DOC I HAVE CANCER OF THE VULVA
Cancer of the vulva is a rare cancer in women which affects the vulva occurring usually in older women past menopause.
The average age is over 60.
The cancer is usually a squamous carcinoma.
Rare tumors are melanoma, basal cell carcinoma and sarcoma.
The most common site is the labium majus(side wall of the vulva) , followed by the clithoris but it may arise anywhere including the urethral area.
The cancer can spread locally to involve the whole vulva and invade the vagina.
Secondary spread of the cancer is along the lymphatic system.
The symptoms and signs of cancer of the vulva are:
1.The cancer is usually symptomless until it ulcerates.
2.It can presents as a lump which is cauliflower in appearance or ulcerated or indurated.
3.inguinal lymph nodes may be enlarged in cases of spread.
4.There may be pain with ulceration or long standing itch.
Diagnosis of cancer of the vulva is by:
1.Physical examination may revealed a lump or more in the vulva region.
2.Biopsy of the lump may reveal cancer
3.Ultrasound may be able to detect any spread to the vagina, uterus or lymph gland.
The treatment of Cancer of the vulva is :
1.Surgery:
If there is no evidence of spread, usually removal of the cancerous lump is sufficient.
If the evidence of spread to the entire vulva region, radical vulvectomy may be done together with removal of the inguinal lymph nodes.
Chemotherapy:
Chemotherapy may help to prevent the spread of the cancer or to prevent a reccurance.
Radiotherapy :
Radiotherapy is not a treatment of choice
Squamous cell carcinoma is relatively resistant to radiotherapy.
The vulval skin is also very sensitive the burning effect of radiotheray.
However in the very old and frail patients, radiotherapy may be considered as an alternative to multilating operation.
Prognosis of cancer of the vulva is:
If the lymph nodes are not involved, there is a chance of 70% 5 year cure rate.
If the superficial lymph nodes are involved, the cure rate drops to 40%.
If the pelvic lymph nodes are involved the cure rate drops to only 20%.
Sunday, May 29, 2011
Friday, May 27, 2011
A Family Doctor's Tale - VESICOVAGINAL FISTULA
DOC I HAVE A VESICOVAGINAL FISTULA
Vesicovaginal Fistula is a chronic granulous track which communicate between the bladder base and the vagina.
Vesicovaginal Fistula usually result from :
1.operation through the vagina causing a hole through vaginal wall to bladder wall
2.follows surgery for hysterectomy
3.Pressure necrosis on the vaginal and bladder walls during a
prolonged and difficult labor.
4.Radiation burns during treatment of cancer of cervix
5.untreated cancer of bladder or genital tract in women
6.Chronic illness such as tuberculosis of bladder or genital tract in women
7.Congenital fistula between bladder and vagina
A veiscovaginal fistula have a natural tendency to close by granulation and fibrosis.
Factors interfering with this are:
1.continual flow of urine
2.sepsis
3.persistance of causative factor such as malignancy or radiation necrosis.
However if the urinary stream can be diverted by a cathether and good bladder drainage and if the sepsis is treated, the natural decrease in size will occur.
Many small fistula of 1 cm diameter or less can be expected to close in 2 to 3 months
Symptoms:
1.incontinence
2.painful urination
3.frequent urination
4.vaginal discharge or wetness
5.painful vagina
Diagnosis:
1.Vaginal examination can show presence of fistula on the roof of vagina
2.Dye instilled into the bladder shows the dye leaking from the roof of vagina
3.Intravenous pyelogram also can show the contrast leaking into the vagina on X-ray.
Treatment of small fistula:
1.The urinary stream can be diverted by a cathether and good bladder drainage
2.The sepsis is treated with antibiotics
Without infection and the constant leakage of urine, the fistula will naturally decrease in size.
Many small fistula of 1 cm diameter or less can be expected to close in 2 to 3 months
3.If this does not happened, the fistula can be easily stitched up.
Treatment of larger fistula:
The vaginal skin is cut open bigger than the fistula for the fresh edges to be stitched.
The granulated hardened edges of the original fistula will not join together so easily as when fresh new tissues are cut and stitched together.
A catheter is left in the bladder to drain the urine and antibiotics are given to prevent infection.
