell Carcinoma?
-----------------------------------------------------------
Squamous Cell Carcinoma presents usually as:
1.single firm lesion
2.raised
3.red
4.indurated
5.scaling
6.ulceration may occur
7.rarely bleeding
8.found in sun exposed areas of body
9.regional lymph nodes may be enlarged
How do you make the Diagnosis of Squamous Cell Carcinoma?
------------------------------------------------------------
Biopsy show malignant epithelial cells with varying degrees of infiltration
What are the complications of Squamous Cell Carcinoma?
-----------------------------------------------------------------
Squamous Cell Carcinoma can spread to the organs and other parts of the body
What is the treatment of Squamous Cell Carcinoma?
---------------------------------------------------
Treatment is simple surgical removal of the skin lesion .
Sometimes the regional lymph nodes are also removed.
If the spread is further, chemotherapy and radiotherapy may be necessary.
What is the prognosis of Squamous Cell Carcinoma?
------------------------------------------------------
The prognosis is good if detected early and there is complete removal of the cancer.
If there is spread to the organs, prognosis is variable depending on the degree of metastases.
What are the preventive measures for Squamous cell carcinoma?
-----------------------------------------------------------------
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats).
Use sunscreens.
2.Good nutrition and healthy lifestyle boost the immune system and helps prevent malignancy.
3.Patients with family history of skin cancer should be reviewed yearly
4.Recently a melanocyte-stimulating hormone called melanotan has been found to provide photo-protection against squamous cell carcinoma of the skin.
----------------------------------------------------
What is Squamous Cell Carcinoma?
---------------------------------------
Squamous Cell Carcinoma is a progressive neoplastic tumor of the epithelial cells of thee skin which are found mainly in the late middle age and consists of a solitary skin lesion.
Who is affected by Squamous Cell Carcinoma?
---------------------------------------------------
Squamous Cell Carcinoma is more common in :
1.People with fair skin than in those with darker skin.
2.People who spend time outdoors under the sun than those staying indoors.
3.People with skin condition called xeroderma pigmentosa
4.People with autoimmune disease such as systemic lupus erythematosus
5.People with family history of Squamous Cell Carcinoma
What is the Cause of Squamous Cell Carcinoma?
-----------------------------------------------------
A.Sun exposure:
Exposure to the sun is one of the most common causes of Squamous Cell Carcinoma.
Risk factors are:
1.intensity of the sun
2.duration of sun exposure,
3.age when sun exposure takes place
4.degree of skin pigmentation
B.Familial:
1.skin condition called xeroderma pigmentosa (autosomal recessive)
2.family history of Squamous Cell Carcinoma
What are the Symptoms and signs of Squamous Cell Carcinoma?
-----------------------------------------------------------
Squamous Cell Carcinoma presents usually as:
1.single firm lesion
2.raised
3.red
4.indurated
5.scaling
6.ulceration may occur
7.rarely bleeding
8.found in sun exposed areas of body
9.regional lymph nodes may be enlarged
How do you make the Diagnosis of Squamous Cell Carcinoma?
------------------------------------------------------------
Biopsy show malignant epithelial cells with varying degrees of infiltration
What are the complications of Squamous Cell Carcinoma?
-----------------------------------------------------------------
Squamous Cell Carcinoma can spread to the organs and other parts of the body
What is the treatment of Squamous Cell Carcinoma?
---------------------------------------------------
Treatment is simple surgical removal of the skin lesion .
Sometimes the regional lymph nodes are also removed.
If the spread is further, chemotherapy and radiotherapy may be necessary.
What is the prognosis of Squamous Cell Carcinoma?
------------------------------------------------------
The prognosis is good if detected early and there is complete removal of the cancer.
If there is spread to the organs, prognosis is variable depending on the degree of metastases.
What are the preventive measures for Squamous cell carcinoma?
-----------------------------------------------------------------
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats).
Use sunscreens.
2.Good nutrition and healthy lifestyle boost the immune system and helps prevent malignancy.
3.Patients with family history of skin cancer should be reviewed yearly
4.Recently a melanocyte-stimulating hormone called melanotan has been found to provide photo-protection against squamous cell carcinoma of the skin.
Wednesday, August 27, 2008
A Simple Guide to Basal cell carcinoma
A Simple Guide to Basal cell carcinoma
----------------------------------------------------
What is Basal cell carcinoma?
---------------------------------------
Basal cell carcinoma is a localized malignant tumor of the basal cells of the skin which seldom spread beyond its location.
It is the most common skin cancer.
It usually occurs in fair skinned people above the age of 50.
It is never life threatening.
Who is affected by Basal cell carcinoma?
---------------------------------------------------
Basal cell carcinoma is more common in :
1.People with fair skin than in those with darker skin.
2.People who spend time outdoors under the sun than those staying indoors.
3.People with a family history of Basal cell carcinoma.
What is the Cause of Basal cell carcinoma?
-----------------------------------------------------
A. Familial:
Familial cases of Basal cell carcinoma with
1.autosomal dominant genes(basal cell nevus) and
2.xeroderma pigmentosum(autosomal recessive)
are more common especially in fair skin people.
B.Sun exposure:
Exposure to the sun is one of the most common causes of Basal cell carcinoma.
The majority of basal cell carcinomas occur on sun-exposed areas of the body.
Risk factors are:
1.intensity of the sun
2.duration of sun exposure,
3.age when sun exposure takes place
4.degree of skin pigmentation
C:Environmental causes:
1.Arsenic exposure in certain occupations(preparation of arsenic products)
2.Exposure to X-ray radiation especially radiotherapy
What are the types of Basal cell carcinoma?
-----------------------------------------------------------
1.Nodular: flesh-colored papule with capillaries which can become ulcerated ( called rodent ulcer )
2.Cystic: less common with a central cystic cavity.
3.Pigmented: pigmented nodular form
4.Sclerosing: looks like a keloid
5.Superficial: a red scaly flat lesion.
What are the Symptoms and signs of Basal cell carcinoma?
-----------------------------------------------------------
Basal cell carcinoma can present as:
1.firm nodule which grows within the skin and below it
2.Color may be like normal skin, dark brown or black.
3.Border is characteristic rolled up edge
4. red, flat, scaling areas similar to a patch of eczema.
How do you make the Diagnosis of Basal cell carcinoma?
------------------------------------------------------------
1.Skin biopsy under local anesthesia
2.small lesions can be totally removed
3.larger ones are biopsied first and surgically removed if there is confirmed malignancy.
What are the complications of Basal cell carcinoma?
--------------------------------------------------------
1.local growth and destruction of neighboring tissues (e.g. nose).
2.Growth into vital structures resulting in the loss of extension or function
3.rarely metastases or cause death.
What is the treatment of Basal cell carcinoma?
---------------------------------------------------
Surgery:
Most basal cell carcinomas are removed by surgical excision with margins of 4-6mm.
Chemotherapy:
local therapy with 5-fluorouracil(a chemotherapy agent) with 70-90% success rate
Radiation:
Radiation therapy may be used in older patients not suitable for surgery.
Cryosurgery:
Cryosurgery can be done for basal cell cancer that invades cartilage.
Mohs surgery:
Mohs micrographic surgery is an outpatient procedure in which the cancer nodule is surgically excised and then immediately examined under a microscope. The base and edges are microscopically examined to confirm no evidence of malignancy before repair is done.
Immunotherapy:
Immunotherapy research indicates that treatment with Euphorbia peplus, a common garden weed, may be effective against Basal cell carcinoma.
What is the prognosis of Basal cell carcinoma?
----------------------------------------------------
Prognosis of majority of cases is good if there is complete removal.
Sclerosing lesions are harder to treat because they invade deeper into the tissues.
What are the preventive measures for Basal cell carcinoma?
-----------------------------------------------------------------
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats). Use sunscreens.
2.Good nutrition and healthy lifestyle boost the immune system and helps prevent malignancy.
3.Patients with family history of skin cancer should be reviewed yearly
----------------------------------------------------
What is Basal cell carcinoma?
---------------------------------------
Basal cell carcinoma is a localized malignant tumor of the basal cells of the skin which seldom spread beyond its location.
It is the most common skin cancer.
It usually occurs in fair skinned people above the age of 50.
It is never life threatening.
Who is affected by Basal cell carcinoma?
---------------------------------------------------
Basal cell carcinoma is more common in :
1.People with fair skin than in those with darker skin.
2.People who spend time outdoors under the sun than those staying indoors.
3.People with a family history of Basal cell carcinoma.
What is the Cause of Basal cell carcinoma?
-----------------------------------------------------
A. Familial:
Familial cases of Basal cell carcinoma with
1.autosomal dominant genes(basal cell nevus) and
2.xeroderma pigmentosum(autosomal recessive)
are more common especially in fair skin people.
B.Sun exposure:
Exposure to the sun is one of the most common causes of Basal cell carcinoma.
The majority of basal cell carcinomas occur on sun-exposed areas of the body.
