DOC I HAVE POSTMENOPAUSAL BLEEDING
Postmenopausal bleeding is a symptom defined as heavy or prolonged occurring one year or more after menopause.
Bleeding can occur from any part of the genital tract.
Causes:
Physiological:
most common 25 per cent show no demonstrable cause
(dysfunctional uterine bleeding)
Iatrogenic:
estrogen replacement therapy
Vulva:
infection
atrophy
granulomatous lesions
carcinoma
Vagina:
atrophy
infection
carcinoma
Cervix:
polyp
carcinoma
Uterus:
polyp
carcinoma
myomas
Others:
tubal or ovarian carcinoma
pelvic inflammatory disease
endometriosis
Diagnosis:
History:
Menstrual history:
cycle length, number of bleeding days, degree of blood loss(number of pads used per day), presence of blood clots, dysmenorrhea (painful Menstruation)
Symptoms suggesting underlying pathology:
Metabolic disorders:
symptoms of hypothyroidism
Bleeding disorders:
easy bruising
anticoagulants
Pelvic inflammatory Disease:
pelvic pain especially during intercourse
vaginal discharge
dysmenorrhea
Endometriosis:
pelvic pain
dysmenorrhea
Medication:
use of post menopausal estrogen
Physical Examination:
Signs of underlying diseases:
infection of vulva and cervix
hypothyroid features
pallour(anaemia)
Abdominal examination:
palpable uterine or ovarian masses
Pelvic examination:
vulval and vaginal examination
bimanual palpation for masses
cervical smear
Investigation:
Full blood count including hemoglobin(to exclude anemia from loss of blood) and platelets(low platelets can cause bleeding)
Transvaginal ultrasound to exclude uterine fibroids and polyps -postmenstrual scans is best when the endometrium is at its thinest.
Endometrial hysteroscopy and biopsy in women
Laparoscopy if required
Treatment:
Medications:
1.Tranexamic acid- oral antifibrinolytic, given only when there is heavy bleeding
2.oral estrogen - prevent proliferation of the endometrium, reduces blood flow. Should be given for 21 days only to assess its effect on menstrual bleeding
3. Injected progesterone -also prevent proliferation of the endometrium, induce uterine atrophy and stop menstruation
4. Levonorgestrel-releasing intrauterine system(LNG-IUS)
-also prevent proliferation of the endometrium
5.Application of estrogen cream for atrophic vulvitis and vaginitis
6.treatment of underlying causes such as bleeding causes, low platelets, hypothyroidism, and cancers
7.treat any anemia caused by post menopausal bleeding
Surgery
1.Endometrial ablation
may be done only if medications has failed
Usually involve the removal of the endometrium through the cervical opening.
There are various forms of endometrial ablation:
First generation:
hysteroscopy with general anaesthesia
-Rollerball ablation
-Transcervical resection of the endometrium
Second Generation:
non-hysteroscopy, no general anaethesia, day surgery,fast recovery
-Impedance-controlled bipolar radiofrequency ablation
-balloon thermal ablation
-microwave ablation
-free fluid thermal ablation
2. Hysterectomy
used only as a last resort in treatment of Postmenopausal bleeding
if other treatment are contraindicated
there is a desire for amenorrhea
there is no desire to retain uterus
Treatment of Underlying causes:
hypothyroidism with thyroxine tablets
reduce anticoagulant treatment if possible
treat any bleeding disease with platelets or blood factor deficient infusion
treatment of endometriosis,
antibiotic treatment of pelvic inflammatory disease
treatment of uterine carcinoma
surgical removal of fibroids and polyps
Prognosis:
generally good after hysterectomy and removal of ovaries,treatment of underlying causes.
Cancer treatment prognosis depends on severity of cancer.
Thursday, March 24, 2011
Tuesday, March 22, 2011
A Family Doctor's Tale - SUBARACHNOID HEMORRHAGE
DOC I HAVE SUBARACHNOID HEMORRHAGE
A Subarachnoid Hemorrhage is bleeding into the cerebrospinal fluid filled space between the pial and arachnoid membrane of the brain.
A Subarachnoid Hemorrhage occurs when:
1.Rupture of a congenital arterial aneurym (weak arterial wall) is the most common cause.
2.Rupture of an arterial capillary or venous bleeding from one or multiple sites of origin. This can be from high blood pressure or head injury .
3.Capillary damage leading to hemorrhage can occur in certain form of encephalitis.
4.Hemorrhagic diseases such as dengue fever, hemophilia, thrombocytopenia of unknown origin
5.Intracranial tumors such as angioblastic meningioma, glioma, pituitary adenoma and intracranial metastases are rare but possible causes
6.Anticoagulant therapy especially overdosage of warfarin
7.Smoking has been associated with subarachnoid hemorrhage.
The symptoms and signs of a Subarachnoid Hemorrhage are:
The affected person may have:
1.sudden severe headache with no known cause,initially excruciating, intense, aching pain, later becoming dull and throbbing but still severe.
2.difficulty in speaking or understanding
3.difficulty in swallowing
4.severe neck and back pain
5.Pain on attempted head movement
6.dizziness
7.vomiting
8.confusion and agitation
9.loss of concentration and memory
10.sudden vision loss in one eye
11.loss of consciousness
12.convulsions
13.coma and death
14.Stiff neck usually appears with onset of meningeal inflammatory reaction up to 6 to 12 hours after onset suggesting meningeal stretching and herniation of cerebellum into foramen magnum.
Other neurological signs:
1.Pupils unequal
2.paresis of vertical and medial movements of one eye
3.optic field may have round smooth hemorrhages near optic disc,
usually unilateral which will indicate site of bleeding in the brain.
Special investigations:
1.lumbar puncture:
pressure of cerebrospinal fluid may be raised
red blood cells present for first week
protein content raised
2.MRI or CAT scan with intravenous dyes can determine the source of the bleeding
The treatment of Subarachnoid Hemorrhage:
Subarachnoid Hemorrhage is an emergency.
Purpose of treatment is to:
1. preserve life
2. limit the amount of brain damage
3. lessen the extent of disability and deformity
4. prevent recurrence.
Admission to hospital is necessary to determine
1. the cause of the Subarachnoid Hemorrhage
2. the extent of damage to the brain using MRI of the brain
3. immediate treatment with medicines(usually anticoagulant,blood circulation,nerve vitamins).
4. whether Surgery is necessary to stop bleeding or remove a blood clot
5. risk factors for Subarachnoid Hemorrhage are investigated and treated (diabetes, high blood pressure etc)
During the acute phase of Subarachnoid Hemorrhage:
1. A clear airway must be maintained
2. Sufficient fluid and electrolyte intake must be maintained
3. adequate nutrition in the form of glucose, proteins and calories must be given
4. bed rest with adequate nursing care is provided to prevent bed sores etc
5. Proper medicines are given
Once the Subarachnoid Hemorrhage is stable:
The Subarachnoid Hemorrhage patient is started on a rehabilitation programme.
This will include
a.exercises to strengthen his muscles,
b.speech training for patients with dysphasia (difficulty in talking)
c.training on how to carry out his daily activities.
d.advice about his diet
Immediate care improves the chance of a complete recovery.
A Subarachnoid Hemorrhage can be very devastating and depressing for a patient.
He will feel that part of his body and brain function is incapacitated.
Therefore he need all the support from everyone involved in the treatment of his condition:
1.doctors,
2.nurses,
3.physiotherapist,
4.speech therapist
5.occupational therapists
6.family members and friends
Family members can provide the most important means of support.
They should be familiar with his disabilities and help him accordingly:
Please do:
1.be understanding and patient.
2. keep the patient cheerful and hopeful
3.learn how to help him with the diet, daily exercises and other care necessary for him
4.allow the person more time to do any task
5.encourage and praise the patient to do as much as possible for himself at his own pace.
6.involve the person in family discussions and activities.
7.be encouraging and praise his daily efforts.
Prognosis of subarachnoid hemorrhage:
1.Recurrence may occur
2.Can be life threatening
A Subarachnoid Hemorrhage is bleeding into the cerebrospinal fluid filled space between the pial and arachnoid membrane of the brain.
A Subarachnoid Hemorrhage occurs when:
1.Rupture of a congenital arterial aneurym (weak arterial wall) is the most common cause.
2.Rupture of an arterial capillary or venous bleeding from one or multiple sites of origin. This can be from high blood pressure or head injury .
3.Capillary damage leading to hemorrhage can occur in certain form of encephalitis.
4.Hemorrhagic diseases such as dengue fever, hemophilia, thrombocytopenia of unknown origin
5.Intracranial tumors such as angioblastic meningioma, glioma, pituitary adenoma and intracranial metastases are rare but possible causes
6.Anticoagulant therapy especially overdosage of warfarin
7.Smoking has been associated with subarachnoid hemorrhage.
The symptoms and signs of a Subarachnoid Hemorrhage are:
The affected person may have:
1.sudden severe headache with no known cause,initially excruciating, intense, aching pain, later becoming dull and throbbing but still severe.
2.difficulty in speaking or understanding
3.difficulty in swallowing
4.severe neck and back pain
5.Pain on attempted head movement
6.dizziness
7.vomiting
8.confusion and agitation
9.loss of concentration and memory
10.sudden vision loss in one eye
11.loss of consciousness
12.convulsions
13.coma and death
14.Stiff neck usually appears with onset of meningeal inflammatory reaction up to 6 to 12 hours after onset suggesting meningeal stretching and herniation of cerebellum into foramen magnum.
Other neurological signs:
1.Pupils unequal
2.paresis of vertical and medial movements of one eye
3.optic field may have round smooth hemorrhages near optic disc,
usually unilateral which will indicate site of bleeding in the brain.
Special investigations:
1.lumbar puncture:
pressure of cerebrospinal fluid may be raised
red blood cells present for first week
protein content raised
2.MRI or CAT scan with intravenous dyes can determine the source of the bleeding
The treatment of Subarachnoid Hemorrhage:
Subarachnoid Hemorrhage is an emergency.
Purpose of treatment is to:
1. preserve life
2. limit the amount of brain damage
3. lessen the extent of disability and deformity
4. prevent recurrence.
Admission to hospital is necessary to determine
1. the cause of the Subarachnoid Hemorrhage
2. the extent of damage to the brain using MRI of the brain
3. immediate treatment with medicines(usually anticoagulant,blood circulation,nerve vitamins).
4. whether Surgery is necessary to stop bleeding or remove a blood clot
5. risk factors for Subarachnoid Hemorrhage are investigated and treated (diabetes, high blood pressure etc)
During the acute phase of Subarachnoid Hemorrhage:
1. A clear airway must be maintained
2. Sufficient fluid and electrolyte intake must be maintained
3. adequate nutrition in the form of glucose, proteins and calories must be given
4. bed rest with adequate nursing care is provided to prevent bed sores etc
5. Proper medicines are given
Once the Subarachnoid Hemorrhage is stable:
The Subarachnoid Hemorrhage patient is started on a rehabilitation programme.
This will include
a.exercises to strengthen his muscles,
b.speech training for patients with dysphasia (difficulty in talking)
c.training on how to carry out his daily activities.
d.advice about his diet
Immediate care improves the chance of a complete recovery.
A Subarachnoid Hemorrhage can be very devastating and depressing for a patient.
He will feel that part of his body and brain function is incapacitated.
Therefore he need all the support from everyone involved in the treatment of his condition:
1.doctors,
2.nurses,
3.physiotherapist,
4.speech therapist
5.occupational therapists
6.family members and friends
Family members can provide the most important means of support.
They should be familiar with his disabilities and help him accordingly:
Please do:
1.be understanding and patient.
2. keep the patient cheerful and hopeful
3.learn how to help him with the diet, daily exercises and other care necessary for him
4.allow the person more time to do any task
5.encourage and praise the patient to do as much as possible for himself at his own pace.
6.involve the person in family discussions and activities.
7.be encouraging and praise his daily efforts.
Prognosis of subarachnoid hemorrhage:
1.Recurrence may occur
2.Can be life threatening
Sunday, March 20, 2011
A Simple Guide to LEPTOSPIROSIS
A Simple Guide to LEPTOSPIROSIS
-----------------------------------------
What is LEPTOSPIROSIS?
------------------------------
LEPTOSPIROSIS is an acute infectious illness caused by the bacteria Leptospira with a wide spectrum of illness from inapparent to fatal.
What is the cause of LEPTOSPIROSIS?
--------------------------------------------
The bacteria which causes LEPTOSPIROSIS is the Leptospira interrogans which is an extremely hardy bacteria occuring in domestic and wild animals. Humans are accidental hosts.
Human infections occur through abraded skin and exposed mucous membranes from urine or tissues of infected animal or through contaminated water soil and vegetation.
The bacteria can affect the liver, kidney, sketal muscle, heart, spleen, lungs and central nervous system.
Hemorrhagic changes and necrosis of tissues may occur together with interstitial edema and lympocytic, plasma cell and neutrophilic leucocyte infiltration.
What are symptoms of LEPTOSPIROSIS?
----------------------------------------------
Incubation period is approximately 10 days.
Illness is typically biphasic.
A.Leptospiremic or First Phase
1.Organisms found in the blood and cerebrospinal fluid
2.Abrupt onset of headache, myalgia, high fever and chills
This will last 4-9 days
3.Anorexia, nausea, vomiting, cough, chest pain, hemoptysis, conjunctival suffusion, cutaneous rash and hemorrhages seen.
B.Immune or Second Phase:
1.Correlates with appearance of circulating IgM antibodies
2.Clinical manifestations in this phase varies:
Patient may be asymptomatic for 1-3 days with return of fever and other symptoms of first stage.
3.Iridocyclitis, optic neuritis, encephalitis, myelitis,
and perpheral neuropathy and meningismus may occur.
Specific Sterotypes:
Weil's Disease:
is severe leptospirosis with
1.liver involvement withjaundice,hyperbilirubinemia
2.renal involvement with proteinuria, pyuria, hematuria
2.hemorrhagic manifestations with epistaxis, hemoptysis, GIT bleeding,subarachnoid hemorrhage
3.anemia
4.changes in consciousness
5.continuous fever
6.pneumonitis
7.aseptic meningitis
8.myocarditis
How is the diagnosis of LEPTOSPIROSIS made?
-----------------------------------------------------
Doctors generally diagnose LEPTOSPIROSIS based on:
1. blood test and cultures.
2.cerebrospinal tests
3.animal innoculation
4.liver scan and ultrasound
What are the complications of LEPTOSPIROSIS?
-------------------------------------------
LEPTOSPIROSIS is a disease which can kill especially through its complications:
1.Liver disease due to damage to the liver leading to cirrhosis
2.Kidney disease can occur from damage to the kidney
3.Brain damage is rare but can occur from spread to the brain and meninges
4.Severe hemorrhage uncommon but can cause death
How is LEPTOSPIROSIS treated?
-------------------------------------
LEPTOSPIROSIS is an infectious disease which can spread to other people through contaminated food and water.
1.Antibiotics such as penicillin and tetracycline are started once the diagnosis is confirmed.
2.intravenous drip and blood transfusion if necessary
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to stop vomiting and itch
4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
5.Get plenty of rest.
How is LEPTOSPIROSIS prevented?
----------------------------------------
Prevention of LEPTOSPIROSIS can be by:
1..Avoid eating or drinking foods or liquids that might be contaminated especially by the germ and animals
5.Good food hygience and hand washing
What is the prognosis of LEPTOSPIROSIS?
-------------------------------------------------
Prognosis depends on the virulence of disease and general condition of the patient.
It is excellent with prompt treatment of leptospirosis infection.
Weil's disease is more serious but will respond well to treatment.
Infection of pregnant women may be associated with increased risk of fetal loss.
-----------------------------------------
What is LEPTOSPIROSIS?
------------------------------
LEPTOSPIROSIS is an acute infectious illness caused by the bacteria Leptospira with a wide spectrum of illness from inapparent to fatal.
What is the cause of LEPTOSPIROSIS?
--------------------------------------------
The bacteria which causes LEPTOSPIROSIS is the Leptospira interrogans which is an extremely hardy bacteria occuring in domestic and wild animals. Humans are accidental hosts.
Human infections occur through abraded skin and exposed mucous membranes from urine or tissues of infected animal or through contaminated water soil and vegetation.
The bacteria can affect the liver, kidney, sketal muscle, heart, spleen, lungs and central nervous system.
Hemorrhagic changes and necrosis of tissues may occur together with interstitial edema and lympocytic, plasma cell and neutrophilic leucocyte infiltration.
What are symptoms of LEPTOSPIROSIS?
----------------------------------------------
Incubation period is approximately 10 days.
Illness is typically biphasic.
A.Leptospiremic or First Phase
1.Organisms found in the blood and cerebrospinal fluid
2.Abrupt onset of headache, myalgia, high fever and chills
This will last 4-9 days
3.Anorexia, nausea, vomiting, cough, chest pain, hemoptysis, conjunctival suffusion, cutaneous rash and hemorrhages seen.