Painkillers may be given if there is pain after the operation.
General treatment:
1.Treatment of associated diseases like diabetes, carcinoma
2.Antibiotics - a full course of at least 2 weeks of antibiotics is needed
3.toilet and dressing of the wounds, with application of antibiotic creams
4.tub baths of the Vesicovaginal region several times a day in plain, warm water for about 10 minutes
Prognosis is good with surgery.
Rarely there may undesirable complication like urinary incontinence.
Vesicovaginal Fistula is a chronic granulous track which communicate between the bladder base and the vagina.
Vesicovaginal Fistula usually result from :
1.operation through the vagina causing a hole through vaginal wall to bladder wall
2.follows surgery for hysterectomy
3.Pressure necrosis on the vaginal and bladder walls during a
prolonged and difficult labor.
4.Radiation burns during treatment of cancer of cervix
5.untreated cancer of bladder or genital tract in women
6.Chronic illness such as tuberculosis of bladder or genital tract in women
7.Congenital fistula between bladder and vagina
A veiscovaginal fistula have a natural tendency to close by granulation and fibrosis.
Factors interfering with this are:
1.continual flow of urine
2.sepsis
3.persistance of causative factor such as malignancy or radiation necrosis.
However if the urinary stream can be diverted by a cathether and good bladder drainage and if the sepsis is treated, the natural decrease in size will occur.
Many small fistula of 1 cm diameter or less can be expected to close in 2 to 3 months
Symptoms:
1.incontinence
2.painful urination
3.frequent urination
4.vaginal discharge or wetness
5.painful vagina
Diagnosis:
1.Vaginal examination can show presence of fistula on the roof of vagina
2.Dye instilled into the bladder shows the dye leaking from the roof of vagina
3.Intravenous pyelogram also can show the contrast leaking into the vagina on X-ray.
Treatment of small fistula:
1.The urinary stream can be diverted by a cathether and good bladder drainage
2.The sepsis is treated with antibiotics
Without infection and the constant leakage of urine, the fistula will naturally decrease in size.
Many small fistula of 1 cm diameter or less can be expected to close in 2 to 3 months
3.If this does not happened, the fistula can be easily stitched up.
Treatment of larger fistula:
The vaginal skin is cut open bigger than the fistula for the fresh edges to be stitched.
The granulated hardened edges of the original fistula will not join together so easily as when fresh new tissues are cut and stitched together.
A catheter is left in the bladder to drain the urine and antibiotics are given to prevent infection.
Painkillers may be given if there is pain after the operation.
General treatment:
1.Treatment of associated diseases like diabetes, carcinoma
2.Antibiotics - a full course of at least 2 weeks of antibiotics is needed
3.toilet and dressing of the wounds, with application of antibiotic creams
4.tub baths of the Vesicovaginal region several times a day in plain, warm water for about 10 minutes
Prognosis is good with surgery.
Rarely there may undesirable complication like urinary incontinence.
Wednesday, May 25, 2011
A Simple Guide to Encephalitis
A Simple Guide to Encephalitis
-----------------------------------
What is Encephalitis?
---------------------------
Encephalitis is a serious medical disease which causes inflammation and infection of the brain.
What are the causes of Encephalitis?
----------------------------------------
The causes of Encephalitis may be divided into:
Infections:
------------
1.viral infections are the most common
(herpes simplex virus, mumps, measles, rubella, chickenpox, West Nile Encephalitis, Japanese Encephalitis, St Lious Encephalitis).
Of these viruses, herpes simplex virus is the most serious and can cause fatality.
2.bacterial infections such as meningoccocus(Neisseria meningitidis) and pneumococcus(Streptococcus pneumoniae) can be serious and fatal in some cases.
Meningococcal Encephalitis can cause outbreaks(spread easily).
3.fungi,
Cryptococcus neoformans is the most common cause of fungal Encephalitis
4.Parasitic
Examples are Toxoplasmosis, malaria, amoeba, Lyme Disease
What are Signs and symptoms of Encephalitis?