Risk factors are:
1.intensity of the sun
2.duration of sun exposure,
3.age when sun exposure takes place
4.degree of skin pigmentation
C:Environmental causes:
1.Arsenic exposure in certain occupations(preparation of arsenic products)
2.Exposure to X-ray radiation especially radiotherapy
What are the types of Basal cell carcinoma?
-----------------------------------------------------------
1.Nodular: flesh-colored papule with capillaries which can become ulcerated ( called rodent ulcer )
2.Cystic: less common with a central cystic cavity.
3.Pigmented: pigmented nodular form
4.Sclerosing: looks like a keloid
5.Superficial: a red scaly flat lesion.
What are the Symptoms and signs of Basal cell carcinoma?
-----------------------------------------------------------
Basal cell carcinoma can present as:
1.firm nodule which grows within the skin and below it
2.Color may be like normal skin, dark brown or black.
3.Border is characteristic rolled up edge
4. red, flat, scaling areas similar to a patch of eczema.
How do you make the Diagnosis of Basal cell carcinoma?
------------------------------------------------------------
1.Skin biopsy under local anesthesia
2.small lesions can be totally removed
3.larger ones are biopsied first and surgically removed if there is confirmed malignancy.
What are the complications of Basal cell carcinoma?
--------------------------------------------------------
1.local growth and destruction of neighboring tissues (e.g. nose).
2.Growth into vital structures resulting in the loss of extension or function
3.rarely metastases or cause death.
What is the treatment of Basal cell carcinoma?
---------------------------------------------------
Surgery:
Most basal cell carcinomas are removed by surgical excision with margins of 4-6mm.
Chemotherapy:
local therapy with 5-fluorouracil(a chemotherapy agent) with 70-90% success rate
Radiation:
Radiation therapy may be used in older patients not suitable for surgery.
Cryosurgery:
Cryosurgery can be done for basal cell cancer that invades cartilage.
Mohs surgery:
Mohs micrographic surgery is an outpatient procedure in which the cancer nodule is surgically excised and then immediately examined under a microscope. The base and edges are microscopically examined to confirm no evidence of malignancy before repair is done.
Immunotherapy:
Immunotherapy research indicates that treatment with Euphorbia peplus, a common garden weed, may be effective against Basal cell carcinoma.
What is the prognosis of Basal cell carcinoma?
----------------------------------------------------
Prognosis of majority of cases is good if there is complete removal.
Sclerosing lesions are harder to treat because they invade deeper into the tissues.
What are the preventive measures for Basal cell carcinoma?
-----------------------------------------------------------------
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats). Use sunscreens.
2.Good nutrition and healthy lifestyle boost the immune system and helps prevent malignancy.
3.Patients with family history of skin cancer should be reviewed yearly
Tuesday, August 26, 2008
A Simple Guide to Melonoma
A Simple Guide to Melonoma
----------------------------------------------------
What is Melonoma?
---------------------------------------
Melanoma is a progressive neoplastic tumor of melanocytes which are found mainly in the skin and can be present in the eye and the intestine.
It is a rare but dangerous cancer because of its rapid growth.
Who is affected by Melonoma?
---------------------------------------------------
Melonoma is more common in :
1.People with fair skin than in those with darker skin.
2.People with multiple atypical nevi(moles)
3.Persons born with giant congenital melanocytic nevi(moles)
4.People who spend time outdoors under the sun than those staying indoors.
5.People with a family history of melanoma
What is the Cause of Melonoma?
-----------------------------------------------------
A. Familial:
Familial cases of melanoma with autosomal dominant genes are more common especially in fair skin people.
B.Sun exposure:
Exposure to the sun is one of the most common causes of melanoma.
Risk factors are:
1.intensity of the sun
2.duration of sun exposure,
3.age when sun exposure takes place
4.degree of skin pigmentation
What are the types of Melanoma?
-------------------------------------
Types of primary melanomas:
1.superficial spreading melanoma
2.nodular melanoma
3.acral lentiginous melanoma
4.lentigo maligna melanoma
Melanomas occuring in non-skin areas:
5.clear cell sarcoma (Soft Parts)
6.mucosal melanoma (Intestines)
7.uveal melanoma (Eye)
What are the Symptoms and signs of Melanoma?
-----------------------------------------------------------
Symptoms & Signs:
--------------------
A skin mole which has the following features:
1.Asymmetrical features
2.Border of the mole is irregular.
3.Color: black, blue or brown with occasional reddish and white areas
4.Diameter: Any mole with a diameter of > 5 mm has a higher chance to become melanomas
5.Elevation: The mole is usually raised above the skin.
Any change in the mole appearance may suggest malignancy
Bleeding and ulcerations are late signs.
Loss of skin markings may be present.
There is rarely pain.
How do you make the Diagnosis of Melanoma?
------------------------------------------------------------
1.Moles that are irregular in color or shape
2.Excision biopsy of the suspected mole.
3.Lactate dehydrogenase (LDH) tests are used to detect metastases
4.chest X-rays - to exclude spread to lungs
4.CT, MRI, PET scans of body to exclude metastases.
What are the complications of Melanoma?
---------------------------------------------------
Metastases or spread of the melanoma can spread through the lymphatic or blood vessels to:
1.lymph nodes - if detected early and removed, survival rate is better
2.skin and lungs - have a better survival rate
3.brain , bone and liver - have the worst survival rates
What is the treatment of Melonoma?
---------------------------------------------------
Surgery is the only treatment for localized cutaneous melanoma.
The skin lesion must be totally removed with an adequate margin of surrounding skin and tissue.
The biopsy will include the epidermal, dermal, and subcutaneous layers of the skin,in order to determine the depth and any infiltration outside the lesion.
The lymph nodes nearest to the lesion are also removed.
Disseminated melanoma (Cancer has spread to other parts of body) requires chemotherapy.
Radiation therapy is also used after surgery for patients with local melanoma or for patients with un-operable distant metastases.
Immuno-therapy with interleukin-2 or interferon has also been used with encouraging good results.
Gene therapy is a new area where the genes are manipulated to help kill the melanoma cells.
What is the prognosis of Melonoma?
-----------------------------------------
Prognosis depends on the following factors:
1.tumor thickness
2.depth related to skin
3.type of melanoma,
4.ulceration presence
5.lymphatic spread
6.tumor infiltrating lymphocytes (if present, prognosis is better),
7.location of lesion,
8.distant metastasis
Early diagnosis, biopsy and surgery usually means better prognosis.
Prognosis also depends on the depth and thickness of the melanoma.
The smaller the thickness of the melanoma the better is the prognosis.
Regional node spread and distant metastases usually suggest poor prognosis.
What are preventive measures for Melanoma?
---------------------------------------------------
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats)
2.Good nutrition and healthy lifestyle boost the immune system and helps prevent malignancy.
3.Patients with family history of skin cancer should be reviewed yearly
4.Israeli scientists from the Oncology Institute of the Hadassa Medical Center in Jerusalem in June 2008 announced the development of a new vaccine which can prevent recurrences and increase survival rates for melanoma patients.
----------------------------------------------------
What is Melonoma?
---------------------------------------
Melanoma is a progressive neoplastic tumor of melanocytes which are found mainly in the skin and can be present in the eye and the intestine.
It is a rare but dangerous cancer because of its rapid growth.
Who is affected by Melonoma?
---------------------------------------------------
Melonoma is more common in :
1.People with fair skin than in those with darker skin.
2.People with multiple atypical nevi(moles)
3.Persons born with giant congenital melanocytic nevi(moles)
4.People who spend time outdoors under the sun than those staying indoors.
5.People with a family history of melanoma
What is the Cause of Melonoma?
-----------------------------------------------------
A. Familial:
Familial cases of melanoma with autosomal dominant genes are more common especially in fair skin people.
B.Sun exposure:
Exposure to the sun is one of the most common causes of melanoma.
Risk factors are:
1.intensity of the sun
2.duration of sun exposure,
3.age when sun exposure takes place
4.degree of skin pigmentation
What are the types of Melanoma?
-------------------------------------
Types of primary melanomas:
1.superficial spreading melanoma
2.nodular melanoma
3.acral lentiginous melanoma
4.lentigo maligna melanoma
Melanomas occuring in non-skin areas:
5.clear cell sarcoma (Soft Parts)
6.mucosal melanoma (Intestines)
7.uveal melanoma (Eye)
What are the Symptoms and signs of Melanoma?
-----------------------------------------------------------
Symptoms & Signs:
--------------------
A skin mole which has the following features:
1.Asymmetrical features
2.Border of the mole is irregular.
3.Color: black, blue or brown with occasional reddish and white areas
4.Diameter: Any mole with a diameter of > 5 mm has a higher chance to become melanomas
5.Elevation: The mole is usually raised above the skin.
Any change in the mole appearance may suggest malignancy
Bleeding and ulcerations are late signs.
Loss of skin markings may be present.
There is rarely pain.
How do you make the Diagnosis of Melanoma?
------------------------------------------------------------
1.Moles that are irregular in color or shape
2.Excision biopsy of the suspected mole.
3.Lactate dehydrogenase (LDH) tests are used to detect metastases
4.chest X-rays - to exclude spread to lungs
4.CT, MRI, PET scans of body to exclude metastases.