B.Immune or Second Phase:
1.Correlates with appearance of circulating IgM antibodies
2.Clinical manifestations in this phase varies:
Patient may be asymptomatic for 1-3 days with return of fever and other symptoms of first stage.
3.Iridocyclitis, optic neuritis, encephalitis, myelitis,
and perpheral neuropathy and meningismus may occur.
Specific Sterotypes:
Weil's Disease:
is severe leptospirosis with
1.liver involvement withjaundice,hyperbilirubinemia
2.renal involvement with proteinuria, pyuria, hematuria
2.hemorrhagic manifestations with epistaxis, hemoptysis, GIT bleeding,subarachnoid hemorrhage
3.anemia
4.changes in consciousness
5.continuous fever
6.pneumonitis
7.aseptic meningitis
8.myocarditis
How is the diagnosis of LEPTOSPIROSIS made?
-----------------------------------------------------
Doctors generally diagnose LEPTOSPIROSIS based on:
1. blood test and cultures.
2.cerebrospinal tests
3.animal innoculation
4.liver scan and ultrasound
What are the complications of LEPTOSPIROSIS?
-------------------------------------------
LEPTOSPIROSIS is a disease which can kill especially through its complications:
1.Liver disease due to damage to the liver leading to cirrhosis
2.Kidney disease can occur from damage to the kidney
3.Brain damage is rare but can occur from spread to the brain and meninges
4.Severe hemorrhage uncommon but can cause death
How is LEPTOSPIROSIS treated?
-------------------------------------
LEPTOSPIROSIS is an infectious disease which can spread to other people through contaminated food and water.
1.Antibiotics such as penicillin and tetracycline are started once the diagnosis is confirmed.
2.intravenous drip and blood transfusion if necessary
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to stop vomiting and itch
4.Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
5.Get plenty of rest.
How is LEPTOSPIROSIS prevented?
----------------------------------------
Prevention of LEPTOSPIROSIS can be by:
1..Avoid eating or drinking foods or liquids that might be contaminated especially by the germ and animals
5.Good food hygience and hand washing
What is the prognosis of LEPTOSPIROSIS?
-------------------------------------------------
Prognosis depends on the virulence of disease and general condition of the patient.
It is excellent with prompt treatment of leptospirosis infection.
Weil's disease is more serious but will respond well to treatment.
Infection of pregnant women may be associated with increased risk of fetal loss.
A Family Doctor's Tale - DUPUYTREN'S CONTRACTURE
DOC I HAVE DUPUYTREN'S CONTRACTURE
DUPUYTREN'S CONTRACTURE is the PROGRESSIVE FIBROSIS OF THE PALMA FASCIA LEADING TO PAINLESS contractures of one or mor finger at metacarpophayngeal joints.
At least one or more fingers will be flexed against the palm.
DUPUYTREN'S CONTRACTURE occur as a result of proliferation and thickening of the connective tissues of the palmar fascia.
Nodules of irregular fibroblasts are formed.
Contraction of proliferated fibrous tissues leads to the deformity.
It is inherited as a Mendelian dominant in some cases.
It occurs predominently among Caucasians.
Men are affected 8 times more than women.
It has been associated with:
1.epilepsy
2.diabetes
3.alcoholism
4.as a late result of post myocasrdial infarction shoulder hand syndrome
Symptoms:
The onset is usually gradual with a wide spectrum of manifestations from simple contracture alone to plantar fascial involvement in the foot.
1.minimal flexion deformity in the early stages
2.palmar fascia can be seen puckering the skin
3.thickened or nodular underlying tissue can be felt
4.on or all fingers of either or both hands may be affected especially the ring and little fingers
5.Affected fingers are partly or completely held in fixed flexion and cannot be extended.
Treatment:
1.In mild cases no treatment is required
2.Corticosteroid injection to reduce inflammation at the thickened or nodular underlying tissues may help some patients
3.Surgery may be necessary as last resort to release the palmar fascia by cutting the tightened fascia
Complication:
If left untreated. it can lead to the permanent loss of the hand
Prognosis :
1.usually good with injection of corticosteroid
2.recurrence may occur after injection in which case surgery should be done
3.Amputation may be considered if the affected fingers interferes with activities of the hand
DUPUYTREN'S CONTRACTURE is the PROGRESSIVE FIBROSIS OF THE PALMA FASCIA LEADING TO PAINLESS contractures of one or mor finger at metacarpophayngeal joints.
At least one or more fingers will be flexed against the palm.
DUPUYTREN'S CONTRACTURE occur as a result of proliferation and thickening of the connective tissues of the palmar fascia.
Nodules of irregular fibroblasts are formed.
Contraction of proliferated fibrous tissues leads to the deformity.
It is inherited as a Mendelian dominant in some cases.
It occurs predominently among Caucasians.
Men are affected 8 times more than women.
It has been associated with:
1.epilepsy
2.diabetes
3.alcoholism
4.as a late result of post myocasrdial infarction shoulder hand syndrome
Symptoms:
The onset is usually gradual with a wide spectrum of manifestations from simple contracture alone to plantar fascial involvement in the foot.
1.minimal flexion deformity in the early stages
2.palmar fascia can be seen puckering the skin
3.thickened or nodular underlying tissue can be felt
4.on or all fingers of either or both hands may be affected especially the ring and little fingers
5.Affected fingers are partly or completely held in fixed flexion and cannot be extended.
Treatment:
1.In mild cases no treatment is required
2.Corticosteroid injection to reduce inflammation at the thickened or nodular underlying tissues may help some patients
3.Surgery may be necessary as last resort to release the palmar fascia by cutting the tightened fascia
Complication:
If left untreated. it can lead to the permanent loss of the hand
Prognosis :
1.usually good with injection of corticosteroid
2.recurrence may occur after injection in which case surgery should be done
3.Amputation may be considered if the affected fingers interferes with activities of the hand
Friday, March 18, 2011
A Family Doctor's Tale - HALLUX VALGUS
DOC I HAVE HALLUX VALGUS
HALLUX VALGUS also known as BUNION deformity is the deformity of the big toe metatarsopharyngeal(MTP) joint in whivh there is medial protrusion and lateral deviation of the great toe.
Shoewear does not cause hallux valgus.
HALLUX VALGUS occur as a result of :
1.heredity
2.flat foot (pes planus)
3.metatarsal primus varus
4.hypermobile first metarsal cuneiform joints
5.abnormal length of first metatarsal
6.joint laxity
Symptoms:
The onset is usually gradual with a wide spectrum of manifestations from simple deviation to severe deviation and deformity.
1.Normal intermetatarsal angle (the angle between the first and second metatarsals is 9 degrees or less.
2.the normal first MTP joint angle is less than 15 degrees.
Any increase of 15 degrees angle is considered as lateral deviation of the first metatarsopharygeal joint.
3.The big toe is turned inwards towards the second causing a medial protrusion of the MTP joint called a bunion.
4.in severe cases the first toe can overlap the second toe or the second toe may cover the inturned big toe.
5.there is pain on walking
6.there is difficulty in wearing shoes
Treatment:
Conservative:
1.In mild cases no treatment is required
2.Shoe wear modifications to increase the width of the toe box will relieve pressure of the MTP joint and help in walking.
3.Pads and splints may also help to relieve symptoms.
Surgery:
The main purpose is to restore the normal anatomical relation of the big toe MTP joint.
1.Osteotomy to realign the first metatarsal
2.Fusion of MTP joint
Prognosis:
90 per cent of patients will have good results after surgery
Conservative treatment can relieve the pain on walking but the deviation may still become worse.
HALLUX VALGUS also known as BUNION deformity is the deformity of the big toe metatarsopharyngeal(MTP) joint in whivh there is medial protrusion and lateral deviation of the great toe.
Shoewear does not cause hallux valgus.
HALLUX VALGUS occur as a result of :
1.heredity
2.flat foot (pes planus)
3.metatarsal primus varus
4.hypermobile first metarsal cuneiform joints
5.abnormal length of first metatarsal
6.joint laxity
Symptoms:
The onset is usually gradual with a wide spectrum of manifestations from simple deviation to severe deviation and deformity.
1.Normal intermetatarsal angle (the angle between the first and second metatarsals is 9 degrees or less.
2.the normal first MTP joint angle is less than 15 degrees.
Any increase of 15 degrees angle is considered as lateral deviation of the first metatarsopharygeal joint.
3.The big toe is turned inwards towards the second causing a medial protrusion of the MTP joint called a bunion.
4.in severe cases the first toe can overlap the second toe or the second toe may cover the inturned big toe.
5.there is pain on walking
6.there is difficulty in wearing shoes
Treatment:
Conservative:
1.In mild cases no treatment is required
2.Shoe wear modifications to increase the width of the toe box will relieve pressure of the MTP joint and help in walking.
3.Pads and splints may also help to relieve symptoms.
Surgery:
The main purpose is to restore the normal anatomical relation of the big toe MTP joint.
1.Osteotomy to realign the first metatarsal
2.Fusion of MTP joint
Prognosis:
90 per cent of patients will have good results after surgery
Conservative treatment can relieve the pain on walking but the deviation may still become worse.
Wednesday, March 16, 2011
A Family Doctor's Tale - TACHYCARDIA
DOC I HAVE TACHYCARDIA
Tachycardia is a symptom defined as heart rate above 100 per minute.
Causes of Tachycardia:
1.Abnormality of the sinus or atrial node in the heart may be continuous or paroxymal in nature
2.Abnormalities of the ventricular conducting system: a.ischemic heart disease b.congenital heart disease
3.Underlying systemic disease:
a.fever
b.anemia
c.thyrotoxicosis
4.Medicines:
a.ephedrine or pseudoephedrine
b.asthmatic drugs like ventolin or bricanyl
c.anticholinergic drugs like atropine, buscopan
5.Psychosomatic like anxiety, emotional upsets, panic attacks
Symptoms:
.palpitations
2.breathlessness
3.fainting
4.polyuria
Signs:
1.heart beat above 100 per minute
2.abnormal heart rhythm
3.ECG will determine
a.location of stimulus of fast heart beat
b.abnormal rhythm -flutter or fibrillation
Treatment of Tachycardia is:
1. Atrial tachycardia can be slowed by carotid sinus massage or Valsalva maneuver
2. Paroxysmal atrial Tachycardia can be terminated by vagal stimulation maneuvers (Valsalva or carotid sinus pressure).
3.Acute atrial attacks if not improved after vagal massage can be treated with: a.digoxin
b.beta blockers such as propanolol or atenolol
c.calcium channel blockers like nefidipine
d.anti-cholinesterase like edrophonium
e.alpha blockers
4.Persistent atrial tachycardia can be treated with a.quinidine, b.beta blockers or c.digoxin or dilatrend
5.Ventricular tachycardia is more dangerous usually associated with coronary heart disease or infarction may be treated with:
a.lidocaine 1-2mg per kg stat followed by infusion of 2-4 mg per kg per min
b.Electo-cardioversion
c.radiofrequency ablation
6. Treat underlying conditions such as thyrotoxicosis
7. No smoking, alcohol or caffiene intake
8.No strenuous exertion or stress
Prognosis:
1.atrial tachycardia may occur in normal young adults and may not indicate heart disease
2.Ventricular tachycardia may herald more serious illness such as life threatening arrthythmia or infarction
Tachycardia is a symptom defined as heart rate above 100 per minute.
Causes of Tachycardia:
1.Abnormality of the sinus or atrial node in the heart may be continuous or paroxymal in nature
2.Abnormalities of the ventricular conducting system: a.ischemic heart disease b.congenital heart disease
3.Underlying systemic disease:
a.fever
b.anemia
c.thyrotoxicosis
4.Medicines:
a.ephedrine or pseudoephedrine
b.asthmatic drugs like ventolin or bricanyl
c.anticholinergic drugs like atropine, buscopan
5.Psychosomatic like anxiety, emotional upsets, panic attacks
Symptoms:
.palpitations
2.breathlessness
3.fainting
4.polyuria
Signs:
1.heart beat above 100 per minute
2.abnormal heart rhythm
3.ECG will determine
a.location of stimulus of fast heart beat
b.abnormal rhythm -flutter or fibrillation
Treatment of Tachycardia is:
1. Atrial tachycardia can be slowed by carotid sinus massage or Valsalva maneuver
2. Paroxysmal atrial Tachycardia can be terminated by vagal stimulation maneuvers (Valsalva or carotid sinus pressure).
3.Acute atrial attacks if not improved after vagal massage can be treated with: a.digoxin
b.beta blockers such as propanolol or atenolol
c.calcium channel blockers like nefidipine
d.anti-cholinesterase like edrophonium
e.alpha blockers
4.Persistent atrial tachycardia can be treated with a.quinidine, b.beta blockers or c.digoxin or dilatrend
5.Ventricular tachycardia is more dangerous usually associated with coronary heart disease or infarction may be treated with:
a.lidocaine 1-2mg per kg stat followed by infusion of 2-4 mg per kg per min
b.Electo-cardioversion
c.radiofrequency ablation
6. Treat underlying conditions such as thyrotoxicosis
7. No smoking, alcohol or caffiene intake
8.No strenuous exertion or stress
Prognosis:
1.atrial tachycardia may occur in normal young adults and may not indicate heart disease
2.Ventricular tachycardia may herald more serious illness such as life threatening arrthythmia or infarction
Monday, March 14, 2011
A Family Doctor's Tale -BRADYCARDIA
DOC I HAVE BRADYCARDIA
Bradycardia is a symptom defined as heart rate below 55 per minute.
Causes of Bradycardia:
1.Bradycardia can occur normally in athletes as a result of training through increased cardiac vagal tone.
2.Abnormalities of the heart conducting system:
a.complete heart block
b.ischemic heart disease
c.congeital heart disease
3.Underlying systemic disease:
a.myxedema
b.increased intracranial disease
4.Medicines:
a.Beta blockers
b.digoxin overdosage
c.reserpine
Symptoms:
1.slow pulse at wrist
2.confirmation with ECG
3.fainting
4.asymptomatic in many cases
Treatment of bradycardia:
1. None if no symptoms and no underlying cause
2. Cardiac bradycardia from heart block may be treated with atropine
3.Sympathommetics such as isoproterenol may be given as temporary measure before treatment of underlying conditions or insertion of pacemaker
4. Treat underlying conditions such as myxedema
5. heart blocks or asystole may need pacemaker implantation
Prognosis:
1.depends on underlying cause -myxedema is less serious than intracranial pressure
2.Patient receiving pacemakers often have an excellent long term survival
Bradycardia is a symptom defined as heart rate below 55 per minute.
Causes of Bradycardia:
1.Bradycardia can occur normally in athletes as a result of training through increased cardiac vagal tone.
2.Abnormalities of the heart conducting system:
a.complete heart block
b.ischemic heart disease
c.congeital heart disease
3.Underlying systemic disease:
a.myxedema
b.increased intracranial disease
4.Medicines:
a.Beta blockers
b.digoxin overdosage
c.reserpine
Symptoms:
1.slow pulse at wrist
2.confirmation with ECG
3.fainting
4.asymptomatic in many cases
Treatment of bradycardia:
1. None if no symptoms and no underlying cause
2. Cardiac bradycardia from heart block may be treated with atropine
3.Sympathommetics such as isoproterenol may be given as temporary measure before treatment of underlying conditions or insertion of pacemaker
4. Treat underlying conditions such as myxedema
5. heart blocks or asystole may need pacemaker implantation
Prognosis:
1.depends on underlying cause -myxedema is less serious than intracranial pressure
2.Patient receiving pacemakers often have an excellent long term survival
Saturday, March 12, 2011
A Family Doctor's Tale - CHILD SCHOOL PROBLEMS
DOC WHY DOES MY CHILD DOES NOT DO WELL IN SCHOOL?
This is an article written by my daughter Carolyn Kee who is the senior Child Psychologist at the Child Guidance Clinic in the Singapore Medical News recently.
She has been working with children and adolescents who feel anxious, depressed or troubled.
She has been with the Child Guidance Clinic for the past 15 years.
Her work includes psychological assessment, individual and group therapy, school consultation, emergency behavior management, as well as conducting talks and workshops on mental health issues.
She has written books and contributed articles on depression,
stress and other mental health conditions.
Her illustrated children’s books on attention deficit hyperactivity disorder (ADHD) and eating disorder (Anorexia Nervosa) are currently being sold at the CGC and other helping agencies.
Although I have written posts on ADHD, anorexia nervosa, autism, dyslexia, depression, anxiety and stress, nothing beats the hands on approach and experience of these dedicated psychologists and psychiatrists at the Child Guidance Clinic in Singapore.
Here is the url to her article:
http://news.sma.org.sg/4302/Child.pdf
This is an article written by my daughter Carolyn Kee who is the senior Child Psychologist at the Child Guidance Clinic in the Singapore Medical News recently.
