A Simple Guide to Tenosynovitis

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

Tenosynovitis is the inflammation and swelling of the tendon sheaths (called the synovium) and the enclosed tendons.

It can occur together with tendinitis(inflammation of the tendons).

It can also cause stenosing tenosynovitis (tightening inflammation of the tendon sheaths).


What are the cause of Tenosynovitis?
-----------------------------------------------

The cause of Tenosynovitis is unknown.

Some possible causes are:
1.Injury or trauma to the tendon

2.Repetitive usage of fingers and wrist joints

3.Arthritis of the joints may predispose to tenosynovitis

4.Systemic diseases such as multiple sclerosis ,amyloidosis, rheumatoid arthritis

5.Tenosynovitis occurs in families, and

6.It is generally seen more often in males than in females


What are the symptoms and signs of Tenosynovitis?
-------------------------------------------------------------------

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

1.Pain on movement of the tendon

2.Swelling of part of the tendon affected

3.Stenosis of the tendon sheath may be present

4.Stiffness of the tendon - inability to stretch

5.Pain is felt most beneath the bone of involved joints

Signs:

1.swelling over the involved tendon

2.Passive stretching of the tendon is painful.

3.There may be local tenderness of the inflamed tendon.

4.The tendons sheaths are usually swollen and thickened

5.The tendons may become stuck in the narrowed tendon sheaths (Trigger Finger)

6.There may be crepitations felt over the tendon as it moves across the sheaths


What is the complications of Tenosynovitis?
-------------------------------------------------

Fibrosis and rupture of the inflamed tendon may occur leading to loss of function.


What is the Treatment of Tenosynovitis?
----------------------------------------------------------------

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

1.rest of the tendon

2.Cold or ice may help reduce inflammation

3.Splints over the hand, wrist and elbow may help to rest the tendons

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

5.Muscle relaxant to relax muscles

6.injection of local anesthetic and long acting steroid into the affected sheath or tendon nodule may help to reduce inflammation

7.Surgery :
------------------

Surgical opening of the synovial sheath may be necessary for tendon release.


What is the prognosis of Tenosynovitis?
----------------------------------------------------------

Prognosis is usually good although recurrence may occur after cortisone injection.

Surgery usually give excellent results.

A Simple Guide to Ovarian torsion

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

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

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

Both normal or enlarged ovaries can be affected.

Rarely both ovaries may be affected.

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


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

Women of all ages can develop this rare condition.

Most cases occur in women under 30 years old.

One fifth of all cases occur in pregnant women.



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

Ovarian torsion is caused by

1.congenital and developmental abnormalities

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

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

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

b.Ovarian cysts or fibromas,

c.tumor of the Ovaries or tubes,

d.Injury to either the ovaries or the tubes


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

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

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

2.Nausea, vomiting,

3.diarrhea, or constipation

4.fever

5.tachycardia.

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

1.tenderness of the lower abdomen

2.tenderness of the Ovarian region on vaginal palpation


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

1.suddenness of lower abdominal pain.

2.pregnancy test.

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

4.laparoscopy.


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

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


What is the treatment of Ovarian torsion?
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Surgical repair of the ovarian torsion must done urgently.

For less severe cases laparoscopic surgery can release the torsion

Pain killers such as NSAIDs are given to control pain.


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

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

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

Infertility may be a result of ovarian torsion.

A Simple Guide to Croup

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

Croup is an acute viral disease of the upper and lower respiratory tract associated with inspiratory stridor ( whistling obstructive sound during inhalation) and respiratory distress in severe cases.

It typically affects infants and children below 6 years old.

It causes a typically barking type of cough and hoarseness of the voice due to obstruction at the vocal box.


What are the causes of Croup?
----------------------------------------

Viral infections:
--------------------

1.parainfluenza virus, primarily types 1 and 2

2.Other viral infections such as adenorhinovirnese, enterovirus and mycoplasma pneumoniae

Genetic predisposition:
------------------------

Some families are more prone than others to get the disease.
It is also more common in males than females.


What are Signs and symptoms of Croup?
---------------------------------------------

Symptoms:

1.harsh barking cough

2.sneeze

3.inspiratory stridor (a high-pitched whistling sound during inspiration),

4.nausea and vomiting

5.fever.

6.Hoarseness -usually present

7.respiratory distress due to airway obstruction

8.lethargy

Signs:

1.Reduced breath sounds - air movement is reduced in the lungs

2.Prolonged inspiration on auscultation with laryngeal stridor

3.Chest retraction

4.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.

This will considered as a medical emergency.