What are the complications of Melanoma?
---------------------------------------------------
Metastases or spread of the melanoma can spread through the lymphatic or blood vessels to:
1.lymph nodes - if detected early and removed, survival rate is better
2.skin and lungs - have a better survival rate
3.brain , bone and liver - have the worst survival rates
What is the treatment of Melonoma?
---------------------------------------------------
Surgery is the only treatment for localized cutaneous melanoma.
The skin lesion must be totally removed with an adequate margin of surrounding skin and tissue.
The biopsy will include the epidermal, dermal, and subcutaneous layers of the skin,in order to determine the depth and any infiltration outside the lesion.
The lymph nodes nearest to the lesion are also removed.
Disseminated melanoma (Cancer has spread to other parts of body) requires chemotherapy.
Radiation therapy is also used after surgery for patients with local melanoma or for patients with un-operable distant metastases.
Immuno-therapy with interleukin-2 or interferon has also been used with encouraging good results.
Gene therapy is a new area where the genes are manipulated to help kill the melanoma cells.
What is the prognosis of Melonoma?
-----------------------------------------
Prognosis depends on the following factors:
1.tumor thickness
2.depth related to skin
3.type of melanoma,
4.ulceration presence
5.lymphatic spread
6.tumor infiltrating lymphocytes (if present, prognosis is better),
7.location of lesion,
8.distant metastasis
Early diagnosis, biopsy and surgery usually means better prognosis.
Prognosis also depends on the depth and thickness of the melanoma.
The smaller the thickness of the melanoma the better is the prognosis.
Regional node spread and distant metastases usually suggest poor prognosis.
What are preventive measures for Melanoma?
---------------------------------------------------
1.Avoid the direct sun (long-sleeved shirts, long trousers, and broad-brimmed hats)
2.Good nutrition and healthy lifestyle boost the immune system and helps prevent malignancy.
3.Patients with family history of skin cancer should be reviewed yearly
4.Israeli scientists from the Oncology Institute of the Hadassa Medical Center in Jerusalem in June 2008 announced the development of a new vaccine which can prevent recurrences and increase survival rates for melanoma patients.
Monday, August 25, 2008
A Simple Guide to Lipoma
A Simple Guide to Lipoma
----------------------------------------------------
What is Lipoma?
---------------------------------------
Lipoma is a benign tumor which consists of well circumscribed fatty tissue.
Who is affected by Lipoma?
---------------------------------------------------
Lipoma is more common in women than in men.
A possible reason is that women has more fatty tissue than men.
Lipomas can also be found all over the body:
1.subcutaneous
2.subfascial
3.subsynovial
4.intrarticular
5.intramuscular
6.perosteal
7.subserous
8.submucous
9.extradural
What is the Cause of Lipoma?
-----------------------------------------------------
Lipoma is a well encapsulated round swelling consisting fats cell which are not distinguishable from normal fat cells.
Possible causes are:
1.hereditary - more common in some families than others
2.injury to fatty tissue - stimulation for the fat cells to grow and accumulate at one site.
What are the Symptoms and signs of Lipoma?
-----------------------------------------------------------
Symptoms :
1.slow growing round soft tissue swelling on the skin
2.mutiple swellings may also be present.
3.painless
Signs:
1.swelling are well demarcated and rounded
2.Soft tissue felt on palpation.
3.May grow to considerable size.
How do you make the Diagnosis of Lipoma?
------------------------------------------------------------
1.round well encapsulated swelling
2.soft on palpation
3.Unlike sebaceous cyst doe not have an central blocked opening
4.Ultrasound may used to confirm the presence of fatty tissue and not a cyst or malignant tumor
5.Biopsy of the swelling will confirm presence of fat cells
What are the complications of Lipoma?
---------------------------------------------------
The lipoma may grow to considerable size over tima and can cause blockage to neighbouring organs:
1.intestinal obstruction at the abdominal area
2.difficulty in breathing especially near the trachea
3.In rare cases lipoma may become malignant liposarcoma
What is the treatment of Lipoma?
---------------------------------------------------
The only treatment is surgical excision of the lipoma.
Small lipomas may left alone if they are slow growing and does not impinge on the nearby organs.
What is the prognosis of Lipoma?
-----------------------------------------
The prognosis is usually excellent.
Recurrence at the smae spot is rare but do occur due to regrowth of the blood vessel supplying the lipoma.
Rarely a lipoma may undergo malignant degeneration and become liposarcoma.
----------------------------------------------------
What is Lipoma?
---------------------------------------
Lipoma is a benign tumor which consists of well circumscribed fatty tissue.
Who is affected by Lipoma?
---------------------------------------------------
Lipoma is more common in women than in men.
A possible reason is that women has more fatty tissue than men.
Lipomas can also be found all over the body:
1.subcutaneous
2.subfascial
3.subsynovial
4.intrarticular
5.intramuscular
6.perosteal
7.subserous
8.submucous
9.extradural
What is the Cause of Lipoma?
-----------------------------------------------------
Lipoma is a well encapsulated round swelling consisting fats cell which are not distinguishable from normal fat cells.
Possible causes are:
1.hereditary - more common in some families than others
2.injury to fatty tissue - stimulation for the fat cells to grow and accumulate at one site.
What are the Symptoms and signs of Lipoma?
-----------------------------------------------------------
Symptoms :
1.slow growing round soft tissue swelling on the skin
2.mutiple swellings may also be present.
3.painless
Signs:
1.swelling are well demarcated and rounded
2.Soft tissue felt on palpation.
3.May grow to considerable size.
How do you make the Diagnosis of Lipoma?
------------------------------------------------------------
1.round well encapsulated swelling
2.soft on palpation
3.Unlike sebaceous cyst doe not have an central blocked opening
4.Ultrasound may used to confirm the presence of fatty tissue and not a cyst or malignant tumor
5.Biopsy of the swelling will confirm presence of fat cells
What are the complications of Lipoma?
---------------------------------------------------
The lipoma may grow to considerable size over tima and can cause blockage to neighbouring organs:
1.intestinal obstruction at the abdominal area
2.difficulty in breathing especially near the trachea
3.In rare cases lipoma may become malignant liposarcoma
What is the treatment of Lipoma?
---------------------------------------------------
The only treatment is surgical excision of the lipoma.
Small lipomas may left alone if they are slow growing and does not impinge on the nearby organs.
What is the prognosis of Lipoma?
-----------------------------------------
The prognosis is usually excellent.
Recurrence at the smae spot is rare but do occur due to regrowth of the blood vessel supplying the lipoma.
Rarely a lipoma may undergo malignant degeneration and become liposarcoma.
Sunday, August 24, 2008
A Simple Guide to Meniere's Disease
A Simple Guide to Meniere's Disease
-----------------------------------------------
What is Meniere's Disease?
------------------------------------
Meniere's Disease is a disease of the inner ear which is characterised by the triad of episodic vertigo(giddiness), tinnitus(buzzing sound in ear) and progressive hearing loss.
It is more common in adults between 30-60years of age and in men more than women.
It usually occurs more in one ear.
What are the causes of Meniere's Disease?
---------------------------------------
The exact cause of Meniere's Disease is unknown.
It is believed to be due to distension of the membranous labyrinth with increased pressure and fluid in the endolymph of the inner ear.
As a result the balance in one ear is affected leading to dizzines
The possible triggers of this condition may be:
1.middle ear infection,
2.head injury
3.upper respiratory tract infection
4.the effect of aspirin,
5.smoking
6.alcohol
7.caffeine
8.salt
Some invetigators believed that there is a link with the herpes zoster virus which is activated when the immune system is low, resulting in inflammation of the eight nerve(hearing).
What are the symptoms and signs of Meniere's Disease?
-------------------------------------------------------------
Symptoms:
-----------
The classical triad of symptoms are:
1.recurrent bouts of vertigo of varying degrees which may last from hours to days.
Recurrences may be as often as 1 week to several years.
2.Slow progressive loss of hearing in one ear or rarely in both ears starting at low pitch sounds first.
3.Unilateral tinnitus (buzzing sound in one ear), sometimes in both ears
Beides these symptoms, there is also :
4.feeling of pressure9fullness) in one or both ears.
5.Nausea and vomiting sometimes occur with the vertigo
6.hypersensitivity to sound
7.nystagmus(uncotrollable jerky eye movements)
8.cognitive performance
How is the diagnosis of Meniere's Disease established?
-------------------------------------------------------------
1.classical history
2.audiometry shows impairment of hearing
3.MRI scan of the head - to exclude a tumour of the eighth cranial nerve (vestibulocochlear nerve)
What is the Treatment of Meniere's Disease?
-------------------------------------------------
Initial treatment:
1.Acute attacks are treated symptomatically with injections of stemetil, maxolon, dimenhydrinate
Other treatments:
1. Oral stemetil, maxolon, dimenhydrinate
2. mild diuretic
3.vitamin B6
4.antihistamines,
5.anticholinergics,
6.corticosteroids orally or injection of steroid medication behind the eardrum
7.Bed rest
8.stress reduction.
9.low-sodium diet.