She has been working with children and adolescents who feel anxious, depressed or troubled.
She has been with the Child Guidance Clinic for the past 15 years.
Her work includes psychological assessment, individual and group therapy, school consultation, emergency behavior management, as well as conducting talks and workshops on mental health issues.
She has written books and contributed articles on depression,
stress and other mental health conditions.
Her illustrated children’s books on attention deficit hyperactivity disorder (ADHD) and eating disorder (Anorexia Nervosa) are currently being sold at the CGC and other helping agencies.
Although I have written posts on ADHD, anorexia nervosa, autism, dyslexia, depression, anxiety and stress, nothing beats the hands on approach and experience of these dedicated psychologists and psychiatrists at the Child Guidance Clinic in Singapore.
Here is the url to her article:
http://news.sma.org.sg/4302/Child.pdf
Thursday, March 10, 2011
A Simple Guide to Threadworms
A Simple Guide to Threadworms
---------------------------------
What is Threadworms?
---------------------------
Threadworms are parasitic worms (also called pinworms) which are found in the intestines of children in undeveloped countries.
It is rare in developed countries because of the modern sanitary conditions and better hygiene.
Several members of the same household may be infested at the same time so all the family should be treated together.
What is the cause of Threadworms infection?
------------------------------------------
Threadworms eggs or larva are present on the hands or food prepared by people who has threadworms infestations. When the eggs or larvae are swallowed they developed into adult worms in the intestines. The adult worms will cling on to the mucosal lining of the intestine and absorb nutrients from the food taken into the intestines by the affected person.
The female worms emerge from the rectum at night to lay their eggs on the skin around the anus.
What are symptoms of Threadworms?
----------------------------------------------
The main symptoms of Threadworms are
1. Itch in the anal region especialy at night when the worms lay the eggs.
2. Itch in the vulva in girls
3. inflammation of the anus as a result of constant scratching.
4.Rarely tiny white worms can be seen wriggling in the feces.
How is the diagnosis of Threadworms made?
-----------------------------------------------------
Doctors generally diagnose Threadworms based on:
1.sticky tape pressed to the anal area in the morning before the patient bathes or go to the toilet will collect the eggs for microscopic examination and confirmation of the presence of threadworms
2.Stool examination and culture
Treatment of threadworm infestation is by the use of anti-parasitic medicine:
1.Zentel or Abendazole 400mg in a single dose
2.Pyrantel pamoate 10mg/kg in a single dose
3.Mebendazole 100mg in a single dose
A single dose will usually cure the patient of threadworms but to prevent re-infection a second dosage is taken 2 weeks later.
All the family members should also be treated.
Prevention is through:
1.good personal hygiene and hand washing
2. good food hygiene
What is the prognosis of Threadworms?
-------------------------------------
Prognosis is excellent with treatment.
---------------------------------
What is Threadworms?
---------------------------
Threadworms are parasitic worms (also called pinworms) which are found in the intestines of children in undeveloped countries.
It is rare in developed countries because of the modern sanitary conditions and better hygiene.
Several members of the same household may be infested at the same time so all the family should be treated together.
What is the cause of Threadworms infection?
------------------------------------------
Threadworms eggs or larva are present on the hands or food prepared by people who has threadworms infestations. When the eggs or larvae are swallowed they developed into adult worms in the intestines. The adult worms will cling on to the mucosal lining of the intestine and absorb nutrients from the food taken into the intestines by the affected person.
The female worms emerge from the rectum at night to lay their eggs on the skin around the anus.
What are symptoms of Threadworms?
----------------------------------------------
The main symptoms of Threadworms are
1. Itch in the anal region especialy at night when the worms lay the eggs.
2. Itch in the vulva in girls
3. inflammation of the anus as a result of constant scratching.
4.Rarely tiny white worms can be seen wriggling in the feces.
How is the diagnosis of Threadworms made?
-----------------------------------------------------
Doctors generally diagnose Threadworms based on:
1.sticky tape pressed to the anal area in the morning before the patient bathes or go to the toilet will collect the eggs for microscopic examination and confirmation of the presence of threadworms
2.Stool examination and culture
Treatment of threadworm infestation is by the use of anti-parasitic medicine:
1.Zentel or Abendazole 400mg in a single dose
2.Pyrantel pamoate 10mg/kg in a single dose
3.Mebendazole 100mg in a single dose
A single dose will usually cure the patient of threadworms but to prevent re-infection a second dosage is taken 2 weeks later.
All the family members should also be treated.
Prevention is through:
1.good personal hygiene and hand washing
2. good food hygiene
What is the prognosis of Threadworms?
-------------------------------------
Prognosis is excellent with treatment.
A Family Doctor's Tale -ECU tendonitis
DOC I HAVE EXTENSOR CARPI ULNARIS TENDONITIS
EXTENSOR CARPI ULNARIS TENDONITIS OR ECU is the inflammation of the tendon sheath of the tendon to the small finger at wrist region.
EXTENSOR CARPI ULNARIS TENDONITIS occur occur as a result of narrowing of the tendon sheath of the thumb and the inflammation of the tendon at the level of the wrist.
When the tendon gets caught in the narrowed sheath, the finger becomes locked in the narrowed tendon sheath resulting in pain and swelling.
Women are affected more than men.
Local causes:
-------------
1.trauma of the tendon of the small finger from repetitive weight bearing of the wrist
2.direct injury on the tendon of the wrist from a direct blow to the hand
3.repetitive use of the wrist on keyboard of computer
4.tenosynovitis(inflammation of the tendon and their synovial sheath)as the tendon becomes swollen in the tendon shift as a result of overusage of the wrist
5.common among young and active especially those who play racket sports and basketball
Symptoms:
The onset is usually spontaneous with gradual increasing pains and tightness of the wrist tendons which causes the patient to seek treatment:
1.swelling and pain of the back of the wrist near the small finger side (opposite De Quarvian's Disease)
2.unable to move wrist or carry heavy objects
Physical examination
1.tendon nodules in flexor tendon of the small finger at wrist level
2.tenderness on flexion of the wrist
2.diagnosis is confirmed with CAT scan or MRI
Treatment:
1.Rest and splinting of affected finger and wrist
2.wrist exercise usually good.
3.Non-steroidal anti-inflammatory drugs for inflammation and pain
4.Corticosteroid injection to reduce inflammation under the narrowed sheath
5.Surgery as last resort to release the tendon by cutting the top part of the narrowed inflammed sheath
Complication:
If left untreated. it can lead to the permanent loss of rotation of the wrist
Prognosis :
1.usually good with injection of corticosteroid
2.recurrence may occur after injection in which case surgery should be done
Prevention:
1.Avoid forceful use of the wrist and small finger
2.Avoid repetitive movement of the wrist.
EXTENSOR CARPI ULNARIS TENDONITIS OR ECU is the inflammation of the tendon sheath of the tendon to the small finger at wrist region.
EXTENSOR CARPI ULNARIS TENDONITIS occur occur as a result of narrowing of the tendon sheath of the thumb and the inflammation of the tendon at the level of the wrist.
When the tendon gets caught in the narrowed sheath, the finger becomes locked in the narrowed tendon sheath resulting in pain and swelling.
Women are affected more than men.
Local causes:
-------------
1.trauma of the tendon of the small finger from repetitive weight bearing of the wrist
2.direct injury on the tendon of the wrist from a direct blow to the hand
3.repetitive use of the wrist on keyboard of computer
4.tenosynovitis(inflammation of the tendon and their synovial sheath)as the tendon becomes swollen in the tendon shift as a result of overusage of the wrist
5.common among young and active especially those who play racket sports and basketball
Symptoms:
The onset is usually spontaneous with gradual increasing pains and tightness of the wrist tendons which causes the patient to seek treatment:
1.swelling and pain of the back of the wrist near the small finger side (opposite De Quarvian's Disease)
2.unable to move wrist or carry heavy objects
Physical examination
1.tendon nodules in flexor tendon of the small finger at wrist level
2.tenderness on flexion of the wrist
2.diagnosis is confirmed with CAT scan or MRI
Treatment:
1.Rest and splinting of affected finger and wrist
2.wrist exercise usually good.
3.Non-steroidal anti-inflammatory drugs for inflammation and pain
4.Corticosteroid injection to reduce inflammation under the narrowed sheath
5.Surgery as last resort to release the tendon by cutting the top part of the narrowed inflammed sheath
Complication:
If left untreated. it can lead to the permanent loss of rotation of the wrist
Prognosis :
1.usually good with injection of corticosteroid
2.recurrence may occur after injection in which case surgery should be done
Prevention:
1.Avoid forceful use of the wrist and small finger
2.Avoid repetitive movement of the wrist.
Tuesday, March 8, 2011
A Family Doctor's Tale - DE QUARVIAN'S DISEASE
DOC I HAVE DE QUERVAIN'S DISEASE
DE QUERVAIN'S DISEASE is the compression of the tendon sheath of one of the two tendons to the thumb at wrist region.
The tendon sheath is a protective cover for the tendon which provides protection for the tendon as it travels across the radius bone especially at the joints.
DE QUERVAIN'S DISEASE occur as a result of narrowing of the tendon sheath of the thumb and the inflammation of the tendon at the level of the wrist.
When the tendon gets caught in the narrowed sheath, the finger becomes locked in the narrowed tendon sheath resulting in pain and swelling
Women are affected more than men.
It is also known as the washer woman's sprain or recently Blackberry thumb after the name of the popular smart phone because of repetitive movement of the thumb on the keys of the phone.
Causes of De Quarvian's Disease:
1.trauma of the tendon sheath of the thumb from too much stress on their thumb from carrying their newborn child especially first time parents
2.pressure on the tendon sheath from weight of the newborn's head on the wrist while feeding the baby
3.repetitive use of the thumb on keyboard of Blackberry phone
4.tenosynovitis (inflammation of the tendon and their synovial sheath) as the tendon becomes swollen in the tendon shift as a result of over usage of the wrist especially when wringing clothes
5.common among middle-aged, housewives and those who often use their thumbs or wrists
Symptoms:
The onset is usually spontaneous with gradual increasing pains and tightness of the wrist tendons which causes the patient to seek treatment:
1.swelling and pain of the thumb side of the wrist
2.unable to open door, bottle caps or wring clothes
Physical examination
1.tendon nodules in flexor tendon of the thumb at wrist level
2.tenderness on flexion of the thumb
3.diagnosis is confirmed with CAT scan or MRI
Treatment of De Quarvian's Disease:
1.Rest and splinting of affected thumb and wrist
2.wrist exercise usually good.
3.Non-steroidal anti-inflammatory drugs for inflammation and pain
4.Corticosteroid injection to reduce inflammation under the narrowed sheath
5.Surgery as last resort to release the tendon by cutting the top part of the narrowed inflamed sheath
Complication of De Quarvian's Disease:
If left untreated. it can lead to the permanent loss of the thumb
Prognosis of De Quarvian's Disease:
1.usually good with injection of corticosteroid
2.recurrence may occur after injection in which case surgery should be done
Prevention of De Quarvian's Disease:
1.Avoid forceful use of the wrist and thumb
2.Avoid carrying newborn baby with head on the wrist
3.Avoid repetitive movement of the thumb.
DE QUERVAIN'S DISEASE is the compression of the tendon sheath of one of the two tendons to the thumb at wrist region.
The tendon sheath is a protective cover for the tendon which provides protection for the tendon as it travels across the radius bone especially at the joints.
DE QUERVAIN'S DISEASE occur as a result of narrowing of the tendon sheath of the thumb and the inflammation of the tendon at the level of the wrist.
When the tendon gets caught in the narrowed sheath, the finger becomes locked in the narrowed tendon sheath resulting in pain and swelling
Women are affected more than men.
It is also known as the washer woman's sprain or recently Blackberry thumb after the name of the popular smart phone because of repetitive movement of the thumb on the keys of the phone.
Causes of De Quarvian's Disease:
1.trauma of the tendon sheath of the thumb from too much stress on their thumb from carrying their newborn child especially first time parents
2.pressure on the tendon sheath from weight of the newborn's head on the wrist while feeding the baby
3.repetitive use of the thumb on keyboard of Blackberry phone
4.tenosynovitis (inflammation of the tendon and their synovial sheath) as the tendon becomes swollen in the tendon shift as a result of over usage of the wrist especially when wringing clothes
5.common among middle-aged, housewives and those who often use their thumbs or wrists
Symptoms:
The onset is usually spontaneous with gradual increasing pains and tightness of the wrist tendons which causes the patient to seek treatment:
1.swelling and pain of the thumb side of the wrist
2.unable to open door, bottle caps or wring clothes
Physical examination
1.tendon nodules in flexor tendon of the thumb at wrist level
2.tenderness on flexion of the thumb
3.diagnosis is confirmed with CAT scan or MRI
Treatment of De Quarvian's Disease:
1.Rest and splinting of affected thumb and wrist
2.wrist exercise usually good.
3.Non-steroidal anti-inflammatory drugs for inflammation and pain
4.Corticosteroid injection to reduce inflammation under the narrowed sheath
5.Surgery as last resort to release the tendon by cutting the top part of the narrowed inflamed sheath
Complication of De Quarvian's Disease:
If left untreated. it can lead to the permanent loss of the thumb
Prognosis of De Quarvian's Disease:
1.usually good with injection of corticosteroid
2.recurrence may occur after injection in which case surgery should be done
Prevention of De Quarvian's Disease:
1.Avoid forceful use of the wrist and thumb
2.Avoid carrying newborn baby with head on the wrist
3.Avoid repetitive movement of the thumb.
Sunday, March 6, 2011
A Family Doctor's Tale - TRIGGER FINGER
DOC I HAVE TRIGGER FINGER
TRIGGER FINGER is the compression of the tendon sheath of one of the tendon to the fingers or thumb(trigger thumb)
The tendon sheath is a protective cover for the tendon which provides protection for the tendon as it travels across the finger's bones especially at the joints.
TRIGGER FINGER occur as a result of narrowing of the tendon sheath and the inflammation of the tendon.
When the tendon gets caught in the sheath, the finger becomes locked in the narrowed tendon sheath until the tendon is freed from the tight area from forced movement of the locked finger using the other hand.
If left untreated an affected finger can become permanently bent inwards.
Women are affected more than men.
Causes of Trigger Finger:
1.trauma of the tendon sheath especially carrying heavy plastic bags and other bags
2.pressure on the tendon sheath from exertion of pressure through use of chopper knife and tools on the tendon sheath
3.repetitive use of the fingers such as computer keyboard or mouse
4.tenosynovitis(inflammation of the tendon and their synovial sheath)as the tendon becomes swollen in the tendon shift preventing movement of finger.
5.common among middle-aged, taxi drivers gripping the wheel for long hours every day, housewifes and those who often use their fingers in a gripping motion.
6.Also common among people who use the computer or mobile phones
Symptoms:
The onset is usually spontaneous with gradual increasing pains and tightness of the finger which causes the patient to seek treatment:
1.Finger is unable to extend after bending.
As you try harder to straighten the finger, it snaps open as the swollen tendon that was restrained is freed suddenly
2.pain at the base of the affected finger on the palm
Physical examination
1.tendon nodules in flexor tendon at metacarpal head that moves with the tendon
2.no active finger flexion
3.finger locks in flexion in active movement;
extension only can be performed passively
slight pain occurs with clicking sound when passively moved
4.diagnosis is confirmed with CAT scan or MRI
Treatment of Trigger Finger:
1.Rest and splinting of affected finger
2.finger exercise usually good.
3.Non-steroidal anti-inflammatory drugs for inflammation and pain
4.Corticosteroid injection to reduce inflammation under the narrowed sheath
5.Surgery as last resort to release the tendon by cutting the top part of the narrowed inflammed sheath
Prognosis of Trigger Finger:
1.usually good with injection of corticosteroid
2.recurrence may occur after injection in which case surgery should be done
Prevention:
1.Avoid forceful use of the fingers
2.Avoid carrying heavy plastic bags
3.Avoid repetitive movement of the fingers.
TRIGGER FINGER is the compression of the tendon sheath of one of the tendon to the fingers or thumb(trigger thumb)
The tendon sheath is a protective cover for the tendon which provides protection for the tendon as it travels across the finger's bones especially at the joints.
TRIGGER FINGER occur as a result of narrowing of the tendon sheath and the inflammation of the tendon.
When the tendon gets caught in the sheath, the finger becomes locked in the narrowed tendon sheath until the tendon is freed from the tight area from forced movement of the locked finger using the other hand.
If left untreated an affected finger can become permanently bent inwards.
Women are affected more than men.
Causes of Trigger Finger:
1.trauma of the tendon sheath especially carrying heavy plastic bags and other bags
2.pressure on the tendon sheath from exertion of pressure through use of chopper knife and tools on the tendon sheath
3.repetitive use of the fingers such as computer keyboard or mouse
4.tenosynovitis(inflammation of the tendon and their synovial sheath)as the tendon becomes swollen in the tendon shift preventing movement of finger.