---------------------------------------------
The symptoms which often defines Encephalitis are:
1.Severe headache
2.Fever
3.Irritabilty
4.Confusion
5.Drowsiness and fatigue
Other symptoms are:
6.seizures and convulsions
7.vomiting
8.hallucinations
9.memory problems
10.tremors
11.weakness of the hands and legs
12.incontinence of urinary and bowel movement
How is the diagnosis of Encephalitis made?
------------------------------------------
1.Typical symptoms of fever, headache, confusion .
2.Physical examination shows confusion ,drowsiness and signs of neck rigidity
3.blood tests (complete blood count, ESR and blood culture)
4.cerebrospinal fluid analysis (CSF) via lumbar puncture is examined for increased white blood cells and protein content, normal glucose level. Red blood cells may be present if there is bleeding. Sometimes the CSF may show the presence of micro-organisms.
This test should not be done if there is suspected cerebral mass lesion or raised intracranial pressure (head injury, localizing neurological signs, or signs of raised ICP).
5.CT or MRI of the brain and spine with MRI preferred over CT because it can detect more easily areas of cerebral edema,tumors, ischemia, and meningeal inflammation.
What are the complications of Encephalitis?
-----------------------------------------------
1.Neurological deficits
2.deafness
3.learning disorders in children
4.brain infarction,
5.septic shock,
6.adult respiratory distress syndrome
7.seizures also more in children
8.pneumonia especially in the elderly
What is the treatment of Encephalitis?
------------------------------------
1.Hospitalisation should be immediate as Encephalitis is an life threatening condition.
2.Antibiotics such as cephalosporin, ampicillin, chloramphenicol, intravenous vancomycin to be started even before doing lumbar puncture.
Acyclovir may be given for herpes virus infection
High dosages of antifungals may be given for Fungal Encephalitis for a prolonged period of time
3.corticosteroids is useful to reduce swelling and inflammation in the brain
4.Sedatives may be needed for irritabilty and restlessness
5.High-flow oxygen
6.intravenous fluids
What is the prognosis of Encephalitis?
------------------------------------------
This depends on the severity and type of infection.
Viral infections except for herpes simplex usually recover quickly.
Bacterial infections such as meningococcus and pneumonia are more dangerous.
What are the Preventive measures taken for Encephalitis?
--------------------------------------------------------
Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of meningitis and encephalitis.
Mumps vaccination as part of Measles,mumps and rubella vaccine(MMR) has reduced the incidence of mumps related form of meningitis and encephalitis
-----------------------------------
What is Encephalitis?
---------------------------
Encephalitis is a serious medical disease which causes inflammation and infection of the brain.
What are the causes of Encephalitis?
----------------------------------------
The causes of Encephalitis may be divided into:
Infections:
------------
1.viral infections are the most common
(herpes simplex virus, mumps, measles, rubella, chickenpox, West Nile Encephalitis, Japanese Encephalitis, St Lious Encephalitis).
Of these viruses, herpes simplex virus is the most serious and can cause fatality.
2.bacterial infections such as meningoccocus(Neisseria meningitidis) and pneumococcus(Streptococcus pneumoniae) can be serious and fatal in some cases.
Meningococcal Encephalitis can cause outbreaks(spread easily).
3.fungi,
Cryptococcus neoformans is the most common cause of fungal Encephalitis
4.Parasitic
Examples are Toxoplasmosis, malaria, amoeba, Lyme Disease
What are Signs and symptoms of Encephalitis?
---------------------------------------------
The symptoms which often defines Encephalitis are:
1.Severe headache
2.Fever
3.Irritabilty
4.Confusion
5.Drowsiness and fatigue
Other symptoms are:
6.seizures and convulsions
7.vomiting
8.hallucinations
9.memory problems
10.tremors
11.weakness of the hands and legs
12.incontinence of urinary and bowel movement
How is the diagnosis of Encephalitis made?
------------------------------------------
1.Typical symptoms of fever, headache, confusion .
2.Physical examination shows confusion ,drowsiness and signs of neck rigidity
3.blood tests (complete blood count, ESR and blood culture)
4.cerebrospinal fluid analysis (CSF) via lumbar puncture is examined for increased white blood cells and protein content, normal glucose level. Red blood cells may be present if there is bleeding. Sometimes the CSF may show the presence of micro-organisms.