10.avoid caffeine, alcohol and cigarettes
Surgery :
is only required if the above treatment does not control the vertigo
1.Decompression of the endolymphatic sac may help to relieve symptoms.
2.Permanent surgical destruction of the balance part of one ear may be done where the disease is severe and affects one ear.
This usually causes permanent deafness.
a.chemical labyrinthectomy: a drug (such as gentamicin) that can cause destruction of the balance portion of the inner ear is injected into the middle ear.
b.vestibular neurectomy where section of the nerve to the balance portion of the inner ear is done surgically
c.surgical removal of the inner ear (labyrinthectomy).
Usually balance returns to normal after sugery but hearing may be permanently damaged in one ear.
3.In the belief that Meniere's disease is caused by herpes virus, acyclovir an antiviral drug is given and has been found to relieve symptoms.
What is the prognosis of Meniere's Disease?
------------------------------------------------
Symptoms may remain the same, worsen or disappear spontaneously.
1.Vertigo symptoms may be worse and more frequent but sometimes disappear spontaneously.
2.Hearing symptoms usually become worse and patients may become deaf in the affected ear.
3.Tinnitus usually is more pronounced with time.
-----------------------------------------------
What is Meniere's Disease?
------------------------------------
Meniere's Disease is a disease of the inner ear which is characterised by the triad of episodic vertigo(giddiness), tinnitus(buzzing sound in ear) and progressive hearing loss.
It is more common in adults between 30-60years of age and in men more than women.
It usually occurs more in one ear.
What are the causes of Meniere's Disease?
---------------------------------------
The exact cause of Meniere's Disease is unknown.
It is believed to be due to distension of the membranous labyrinth with increased pressure and fluid in the endolymph of the inner ear.
As a result the balance in one ear is affected leading to dizzines
The possible triggers of this condition may be:
1.middle ear infection,
2.head injury
3.upper respiratory tract infection
4.the effect of aspirin,
5.smoking
6.alcohol
7.caffeine
8.salt
Some invetigators believed that there is a link with the herpes zoster virus which is activated when the immune system is low, resulting in inflammation of the eight nerve(hearing).
What are the symptoms and signs of Meniere's Disease?
-------------------------------------------------------------
Symptoms:
-----------
The classical triad of symptoms are:
1.recurrent bouts of vertigo of varying degrees which may last from hours to days.
Recurrences may be as often as 1 week to several years.
2.Slow progressive loss of hearing in one ear or rarely in both ears starting at low pitch sounds first.
3.Unilateral tinnitus (buzzing sound in one ear), sometimes in both ears
Beides these symptoms, there is also :
4.feeling of pressure9fullness) in one or both ears.
5.Nausea and vomiting sometimes occur with the vertigo
6.hypersensitivity to sound
7.nystagmus(uncotrollable jerky eye movements)
8.cognitive performance
How is the diagnosis of Meniere's Disease established?
-------------------------------------------------------------
1.classical history
2.audiometry shows impairment of hearing
3.MRI scan of the head - to exclude a tumour of the eighth cranial nerve (vestibulocochlear nerve)
What is the Treatment of Meniere's Disease?
-------------------------------------------------
Initial treatment:
1.Acute attacks are treated symptomatically with injections of stemetil, maxolon, dimenhydrinate
Other treatments:
1. Oral stemetil, maxolon, dimenhydrinate
2. mild diuretic
3.vitamin B6
4.antihistamines,
5.anticholinergics,
6.corticosteroids orally or injection of steroid medication behind the eardrum
7.Bed rest
8.stress reduction.
9.low-sodium diet.
10.avoid caffeine, alcohol and cigarettes
Surgery :
is only required if the above treatment does not control the vertigo
1.Decompression of the endolymphatic sac may help to relieve symptoms.
2.Permanent surgical destruction of the balance part of one ear may be done where the disease is severe and affects one ear.
This usually causes permanent deafness.
a.chemical labyrinthectomy: a drug (such as gentamicin) that can cause destruction of the balance portion of the inner ear is injected into the middle ear.
b.vestibular neurectomy where section of the nerve to the balance portion of the inner ear is done surgically
c.surgical removal of the inner ear (labyrinthectomy).
Usually balance returns to normal after sugery but hearing may be permanently damaged in one ear.
3.In the belief that Meniere's disease is caused by herpes virus, acyclovir an antiviral drug is given and has been found to relieve symptoms.
What is the prognosis of Meniere's Disease?
------------------------------------------------
Symptoms may remain the same, worsen or disappear spontaneously.
1.Vertigo symptoms may be worse and more frequent but sometimes disappear spontaneously.
2.Hearing symptoms usually become worse and patients may become deaf in the affected ear.
3.Tinnitus usually is more pronounced with time.
Friday, August 22, 2008
A Simple Guide to Hydrocoele
A Simple Guide to Hydrocoele
-----------------------------
What is Hydrocoele?
--------------------
Hydrocoele is the excess accumulation of fluid inside the sac containing your testis.
What causes Hydrocoele?
------------------------
The causes of Hydrocoele are mostly due:
A.Congenital:
----------------------
Children are born with with enlarged testicular sac with fluid which communicate with abdominal cavity through a patent duct which should be closed at birth.
B.Infections:
---------------------
Infections of the testicle can cause inflammation of the cavity surrounding the testicle and its appendages.
c. Obstruction to fluid flow:
Obstruction to lymphatic and venous flow in the testicular cavity prevents the fluid in the testicular cavity from being re-absorbed into the general system.
What are the symptoms of Hydrocoele?
-------------------------------------
The Symptoms of Hydrocoele are:
1.heaviness anf fullness of the scrotum
2.enlargement of scrotum usually on 1 side
3.usually painless except when inflammed or infected
Signs:
1.redness and swelling of the scrotum
2.enlargement of the scrotum on 1 side
5.Inguinal lymph nodes may be swollen and painful if there is severe infection(rare)
What are the complications of Hydrocoele?
-----------------------------------------------
1.Abscess formation
2.torsion of the testicle(rare)
How is diagnosis of Hydrocoele confirmed?
------------------------------------------
1. clinical features and trans-illumination of scrotal swelling
3. Ultrasound scan of the scrotal swelling to exclude any tumors of the testicle or torsion.
What is the treatment of Hydrocoele?
------------------------------------
1. Aspiration of the fluid in the scrotal cavity usually helps to reduce swelling but recurrences are common
2.Rest and support of the scrotum with loose underwear
3. surgery with drainage of fluid from scrotum.
The scrotal cavity is opened up and the fluid drained.
If the testicle is normal it should be left alone.
If the testicle is disease and shrunken, it is usually removed.
What is the Prognosis of Hydrocoele?
------------------------------------
Most cases of Hydrocoele usually will recover with surgical treatment.
Aspiration is a temporary measure as recurrences are common.
Congenital cases of Hydrocoele usually resolve spontaneously
What are the Preventive measures for Hydrocoele?
----------------------------------------------------
Avoid too tight underwear which can obstruct the lymphatic or blood vessels of the scrotum.
/span>
-----------------------------
What is Hydrocoele?
--------------------
Hydrocoele is the excess accumulation of fluid inside the sac containing your testis.
What causes Hydrocoele?
------------------------
The causes of Hydrocoele are mostly due:
A.Congenital:
----------------------
Children are born with with enlarged testicular sac with fluid which communicate with abdominal cavity through a patent duct which should be closed at birth.
B.Infections:
---------------------
Infections of the testicle can cause inflammation of the cavity surrounding the testicle and its appendages.
c. Obstruction to fluid flow:
Obstruction to lymphatic and venous flow in the testicular cavity prevents the fluid in the testicular cavity from being re-absorbed into the general system.
What are the symptoms of Hydrocoele?
-------------------------------------
The Symptoms of Hydrocoele are:
1.heaviness anf fullness of the scrotum
2.enlargement of scrotum usually on 1 side
3.usually painless except when inflammed or infected
Signs:
1.redness and swelling of the scrotum
2.enlargement of the scrotum on 1 side
5.Inguinal lymph nodes may be swollen and painful if there is severe infection(rare)
What are the complications of Hydrocoele?
-----------------------------------------------
1.Abscess formation
2.torsion of the testicle(rare)
How is diagnosis of Hydrocoele confirmed?
------------------------------------------
1. clinical features and trans-illumination of scrotal swelling
3. Ultrasound scan of the scrotal swelling to exclude any tumors of the testicle or torsion.
What is the treatment of Hydrocoele?
------------------------------------
1. Aspiration of the fluid in the scrotal cavity usually helps to reduce swelling but recurrences are common
2.Rest and support of the scrotum with loose underwear
3. surgery with drainage of fluid from scrotum.
The scrotal cavity is opened up and the fluid drained.
If the testicle is normal it should be left alone.
If the testicle is disease and shrunken, it is usually removed.
What is the Prognosis of Hydrocoele?
------------------------------------
Most cases of Hydrocoele usually will recover with surgical treatment.
Aspiration is a temporary measure as recurrences are common.
Congenital cases of Hydrocoele usually resolve spontaneously
What are the Preventive measures for Hydrocoele?