5.common among middle-aged, taxi drivers gripping the wheel for long hours every day, housewifes and those who often use their fingers in a gripping motion.
6.Also common among people who use the computer or mobile phones
Symptoms:
The onset is usually spontaneous with gradual increasing pains and tightness of the finger which causes the patient to seek treatment:
1.Finger is unable to extend after bending.
As you try harder to straighten the finger, it snaps open as the swollen tendon that was restrained is freed suddenly
2.pain at the base of the affected finger on the palm
Physical examination
1.tendon nodules in flexor tendon at metacarpal head that moves with the tendon
2.no active finger flexion
3.finger locks in flexion in active movement;
extension only can be performed passively
slight pain occurs with clicking sound when passively moved
4.diagnosis is confirmed with CAT scan or MRI
Treatment of Trigger Finger:
1.Rest and splinting of affected finger
2.finger exercise usually good.
3.Non-steroidal anti-inflammatory drugs for inflammation and pain
4.Corticosteroid injection to reduce inflammation under the narrowed sheath
5.Surgery as last resort to release the tendon by cutting the top part of the narrowed inflammed sheath
Prognosis of Trigger Finger:
1.usually good with injection of corticosteroid
2.recurrence may occur after injection in which case surgery should be done
Prevention:
1.Avoid forceful use of the fingers
2.Avoid carrying heavy plastic bags
3.Avoid repetitive movement of the fingers.
Friday, March 4, 2011
A Family Doctor's Tale - Lumbar Spinal Stenosis
DOC I HAVE A LUMBAR SPINAL STENOSIS
Lumbar Spinal Stenosis is a condition due to the narrowing of the spinal canal either in the central part or peripheral(lateral) to the the side in the nerve root canal.
This results in pain in one leg without back pain
Every one can get Lumbar Spinal Stenosis.
The age of onset is usually in the late 40's.
It is also more common in men than women .
The causes of lumbar spinal stenosis are:
1.congenital - in born narrowing of the spinal canal
2.Acquired
a.carrying heavy objects improperly with the back instead of the knees
b.trauma or injury to the spine or pelvic bone
c.staying in crouched or seated positions for too long
Symptoms:
1.The onset is usually gradual with bouts of back pain and stiffness over weeks or months.
2.Early morning stiffness and pain occurs,then wears off during the day.
3.It gradually affects the lower limbs with pain and stiffness.
4.Typically there is low back pain radiating to the buttocks and leg which is aggravated by activity especially walking
Signs:
1.Physical signs are not present in early cases
2. there may be a Simian stance (like a monkey) with flexion at the hips and knees
3.Spinal movements are restricted
4.motor, sensory and reflex abnormalities present in one or both lower limbs
4.sphincter impairments may be present rarely
Diagnosis:
1.medical history of duration of symptoms and the extent of pain in the back and legs
2.neurological examinations of deficits in the spinal nerve
3.Confirmation is usually by a x-ray of the spine and pelvis.
-disk height, narrowing of intervertebral space, bone spurs or osteophytes
4.MRI or CAT scans will show clearly the spinal narrowing or narrowing of the nerve root canals
Treatment:
Conservative Management:
1.physiotherapy with traction and short wave diathermy
strengthening of spinal muscles
2.spinal support with corset or light weight brace
3.Proper usage of back muscles
4. medications such as NSAIDs
5.epidural steroid injections
Surgery:
surgery may be needed if:
1. the patients do not improve with above treatments
2.the symptoms become progressively worse
3.weakness of legs
4.loss of bowel or bladder function
There is lumbar decompression surgery
1.Laminectomy or removal of disk
2.foraminotomy to widen the hole where the nerve root comes out.
3.Spinal fusion to strenthen the spine and prevent abnormal loose movement of the spine
Prognosis:
Usually very good after surgery
Prevention:
Symptoms comes and go.
There should proper posture during sitting, standing and carrying heavy things
With exercise and strengthening of the spinal muscles, pain is reduced and flexibility of the spine is improved especially with regular exercise and proper posture.
Lumbar Spinal Stenosis is never life threatening and can be controlled but not cured.
Lumbar Spinal Stenosis is a condition due to the narrowing of the spinal canal either in the central part or peripheral(lateral) to the the side in the nerve root canal.
This results in pain in one leg without back pain
Every one can get Lumbar Spinal Stenosis.
The age of onset is usually in the late 40's.
It is also more common in men than women .
The causes of lumbar spinal stenosis are:
1.congenital - in born narrowing of the spinal canal
2.Acquired
a.carrying heavy objects improperly with the back instead of the knees
b.trauma or injury to the spine or pelvic bone
c.staying in crouched or seated positions for too long
Symptoms:
1.The onset is usually gradual with bouts of back pain and stiffness over weeks or months.
2.Early morning stiffness and pain occurs,then wears off during the day.
3.It gradually affects the lower limbs with pain and stiffness.
4.Typically there is low back pain radiating to the buttocks and leg which is aggravated by activity especially walking
Signs:
1.Physical signs are not present in early cases
2. there may be a Simian stance (like a monkey) with flexion at the hips and knees
3.Spinal movements are restricted
4.motor, sensory and reflex abnormalities present in one or both lower limbs
4.sphincter impairments may be present rarely
Diagnosis:
1.medical history of duration of symptoms and the extent of pain in the back and legs
2.neurological examinations of deficits in the spinal nerve
3.Confirmation is usually by a x-ray of the spine and pelvis.
-disk height, narrowing of intervertebral space, bone spurs or osteophytes
4.MRI or CAT scans will show clearly the spinal narrowing or narrowing of the nerve root canals
Treatment:
Conservative Management:
1.physiotherapy with traction and short wave diathermy
strengthening of spinal muscles
2.spinal support with corset or light weight brace
3.Proper usage of back muscles
4. medications such as NSAIDs
5.epidural steroid injections
Surgery:
surgery may be needed if:
1. the patients do not improve with above treatments
2.the symptoms become progressively worse
3.weakness of legs
4.loss of bowel or bladder function
There is lumbar decompression surgery
1.Laminectomy or removal of disk
2.foraminotomy to widen the hole where the nerve root comes out.
3.Spinal fusion to strenthen the spine and prevent abnormal loose movement of the spine
Prognosis:
Usually very good after surgery
Prevention:
Symptoms comes and go.
There should proper posture during sitting, standing and carrying heavy things
With exercise and strengthening of the spinal muscles, pain is reduced and flexibility of the spine is improved especially with regular exercise and proper posture.
Lumbar Spinal Stenosis is never life threatening and can be controlled but not cured.
Wednesday, March 2, 2011
A Family Doctor's Tale - TENNIS ELBOW
DOC I HAVE TENNIS ELBOW
Tennis Elbow or Lateral Epicondylitis is a common conditions in adults which is due to small tear in the tendons on the lateral or outside part of the elbow.
These tendons attach the forearm muscles to the lateral epicondle of the elbow.
Repeated tears tears leads to damage in the tendon a condition called angiofibroblastic hyperplasia.
The microtears and subsequent development of the damaged tissue is due to forceful or repeated use of the forearm muscles.
Recently it has also been called golf elbow.
In fact any repetitive forceful usage of the forearm muscle during work or sports can give to this condition.
Risk factors:
1.Age above 40
2.Activity - regular tennis of more than 2 hours playing per session or a similar activity such as golf
3.Technique - poor stroke technique in tennis or golf (hitting the ball with flexed muscle) and improper grip size
4.Other factors - over exertion of muscles
Symptoms:
1.pain and tenderness over the lateral part of the elbow joint
2.Pain is worse on resisted wrist and finger extension with elbow in full extension.
Diagnosis :
1.Diagnosis is based mainly of history and site of tenderness of the elbow
2.X-rays of elbow are done to evaluate the bone surrounding the muscles and exclude other causes of pain.
It may also reveal calcification of development of bone spurs of the lateral epicondylar region in chronic cases.
Treatment:
Conservative management with rest and observation for 6 months:
1.activity modification
2.correction of playing techniques in sports
3.improved ergonomic in work related usage of elbow
4.stretching exercises
5. counterforce bracing
6.pain killers and anti-inflammation drugs
7.Topical injection of steroid into the tendon
Surgery:
3 surgical options are:
1.open release of affected tendons with excision of damaged tissues
2.arthroscopic release
3.new techniques which improved blood supply to the affected area.
Prognosis:
Usually very good with injections or surgery
Prevention:
1.Adequate warm up exercise before strenuous activity to forearm
2.limit duration of play or activity
3.use correct technique
Tennis Elbow or Lateral Epicondylitis is a common conditions in adults which is due to small tear in the tendons on the lateral or outside part of the elbow.
These tendons attach the forearm muscles to the lateral epicondle of the elbow.
Repeated tears tears leads to damage in the tendon a condition called angiofibroblastic hyperplasia.
The microtears and subsequent development of the damaged tissue is due to forceful or repeated use of the forearm muscles.
Recently it has also been called golf elbow.
In fact any repetitive forceful usage of the forearm muscle during work or sports can give to this condition.
Risk factors:
1.Age above 40
2.Activity - regular tennis of more than 2 hours playing per session or a similar activity such as golf
3.Technique - poor stroke technique in tennis or golf (hitting the ball with flexed muscle) and improper grip size
4.Other factors - over exertion of muscles
Symptoms:
1.pain and tenderness over the lateral part of the elbow joint
2.Pain is worse on resisted wrist and finger extension with elbow in full extension.
Diagnosis :
1.Diagnosis is based mainly of history and site of tenderness of the elbow
2.X-rays of elbow are done to evaluate the bone surrounding the muscles and exclude other causes of pain.
It may also reveal calcification of development of bone spurs of the lateral epicondylar region in chronic cases.
Treatment:
Conservative management with rest and observation for 6 months:
1.activity modification
2.correction of playing techniques in sports
3.improved ergonomic in work related usage of elbow
4.stretching exercises
5. counterforce bracing
6.pain killers and anti-inflammation drugs
7.Topical injection of steroid into the tendon
Surgery:
3 surgical options are:
1.open release of affected tendons with excision of damaged tissues
2.arthroscopic release
3.new techniques which improved blood supply to the affected area.
Prognosis:
Usually very good with injections or surgery
Prevention:
1.Adequate warm up exercise before strenuous activity to forearm
2.limit duration of play or activity
3.use correct technique
Saturday, February 26, 2011
A Simple Guide to Amoebiasis
A Simple Guide to Amoebiasis
------------------------------------------
What is Amoebiasis?
---------------------------
Amoebiasis is an acute infectious illness caused by the parasite Entoamoeba histolytica.
What is the cause of Amoebiasis?
----------------------------------
The bacteria which causes Amoebiasis is the Entmoeba histytica which is an extremely hardy parasite able to live in polluted water, contaminated food and soiled clothes.
Amebic infections occur most common in the cacum and rectosigmoid region of the colon.
Initial infections are small ulcers, usually discrete erosions whhich may extend more deeply ,coalescing to form bigger lesions resulting in extensive mucosal loss.
Penetration through the muscle lining may occur causing peritonitis.
Liver involvement may occur with the ameba traveling through the portal vein.
Liver abscesses consists of necrotic liver tissue.
Secondary bacterial infection are rare.
Most liver abscesses are solitary, rarely multiple and occur long after clinically evident bowel ulceration.
Single and multiple liver abscesses may occur shortly after a bout of amebic dysentry.
Abscesses of the brain and lung may occur.
Ulcers heal rapidly after treatment and permanent scarring is rare.
What are symptoms of Amoebiasis?
----------------------------------------------
The main symptoms of Amoebiasis are
1. Many people with E.histolytica in stools are passive carrier
2. Invasive bowel disease begins 1-6 months after infection sometimes later
3. abdominal pain especially at the sides
4. altered bowel habit
5.diarrhea with blood or mucus in stools
6.foul stools
7.adominal bloating or gas
8.tenderness on palpation at caecum or sigmoid colon regions
Severe cases may have:
1.more severe symptoms as above
2.bloody stools
3.fever
4.weight loss
5.liver enlargement and tenderness on palpation
6.dehydration and its effects such as delirium and disorientation
7. lassitude and tiredness
8. convulsions
9.tender abdominal mass with obstruction
How is the diagnosis of Amoebiasis made?
-----------------------------------------------------
Doctors generally diagnose Amoebiasis based on:
1. stool cultures.
2.blood tests
3.colonoscopy
4.liver scan and ultrasound
What are the complications of Amoebiasis?
-------------------------------------------------------
Amoebiasis is a disease which can kill espcially through its complications:
1.Perforation of bowel leading to peritonitis or inta-abdominal abscesses
2.Severe hemorrhage uncommon but can cause death
3.Intussusception or insertion of part of colon into another part of colon is rare but can follow amebic ulceration and may cause intestinal obstruction
4.irritable bowel syndrome may persist for some months
5.Lung and pericardial involvement rare but can pose danger
6. cutaneous amebiasis cause deep painful and rapidly spreading ulceration
7.Liver infection can cause damage to liver and result in cirrhosis
8.Liver abscess may perforate and cause peritonitis or produce lung abscess or amebic pericarditis
9.Amebic brain abscess are rare but can occur.
How is Amoebiasis treated?
-------------------------------------
Amoebiasis is an infectious disease which can spread to other people through contaminated food and water.
1.Anti-parasitic medicines like metronidazole 750mg three times a day for 10 days should work for mild to moderate disease.
2.Metronidazole 750mg three times a day for 10 days and chloroquine or diiodohydroquin (1000mg for 2 days followed by 500mg per day up to 3 weeks) for hepatic amebiosis
3.Emetine hydrochloride 1mg pere kg per day by intramuscular injections for 5 days in acute amebic dysenery
4.tetracycline 250mg four times a day for 10 days my be needed for some with invasive intestinal disease.
5.Diloxanide furoate 500mg three a day for 10 days for asymptomatic amebic cyst carrier
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to harden the stools such as kaolin
4.slow down the intestinal movement (lomotil or loperamide).
Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
Get plenty of rest.
How is Amoebiasis prevented?
----------------------------------------
Prevention of Amoebiasis can be by:
1.boil drinking and cooking water for 5 minutes
2.Proper filtration of water
3.Examination of stools of food handlers
4.Avoid eating or drinking foods or liquids that might be contaminated especially by flies
5.Good food hygience and hand washing
What is the prognosis of Amoebiasis?
------------------------------------------------
Prognosis depends on the stage of disease
It is excellent with prompt treatment of amebic infection.
Luminal disease or dysentery usually respond well to treatment.
In refractory cases chloroquine may be added to metronidazole.
Surgery is rarely necessary.
------------------------------------------
What is Amoebiasis?
---------------------------
Amoebiasis is an acute infectious illness caused by the parasite Entoamoeba histolytica.
What is the cause of Amoebiasis?
----------------------------------
The bacteria which causes Amoebiasis is the Entmoeba histytica which is an extremely hardy parasite able to live in polluted water, contaminated food and soiled clothes.
Amebic infections occur most common in the cacum and rectosigmoid region of the colon.
Initial infections are small ulcers, usually discrete erosions whhich may extend more deeply ,coalescing to form bigger lesions resulting in extensive mucosal loss.
Penetration through the muscle lining may occur causing peritonitis.
Liver involvement may occur with the ameba traveling through the portal vein.
Liver abscesses consists of necrotic liver tissue.
Secondary bacterial infection are rare.
Most liver abscesses are solitary, rarely multiple and occur long after clinically evident bowel ulceration.
Single and multiple liver abscesses may occur shortly after a bout of amebic dysentry.
Abscesses of the brain and lung may occur.
Ulcers heal rapidly after treatment and permanent scarring is rare.
What are symptoms of Amoebiasis?
----------------------------------------------
The main symptoms of Amoebiasis are
1. Many people with E.histolytica in stools are passive carrier
2. Invasive bowel disease begins 1-6 months after infection sometimes later
3. abdominal pain especially at the sides
4. altered bowel habit
5.diarrhea with blood or mucus in stools
6.foul stools
7.adominal bloating or gas
8.tenderness on palpation at caecum or sigmoid colon regions
Severe cases may have:
1.more severe symptoms as above
2.bloody stools
3.fever
4.weight loss
5.liver enlargement and tenderness on palpation
6.dehydration and its effects such as delirium and disorientation
7. lassitude and tiredness
8. convulsions
9.tender abdominal mass with obstruction
How is the diagnosis of Amoebiasis made?
-----------------------------------------------------
Doctors generally diagnose Amoebiasis based on:
1. stool cultures.
2.blood tests
3.colonoscopy
4.liver scan and ultrasound
What are the complications of Amoebiasis?