This test should not be done if there is suspected cerebral mass lesion or raised intracranial pressure (head injury, localizing neurological signs, or signs of raised ICP).
5.CT or MRI of the brain and spine with MRI preferred over CT because it can detect more easily areas of cerebral edema,tumors, ischemia, and meningeal inflammation.
What are the complications of Encephalitis?
-----------------------------------------------
1.Neurological deficits
2.deafness
3.learning disorders in children
4.brain infarction,
5.septic shock,
6.adult respiratory distress syndrome
7.seizures also more in children
8.pneumonia especially in the elderly
What is the treatment of Encephalitis?
------------------------------------
1.Hospitalisation should be immediate as Encephalitis is an life threatening condition.
2.Antibiotics such as cephalosporin, ampicillin, chloramphenicol, intravenous vancomycin to be started even before doing lumbar puncture.
Acyclovir may be given for herpes virus infection
High dosages of antifungals may be given for Fungal Encephalitis for a prolonged period of time
3.corticosteroids is useful to reduce swelling and inflammation in the brain
4.Sedatives may be needed for irritabilty and restlessness
5.High-flow oxygen
6.intravenous fluids
What is the prognosis of Encephalitis?
------------------------------------------
This depends on the severity and type of infection.
Viral infections except for herpes simplex usually recover quickly.
Bacterial infections such as meningococcus and pneumonia are more dangerous.
What are the Preventive measures taken for Encephalitis?
--------------------------------------------------------
Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of meningitis and encephalitis.
Mumps vaccination as part of Measles,mumps and rubella vaccine(MMR) has reduced the incidence of mumps related form of meningitis and encephalitis
A Family Doctor's Tale -UTERINE PROLAPSE
DOC I HAVE UTERINE PROLAPSE
Uterine prolapse occurs when the ligaments and muscles holding the uterus in place has weakened to allow it to drop out of the vagina especially in a squatting position.
Causes of Uterine Prolapse:
1.Pregnancy and childbirth -the physical trauma of child birth can strain the pelvic muscles and ligaments to the extent that they are not as strong as before childbirth
2.large fibroids or pelvic tumors can cause pressure on the pelvic muscles downward by gravity
3.age and menopause can weaken the pelvic muscles and the elasticity of the ligaments
4.Heavy lifting as in manual work can also strain and damage pelvic muscles
5.overweight women are more prone to prolapse
6.Pelvic or spinal surgery may damage nerves and pelvic muscles increasing the risk of prolapse.
8.Chronic coughing from smoking or the straining due to constipation, increases the risk of prolapse
Symptoms and signs of uterine prolapse are:
1.Heaviness or protrusion out of the vagina
2.Some thing dropping out of the vaginal area
3.Discomfort or pain in pelvis, abdomen or back
4.Vaginal discharge is excessive or unusual
5.Frequency of urination or urine infection
6.Loss of control of urination(incontinence)
Symptoms may be worse in the evening after prolonged standing or walking
Signs of Uterine prolapse are:
1.Physical examination may show a protrusion of the uterus on squatting.
2.Vaginal examination show the degree of uterine prolapse especially in the standing position:
Stage I Descent of the uterus to any point in the vagina above the level of the hymen
Stage II Descent to the level of the hymen
Stage III - Descent beyond the hymen
Stage IV - Total prolapse
3.Ultrasound of the pelvis may exclude other conditions than uterine prolapse
Treatment of Uterine Prolapse :
Conservative usually for mild cases of uterine prolapse:
1.Kegel exercises help to strengthen the pelvic floor muscles.
The patient is asked to tighten the pelvic muscles by tightening the anus for a few seconds and then release many times a day.
2.Vaginal pessary is a rubber or plastic device which is placed around or under the cervix to support the uterus and hold it in position.
Regular removal and cleaning is important to prevent infection.
It is a temporary measure.
Surgery:
This is the more permanent method of treatment.
1.Colpocleisis involves the removal of a part of anterior and posterior vaginal wall and closing of the margins of the two walls resulting in a small vaginal canal.
The uterus is thus unable to drop out of the smaller vaginal canal.
Success is 90-100%.