----------------------------------------------------
Avoid too tight underwear which can obstruct the lymphatic or blood vessels of the scrotum.
/span>
Thursday, August 21, 2008
A Simple Guide to Inguinal Hernia
A Simple Guide to Inguinal Hernia
-------------------------------------------
What is Inguinal Hernia?
----------------------------------
Inguinal Hernia is protrusion of the part of the viscera(contents in the abdominal cavity) through the inguinal canal which is the tunnel which leads the spermatic duct from the testis to the urethra or seminal vesicles in the abdomen.
What are the different types of Inguinal Hernia?
---------------------------------------------------
1.Indirect:
The abdominal contents such as small intestine enter the the enlarged internal inguinal ring and protrude into the inguinal canal entering the scrotum.
2:Direct:
The abdominal contents find a weak spot in the abdominal wall and enter the the inguinal canal.
What causes Inguinal Hernia?
---------------------------------------
The causes of Inguinal Hernia are mostly due:
A.Congenital :
----------------------
The inguinal canal follows the same route as the descent of the testes from the abdomen out to the scrotum outside the abdomen during the embryonic stage.
If there is partial closure of the internal inguinal ring, then weakness of the of abdominal wall occurs allowing abdominal content to protrude through the inguinal canal.
B.Increased abdominal pressure:
------------------------------------
Increased intra-abdominal pressure can occur as a result of :
1.coughing
2.straining
3.distension
4.obstruction
C.Weakening of the abdominal muscle:
---------------------------------------
1.Obesity
2.muscle wasting diseases
Hernias are more common in men than in women because the inguinal canal is usually closed in women whereas in men the canal carries the spermatic duct.
What are the symptoms of Inguinal Hernia?
------------------------------------------------
Symptoms:
1.Swelling in the groin area which is worse on coughing, straining or standing up
2.swelling of the groin usually disappear on lying down(abdominal contents is returned to the abdominal cavity).
3.Pain or discomfort may be present
Signs:
1.Swelling in the groin can be felt.
If a finger is pressed into the external inguinal ring, coughing can make the swelling feel more palpable
2.There may gurgling sounds of intestinal gas movement on auscultation of the swelling with the stethoscope.
3.Local tenderness of swelling
What are the complications of Inguinal Hernia?
----------------------------------------------------
1.Irreducible hernia may occur when the abdominal contents cannot be returned to the peritoneal cavity due to adhesions of the inguinal canal of the faecal matter stuck in the protruded intestine.
This complication may be serious
2.Strangulated hernia occur when the blood circulation is cut off due to constriction of the neck of the hernial sac resulting in ischemia and gangrene of the gut.
Signs and symptoms of intestinal obstruction then becomes obvious with increased abdominal pain and local tenderness.
This is a medical emergency and should be treated immediately.
3.Peritonitis - burst abdomen as a result of intestinal obstruction
How is diagnosis of Hernia confirmed?
------------------------------------------
1. clinical features of swelling in the inguinal area
2. CT and Ultrasound scan of the inguinal region and scrotum to exclude hydrocoele and tumors
What is the treatment of Hernia?
------------------------------------
1. At the early stage of inguinal hernia, a truss which press against the internal inguinal ring may help to elevate symptoms and prevent the hernia from bulging out.
They are useful in patients with poor general condition who are unable to tolerate full surgery.
They are seldom used now.
2.All inguinal hernia patients should undergo elective (non-emergency) surgery to repair the hernia before complications such as strangulated hernia sets in.
Such surgery called herniorrhaphy or hernioplasty can be done on a day surgery under local anethesia and using laparoscopy.
It usually involved sewing a wire mesh over the inguinal ring to tighten the inguinal ring and prevent the contents of the abdomen from pushing its way out into the inguinal canal.
Patient is usually asked to cough after the surgery to make sure the abdominal wall is tight enough to prevent any intestine to protrude out.
3.Emergency surgery is required if there is any strangulated inguinal hernia or intestinal obstruction.
4.Most congenital hernia may disappear by the end of the first year.
What is the Prognosis of Hernia?
------------------------------------
Most cases of inguinal hernia usually will recover with proper surgical treatment.
Very rarely there may be complications such as postoperative infections or recurrence.
What are the Preventive measures for Hernia?
----------------------------------------------------
Avoid straining at stools, severe coughing.
Avoid carrying heavy weights.
Lose some weight.
-------------------------------------------
What is Inguinal Hernia?
----------------------------------
Inguinal Hernia is protrusion of the part of the viscera(contents in the abdominal cavity) through the inguinal canal which is the tunnel which leads the spermatic duct from the testis to the urethra or seminal vesicles in the abdomen.
What are the different types of Inguinal Hernia?
---------------------------------------------------
1.Indirect:
The abdominal contents such as small intestine enter the the enlarged internal inguinal ring and protrude into the inguinal canal entering the scrotum.
2:Direct:
The abdominal contents find a weak spot in the abdominal wall and enter the the inguinal canal.
What causes Inguinal Hernia?
---------------------------------------
The causes of Inguinal Hernia are mostly due:
A.Congenital :
----------------------
The inguinal canal follows the same route as the descent of the testes from the abdomen out to the scrotum outside the abdomen during the embryonic stage.
If there is partial closure of the internal inguinal ring, then weakness of the of abdominal wall occurs allowing abdominal content to protrude through the inguinal canal.
B.Increased abdominal pressure:
------------------------------------
Increased intra-abdominal pressure can occur as a result of :
1.coughing
2.straining
3.distension
4.obstruction
C.Weakening of the abdominal muscle:
---------------------------------------
1.Obesity
2.muscle wasting diseases
Hernias are more common in men than in women because the inguinal canal is usually closed in women whereas in men the canal carries the spermatic duct.
What are the symptoms of Inguinal Hernia?
------------------------------------------------
Symptoms:
1.Swelling in the groin area which is worse on coughing, straining or standing up
2.swelling of the groin usually disappear on lying down(abdominal contents is returned to the abdominal cavity).
3.Pain or discomfort may be present
Signs:
1.Swelling in the groin can be felt.
If a finger is pressed into the external inguinal ring, coughing can make the swelling feel more palpable
2.There may gurgling sounds of intestinal gas movement on auscultation of the swelling with the stethoscope.
3.Local tenderness of swelling
What are the complications of Inguinal Hernia?
----------------------------------------------------
1.Irreducible hernia may occur when the abdominal contents cannot be returned to the peritoneal cavity due to adhesions of the inguinal canal of the faecal matter stuck in the protruded intestine.
This complication may be serious
2.Strangulated hernia occur when the blood circulation is cut off due to constriction of the neck of the hernial sac resulting in ischemia and gangrene of the gut.
Signs and symptoms of intestinal obstruction then becomes obvious with increased abdominal pain and local tenderness.
This is a medical emergency and should be treated immediately.
3.Peritonitis - burst abdomen as a result of intestinal obstruction
How is diagnosis of Hernia confirmed?
------------------------------------------
1. clinical features of swelling in the inguinal area
2. CT and Ultrasound scan of the inguinal region and scrotum to exclude hydrocoele and tumors
What is the treatment of Hernia?
------------------------------------
1. At the early stage of inguinal hernia, a truss which press against the internal inguinal ring may help to elevate symptoms and prevent the hernia from bulging out.
They are useful in patients with poor general condition who are unable to tolerate full surgery.
They are seldom used now.
2.All inguinal hernia patients should undergo elective (non-emergency) surgery to repair the hernia before complications such as strangulated hernia sets in.
Such surgery called herniorrhaphy or hernioplasty can be done on a day surgery under local anethesia and using laparoscopy.
It usually involved sewing a wire mesh over the inguinal ring to tighten the inguinal ring and prevent the contents of the abdomen from pushing its way out into the inguinal canal.
Patient is usually asked to cough after the surgery to make sure the abdominal wall is tight enough to prevent any intestine to protrude out.
3.Emergency surgery is required if there is any strangulated inguinal hernia or intestinal obstruction.
4.Most congenital hernia may disappear by the end of the first year.
What is the Prognosis of Hernia?
------------------------------------
Most cases of inguinal hernia usually will recover with proper surgical treatment.
Very rarely there may be complications such as postoperative infections or recurrence.
What are the Preventive measures for Hernia?
----------------------------------------------------
Avoid straining at stools, severe coughing.
Avoid carrying heavy weights.
Lose some weight.
A Simple Guide to Pneumothorax
A Simple Guide to Pneumothorax
---------------------------------------
What is Pneumothorax?
-------------------------------------
Pneumothorax is a medical emergency caused by collection of air in the pleural space between the perietal and visceral pleura.
What are the types of pneumothorax?
---------------------------------------
Tension pneumothorax:
-----------------------------
This ia a medical emergency as air builds up in the pleural space with each breath.
The rising intrathoracic pressure pushes the mediastinum away from the affected lung to the other compressing intrathoracic vessels and causing collapse of the lung.
Tension pneumothorax are life threatening.
Non-tension pneumothorax:
-----------------------------
A non-tension pneumothorax is less serious because there is no increasing pressure of air in the thoracic region and hence no increasing pressure on the intrathoracic organs.