-------------------------------------------------------
Amoebiasis is a disease which can kill espcially through its complications:
1.Perforation of bowel leading to peritonitis or inta-abdominal abscesses
2.Severe hemorrhage uncommon but can cause death
3.Intussusception or insertion of part of colon into another part of colon is rare but can follow amebic ulceration and may cause intestinal obstruction
4.irritable bowel syndrome may persist for some months
5.Lung and pericardial involvement rare but can pose danger
6. cutaneous amebiasis cause deep painful and rapidly spreading ulceration
7.Liver infection can cause damage to liver and result in cirrhosis
8.Liver abscess may perforate and cause peritonitis or produce lung abscess or amebic pericarditis
9.Amebic brain abscess are rare but can occur.
How is Amoebiasis treated?
-------------------------------------
Amoebiasis is an infectious disease which can spread to other people through contaminated food and water.
1.Anti-parasitic medicines like metronidazole 750mg three times a day for 10 days should work for mild to moderate disease.
2.Metronidazole 750mg three times a day for 10 days and chloroquine or diiodohydroquin (1000mg for 2 days followed by 500mg per day up to 3 weeks) for hepatic amebiosis
3.Emetine hydrochloride 1mg pere kg per day by intramuscular injections for 5 days in acute amebic dysenery
4.tetracycline 250mg four times a day for 10 days my be needed for some with invasive intestinal disease.
5.Diloxanide furoate 500mg three a day for 10 days for asymptomatic amebic cyst carrier
Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache
2.antispasmodic drug to stop abdominal cramps
3.medicine to harden the stools such as kaolin
4.slow down the intestinal movement (lomotil or loperamide).
Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.
Get plenty of rest.
How is Amoebiasis prevented?
----------------------------------------
Prevention of Amoebiasis can be by:
1.boil drinking and cooking water for 5 minutes
2.Proper filtration of water
3.Examination of stools of food handlers
4.Avoid eating or drinking foods or liquids that might be contaminated especially by flies
5.Good food hygience and hand washing
What is the prognosis of Amoebiasis?
------------------------------------------------
Prognosis depends on the stage of disease
It is excellent with prompt treatment of amebic infection.
Luminal disease or dysentery usually respond well to treatment.
In refractory cases chloroquine may be added to metronidazole.
Surgery is rarely necessary.
Wednesday, February 23, 2011
A Simple guide to Reye's Syndrome
A Simple Guide to Reye's Syndrome
--------------------------------------------------
What is Reye's Syndrome?
-----------------------
Reye's Syndrome is an acute hepatitis and metabolic encephalopathy occurring in children.
1.Liver usually shows microvesicular fatty infiltration
2. The brain shows cerebral edema with herniation
Causes are not completely known but:
1.Aspirin and salicylate has been suspected as an aggravating cause
2.A number of fatty acids has been postulated as toxic agents
What are the Signs and Symptoms of Reye's Syndrome
----------------------------------------------------------------------
Symptoms:
1.mild prodromal illness like influenza
Mild cases occur without progression to coma.
2.acute onset with:
a.vomiting
b.delirium
c.lethargy
d.stupor
e.coma within 24-48 hours
Signs:
1.Liver enzymes markedly elevated with normal alkaline phosphatase
2.Increased serum ammonia
3.Raised prothrombin time
4.Low blood glucose especially in younger children
5.Intracranial pressure markedly increased
6.Cerebrospinal fluid normal except for increased protein.
7.Respiratory alkalosis with metabolic alkalosis may occur
Clinical progression with marked cerebral edema occurs with improving liver function.
Outcome depends on reversibility and control of intracranial hypertension
Worse case scenerio will be rapid progression to coma and death.
What are the complications of Reye's Syndrome?
---------------------------------------------
The complications are:
1.liver damage
2.brain damage
What is the Treatment of Reye's Syndrome?
--------------------------------------------
Treatment is urgent:
1.Hospitalization with intensive care management
2.Respiratory support
3.Intravenous fluid and glucose to maintain blood glucose
4.Immediate treatment of intracranial pressure important
5.In coma cases, intracranial pressure monitoring with treatment of pressure over 30mm mercury with mannitol, hyper ventilation and removal of CSF if necessary through spinal tap
6. No protein given by mouth because of liver condition
7.Vitamin K as well as fresh blood platelets transfusion to control coagulation problems
Other treatments include:
1.exchange blood transfusion
2.dialysis
3.plasmapheresis
4.Glucose plus insulin
5.citrulline
Prognosis:
Mortality is 50% if inital ammonia is more than 300micrograms per dl and coma present on admission
Outcome depends on management of intra cranial pressure
Subclinal cases are more common than previously thought
--------------------------------------------------
What is Reye's Syndrome?
-----------------------
Reye's Syndrome is an acute hepatitis and metabolic encephalopathy occurring in children.
1.Liver usually shows microvesicular fatty infiltration
2. The brain shows cerebral edema with herniation
Causes are not completely known but:
1.Aspirin and salicylate has been suspected as an aggravating cause
2.A number of fatty acids has been postulated as toxic agents
What are the Signs and Symptoms of Reye's Syndrome
----------------------------------------------------------------------
Symptoms:
1.mild prodromal illness like influenza
Mild cases occur without progression to coma.
2.acute onset with:
a.vomiting
b.delirium
c.lethargy
d.stupor
e.coma within 24-48 hours
Signs:
1.Liver enzymes markedly elevated with normal alkaline phosphatase
2.Increased serum ammonia
3.Raised prothrombin time
4.Low blood glucose especially in younger children
5.Intracranial pressure markedly increased
6.Cerebrospinal fluid normal except for increased protein.
7.Respiratory alkalosis with metabolic alkalosis may occur
Clinical progression with marked cerebral edema occurs with improving liver function.
Outcome depends on reversibility and control of intracranial hypertension
Worse case scenerio will be rapid progression to coma and death.
What are the complications of Reye's Syndrome?
---------------------------------------------
The complications are:
1.liver damage
2.brain damage
What is the Treatment of Reye's Syndrome?
--------------------------------------------
Treatment is urgent:
1.Hospitalization with intensive care management
2.Respiratory support
3.Intravenous fluid and glucose to maintain blood glucose
4.Immediate treatment of intracranial pressure important
5.In coma cases, intracranial pressure monitoring with treatment of pressure over 30mm mercury with mannitol, hyper ventilation and removal of CSF if necessary through spinal tap
6. No protein given by mouth because of liver condition
7.Vitamin K as well as fresh blood platelets transfusion to control coagulation problems
Other treatments include:
1.exchange blood transfusion
2.dialysis
3.plasmapheresis
4.Glucose plus insulin
5.citrulline
Prognosis:
Mortality is 50% if inital ammonia is more than 300micrograms per dl and coma present on admission
Outcome depends on management of intra cranial pressure
Subclinal cases are more common than previously thought
Sunday, February 20, 2011
A Simple guide to Buerger's Disease
A Simple guide to Buerger's Disease
--------------------------------------------------
What is Buerger's Disease?
-----------------------
Buerger's Disease is an uncommon form of arterial obstructive disease of the large and medium sized peripheral arteries of legs in men under age 40 giving rise to intermittent claudication.
Occasionally the arteries of the arms and the veins may be involved.
Causes of Buerger's Disease are:
1.heavy smoking
2.arterial lesions are inflammatory rather than degenerative.
3.The appearrance is non-suppurative(no pus) panvasculitis
4.arterial obstructions in the legs are often associated with obstructive arterial lesion elsewhereExample:angina pectoris
5.Diabetes and high lipid patterns are aggravating factors.
What are the Signs and Symptoms of Buerger's Disease
---------------------------------------------------
Symptoms:
1.onset is sudden
2.classic symptom of heavy aching pain in the legs when walking(intermittent claudication)
3.loss of arterial pilses
4.leg pallor and coldness
5.Raynaud's phenomenon
6.Other arterial diseases:
a.retinopathy
b.coronary ischemia
c.renal ischemia
7.evidence of peripheral ischemia or gangrene
How to diagnose Buerger's Disease?
-------------------------------------------------------------
1.Symptoms and signs as above
2.pallor on raising legs
3.angiography to determine site of lesion
What are the complications of Buerger's Disease?
---------------------------------------------
The complications are:
gangrene of the legs
What is the Treatment of Buerger's Disease?
--------------------------------------------
1.stop smoking
2.general measures:
a.graded exercise
b.physical training
c.weight loss
3.avoid injury from
a.heat
b.cold
c.trauma
d.infections
Medicines:
vasodilator drugs like persantin, nitrates
Surgery:
reconstructive surgery for localized blockage but may not work
Amputation is preferable with gangrene in elderly
What is the Prevention for Buerger's Disease?
-----------------------------------------
Avoiding smoking
Prognosis of Buerger's Disease
-------------------------------------
disease is often progressive and amputation may be necessary.
--------------------------------------------------
What is Buerger's Disease?
-----------------------
Buerger's Disease is an uncommon form of arterial obstructive disease of the large and medium sized peripheral arteries of legs in men under age 40 giving rise to intermittent claudication.
Occasionally the arteries of the arms and the veins may be involved.
Causes of Buerger's Disease are:
1.heavy smoking
2.arterial lesions are inflammatory rather than degenerative.
3.The appearrance is non-suppurative(no pus) panvasculitis
4.arterial obstructions in the legs are often associated with obstructive arterial lesion elsewhereExample:angina pectoris
5.Diabetes and high lipid patterns are aggravating factors.
What are the Signs and Symptoms of Buerger's Disease
---------------------------------------------------
Symptoms:
1.onset is sudden
2.classic symptom of heavy aching pain in the legs when walking(intermittent claudication)
3.loss of arterial pilses
4.leg pallor and coldness
5.Raynaud's phenomenon
6.Other arterial diseases:
a.retinopathy
b.coronary ischemia
c.renal ischemia
7.evidence of peripheral ischemia or gangrene
How to diagnose Buerger's Disease?
-------------------------------------------------------------
1.Symptoms and signs as above
2.pallor on raising legs
3.angiography to determine site of lesion
What are the complications of Buerger's Disease?
---------------------------------------------
The complications are:
gangrene of the legs
What is the Treatment of Buerger's Disease?
--------------------------------------------
1.stop smoking
2.general measures:
a.graded exercise
b.physical training
c.weight loss
3.avoid injury from
a.heat
b.cold
c.trauma
d.infections
Medicines:
vasodilator drugs like persantin, nitrates
Surgery:
reconstructive surgery for localized blockage but may not work
Amputation is preferable with gangrene in elderly
What is the Prevention for Buerger's Disease?
-----------------------------------------
Avoiding smoking
Prognosis of Buerger's Disease
-------------------------------------
disease is often progressive and amputation may be necessary.
Wednesday, February 16, 2011
A Simple Guide to Syncope
A Simple guide to Syncope
------------------------------------
What is Syncope?
-----------------------
Syncope is a temporary loss of consciousness resulting from inadequate cerebral blood supply.
Causes:
A.Vasomotor:
1.Vagal slowing of heart and reduction of blood pressure from fear, severe pain or psychogenic disturbance
2.Hemorrhage or circulatory fluid loss from burns
3.Postural hypotension - blood pressure drops from sleeping or sitting position to upright position
4.Vasoactive drugs such as anti-hypertensive (prazosin, methyl dopa) and heart medicines(nitites, adrenergic blockers)
5.Carotid sinus compression
B.Cardiac:
1.Asystole or heart blockage
2.Sudden arrhythmias with high ventricular rate
3.Heart valve prosthesis
4.Aortic stenosis with exertion
5.Cardiogenic shock following myocardial infarction
6.Sudden cardiac compression
What are the Signs and Symptoms of Syncope
---------------------------------------------------
A.Vasomotor:
Symptoms:
1.cold sweats, pallor, yawning,
2.Urge to urinate or defecate
3.low blood pressure
4.dilated pupils
5.Drug therapy such as adrenagenic blockers
B.Cardiac:
1.ECG evidence of arrhythmia, heart block, asystile, or myocardial infarction
2.history of valve prosthesis, aortic stenosis or chest injury
What are the complications of Syncope?
---------------------------------------------
The complications are:
1.head injury
2.fractures
What is the Treatment of Syncope?
--------------------------------------------
1. Patients with postural or psychogenic syncope recover in recumbent position
2.Cardiac syncope from myocardial infarction needs the patient to be hospitalized and managed in cardiac care unit
3. heart blocks or asystole may need pacemaker implantation
4.Tachycardia with arrhythmia must be treated with special medicies to slow the heart
5.review drug therapy abd dosage of potentially causative medicines such as adrenergenic blocking drugs, beta blockers or vasodilators such as nitrates
Prognosis:
1.depends on cause -vasomotor are less serious than cardiac.
2.it may present as a life threatening condition requiring immediate treatment in cardiac syncope
------------------------------------
What is Syncope?
-----------------------
Syncope is a temporary loss of consciousness resulting from inadequate cerebral blood supply.
Causes:
A.Vasomotor:
1.Vagal slowing of heart and reduction of blood pressure from fear, severe pain or psychogenic disturbance
2.Hemorrhage or circulatory fluid loss from burns
3.Postural hypotension - blood pressure drops from sleeping or sitting position to upright position
4.Vasoactive drugs such as anti-hypertensive (prazosin, methyl dopa) and heart medicines(nitites, adrenergic blockers)
5.Carotid sinus compression
B.Cardiac:
1.Asystole or heart blockage
2.Sudden arrhythmias with high ventricular rate
3.Heart valve prosthesis
4.Aortic stenosis with exertion
5.Cardiogenic shock following myocardial infarction
6.Sudden cardiac compression
What are the Signs and Symptoms of Syncope
---------------------------------------------------
A.Vasomotor:
Symptoms:
1.cold sweats, pallor, yawning,
2.Urge to urinate or defecate
3.low blood pressure
4.dilated pupils
5.Drug therapy such as adrenagenic blockers
B.Cardiac:
1.ECG evidence of arrhythmia, heart block, asystile, or myocardial infarction
2.history of valve prosthesis, aortic stenosis or chest injury
What are the complications of Syncope?
---------------------------------------------
The complications are:
1.head injury
2.fractures
What is the Treatment of Syncope?
--------------------------------------------
1. Patients with postural or psychogenic syncope recover in recumbent position
2.Cardiac syncope from myocardial infarction needs the patient to be hospitalized and managed in cardiac care unit
3. heart blocks or asystole may need pacemaker implantation
4.Tachycardia with arrhythmia must be treated with special medicies to slow the heart
5.review drug therapy abd dosage of potentially causative medicines such as adrenergenic blocking drugs, beta blockers or vasodilators such as nitrates
Prognosis:
1.depends on cause -vasomotor are less serious than cardiac.
2.it may present as a life threatening condition requiring immediate treatment in cardiac syncope
Friday, February 11, 2011
A Simple Guide to Anorectal Abscess
A Simple guide to Anorectal abscess
-------------------------------------------
What is Anorectal abscess?
-----------------------------------
Anorectal abscess is a pocket of pus in the anal region below the anal sphincter muscles.
Perianal abscess lies within the external anal sphincter.
Ischiorectal abscess is situated above the anal sphincter and in the ischiorectal fossa.
How is Anorectal abscess caused?
---------------------------------
Anorectal abscess is caused by infection in the anal glands of the anal mucosa and becomes abscesses or pockets of pus.
1.Trauma or injury causes cell damage and infection
2.Small mucosal tears from hard fecesmay lead to infection
3.Anal fissures, hemorrhoids or colis can also lead to abscess
Most infections are E.coli infections less often staphylococcus
What are the Signs and Symptoms of Anorectal abscess?
---------------------------------------------------
Symptoms start off with:
1. throbbing pain around
2. sitting walking defecation painful
3.Fever, malaise
4.Abscess seen on inspection or rectal exam
How to diagnose Anorectal abscess?
-------------------------------------------------------------
1.Symptoms of
a.anal swelling pain
b.proctoscopy
c.swab & culture
2.ESR raised very high somtimes > 80
3.moderate leucytosis with lymphopenia
What are the complications of Anorectal abscess?
---------------------------------------------
The complications are:
1.colitis
What is the Treatment of Anorectal abscess?
--------------------------------------------
Incision & drainage.
1.Antibiotics
What is the Prevention for Anorectal abscess?
-----------------------------------------
Avoiding infection
Prognosis of Anorectal abscess
-------------------------------------
Early therapy with antibiotics produce good results
-------------------------------------------
What is Anorectal abscess?
-----------------------------------
Anorectal abscess is a pocket of pus in the anal region below the anal sphincter muscles.
Perianal abscess lies within the external anal sphincter.
Ischiorectal abscess is situated above the anal sphincter and in the ischiorectal fossa.
How is Anorectal abscess caused?
---------------------------------
Anorectal abscess is caused by infection in the anal glands of the anal mucosa and becomes abscesses or pockets of pus.
1.Trauma or injury causes cell damage and infection
2.Small mucosal tears from hard fecesmay lead to infection
3.Anal fissures, hemorrhoids or colis can also lead to abscess
Most infections are E.coli infections less often staphylococcus
What are the Signs and Symptoms of Anorectal abscess?