How is the diagnosis of Croup made?
------------------------------------------

1.Symptoms and signs of fever, laryngeal stridor and barking cough

2.blood tests (complete blood count, ESR and blood culture)

5.frontal X-ray of the C-spine
the presence of the the steeple sign confirms the diagnosis of croup.


What are the complications of Croup?
-----------------------------------------------

1.Respiratory distress

2.Bacterial tracheitis


What is the treatment of Croup?
------------------------------------

1.Rest, fluids and oxygen

2.Humidifiers and steam inhalations

3.Corticosteroids especially dexamethasone are the most commonly used agent as it reduces inflammation

4.Antibiotics are not useful because the cause is viral. If there is bacterial tracheitis, antibiotics may be needed

5.Bronchodilators such as theophylline, epinephrine, ventolin, bricanyl are all helpful to open the airways

6.Intubation and tracheostomy may be needed in severe cases.


What is the prognosis of Croup ?
------------------------------------------

This depends on the severity and type of infection.

Most cases, if treated early and correctly, recovered completely with return of normal lung function within 7 days.


What are the Preventive measures taken for Croup ?
--------------------------------------------------------

Vaccination against the influenza virus may help.

A Simple Guide to Obstructive Sleep Apnea

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

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

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

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

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

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

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

3.excessive soft palatial tissue or long uvula

4.receding chin resulting in a backward prolapsing tongue

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

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

1.Hypothyroidism

2.Acromegaly

3.Alcohol

4.Sedatives

5.Obesity

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

Symptoms:

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

2.unrefreshed sleep

3.daytime sleepiness

4.poor concentration

5.forgetfulness

6.morning headaches

7.dryness of mouth in the morning

8.irritability

9.depression

10.sexual dysfunction

Signs:

1.Enlarged nasal turbinates, polyps , and nasal blockage

2.Enlarged tonsils and adenoids

3.Long uvula

4.large protruding tongue


How is the diagnosis of Obstructive Sleep Apnea made?
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A.Symptoms of snoring, nasal congestion and inadequate sleep

B.observation of airway obstruction during sleep

C.Sleep study using monitoring devices such as

1.electroencephalogram(EEG)- brain waves

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

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

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

5.Blood oxygen studies

6.Body position

7.Nasal and oral airflow

8.Thoracic movement

9.abdominal movement

10.Snoring sounds


What are the complications of Obstructive Sleep Apnea?
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1.higher risk of hypertension

2.cardiovascular disease

3.Congestive heart failure

4.cardiac arrhythmias

5.cerebrovascular accidents

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1.Lose weight in obese individual with OSA

2.Healthy lifestyle with balanced diet and exercise.

3.Neck elevation

4.Avoid alcohol

A Simple Guide to Cervicitis

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

Cervicitis is non-specific infection of the cervix.

It is most common on the posterior cervix but may be anterior or concentric.


Who is affected by Cervicitis?
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1.Congeital cervical erosions or cervicitis can occur in virgins.

2.sexually active females

3.dilatation in labor or during abortion

What are the types of Cervicitis?
-------------------------------------------

1.Simple:

Erosion surface is smooth

2.Papillary:

Erosion surface is rough

3.Follicular:

Erosion surface is cystic

What are the Causes of Cervicitis?
-----------------------------------------------------

Bacterial infections:
---------------------------

1.Gonorrhea

2.Chlamydia

3.staphylococcus aureus

4.Streptococcus

5.Mycobacterium tuberculosis.

6.E.coli

Viral infections:
--------------------------

1.Genital herpes

2.Human Papilloma Virus

Other causes:
--------------------

1.Cervical cap

2.Device to support the uterus (pessary)

3.Diaphragm

4.allergy to spermicides

5.Exposure to a chemical

What are the complications of Cervicitis?
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1.Pelvic inflammatory disease

2.Urethritis and cystitis

3.rarely malignant changes in cervix

4.inguinal lymphadenitis

5.Cervical cancer

What are the Symptoms and signs of Cervicitis?
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1.Mucopurulent vaginal discharge (Gray, white, or yellow color) with odor

2.Blood in the vaginal discharge
a.After intercourse
b.After menopause
c.Between periods

3.Urinary infection symptoms - frequency and pain

3.hematuria (blood in the urine)

4.Pelvic pain

5.Backache

6.Painful sexual intercourse

7.Pain in the vagina

8.Pressure or heaviness in the pelvis

Signs:

1.reddened area of cervix

2.erosion of cervical wall

3.Vaginal surface of cervix may be affected

4.pus discharge from the cervix

5.Swelling (inflammation) of the walls of the vagina

How is diagnosis of Cervicitis made?
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1.Vaginal examination with Pap's smear of cervical cells

2.Cervical swab for culture and sensitivity to antibiotics

3.Blood tests( white cell count , blood culture, chlamydia, gonorrhea)

4.Biopsy of cervical erosions.