Hemopneumothorax:
----------------------
When blood accumulates in the thoracic cavity (hemothorax), there is even more increased pressure in the pleural cavity. This is called a hemopneumothorax and also be life threatening.
What is the causes of pneumothorax?
---------------------------------------------------
It is most commonly due to:
Spontaneous pneumothorax
-----------------------------
This is due to the rupture of superficial air sacs following severe coughing or strenous exercise in:
1.tall young males and in Marfan syndrome
2.Tuberculosis
3.Bronchial obstruction
4.Cancer
Non-spontaneous pneumothorax
--------------------------------
1.penetrating chest wound
2.surgical trauma
3.pleural effusion tap
What are the Signs and symptoms of Pneumothorax?
----------------------------------------------------
Symptoms:
---------------
1.Sudden onset of chest pain, back
2.shortness of breath,
3.dry coughs,
4.cyanosis (turning blue)
5.coma
Signs:
--------------
1.Pale or cyanotic
2.Percussion show resonance at normal lung while none at the pneumothorax lung area
3.Auscultation reveals breath sounds on the normal side but none at the pneumothoracic lung
4.There may be a characteristic clicking sound with respiration.
5.In penetrating chest wounds, there is a typical "sucking" sound of air flowing through the puncture hole .
6.The flopping sound of the punctured lung can sometimes be heard
How is the Diagnosis of Pneumothorax made?
---------------------------------------------------
Physical examination:
a. absence of audible breath sounds through a stethoscope
b. hyperresonance (higher pitched sounds than normal) to percussion of the chest wall is suggestive of the diagnosis.
c.Two coins when tapped on the affected side results in a tinkling resonant sound
Chest X-ray reveals a typical pattern of complete lung collapse with air space surrounding the lung edge.
Medistinal shifts can be seen on inspiratory and expiratory films
CT scan and MRI can revealed a clearer picture of the pneumothorax and even the bubbles on the lung surface which may burst and cause a pneumothorax.
What is the complication of Pneumothorax?
------------------------------------------------
Respiratory failure with circulatory collapse
What is the treatment of Pneumothorax?
--------------------------------------------
All pneumothorax patients are to be admitted to hospital for treatment.
1. Small spontaneous pneumothorax
-------------------------------------
A small spontaneous pneumothorax can be left alone to reabsorb on its own.
The patient is monitored in hospital and given oxygen until the pneumothorax has disappeared.
2.Tension Pneumothorax
-----------------------------
Tension Pneumothorax is a medical emergency.
Any perimedic or doctor attending to the patient should insert a needle immediately into the pleural cavity to allow the air to escape.
Tube drainage can also be done if available. If the tube is not available, immediate evacuation to the hospital should be done for advanced medical care.
The tube should be inserted with underwater seal and suction of the air out of the pleural cavity done using a simple one way valve or vacuum and a water valve device, depending on severity.
The lung should re-expand in the thoracic cavity nad the result is monitored by frequent x-rays
Where rarely the chest tube does not help healing of the lung , surgery may be done to staple the lung closed.
Penetrating wounds:
---------------------
A chest drain is inserted first before any treatment of the wounds is done.
Supprtive treatment:
------------------------
Oxygen therapy
Rest
Antibiotics for infections
Painkillers for pain
Recurrent pneumothorax
------------------------------
1.pleurodesis may be required in recurrent pneumothorax.
2.bullectomy (the removal or stapling of bullae).
3.Chemical pleurodesis uses chemical irritant that leads to adhesion of the lung to the parietal pleura.
4.Mechanical pleurodesis The inside chest wall is roughened so the lung attaches to the peural wall with scar tissues
5.pleurectomy is the removal of the parietal pleura which can be performed using keyhole surgery
What is the prognosis of Pneumothorax?
----------------------------------------------
It is usually good following treatment.
However treatment is always needed to address the cause of the underlying diseases causing the pneumothorax.
---------------------------------------
What is Pneumothorax?
-------------------------------------
Pneumothorax is a medical emergency caused by collection of air in the pleural space between the perietal and visceral pleura.
What are the types of pneumothorax?
---------------------------------------
Tension pneumothorax:
-----------------------------
This ia a medical emergency as air builds up in the pleural space with each breath.
The rising intrathoracic pressure pushes the mediastinum away from the affected lung to the other compressing intrathoracic vessels and causing collapse of the lung.
Tension pneumothorax are life threatening.
Non-tension pneumothorax:
-----------------------------
A non-tension pneumothorax is less serious because there is no increasing pressure of air in the thoracic region and hence no increasing pressure on the intrathoracic organs.
Hemopneumothorax:
----------------------
When blood accumulates in the thoracic cavity (hemothorax), there is even more increased pressure in the pleural cavity. This is called a hemopneumothorax and also be life threatening.
What is the causes of pneumothorax?
---------------------------------------------------
It is most commonly due to:
Spontaneous pneumothorax
-----------------------------
This is due to the rupture of superficial air sacs following severe coughing or strenous exercise in:
1.tall young males and in Marfan syndrome
2.Tuberculosis
3.Bronchial obstruction
4.Cancer
Non-spontaneous pneumothorax
--------------------------------
1.penetrating chest wound
2.surgical trauma
3.pleural effusion tap
What are the Signs and symptoms of Pneumothorax?
----------------------------------------------------
Symptoms:
---------------
1.Sudden onset of chest pain, back
2.shortness of breath,
3.dry coughs,
4.cyanosis (turning blue)
5.coma
Signs:
--------------
1.Pale or cyanotic
2.Percussion show resonance at normal lung while none at the pneumothorax lung area
3.Auscultation reveals breath sounds on the normal side but none at the pneumothoracic lung
4.There may be a characteristic clicking sound with respiration.
5.In penetrating chest wounds, there is a typical "sucking" sound of air flowing through the puncture hole .
6.The flopping sound of the punctured lung can sometimes be heard
How is the Diagnosis of Pneumothorax made?
---------------------------------------------------
Physical examination:
a. absence of audible breath sounds through a stethoscope
b. hyperresonance (higher pitched sounds than normal) to percussion of the chest wall is suggestive of the diagnosis.
c.Two coins when tapped on the affected side results in a tinkling resonant sound
Chest X-ray reveals a typical pattern of complete lung collapse with air space surrounding the lung edge.
Medistinal shifts can be seen on inspiratory and expiratory films
CT scan and MRI can revealed a clearer picture of the pneumothorax and even the bubbles on the lung surface which may burst and cause a pneumothorax.
What is the complication of Pneumothorax?
------------------------------------------------
Respiratory failure with circulatory collapse
What is the treatment of Pneumothorax?
--------------------------------------------
All pneumothorax patients are to be admitted to hospital for treatment.
1. Small spontaneous pneumothorax
-------------------------------------
A small spontaneous pneumothorax can be left alone to reabsorb on its own.
The patient is monitored in hospital and given oxygen until the pneumothorax has disappeared.
2.Tension Pneumothorax
-----------------------------
Tension Pneumothorax is a medical emergency.
Any perimedic or doctor attending to the patient should insert a needle immediately into the pleural cavity to allow the air to escape.
Tube drainage can also be done if available. If the tube is not available, immediate evacuation to the hospital should be done for advanced medical care.
The tube should be inserted with underwater seal and suction of the air out of the pleural cavity done using a simple one way valve or vacuum and a water valve device, depending on severity.
The lung should re-expand in the thoracic cavity nad the result is monitored by frequent x-rays
Where rarely the chest tube does not help healing of the lung , surgery may be done to staple the lung closed.
Penetrating wounds:
---------------------
A chest drain is inserted first before any treatment of the wounds is done.
Supprtive treatment:
------------------------
Oxygen therapy
Rest
Antibiotics for infections
Painkillers for pain
Recurrent pneumothorax
------------------------------
1.pleurodesis may be required in recurrent pneumothorax.
2.bullectomy (the removal or stapling of bullae).
3.Chemical pleurodesis uses chemical irritant that leads to adhesion of the lung to the parietal pleura.
4.Mechanical pleurodesis The inside chest wall is roughened so the lung attaches to the peural wall with scar tissues
5.pleurectomy is the removal of the parietal pleura which can be performed using keyhole surgery
What is the prognosis of Pneumothorax?
----------------------------------------------
It is usually good following treatment.
However treatment is always needed to address the cause of the underlying diseases causing the pneumothorax.
Tuesday, August 19, 2008
A Simple Guide to Infectious Mononucleosis
A Simple Guide to Infectious Mononucleosis
-------------------------------------------------
What is Infectious Mononucleosis?
-------------------------------------------
Infectious Mononucleosis is an infectious disease which typically cause swelling of the lymph nodes of neck, sore throat and fever.
What is the cause of Infectious Mononucleosis?
-------------------------------------------------------
The cause of Infectious Mononucleosis is the Epstein Barr virus which can be spread by droplets and kissing.
It is more common in young adults.
The incubation period (from contact to illness) is 10-15 days.
It is usually sporadic but may be epidemic.
What are Signs and symptoms of Infectious Mononucleosis?