---------------------------------------------------
Symptoms start off with:
1. throbbing pain around
2. sitting walking defecation painful
3.Fever, malaise
4.Abscess seen on inspection or rectal exam
How to diagnose Anorectal abscess?
-------------------------------------------------------------
1.Symptoms of
a.anal swelling pain
b.proctoscopy
c.swab & culture
2.ESR raised very high somtimes > 80
3.moderate leucytosis with lymphopenia
What are the complications of Anorectal abscess?
---------------------------------------------
The complications are:
1.colitis
What is the Treatment of Anorectal abscess?
--------------------------------------------
Incision & drainage.
1.Antibiotics
What is the Prevention for Anorectal abscess?
-----------------------------------------
Avoiding infection
Prognosis of Anorectal abscess
-------------------------------------
Early therapy with antibiotics produce good results
Thursday, January 27, 2011
A Simple Guide to Alcoholism
A Simple Guide to Alcoholism
-------------------------------------------
What is Alcoholism?
---------------------------
Alcoholism is a chronic disease manifested by a pattern of pathological alcohol usage with inability to stop drinking more than temporary resulting in physical, psychological and social consequences.
Who is at risk of getting Alcoholism?
-------------------------------------------
1.Familial
2.Cultural factors especially alcohol drinking friends
3.Social pressure and Stress
4.Depression may be a cause of Alcoholism
What are the Symptoms and signs of Alcoholism?
-----------------------------------------------
Common symptoms of Alcoholism are:
1.Need for daily use of alcohol
2.Binge drinking
3.Inability to stop drinking more than a temporary phase
4.Impairment of social and occupational function
5.Blackouts and amnesia
6.Violent behavior when intoxicated with arguments with friends and family
7.Absence from work or loss of job
8.Legal problems such as arrests for drink driving or traffic accidents
9.Evidence of tolerance for more alcohol to achieve sense of comfort
10.Development of alcohol withdrawal (tremors on awakening, insomnia, hallucinations)
How is the diagnosis of Alcoholism made?
-----------------------------------------------------
1. level of blood alcohol above the permitted limit.
2.Liver function tests are abnormal:
a.Aminotransferases - AST and ALT are moderately elevated, with AST > ALT.
b.Alkaline phosphatase - usually slightly elevated.
c.GGT - correlates with AP levels- much higher in chronic liver disease from alcohol.
3. ECG and EEG
What are the complications of Alcoholism?
-----------------------------------------------------
Complications may develop with progression of the alcoholism.
1.Delirium tremors
2.Acute alcohol delusional states
3.Untidy appearance
a.neglect of personal appearance,
b.unresponsiveness,
c.forgetfulness,
d.trouble concentrating,
e.changes in sleep habits.
5.Alcoholic hepatitis and cirrhosis
6.Wernicke's encephalopathy
7.Alcoholic cerebellar degeneration
8.Pellagra
What is the treatment of Alcoholism?
-----------------------------------------------------
In all cases of Alcoholism, assessment of the patient's alcoholism and complications are needed.
1. Detoxification in special centers
2. treatment of complications
3.Alcohol withdrawal with the help of transquillizers and vitamin supplements
4.Antabuse therapy to cure alcohol dependence
5.Psychological therapy and Alcoholic Anonymous
What is the prognosis for Alcoholism?
---------------------------------------------------
Prognosis is dependent on initial severity and the patient's motivation to return to sobriety
Alcoholism is a serious chronic disease which can be controlled but seldom cured.
What is the best prevention for Alcoholism?
---------------------------------------------------
1. No drinking of any form of alcohol
2. Family support and psychotherapy and self help groups
-------------------------------------------
What is Alcoholism?
---------------------------
Alcoholism is a chronic disease manifested by a pattern of pathological alcohol usage with inability to stop drinking more than temporary resulting in physical, psychological and social consequences.
Who is at risk of getting Alcoholism?
-------------------------------------------
1.Familial
2.Cultural factors especially alcohol drinking friends
3.Social pressure and Stress
4.Depression may be a cause of Alcoholism
What are the Symptoms and signs of Alcoholism?
-----------------------------------------------
Common symptoms of Alcoholism are:
1.Need for daily use of alcohol
2.Binge drinking
3.Inability to stop drinking more than a temporary phase
4.Impairment of social and occupational function
5.Blackouts and amnesia
6.Violent behavior when intoxicated with arguments with friends and family
7.Absence from work or loss of job
8.Legal problems such as arrests for drink driving or traffic accidents
9.Evidence of tolerance for more alcohol to achieve sense of comfort
10.Development of alcohol withdrawal (tremors on awakening, insomnia, hallucinations)
How is the diagnosis of Alcoholism made?
-----------------------------------------------------
1. level of blood alcohol above the permitted limit.
2.Liver function tests are abnormal:
a.Aminotransferases - AST and ALT are moderately elevated, with AST > ALT.
b.Alkaline phosphatase - usually slightly elevated.
c.GGT - correlates with AP levels- much higher in chronic liver disease from alcohol.
3. ECG and EEG
What are the complications of Alcoholism?
-----------------------------------------------------
Complications may develop with progression of the alcoholism.
1.Delirium tremors
2.Acute alcohol delusional states
3.Untidy appearance
a.neglect of personal appearance,
b.unresponsiveness,
c.forgetfulness,
d.trouble concentrating,
e.changes in sleep habits.
5.Alcoholic hepatitis and cirrhosis
6.Wernicke's encephalopathy
7.Alcoholic cerebellar degeneration
8.Pellagra
What is the treatment of Alcoholism?
-----------------------------------------------------
In all cases of Alcoholism, assessment of the patient's alcoholism and complications are needed.
1. Detoxification in special centers
2. treatment of complications
3.Alcohol withdrawal with the help of transquillizers and vitamin supplements
4.Antabuse therapy to cure alcohol dependence
5.Psychological therapy and Alcoholic Anonymous
What is the prognosis for Alcoholism?
---------------------------------------------------
Prognosis is dependent on initial severity and the patient's motivation to return to sobriety
Alcoholism is a serious chronic disease which can be controlled but seldom cured.
What is the best prevention for Alcoholism?
---------------------------------------------------
1. No drinking of any form of alcohol
2. Family support and psychotherapy and self help groups
Tuesday, January 25, 2011
A Simple Guide to Coeliac Disease
A Simple Guide to Coeliac Disease
---------------------------------------------
What is Coeliac Disease?
--------------------------------
Coeliac Disease(Gluten Enteropathy) is a chronic disease of the small intestine which affects the lining of the small intestine to develop abnormalities on contact with gluten.
The small bowel mucosa shows
1.villous atrophy
2.columnal to cuboidal changes in absorbing cells
3.infiltration of lamina propia with lymphocytes and plasma cells
Who is affected by Coeliac Disease?
---------------------------------------------------
Coeliac Disease is more common in people with certain HLA antigens and blood group O.
There is a possibility of enzyme deficiency and abnormal immunological response.
Coeliac Disease can be found in all ages but are more common in the 10-30 years age group.
What is the Cause of Coeliac Disease?
-----------------------------------------------------
The exact cause of Coeliac Disease is not known.
It has been suggested that an autoimmune disease is the main cause of Coeliac Disease.
A protein produced by the immune system, called HLA antigen may be a possible cause of the body's reaction in the lining of the small intestinal tract resulting in inflammation.
What are the Symptoms and signs of Coeliac Disease?
---------------------------------------------------------------------
Symptoms varies from mild to severe:
1.severe abdominal pain, bloating
2.diarrhea and steatorrhea
3.Weight loss despite good appetite and intake
4.edema
5.glossitis
6.apthous ulcers
7.finger clubbing
8.hypotension
9.Polyneuritis
10.psychiatric symptoms
In children there may be:
1.failure of weight gain
2.irritability
3.general malaise
How do you make the Diagnosis of Coeliac Disease?
-------------------------------------------------------------------
1.A history of abdominal pain , diarrhea and weight loss
2.small bowels radiology
3.D-xylose absorption study
4.fecal fat assessment
5.Jejunal biopsy
What are the complications of Coeliac Disease?
------------------------------------------------------------
1.weight loss
2.Nutrition: malabsorption and vitamin deficiency
What is the treatment of Coeliac Disease?
---------------------------------------------------
Treatment is :
Control of Diet
1.gluten free diet especially wheat, oats, barley, rye
use rice corn potato in place
2.avoid beer, ale, whisky, vodka which contains a lot of gluten
3.Special diet for gluten sensitive patients
4.Question diet and review diagnosis if no response
Medication
1.Antispasmotic medication for abdominal pain
2.Oral corticosteroids may help in patients not responding after 3 months of careful adherence to diet
Start with high doses at first, followed by reduction of dosage.
These are for short term use only because of the side effects.
3.Correction of anemia and nutritional deficiencies is important to enhance the immune system
What is the prognosis of Coeliac Disease?
-----------------------------------------
The prognosis depends on the conition of the disease
Improvement occurs within 1-3 days following institution of diet seen in 30% of patients.
80% will respond within a month.
the remaining 20%may take up to 2 years for symptoms control.
There may be recurrence if therapy is stopped.
What are preventive measures in Coeliac Disease?
------------------------------------------------------------------
A nutritious diet with vitamin supplements can strengthen the body resistance against illness.
A gluten free diet will prevent recurrence
---------------------------------------------
What is Coeliac Disease?
--------------------------------
Coeliac Disease(Gluten Enteropathy) is a chronic disease of the small intestine which affects the lining of the small intestine to develop abnormalities on contact with gluten.
The small bowel mucosa shows
1.villous atrophy
2.columnal to cuboidal changes in absorbing cells
3.infiltration of lamina propia with lymphocytes and plasma cells
Who is affected by Coeliac Disease?
---------------------------------------------------
Coeliac Disease is more common in people with certain HLA antigens and blood group O.
There is a possibility of enzyme deficiency and abnormal immunological response.
Coeliac Disease can be found in all ages but are more common in the 10-30 years age group.
What is the Cause of Coeliac Disease?
-----------------------------------------------------
The exact cause of Coeliac Disease is not known.
It has been suggested that an autoimmune disease is the main cause of Coeliac Disease.
A protein produced by the immune system, called HLA antigen may be a possible cause of the body's reaction in the lining of the small intestinal tract resulting in inflammation.
What are the Symptoms and signs of Coeliac Disease?
---------------------------------------------------------------------
Symptoms varies from mild to severe:
1.severe abdominal pain, bloating
2.diarrhea and steatorrhea
3.Weight loss despite good appetite and intake
4.edema
5.glossitis
6.apthous ulcers
7.finger clubbing
8.hypotension
9.Polyneuritis
10.psychiatric symptoms
In children there may be:
1.failure of weight gain
2.irritability
3.general malaise
How do you make the Diagnosis of Coeliac Disease?
-------------------------------------------------------------------
1.A history of abdominal pain , diarrhea and weight loss
2.small bowels radiology
3.D-xylose absorption study
4.fecal fat assessment
5.Jejunal biopsy
What are the complications of Coeliac Disease?
------------------------------------------------------------
1.weight loss
2.Nutrition: malabsorption and vitamin deficiency
What is the treatment of Coeliac Disease?
---------------------------------------------------
Treatment is :
Control of Diet
1.gluten free diet especially wheat, oats, barley, rye
use rice corn potato in place
2.avoid beer, ale, whisky, vodka which contains a lot of gluten
3.Special diet for gluten sensitive patients
4.Question diet and review diagnosis if no response
Medication
1.Antispasmotic medication for abdominal pain
2.Oral corticosteroids may help in patients not responding after 3 months of careful adherence to diet
Start with high doses at first, followed by reduction of dosage.
These are for short term use only because of the side effects.
3.Correction of anemia and nutritional deficiencies is important to enhance the immune system
What is the prognosis of Coeliac Disease?
-----------------------------------------
The prognosis depends on the conition of the disease
Improvement occurs within 1-3 days following institution of diet seen in 30% of patients.
80% will respond within a month.
the remaining 20%may take up to 2 years for symptoms control.
There may be recurrence if therapy is stopped.
What are preventive measures in Coeliac Disease?
------------------------------------------------------------------
A nutritious diet with vitamin supplements can strengthen the body resistance against illness.
A gluten free diet will prevent recurrence
Friday, January 21, 2011
A Simple guide to Raynaud's Disease
A Simple Guide to Raynaud's Disease
------------------------------------------------
What is Raynaud's Disease?
------------------------------------
Raynaud's Disease is a transient vasospasm of small arteries of the hand precipitated by cold.
There is typical whiteness and blueness of fingers.
Causes are:
1.classically cold precipitated, more common in winter
2.Emotional factors such as fear and anxiety
It may secondary to other conditions such as:
1.auto immune disease such as SLE
2.arterial compression syndrome from cervical ribs
3.hypothyroidism
4.pulmonary hypertension
5.medicines such as ergotamine
6.vinyl chloride exposure
7.low immune patients such as cancer
It occurs more commonly in women and usually rare in men
What are the Signs and Symptoms of Raynaud's Disease?
-----------------------------------------------------------------------
Symptoms start off with:
cold extremities with at least 2 of the following changes for diagnosis:
1.blanching and numbness of fingers spreading up to the rest of hand
2.blanching and whiteness of fingers then blue mottling followed by red as circulation returns
3.pain during color changes common
4.skin shiny or wax like
5.feet may be involved, also nose and tongue
6.gangrene of finger tips
How to diagnose Raynaud's Disease?
-------------------------------------------------------------
1.Symptoms and signs as above
2.skin capillary microscopy
3.hand films may show terminal tuft atrophy in vinyl chloride exposure
What are the complications of Raynaud's Disease?
---------------------------------------------
The complications are:
gangrene of the fingers
What is the Treatment of Raynaud's Disease?
--------------------------------------------
1.Avoid of cold temperature
2.Avoid emotional upset and stress
3.Keep body and environment warm
4.treat underlying cause
5.calcium channel blockers
reserpine
methyl dopa
6.sympathectomy
What is the Prevention for Raynaud's Disease?
-----------------------------------------------------------
Avoiding cold temperature and stress
Prognosis of Raynaud's Disease
----------------------------------------------
depends on cause and response to therapy
------------------------------------------------
What is Raynaud's Disease?
------------------------------------
Raynaud's Disease is a transient vasospasm of small arteries of the hand precipitated by cold.
There is typical whiteness and blueness of fingers.
Causes are:
1.classically cold precipitated, more common in winter
2.Emotional factors such as fear and anxiety
It may secondary to other conditions such as:
1.auto immune disease such as SLE
2.arterial compression syndrome from cervical ribs
3.hypothyroidism
4.pulmonary hypertension
5.medicines such as ergotamine
6.vinyl chloride exposure
7.low immune patients such as cancer
It occurs more commonly in women and usually rare in men
What are the Signs and Symptoms of Raynaud's Disease?
-----------------------------------------------------------------------
Symptoms start off with:
cold extremities with at least 2 of the following changes for diagnosis:
1.blanching and numbness of fingers spreading up to the rest of hand
2.blanching and whiteness of fingers then blue mottling followed by red as circulation returns
3.pain during color changes common
4.skin shiny or wax like
5.feet may be involved, also nose and tongue
6.gangrene of finger tips
How to diagnose Raynaud's Disease?
-------------------------------------------------------------
1.Symptoms and signs as above
2.skin capillary microscopy
3.hand films may show terminal tuft atrophy in vinyl chloride exposure
What are the complications of Raynaud's Disease?
---------------------------------------------
The complications are:
gangrene of the fingers
What is the Treatment of Raynaud's Disease?
--------------------------------------------
1.Avoid of cold temperature
2.Avoid emotional upset and stress
3.Keep body and environment warm
4.treat underlying cause
5.calcium channel blockers
reserpine
methyl dopa
6.sympathectomy
What is the Prevention for Raynaud's Disease?
-----------------------------------------------------------
Avoiding cold temperature and stress
Prognosis of Raynaud's Disease
----------------------------------------------
depends on cause and response to therapy
Wednesday, January 19, 2011
A Simple guide to Legionnaire's Disease
A Simple guide to Legionnaire's Disease
----------------------------------------------------
What is Legionnaire's Disease?
-------------------------------------------
Legionnaire's Disease is an acute, infectious disease of the respiratory tract caused by the bacillus Legionella pneumophilia, a Gram negative, non-sporulating aerobic micro-organism..
The bacteria is found mostly in soil and water.
How is Legionnaire's Disease transmitted?
---------------------------------
Legionnaire's Disease is transmitted through the air or in dust associated with movement of soil or contaminated air from air conditioner units.
It is highly infectious.
Incubation period is 10-20 days.
The organism enters the blood and then enter the cells of the lower respiratory tract
The infections occur in persons of all ages but peak incidence is 50-60 years. Males are affected twice as often as females.
Predisposing factors are:
pre-existing lung disease
heavy smoking
low immune patients such as cancer
What are the Signs and Symptoms of Legionnaire's Disease?