What is the treatment of Cervicitis?
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1. Antibiotics is given according to the sensitivity of bacteria in the culture.

2.Pelvic pain and backache may be treated with paracetamol

3.Local application of sulphonamide, tetracycline or other antibiotic cream to affected cervical area

4.Electro-Cauterisation of the affected cervical area

5.Cryosurgery of cervical erosions

6.Cone biopsy if necessary of affected cervix area.

7.Hormonal therapy (especially in postmenopausal women)

8.Laser therapy of cervical erosions

What is the prognosis of Cervicitis?
-------------------------------------------------------------

Prognosis with appropriate treatment and antibiotics is generally good.

Recurrence is common.

Cervicitis may last for months to years.

Cervicitis may lead to pain with intercourse (dyspareunia).

What are Preventive measures for Cervicitis?
-------------------------------------------------------------------

Avoid sexual intercourse with multiple partners.

Use condoms during sexual intercourse.

Vaccination against human papilloma virus

Avoid chemical irritants such as douches and deodorant tampons.

Avoid using spermicidal contraceptives

Make sure that any foreign objects that inserted into the vagina is clean or sterile

A Simple Guide to Epididymitis and Orchitis

A Simple Guide to Epididymitis and Orchitis
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What is Epididymitis and Orchitis?
---------------------------------------

Epididymitis and orchitis is acute bacterial or viral infection of the epididymis and testis.

The epididymis is the small organ on top of the testis.


Who is affected by Epididymitis and Orchitis?
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1.childhood, usually related to mumps infection

2.sexually active males

3.Epididymitis is more common than Orchitis


What are the Causes of Epididymitis and Orchitis?
-----------------------------------------------------

Bacterial infections:

1.Gonorrhea

2.Chlamydia

3.staphylococcus aureus

4.Streptococcus

5.Mycobacterium tuberculosis.

6.E.coli

Viral infections:

1.mumps in childhood

2.measles


What are the complications of Epididymitis and Orchitis?
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1.Orchitis or infection of the testis following epididymitis

2.Abscess formation of the epididymis

3.gangrene of the testis if blood flow is affected.

4.inguinal lymphadenitis


What are the Symptoms and signs of Epididymitis and Orchitis?
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1.Pain in scrotum

2.ejaculation of blood

3.hematuria (blood in the urine)

4.Fever

Signs:

1.Scrotal swelling

2.Induration of scrotum wall

3.tenderness of epididymis

4.tenderness of the testis if orchitis is present


How is diagnosis of Epididymitis and Orchitis made?
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1.pain and tenderness of the epididymis and testis

2.Mid stream urine for culture

3.Blood tests( white cell count , blood culture)

4.Ultrasound of the testis


What is the treatment of Epididymitis and Orchitis?
---------------------------------------------------

Acute Epididymitis and Orchitis

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.Scrotal support

4.Ice packs for scrotum

5.Bed rest and Fluids

6.Surgical drainage if there is abscess formation.


What is the prognosis of Epididymitis and Orchitis?
-------------------------------------------------------------

Prognosis with appropriate treatment and antibiotics is generally good.

There is a risk of sterility and decreased male hormone production if treatment is inadequate.


What are Preventive measures for Epididymitis and Orchitis?
-------------------------------------------------------------------

Avoid sexual partners with multiple partners.

Use condoms during sexual intercourse.

A Simple Guide to Testicular torsion

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


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


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

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


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


Testicular torsion is caused by

1.incomplete fixation of the epididymis to the testis

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

3.loose ligaments holding the testis to its cord .

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


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


Symptoms :

1.Severe pain in the testis

2.nausea and vomiting

3.fever

Signs:

1.scrotal swelling and edema

2.tenderness of the testis on palpation

3.redness and inflammation of the scrotal pouch

4.enlarged scrotal pouch


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


1.Characteristic appearance of the testis

2.Ultrasound examination can detect the obvious torsion


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


Damage to the testis with gangrene formation


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


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

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


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


The prognosis is usually excellent if treated early.

Gangrenous testis must be removed.


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


Avoid strenuous activities

Wear loose underwear

A Simple Guide to Retinitis pigmentosa

A Simple Guide to Retinitis pigmentosa
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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