------------------------------------------------------------------
The triad of symptoms which are common to Infectious Mononucleosis are:
1.Neck and axillary lymph nodes are enlarged
2.Fever with headache
3.sore throat with sometimes extensive tonsillar exudates and swelling
Other symptoms are:
4.fatigue
5.bodyaches
6.jaundice(rare)
Signs:
1.Throat is red and inflamed with enlarged tonsils
2.Pinpoint petechiae at junction of hard and soft palate
3.Enlarged lymph nodes are felt below the jaw and neck region; sometimes in the axillary region
4.Swelling of lacrimal glands and eyelids
5.Spleen is enlarged in 50% of cases
6.Generalized maculopapular rash may occur
Onset is usually insidious with mild fever which may becomes worse and lasts for 2 to 21 days.
Disease usually lasts for 2-3 weeks.
How is the diagnosis of Infectious Mononucleosis made?
---------------------------------------------------------------
1.Classical symptoms and signs as above especially lymph nodes enlargement.
2.blood tests (complete blood count, ESR, liver function tests and blood culture).
Blood count usually shows more than 10% atypical mononuclear cells.
3.Blood for Epstein Barr antibody
3.X-rays of chest and abdomen
4.CT Scan or ultrasound of the abdomen to detect presence of other lymph nodes and enlarged spleen.
What are the complications of Infectious Mononucleosis?
---------------------------------------------------------------
1.Obstruction to airway from enlarged lymph nodes
2.thrombopenic purpura
3.myocarditis
4.pericarditis
5.lymphocytic meningitis
6.encephalitis
7.polyneuritis
8.hepatitis
What is the treatment of Infectious Mononucleosis?
------------------------------------------------------------
1.Bed rest in isolation ward
2.Adequate fluids
3.Antipyretic medicines such as paracetamol for fever
3.corticosteroids is useful to reduce complications such as upper airway obstruction and severe hepatitis
4.High-flow oxygen and tracheostomy in airway obstruction
What is the prognosis of Infectious Mononucleosis?
-----------------------------------------------------------
Prognosis of Infectious Mononucleosis is generally good.
Epstein Barr infections has been associated with nasopharyngeal cancer.
What are the Preventive measures taken for Infectious Mononucleosis?
------------------------------------------------------------------------
Isolation of cases at home or in hospital.
Avoid contacts.
-------------------------------------------------
What is Infectious Mononucleosis?
-------------------------------------------
Infectious Mononucleosis is an infectious disease which typically cause swelling of the lymph nodes of neck, sore throat and fever.
What is the cause of Infectious Mononucleosis?
-------------------------------------------------------
The cause of Infectious Mononucleosis is the Epstein Barr virus which can be spread by droplets and kissing.
It is more common in young adults.
The incubation period (from contact to illness) is 10-15 days.
It is usually sporadic but may be epidemic.
What are Signs and symptoms of Infectious Mononucleosis?
------------------------------------------------------------------
The triad of symptoms which are common to Infectious Mononucleosis are:
1.Neck and axillary lymph nodes are enlarged
2.Fever with headache
3.sore throat with sometimes extensive tonsillar exudates and swelling
Other symptoms are:
4.fatigue
5.bodyaches
6.jaundice(rare)
Signs:
1.Throat is red and inflamed with enlarged tonsils
2.Pinpoint petechiae at junction of hard and soft palate
3.Enlarged lymph nodes are felt below the jaw and neck region; sometimes in the axillary region
4.Swelling of lacrimal glands and eyelids
5.Spleen is enlarged in 50% of cases
6.Generalized maculopapular rash may occur
Onset is usually insidious with mild fever which may becomes worse and lasts for 2 to 21 days.
Disease usually lasts for 2-3 weeks.
How is the diagnosis of Infectious Mononucleosis made?
---------------------------------------------------------------
1.Classical symptoms and signs as above especially lymph nodes enlargement.
2.blood tests (complete blood count, ESR, liver function tests and blood culture).
Blood count usually shows more than 10% atypical mononuclear cells.
3.Blood for Epstein Barr antibody
3.X-rays of chest and abdomen
4.CT Scan or ultrasound of the abdomen to detect presence of other lymph nodes and enlarged spleen.
What are the complications of Infectious Mononucleosis?
---------------------------------------------------------------
1.Obstruction to airway from enlarged lymph nodes
2.thrombopenic purpura
3.myocarditis
4.pericarditis
5.lymphocytic meningitis
6.encephalitis
7.polyneuritis
8.hepatitis
What is the treatment of Infectious Mononucleosis?
------------------------------------------------------------
1.Bed rest in isolation ward
2.Adequate fluids
3.Antipyretic medicines such as paracetamol for fever
3.corticosteroids is useful to reduce complications such as upper airway obstruction and severe hepatitis
4.High-flow oxygen and tracheostomy in airway obstruction
What is the prognosis of Infectious Mononucleosis?
-----------------------------------------------------------
Prognosis of Infectious Mononucleosis is generally good.
Epstein Barr infections has been associated with nasopharyngeal cancer.
What are the Preventive measures taken for Infectious Mononucleosis?
------------------------------------------------------------------------
Isolation of cases at home or in hospital.
Avoid contacts.
Monday, August 18, 2008
A Simple Guide to Pneumonia
A Simple Guide to Pneumonia
-----------------------------------
What is Pneumonia?
---------------------------
Pneumonia is a serious medical disease which causes inflammation and infection of the lung tissues of one or both lungs.
The alveoli of the lungs are filled with exudates and white blood cells sent by the body to contain the infection.
Because of the congestion of the lungs there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .
It is one of the top causes of death in the world.
What are the causes of Pneumonia?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus pneumoniae and Staphylococcus may be serious and fatal in some cases.
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Mycobacterium tuberculosis pneumonia are more common in developing countries and in people whose immune systems are impaired(e.g. AIDS) and are preceded by active tuberculosis infections elsewhere.
Viral infections:
--------------------
Influenza, arbovirus, Severe Acute Respiratory Syndrome(SARS) virus, coxsackie virus
Fungal infections:
-----------------------
Cryptococcus neoformans
Non-infectious:
------------------
1.chemicals such as asbestos can damage the lungs and cause pneumonia
2.Othostatic pneumonia occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs
3.Aspiration pneumonia occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.
This occurs in comatose patients and people having seizures or stroke.
What are Signs and symptoms of pneumonia?
---------------------------------------------
Symptoms:
1.cold or runny nose is usually the first symptom
2.Fever is usually high
3.cough with productive purulent sputum which can yellow, green or bloody
4.Breathlessness due to congestion of the lungs
5.chest pain especially the sides of the chest due to coughing and fever
6.Myalgia (bodyaches) and headache which may be related to the fever
7.abdominal discomfort
8.lethargy especially in small children
Signs:
1.creptitation sounds on auscultation with stethoscope due to large amount of phlegm in the alveoli of the lungs
2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs
3.Reduced breath sounds - air movement is reduced in the lungs
4.Hyporesonance on percussion of the lungs
5.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.
This will considered as a medical emergency.
Children and babies with pneumonia may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.
Elderly people also do not have much symptoms except for fever and breathlessness
How is the diagnosis of Pneumonia made?
------------------------------------------
1.Symptoms and signs of fever, breathless and productive cough
2.blood tests (complete blood count, ESR and blood culture) including viral and legionaire's disease
3.Sputum culture to determine the type of micro-organism
4.Chest X-rays to establish site and character of the lung infection
5.Pleural tap may be necessary if there is pleural effusion. The pleural aspirate is then sent for culture and microscopic examination.
6.CT or MRI of the lungs may be done if required especailly if there is suspicion of lung cancer.
What are the complications of Pneumonia?
-----------------------------------------------
1.Pleural effusion
2.septic shock,
3.adult respiratory distress syndrome
4.seizures also more in children
5.Emphysema
6.Pericarditis
What is the treatment of pneumonia?
------------------------------------
1.Hospitalization should be immediate as pneumonia can be a life threatening condition.
2.Antibiotics depending on the organism found:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
c.Tetracycline or erythromycin for mycoplasma and chlamydia
d.Erythromycin and rifampicin for Legionaire's disease.
3.Antivirals such as Tamiflu for Influenza infection
Acyclovir may be given for herpes virus infection
4.High dosages of anti-fungals may be given for Fungal pneumonia for a prolonged period of time
3.corticosteroids is useful to reduce complications
4.High-flow oxygen
5.intravenous fluids
What is the prognosis of pneumonia ?
------------------------------------------
This depends on the severity and type of infection.
Most cases if treated early and correctly recovered completely.
The elderly, babies and bedridden has a higher mortality.
What are the Preventive measures taken for pneumonia ?
--------------------------------------------------------
Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of pneumonia.
Pneumococcal vaccine against Streptococcus pneumoniae has been given to newborns to prevent pneumonia.
Vaccinations are recommended in:
Adults age 65 or older
Patient over two years of age
1. with diseased lungs, heart, liver, or kidneys
2. health problems like diabetes, alcoholism, AIDS
3. taking any medications or therapy that can affect the body's immune system
e.g chemotherapy
-----------------------------------
What is Pneumonia?