------------------------------------------------------------------------------
Symptoms start off with:
1. sudden onset of malaise
2. high fever 39-40 degrees centigrade
3. chills and rigors
4. headache
5. dry cough
6. diarrhea
7. upper and lower gastrointestinal bleeding
8. difficult breathing
9. slow heart rate
10. confusion and dilirium
How to diagnose Legionnaire's Disease?
-------------------------------------------------------------
1.Symptoms of
a.prodromal viral like disease (myalgia, malaise, headache)
b.dry cough, confusion, diarrhea
c.lymphopenia without neutropenia
d.hyponatremia
2.ESR raised very high somtimes > 80
3.moderate leucocytosis with lymphopenia
4.low blood sodium
5.low blood calcium
6.abnormal liver function tests with albumin and raised SGOT
7.Urine shows protein and blood
8.Chest x-ray show patchy consolidation usually confined to one lobe
9.Indirect legionna bacterial antibody higher than 1.256
10.symptoms of renal failure
What are the complications of Legionnaire's Disease?
---------------------------------------------
The complications are:
1.pneumonia
2.liver dysfunction
3.renal failure
What is the Treatment of Legionnaire's Disease?
--------------------------------------------
Isolation in hospital is unnecessary.
1.Antibiotics (erythromycin or rifampicin) are used in the treatment of Legionnaire's Disease.
2.Tetracycline can be given
3.pulmonary care -nebulizer, oxygen, deep breathing exercises may be necessary if there is breathing difficulty
Besides antibiotics, the following will help:
Steam inhalation
cough mixtures
avoid smokes, dust, dry air,sudden temperature change
What is the Prevention for Legionnaire's Disease?
-----------------------------------------
Avoiding dust
Proper cleaning of air conditioners and ventilation system
Prognosis of Legionnaire's Disease
---------------------------------------------
Early therapy with antibiotics produce good results
low mortality rates as early cases are detected
Rarely pulmonary fibrosis develops as remnant from disease.
----------------------------------------------------
What is Legionnaire's Disease?
-------------------------------------------
Legionnaire's Disease is an acute, infectious disease of the respiratory tract caused by the bacillus Legionella pneumophilia, a Gram negative, non-sporulating aerobic micro-organism..
The bacteria is found mostly in soil and water.
How is Legionnaire's Disease transmitted?
---------------------------------
Legionnaire's Disease is transmitted through the air or in dust associated with movement of soil or contaminated air from air conditioner units.
It is highly infectious.
Incubation period is 10-20 days.
The organism enters the blood and then enter the cells of the lower respiratory tract
The infections occur in persons of all ages but peak incidence is 50-60 years. Males are affected twice as often as females.
Predisposing factors are:
pre-existing lung disease
heavy smoking
low immune patients such as cancer
What are the Signs and Symptoms of Legionnaire's Disease?
------------------------------------------------------------------------------
Symptoms start off with:
1. sudden onset of malaise
2. high fever 39-40 degrees centigrade
3. chills and rigors
4. headache
5. dry cough
6. diarrhea
7. upper and lower gastrointestinal bleeding
8. difficult breathing
9. slow heart rate
10. confusion and dilirium
How to diagnose Legionnaire's Disease?
-------------------------------------------------------------
1.Symptoms of
a.prodromal viral like disease (myalgia, malaise, headache)
b.dry cough, confusion, diarrhea
c.lymphopenia without neutropenia
d.hyponatremia
2.ESR raised very high somtimes > 80
3.moderate leucocytosis with lymphopenia
4.low blood sodium
5.low blood calcium
6.abnormal liver function tests with albumin and raised SGOT
7.Urine shows protein and blood
8.Chest x-ray show patchy consolidation usually confined to one lobe
9.Indirect legionna bacterial antibody higher than 1.256
10.symptoms of renal failure
What are the complications of Legionnaire's Disease?
---------------------------------------------
The complications are:
1.pneumonia
2.liver dysfunction
3.renal failure
What is the Treatment of Legionnaire's Disease?
--------------------------------------------
Isolation in hospital is unnecessary.
1.Antibiotics (erythromycin or rifampicin) are used in the treatment of Legionnaire's Disease.
2.Tetracycline can be given
3.pulmonary care -nebulizer, oxygen, deep breathing exercises may be necessary if there is breathing difficulty
Besides antibiotics, the following will help:
Steam inhalation
cough mixtures
avoid smokes, dust, dry air,sudden temperature change
What is the Prevention for Legionnaire's Disease?
-----------------------------------------
Avoiding dust
Proper cleaning of air conditioners and ventilation system
Prognosis of Legionnaire's Disease
---------------------------------------------
Early therapy with antibiotics produce good results
low mortality rates as early cases are detected
Rarely pulmonary fibrosis develops as remnant from disease.
Saturday, August 21, 2010
Best Yahoo Answer -Is it possible to gain imunity to muscle relaxants?
Is it possible to gain imunity to muscle relaxants?
when a person gains imunity to medacation can that medication still cause organ failure if still used my friend gained imunity to muscle relaxants but she still takes them can they cuase her organ failure or damage?
Best Answer - Chosen by Voters
No one can get immunity to muscle relaxant. Immunity occurs when you develops antibodies against a virus or bacteria.
If you friend is addicted to muscle relaxant then frequent taking of muscle relaxant may have side effect on your friend. One possibility is organ damage or failure if the muscle relaxant is taken for a long time.
If you friend is addicted to muscle relaxant then frequent taking of muscle relaxant may have side effect on your friend. One possibility is organ damage or failure if the muscle relaxant is taken for a long time.
Source(s):
A Simple Guide to Medical Conditions
http://kennethkee.blogspot.com
http://kennethkee.blogspot.com
Friday, August 6, 2010
A Simple Guide to Cataract
A Simple Guide to Cataract
---------------------------------------
What is a Catarct?
-------------------------------
A cataract is a clouding of the eye's natural transparent lens, which helps us to focus on the objects we see.
The lens is mostly made of water and protein.
Due to age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.
How are Cataract Classified?
-----------------------------------------
Cataracts are classified as one of three types:
1.A nuclear cataract is most commonly seen as it forms.
This cataract forms in the nucleus, the center of the lens, and is due to natural aging changes.
2.A cortical cataract, which forms in the outer lens cortex, gradually extends its spokes from the outside of the lens to the center. Many diabetics develop cortical cataracts.
3.A subcapsular cataract begins at the back of the lens.
People with diabetes, high farsightedness, retinitis pigmentosa or those taking high doses of steroids may develop a subcapsular cataract.
How Do You Diagnose a Cataract ?
----------------------------------------------
A cataract begins slowly and at first has little effect on your vision.
There may some blurring of vision .
Light from the sun or a lamp may seem too bright or glaring.
Colors may not appear as bright as they once did.
What are the causes of Cataracts?
-------------------------------------------------
The eye's lens changes as we age, forming cataracts.
1. exposure to ultraviolet light may be a cause of cataract development, so eye specialist recommend wearing sunglasses and a wide-brimmed hat.
2.Other types of radiation such as from TV or PC monitors may also be causes.
Airline pilots may be exposed to cosmic radiation.
3.People with diabetes are at risk for developing a cataract.
The same goes for users of steroids and diuretics.
4.Other risk factors include cigarette smoke, air pollution and heavy alcohol consumption
What is the treatment of Cataract?
------------------------------------------------
Symptomatic treatment:
When symptoms begin to appear, you may be able to improve your vision for a while using new glasses, strong bifocals, magnification, appropriate lighting or other visual aids.
Some eye care practitioners believe that a diet high in antioxidants, such as beta-carotene (vitamin A), selenium and vitamins C may slow down cataract development.
Eye drops such as Catalin and Quinax has been prescribed to slow down the development of cataract.
Surgical treatment:
An intraocular lens (IOL) is implanted in the eye in place of the patient's clouded natural lens.
During surgery, the surgeon will remove your clouded lens, and in most cases replace it with a clear, plastic intraocular lens (IOL).
What is the prognosis of Cataract?
-------------------------------------------------
Cataract surgery is very successful in restoring vision.
How do you Prevent Cataract?
----------------------------------------
The most important prevention for cataracts is to avoid direct sun rays and other forms of radiation from TV or PC monitors, polluted air and smoking.
---------------------------------------
What is a Catarct?
-------------------------------
A cataract is a clouding of the eye's natural transparent lens, which helps us to focus on the objects we see.
The lens is mostly made of water and protein.
Due to age, some of the protein may clump together and start to cloud a small area of the lens. This is a cataract, and over time, it may grow larger and cloud more of the lens, making it harder to see.
How are Cataract Classified?
-----------------------------------------
Cataracts are classified as one of three types:
1.A nuclear cataract is most commonly seen as it forms.
This cataract forms in the nucleus, the center of the lens, and is due to natural aging changes.
2.A cortical cataract, which forms in the outer lens cortex, gradually extends its spokes from the outside of the lens to the center. Many diabetics develop cortical cataracts.
3.A subcapsular cataract begins at the back of the lens.
People with diabetes, high farsightedness, retinitis pigmentosa or those taking high doses of steroids may develop a subcapsular cataract.
How Do You Diagnose a Cataract ?
----------------------------------------------
A cataract begins slowly and at first has little effect on your vision.
There may some blurring of vision .
Light from the sun or a lamp may seem too bright or glaring.
Colors may not appear as bright as they once did.
What are the causes of Cataracts?
-------------------------------------------------
The eye's lens changes as we age, forming cataracts.
1. exposure to ultraviolet light may be a cause of cataract development, so eye specialist recommend wearing sunglasses and a wide-brimmed hat.
2.Other types of radiation such as from TV or PC monitors may also be causes.
Airline pilots may be exposed to cosmic radiation.
3.People with diabetes are at risk for developing a cataract.
The same goes for users of steroids and diuretics.
4.Other risk factors include cigarette smoke, air pollution and heavy alcohol consumption
What is the treatment of Cataract?
------------------------------------------------
Symptomatic treatment:
When symptoms begin to appear, you may be able to improve your vision for a while using new glasses, strong bifocals, magnification, appropriate lighting or other visual aids.
Some eye care practitioners believe that a diet high in antioxidants, such as beta-carotene (vitamin A), selenium and vitamins C may slow down cataract development.
Eye drops such as Catalin and Quinax has been prescribed to slow down the development of cataract.
Surgical treatment:
An intraocular lens (IOL) is implanted in the eye in place of the patient's clouded natural lens.
During surgery, the surgeon will remove your clouded lens, and in most cases replace it with a clear, plastic intraocular lens (IOL).
What is the prognosis of Cataract?
-------------------------------------------------
Cataract surgery is very successful in restoring vision.
How do you Prevent Cataract?
----------------------------------------
The most important prevention for cataracts is to avoid direct sun rays and other forms of radiation from TV or PC monitors, polluted air and smoking.
Wednesday, August 4, 2010
Best Yahoo Answer -My Doctor Said I Don't have a UTI but...?
Best Yahoo Answer
My Doctor Said I Don't have a UTI but...?
I went to the doctors yesterday and I took a urine test and everything looked fine. She said I didn't have a UTI, so I went home and drank cranberry juice like she said. I just woke up this morning and it feels like Iike I have to pee, but I don't.
Thanks.
Thanks.
Best Answer - Chosen by Asker
A urine test at the doctor should normally detect any Urinary Tract Infection. Drinking at least 2 liters of water is the best way to prevent any urine infection.
Source(s):
A Simple Guide to Urinary Tract Infection or Cystitis
http://kennethkee.blogspot.com
http://kennethkee.blogspot.com
Friday, July 2, 2010
Site Map
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To get to an article, please click on Table of Contents or labels:
A Simple Guide to Acne 10/14/07
A Simple Guide to Acne Rosacea 9/27/08
A Simple Guide to Acoustic Neuroma 10/5/08
A Simple Guide to Adenoiditis 7/6/08
A Simple Guide to AIDS 12/7/07
A Simple Guide to Allergies 6/11/08
A Simple Guide to Alopecia(Hair Loss) 9/9/07
A Simple Guide to Alzheimer's disease 9/15/07
A Simple Guide to Amenorrhea 7/3/08
A Simple Guide to Anal fissure 12/15/07
A Simple Guide to Anal fistula 7/15/08
A Simple Guide to Anaemia 8/27/07
A Simple Guide to Ankylosing Spondylosis 8/11/07
A Simple Guide to Anthrax 11/13/07
A Simple Guide to Appendicitis 12/14/07
A Simple Guide to Asthma 9/6/07
A Simple Guide to Astigmatism 10/1/07
A Simple Guide to Athlete's Foot 12/3/07
A Simple Guide to Atopic Dermatitis 11/25/08
A Simple Guide to Atrial Fibrillation I 10/13/08
A Simple Guide to Atrial Fibrillation II 10/14/08
A Simple Guide to Backache 10/4/07
A Simple Guide to Bacterial Vaginosis 11/22/07
A Simple Guide to Balanitis 12/16/07
A Simple Guide to Basal cell carcinoma 8/27/08
A Simple Guide to Beestings 12/8/07
A Simple Guide to Benign Prostatic Hyperplasia 5/23/08
A Simple Guide to Bladder Cancer 9/25/07
A Simple Guide to Blood Cancer 9/29/07
A Simple Guide to Breast Cancer 8/31/07
A Simple Guide to Bronchitis 9/9/08
A Simple Guide to Bruise 10/12/07
A Simple Guide to Burns & Scalds 12/19/07
A Simple Guide to Cancer 10/6/07
A Simple Guide to Candidiasis 11/17/07
A Simple Guide to Carpal Tunnel Syndrome 12/17/07
A Simple Guide to Cataract 8/6/10
A Simple Guide to Cellulitis 12/18/07