3.Sacrohysteropexy make use of a strip of synthetic mesh to hold the uterus in place in an operation done through a 15-cm incision or laparoscopy. One end of the mesh is attached to the cervix and top of the vagina and the other to the sacrum thus supporting the uterus.
Prognosis of uterine prolapse indicates the treatment in most cases will relieve the symptoms and discomfort.
Prevention of uterine prolapse :
1.Avoid constipation by taking a healthy diet
2.Pelvic muscle exercise (Kegel exercises) should be done regularly
3.Avoid straing of pelvic muscle by using correct lifting techniques
4.Avoid smoking to prevent a chronic cough
Uterine prolapse occurs when the ligaments and muscles holding the uterus in place has weakened to allow it to drop out of the vagina especially in a squatting position.
Causes of Uterine Prolapse:
1.Pregnancy and childbirth -the physical trauma of child birth can strain the pelvic muscles and ligaments to the extent that they are not as strong as before childbirth
2.large fibroids or pelvic tumors can cause pressure on the pelvic muscles downward by gravity
3.age and menopause can weaken the pelvic muscles and the elasticity of the ligaments
4.Heavy lifting as in manual work can also strain and damage pelvic muscles
5.overweight women are more prone to prolapse
6.Pelvic or spinal surgery may damage nerves and pelvic muscles increasing the risk of prolapse.
7.Genetic conditions or muscle dystrophy conditions may be responsible for weak muscles
8.Chronic coughing from smoking or the straining due to constipation, increases the risk of prolapse
Symptoms and signs of uterine prolapse are:
1.Heaviness or protrusion out of the vagina
2.Some thing dropping out of the vaginal area
3.Discomfort or pain in pelvis, abdomen or back
4.Vaginal discharge is excessive or unusual
5.Frequency of urination or urine infection
6.Loss of control of urination(incontinence)
Symptoms may be worse in the evening after prolonged standing or walking
Signs of Uterine prolapse are:
1.Physical examination may show a protrusion of the uterus on squatting.
2.Vaginal examination show the degree of uterine prolapse especially in the standing position:
Stage I Descent of the uterus to any point in the vagina above the level of the hymen
Stage II Descent to the level of the hymen
Stage III - Descent beyond the hymen
Stage IV - Total prolapse
3.Ultrasound of the pelvis may exclude other conditions than uterine prolapse
Treatment of Uterine Prolapse :
Conservative usually for mild cases of uterine prolapse:
1.Kegel exercises help to strengthen the pelvic floor muscles.
The patient is asked to tighten the pelvic muscles by tightening the anus for a few seconds and then release many times a day.
2.Vaginal pessary is a rubber or plastic device which is placed around or under the cervix to support the uterus and hold it in position.
Regular removal and cleaning is important to prevent infection.
It is a temporary measure.
Surgery:
This is the more permanent method of treatment.
1.Colpocleisis involves the removal of a part of anterior and posterior vaginal wall and closing of the margins of the two walls resulting in a small vaginal canal.
The uterus is thus unable to drop out of the smaller vaginal canal.
Success is 90-100%.
2.Sacrospinous fixation is a procedure where the uterosacral ligaments bilaterally is sutured to the sacrospinous ligaments preventing the prolapse.
3.Sacrohysteropexy make use of a strip of synthetic mesh to hold the uterus in place in an operation done through a 15-cm incision or laparoscopy. One end of the mesh is attached to the cervix and top of the vagina and the other to the sacrum thus supporting the uterus.
4.Vaginal hysterectomy -the uterus is removed through the vagina and the uterosacral and cardinal ligaments are sutured together.
5.Abdominal hysterectomy is done when there is pelvic inflammatory disease or previous intra-abdominal operation when a vaginal hysterectomy is not advisable. The uterus is removed followed by a vaginal anterior and posterior colporrhaphy.
Prognosis of uterine prolapse indicates the treatment in most cases will relieve the symptoms and discomfort.
Prevention of uterine prolapse :
1.Avoid constipation by taking a healthy diet
2.Pelvic muscle exercise (Kegel exercises) should be done regularly
3.Avoid straing of pelvic muscle by using correct lifting techniques
4.Avoid smoking to prevent a chronic cough
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