---------------------------
Pneumonia is a serious medical disease which causes inflammation and infection of the lung tissues of one or both lungs.
The alveoli of the lungs are filled with exudates and white blood cells sent by the body to contain the infection.
Because of the congestion of the lungs there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .
It is one of the top causes of death in the world.
What are the causes of Pneumonia?
----------------------------------------
Bacterial Infections:
----------------------------
1.Gram positive bacteria such as Streptococcus pneumoniae and Staphylococcus may be serious and fatal in some cases.
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Mycobacterium tuberculosis pneumonia are more common in developing countries and in people whose immune systems are impaired(e.g. AIDS) and are preceded by active tuberculosis infections elsewhere.
Viral infections:
--------------------
Influenza, arbovirus, Severe Acute Respiratory Syndrome(SARS) virus, coxsackie virus
Fungal infections:
-----------------------
Cryptococcus neoformans
Non-infectious:
------------------
1.chemicals such as asbestos can damage the lungs and cause pneumonia
2.Othostatic pneumonia occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs
3.Aspiration pneumonia occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.
This occurs in comatose patients and people having seizures or stroke.
What are Signs and symptoms of pneumonia?
---------------------------------------------
Symptoms:
1.cold or runny nose is usually the first symptom
2.Fever is usually high
3.cough with productive purulent sputum which can yellow, green or bloody
4.Breathlessness due to congestion of the lungs
5.chest pain especially the sides of the chest due to coughing and fever
6.Myalgia (bodyaches) and headache which may be related to the fever
7.abdominal discomfort
8.lethargy especially in small children
Signs:
1.creptitation sounds on auscultation with stethoscope due to large amount of phlegm in the alveoli of the lungs
2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs
3.Reduced breath sounds - air movement is reduced in the lungs
4.Hyporesonance on percussion of the lungs
5.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.
This will considered as a medical emergency.
Children and babies with pneumonia may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.
Elderly people also do not have much symptoms except for fever and breathlessness
How is the diagnosis of Pneumonia made?
------------------------------------------
1.Symptoms and signs of fever, breathless and productive cough
2.blood tests (complete blood count, ESR and blood culture) including viral and legionaire's disease
3.Sputum culture to determine the type of micro-organism
4.Chest X-rays to establish site and character of the lung infection
5.Pleural tap may be necessary if there is pleural effusion. The pleural aspirate is then sent for culture and microscopic examination.
6.CT or MRI of the lungs may be done if required especailly if there is suspicion of lung cancer.
What are the complications of Pneumonia?
-----------------------------------------------
1.Pleural effusion
2.septic shock,
3.adult respiratory distress syndrome
4.seizures also more in children
5.Emphysema
6.Pericarditis
What is the treatment of pneumonia?
------------------------------------
1.Hospitalization should be immediate as pneumonia can be a life threatening condition.
2.Antibiotics depending on the organism found:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
c.Tetracycline or erythromycin for mycoplasma and chlamydia
d.Erythromycin and rifampicin for Legionaire's disease.
3.Antivirals such as Tamiflu for Influenza infection
Acyclovir may be given for herpes virus infection
4.High dosages of anti-fungals may be given for Fungal pneumonia for a prolonged period of time
3.corticosteroids is useful to reduce complications
4.High-flow oxygen
5.intravenous fluids
What is the prognosis of pneumonia ?
------------------------------------------
This depends on the severity and type of infection.
Most cases if treated early and correctly recovered completely.
The elderly, babies and bedridden has a higher mortality.
What are the Preventive measures taken for pneumonia ?
--------------------------------------------------------
Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of pneumonia.
Pneumococcal vaccine against Streptococcus pneumoniae has been given to newborns to prevent pneumonia.
Vaccinations are recommended in:
Adults age 65 or older
Patient over two years of age
1. with diseased lungs, heart, liver, or kidneys
2. health problems like diabetes, alcoholism, AIDS
3. taking any medications or therapy that can affect the body's immune system
e.g chemotherapy
Sunday, August 17, 2008
Normal Pressure Hydrocephalus
A Simple Guide to Normal Pressure Hydrocephalus
---------------------------------------------------------
What is Normal Pressure Hydrocephalus?
--------------------------------------------
Normal Pressure Hydrocephalus(NPH) is an abnormal accumulation of cerebrospinal fluid in the cavities of the brain.
Who is at risk of getting Normal Pressure Hydrocephalus?
-------------------------------------------------------------
Normal Pressure Hydrocephalus occurs in adults of 55 years old and above.
The accumulation of cerebrospinal fluid is gradual leading to enlargement of the cavities in the brain called ventricles.
This in turn stretches the nerve tissues of the brain giving rise to 3 main neurological disturbances in the brain which is characteristic of NPH.
What are the causes of Normal Pressure Hydrocephalus?
------------------------------------------------------------
In most cases the cause is unknown.
In the remaining cases, the secondary causes can be found:
1. Brain infection can cause damage to brain tissues and the resulting cell damage can increase fluid in the brain
2. Stroke may damage brain cells resulting in damaged brain tissues and increase fluid in the brain
3. Trauma and head injury may damage brain cells similar to above
4. Brain tumors are another cause of increased fluid in the brain
What are the Symptoms of Normal Pressure Hydrocephalus?
----------------------------------------------------------------
Onset is slow and gradual but typically the following symptoms are present:
Gait disturbance
-----------------
Difficulty in walking or balancing
Cognitive impairment
---------------------------
mild dementia
Urinary Incontinence
---------------------
Problems with bladder control and hence incontinence
How is the diagnosis of Normal Pressure Hydrocephalus confirmed?
------------------------------------------------------------------------
1.History of the above 3 symptoms
2.Physical examination shows the neurological deficits:
difficulty in walking
mild dementia
urinary incontinence
3.MRI of brain shows the presence of enlarged ventricles in the brain
What is the Treatment of Normal Pressure Hydrocephalus?
-------------------------------------------------------------------
NPH cannot be cured but its symptoms can be controlled.
Treatment is by surgery using a shunt to divert the excessive fluid in the brain to the peritoneal cavity.
What are the complications of Normal Pressure Hydrocephalus?
-------------------------------------------------------------------
1. Dementia
2. Disabilty
3. Disturbed urinary and bowel function.
What is the prognosis of Normal Pressure Hydrocephalus?
------------------------------------------------------------------------
With early diagnosis and treatment, symptoms can be partially or fully reversed leading to resumption of a normal life.
With the use of the shunt, symptoms may disappear within days or at most a few months.
There is dramatic improvement in the first week in mild cases.
Some adjustments of the valve are often needed before the correct setting is obtained for the individual.
---------------------------------------------------------
What is Normal Pressure Hydrocephalus?
--------------------------------------------
Normal Pressure Hydrocephalus(NPH) is an abnormal accumulation of cerebrospinal fluid in the cavities of the brain.
Who is at risk of getting Normal Pressure Hydrocephalus?
-------------------------------------------------------------
Normal Pressure Hydrocephalus occurs in adults of 55 years old and above.
The accumulation of cerebrospinal fluid is gradual leading to enlargement of the cavities in the brain called ventricles.
This in turn stretches the nerve tissues of the brain giving rise to 3 main neurological disturbances in the brain which is characteristic of NPH.
What are the causes of Normal Pressure Hydrocephalus?
------------------------------------------------------------
In most cases the cause is unknown.
In the remaining cases, the secondary causes can be found:
1. Brain infection can cause damage to brain tissues and the resulting cell damage can increase fluid in the brain
2. Stroke may damage brain cells resulting in damaged brain tissues and increase fluid in the brain
3. Trauma and head injury may damage brain cells similar to above
4. Brain tumors are another cause of increased fluid in the brain
What are the Symptoms of Normal Pressure Hydrocephalus?
----------------------------------------------------------------
Onset is slow and gradual but typically the following symptoms are present:
Gait disturbance
-----------------
Difficulty in walking or balancing
Cognitive impairment
---------------------------
mild dementia
Urinary Incontinence
---------------------
Problems with bladder control and hence incontinence
How is the diagnosis of Normal Pressure Hydrocephalus confirmed?
------------------------------------------------------------------------
1.History of the above 3 symptoms
2.Physical examination shows the neurological deficits:
difficulty in walking
mild dementia
urinary incontinence
3.MRI of brain shows the presence of enlarged ventricles in the brain
What is the Treatment of Normal Pressure Hydrocephalus?
-------------------------------------------------------------------
NPH cannot be cured but its symptoms can be controlled.
Treatment is by surgery using a shunt to divert the excessive fluid in the brain to the peritoneal cavity.
What are the complications of Normal Pressure Hydrocephalus?
-------------------------------------------------------------------
1. Dementia
2. Disabilty
3. Disturbed urinary and bowel function.
What is the prognosis of Normal Pressure Hydrocephalus?
------------------------------------------------------------------------
With early diagnosis and treatment, symptoms can be partially or fully reversed leading to resumption of a normal life.
With the use of the shunt, symptoms may disappear within days or at most a few months.
There is dramatic improvement in the first week in mild cases.
Some adjustments of the valve are often needed before the correct setting is obtained for the individual.
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