A Simple Guide to Cerebral aneurysm 11/11/07
A Simple Guide to Cerebral Palsy 9/3/07
A Simple Guide to Cervical Cancer 9/19/07
A Simple Guide to Cervical Spondylosis 2/12/08
A Simple Guide to Cervicitis 9/17/08
A Simple Guide to Chickenpox 8/14/07
A Simple Guide to Chikungunya Fever 1/3/2008
A Simple Guide to Chlamydia 10/9/07
A Simple Guide to Cholecystitis 12/21/07
A Simple Guide to Cholera 2/13/08
A Simple Guide to Chronic Obstructive Lung Disease10/11/07
A Simple Guide to Colorectal Cancer 9/2/07
A Simple Guide to Conjunctivitis 8/17/07
A Simple Guide to Constipation 8/8/07
A Simple Guide to Corneal Ulcer 8/2/08
A Simple Guide to Coronary Heart Disease Part 2 12/27/07
A Simple Guide to Coronary Heart Disease 12/26/07
A Simple Guide to Coryza(Common Cold) 9/10/07
A Simple Guide to Coughing 6/9/08
A Simple Guide to Crohn's Disease 7/30/08
A Simple Guide to Cutaneous Larva migrans 10/25/08
A Simple Guide to Cystitis 2/19/08
A Simple Guide to Dandruff 7/21/08
A Simple Guide to Deep Vein Thrombosis 9/21/07
A Simple Guide to Dengue Fever 1/3/08
A Simple Guide to Depression 11/2/07
A Simple Guide to Diabetes Part 2 12/11/07
A Simple Guide to Diabetes Mellitus 12/10/07
A Simple guide to Diphtheria 12/5/07
A Simple Guide to Diverticulosis 6/21/08
A Simple Guide to Dizziness 9/11/07
A Simple Guide to Dysmenorrhea 11/26/07
A Simple Guide to Ear Infections 9/12/07
A Simple Guide to Eczema 8/29/07
A Simple Guide to Endometriosis 10/10/07
A Simple Guide to Epididymitis and Orchitis 9/16/08
A Simple Guide to Epilepsy 11/1/07
A Simple Guide to Erectile Dysfunction 4/4/08
A Simple Guide to Facial Palsy 7/9/08
A Simple Guide to Fever 11/4/07
A Simple Guide to Fibromyalgia I 11/6/08
A Simple Guide to Fibromyalgia II 11/7/08
A Simple Guide to Folliculitis 10/24/08
A Simple Guide to Foot Care 7/27/2008
A Simple Guide to Frozen Shoulder 7/22/08
A Simple Guide to Gallstones 3/21/08
A Simple Guide to Gastritis 9/17/07
A Simple Guide to Gastroenteritis 8/15/07
A Simple Guide to Genital Herpes 11/9/07
A Simple Guide to Gingivitis 9/11/08
A Simple Guide to Glaucoma 8/21/07
A Simple Guide to Gonorrhea 11/12/07
A Simple Guide To Gout 8/10/07
A Simple Guide to Gynecomastia 10/21/08
A Simple Guide to Hand, Foot and Mouth Disease 11/5/07
A Simple Guide to Halitosis(Bad breath) 6/6/08
A Simple Guide to Headache 11/3/07
A Simple Guide to Heat Stroke 11/19/08
A Simple guide to Hemorrhoids 8/13/07
A Simple Guide to Hepatitis A 11/7/07
A Simple Guide to Hepatitis B 11/6/07
A Simple Guide to Hepatitis C 11/20/07
A Simple Guide to Hepatitis - Update 12/22/07
A Simple Guide to Hiccups 12/4/07
A Simple Guide to High Cholesterol 9/10/08
A Simple Guide to Human papilloma virus Infection 11/14/07
A Simple Guide to Hydrocoele 8/22/08
A Simple Guide to Hyperhidrosis 7/18/08
A Simple Guide to Hypertension 9/18/07
A Simple Guide to Hyperthyroid Disease 8/11/08
A Simple Guide to Hypothyroidism 8/12/08
A Simple Guide to Keloid 9/3/08
A Simple Guide to Kidney Cancer 11/13/08
A Simple Guide to Knee cap Dislocation 7/24/08
A Simple Guide to Infectious Mononucleosis 8/19/08
A Simple Guide to Inguinal Hernia 8/21/08
A Simple Guide to Irritable Bowel Syndrome 9/14/07
A Simple Guide to Laceration 10/13/07
A Simple Guide to Laryngitis 11/24/07
A Simple Guide to Laryngeal Cancer 5/4/10
A Simple Guide to Leprosy 11/24/07
A Simple Guide to Lice 11/19/07
A Simple Guide to Lichen Planus 9/4/08
A Simple Guide to Lipoma 8/24/08
A Simple Guide to Liver Cancer 9/26/07
A Simple Guide to Liver Cirrhosis I 10/28/08
A Simple Guide to Liver Cirrhosis II 10/29/08
A Simple Guide to Lung Cancer 9/22/07
A Simple Guide to Lymphoma 9/28/07
A Simple Guide to Malaria 10/7/07
A Simple Guide to Measles 11/21/07
A Simple Guide to Melonoma 8/26/08
A Simple Guide to Meniere's Disease 8/23/08
A Simple Guide to Meningitis 8/15/08
A Simple Guide to Menorrhagia 10/2/07
A Simple Guide to Menorrhagia2 6/29/08
A Simple Guide to Menopause2 12/2/07
A Simple Guide to Menopause 12/1/07
A Simple Guide to Mouth Ulcers 9/15/07
A Simple Guide to Mumps 10/3/07
A Simple Guide to Multiple Myeloma 9/29/07
A Simple Guide to Myasthenia Gravis 11/16/07
A Simple Guide to Nasopharyngeal Cancer 9/23/07
A Simple Guide to Non Pressure Hydrocephalus 8/17/08
A Simple Guide to Nosebleed (Epistaxis) 9/13/07
A Simple Guide to Obesity Part 2 12/31/07
A Simple Guide to Obesity 12/31/07
A Simple Guide to Obstructive Sleep Apnea 9/18/08
A Simple Guide to Osteoarthritis 8/7/07
A Simple Guide to Osteogenesis Imperfecta 10/22/08
A Simple Guide to Osteomyelitis 10/9/08
A Simple Guide to Osteoporosis 9/4/07
A Simple Guide to Otitis media 9/7/08
A Simple Guide to Ovarian Cancer 9/24/07
A Simple Guide to Pancreatic Cancer 6/18/08
A Simple Guide to Pancreatitis 6/14/08
A Simple Guide to Paronychia 6/25/08
A Simple Guide to Parkinson's Disease 8/23/07
A Simple Guide to Pecoma Cancer 3/3/08
A Simple Guide to Pelvic Inflammatory Disease 11/23/07
A Simple Guide to Pericarditis 11/1/08
A Simple Guide to Pityriasis Rosea 10/1/08
A Simple Guide to Plantar Fascilitis 7/25/08
A Simple Guide to Pleural effusion 11/11/08
A Simple Guide to Pneumonia 8/18/08
A Simple Guide to Pneumothorax 8/20/08
A Simple Guide to Poliomyelitis 12/19/07
A Simple Guide to Prickly Heat 10/23/08
A Simple Guide to Prolapsed Intervertebral Disc 7/17/08
A Simple Guide to Prostatitis 3/7/08
A Simple Guide to Prostate Cancer 9/5/07
A Simple Guide to Psoriasis 8/29/07
A Simple Guide to Retinal Detachment 9/12/08
A Simple Guide to Retinitis pigmentosa 9/14/08
A Simple Guide to Rheumatoid Arthritis 8/22/07
A Simple Guide to Rubella 9/20/07
A Simple Guide to Salivary Gland Cancer 11/28/08
A Simple Guide to Salpingitis 6/30/08
A Simple Guide to Scabies 10/5/07
A Simple Guide to Sciatica 7/14/08
A Simple Guide to Scoliosis 9/7/07
A Simple Guide to Shingles 8/17/07
A Simple Guide to Sinusitis 8/19/07
A Simple Guide to Skin Polyp 8/29/08
A Simple Guide to Squamous Cell Carcinoma 8/28/08
A Simple Guide to Stomach Cancer 9/26/07
A Simple Guide to Stomatitis 2/28/08
A Simple guide to Stress 10/8/07
A Simple Guide to Stroke 2 12/24/07
A Simple Guide to Stroke 12/23/07
A Simple Guide to Stye and Chalazion 8/23/07
A Simple Guide to Syphilis 11/18/07
A Simple Guide to Systemic Lupus Erythematosis 10/6/08
A Simple Guide to Tetanus 5/29/10
A Simple Guide to Testicular torsion 9/15/08
A Simple Guide to Thyroid Nodules 9/8/08
A Simple Guide to Tonsillitis 8/20/07
A Simple Guide to Trichomoniasis 11/15/07
A Simple Guide to Trigeminal Neuralgia 7/11/08
A Simple Guide to Typhoid Fever 12/4/07
A Simple Guide to Ulcerative Colitis 7/29/08
A Simple Guide to Uterine Fibroids 7/2/08
A Simple Guide to Urethritis 3/10/08
A Simple Guide to Urinary Incontinence 5/27/08
A Simple Guide to Urinary Stones 3/25/08
A Simple Guide to Urticaria 2/8/08
A Simple Guide to Uveitis 8/24/07
A Simple Guide to Varicose Veins 1/24/08
A Simple Guide to Vasomotor rhinitis 8/28/07
A Simple Guide to Vitiligo 4/28/09
A Simple Guide to Vulvitis 3/13/08
A Simple guide to Whooping Cough 11/27/07
Best Yahoo Answers to some Medical Conditions 2/19/09
Best Yahoo Answers to Medical Conditions 2/20/09
Best Yahoo Answer to question about Vitamin E 7/2/10
Answer about Sinusitis 11/4/09
-----------
To get to an article, please click on Table of Contents or labels:
A Simple Guide to Acne 10/14/07
A Simple Guide to Acne Rosacea 9/27/08
A Simple Guide to Acoustic Neuroma 10/5/08
A Simple Guide to Adenoiditis 7/6/08
A Simple Guide to AIDS 12/7/07
A Simple Guide to Allergies 6/11/08
A Simple Guide to Alopecia(Hair Loss) 9/9/07
A Simple Guide to Alzheimer's disease 9/15/07
A Simple Guide to Amenorrhea 7/3/08
A Simple Guide to Anal fissure 12/15/07
A Simple Guide to Anal fistula 7/15/08
A Simple Guide to Anaemia 8/27/07
A Simple Guide to Ankylosing Spondylosis 8/11/07
A Simple Guide to Anthrax 11/13/07
A Simple Guide to Appendicitis 12/14/07
A Simple Guide to Asthma 9/6/07
A Simple Guide to Astigmatism 10/1/07
A Simple Guide to Athlete's Foot 12/3/07
A Simple Guide to Atopic Dermatitis 11/25/08
A Simple Guide to Atrial Fibrillation I 10/13/08
A Simple Guide to Atrial Fibrillation II 10/14/08
A Simple Guide to Backache 10/4/07
A Simple Guide to Bacterial Vaginosis 11/22/07
A Simple Guide to Balanitis 12/16/07
A Simple Guide to Basal cell carcinoma 8/27/08
A Simple Guide to Beestings 12/8/07
A Simple Guide to Benign Prostatic Hyperplasia 5/23/08
A Simple Guide to Bladder Cancer 9/25/07
A Simple Guide to Blood Cancer 9/29/07
A Simple Guide to Breast Cancer 8/31/07
A Simple Guide to Bronchitis 9/9/08
A Simple Guide to Bruise 10/12/07
A Simple Guide to Burns & Scalds 12/19/07
A Simple Guide to Cancer 10/6/07
A Simple Guide to Candidiasis 11/17/07
A Simple Guide to Carpal Tunnel Syndrome 12/17/07
A Simple Guide to Cataract 8/6/10
A Simple Guide to Cellulitis 12/18/07
A Simple Guide to Cerebral aneurysm 11/11/07
A Simple Guide to Cerebral Palsy 9/3/07
A Simple Guide to Cervical Cancer 9/19/07
A Simple Guide to Cervical Spondylosis 2/12/08
A Simple Guide to Cervicitis 9/17/08
A Simple Guide to Chickenpox 8/14/07
A Simple Guide to Chikungunya Fever 1/3/2008
A Simple Guide to Chlamydia 10/9/07
A Simple Guide to Cholecystitis 12/21/07
A Simple Guide to Cholera 2/13/08
A Simple Guide to Chronic Obstructive Lung Disease10/11/07
A Simple Guide to Colorectal Cancer 9/2/07
A Simple Guide to Conjunctivitis 8/17/07
A Simple Guide to Constipation 8/8/07
A Simple Guide to Corneal Ulcer 8/2/08
A Simple Guide to Coronary Heart Disease Part 2 12/27/07
A Simple Guide to Coronary Heart Disease 12/26/07
A Simple Guide to Coryza(Common Cold) 9/10/07
A Simple Guide to Coughing 6/9/08
A Simple Guide to Crohn's Disease 7/30/08
A Simple Guide to Cutaneous Larva migrans 10/25/08
A Simple Guide to Cystitis 2/19/08
A Simple Guide to Dandruff 7/21/08
A Simple Guide to Deep Vein Thrombosis 9/21/07
A Simple Guide to Dengue Fever 1/3/08
A Simple Guide to Depression 11/2/07
A Simple Guide to Diabetes Part 2 12/11/07
A Simple Guide to Diabetes Mellitus 12/10/07
A Simple guide to Diphtheria 12/5/07
A Simple Guide to Diverticulosis 6/21/08
A Simple Guide to Dizziness 9/11/07
A Simple Guide to Dysmenorrhea 11/26/07
A Simple Guide to Ear Infections 9/12/07
A Simple Guide to Eczema 8/29/07
A Simple Guide to Endometriosis 10/10/07
A Simple Guide to Epididymitis and Orchitis 9/16/08
A Simple Guide to Epilepsy 11/1/07
A Simple Guide to Erectile Dysfunction 4/4/08
A Simple Guide to Facial Palsy 7/9/08
A Simple Guide to Fever 11/4/07
A Simple Guide to Fibromyalgia I 11/6/08
A Simple Guide to Fibromyalgia II 11/7/08
A Simple Guide to Folliculitis 10/24/08
A Simple Guide to Foot Care 7/27/2008
A Simple Guide to Frozen Shoulder 7/22/08
A Simple Guide to Gallstones 3/21/08
A Simple Guide to Gastritis 9/17/07
A Simple Guide to Gastroenteritis 8/15/07
A Simple Guide to Genital Herpes 11/9/07
A Simple Guide to Gingivitis 9/11/08
A Simple Guide to Glaucoma 8/21/07
A Simple Guide to Gonorrhea 11/12/07
A Simple Guide To Gout 8/10/07
A Simple Guide to Gynecomastia 10/21/08
A Simple Guide to Hand, Foot and Mouth Disease 11/5/07
A Simple Guide to Halitosis(Bad breath) 6/6/08
A Simple Guide to Headache 11/3/07
A Simple Guide to Heat Stroke 11/19/08
A Simple guide to Hemorrhoids 8/13/07
A Simple Guide to Hepatitis A 11/7/07
A Simple Guide to Hepatitis B 11/6/07
A Simple Guide to Hepatitis C 11/20/07
A Simple Guide to Hepatitis - Update 12/22/07
A Simple Guide to Hiccups 12/4/07
A Simple Guide to High Cholesterol 9/10/08
A Simple Guide to Human papilloma virus Infection 11/14/07
A Simple Guide to Hydrocoele 8/22/08
A Simple Guide to Hyperhidrosis 7/18/08
A Simple Guide to Hypertension 9/18/07
A Simple Guide to Hyperthyroid Disease 8/11/08
A Simple Guide to Hypothyroidism 8/12/08
A Simple Guide to Keloid 9/3/08
A Simple Guide to Kidney Cancer 11/13/08
A Simple Guide to Knee cap Dislocation 7/24/08
A Simple Guide to Infectious Mononucleosis 8/19/08
A Simple Guide to Inguinal Hernia 8/21/08
A Simple Guide to Irritable Bowel Syndrome 9/14/07
A Simple Guide to Laceration 10/13/07
A Simple Guide to Laryngitis 11/24/07
A Simple Guide to Laryngeal Cancer 5/4/10
A Simple Guide to Leprosy 11/24/07
A Simple Guide to Lice 11/19/07
A Simple Guide to Lichen Planus 9/4/08
A Simple Guide to Lipoma 8/24/08
A Simple Guide to Liver Cancer 9/26/07
A Simple Guide to Liver Cirrhosis I 10/28/08
A Simple Guide to Liver Cirrhosis II 10/29/08
A Simple Guide to Lung Cancer 9/22/07
A Simple Guide to Lymphoma 9/28/07
A Simple Guide to Malaria 10/7/07
A Simple Guide to Measles 11/21/07
A Simple Guide to Melonoma 8/26/08
A Simple Guide to Meniere's Disease 8/23/08
A Simple Guide to Meningitis 8/15/08
A Simple Guide to Menorrhagia 10/2/07
A Simple Guide to Menorrhagia2 6/29/08
A Simple Guide to Menopause2 12/2/07
A Simple Guide to Menopause 12/1/07
A Simple Guide to Mouth Ulcers 9/15/07
A Simple Guide to Mumps 10/3/07
A Simple Guide to Multiple Myeloma 9/29/07
A Simple Guide to Myasthenia Gravis 11/16/07
A Simple Guide to Nasopharyngeal Cancer 9/23/07
A Simple Guide to Non Pressure Hydrocephalus 8/17/08
A Simple Guide to Nosebleed (Epistaxis) 9/13/07
A Simple Guide to Obesity Part 2 12/31/07
A Simple Guide to Obesity 12/31/07
A Simple Guide to Obstructive Sleep Apnea 9/18/08
A Simple Guide to Osteoarthritis 8/7/07
A Simple Guide to Osteogenesis Imperfecta 10/22/08
A Simple Guide to Osteomyelitis 10/9/08
A Simple Guide to Osteoporosis 9/4/07
A Simple Guide to Otitis media 9/7/08
A Simple Guide to Ovarian Cancer 9/24/07
A Simple Guide to Pancreatic Cancer 6/18/08
A Simple Guide to Pancreatitis 6/14/08
A Simple Guide to Paronychia 6/25/08
A Simple Guide to Parkinson's Disease 8/23/07
A Simple Guide to Pecoma Cancer 3/3/08
A Simple Guide to Pelvic Inflammatory Disease 11/23/07
A Simple Guide to Pericarditis 11/1/08
A Simple Guide to Pityriasis Rosea 10/1/08
A Simple Guide to Plantar Fascilitis 7/25/08
A Simple Guide to Pleural effusion 11/11/08
A Simple Guide to Pneumonia 8/18/08
A Simple Guide to Pneumothorax 8/20/08
A Simple Guide to Poliomyelitis 12/19/07
A Simple Guide to Prickly Heat 10/23/08
A Simple Guide to Prolapsed Intervertebral Disc 7/17/08
A Simple Guide to Prostatitis 3/7/08
A Simple Guide to Prostate Cancer 9/5/07
A Simple Guide to Psoriasis 8/29/07
A Simple Guide to Retinal Detachment 9/12/08
A Simple Guide to Retinitis pigmentosa 9/14/08
A Simple Guide to Rheumatoid Arthritis 8/22/07
A Simple Guide to Rubella 9/20/07
A Simple Guide to Salivary Gland Cancer 11/28/08
A Simple Guide to Salpingitis 6/30/08
A Simple Guide to Scabies 10/5/07
A Simple Guide to Sciatica 7/14/08
A Simple Guide to Scoliosis 9/7/07
A Simple Guide to Shingles 8/17/07
A Simple Guide to Sinusitis 8/19/07
A Simple Guide to Skin Polyp 8/29/08
A Simple Guide to Squamous Cell Carcinoma 8/28/08
A Simple Guide to Stomach Cancer 9/26/07
A Simple Guide to Stomatitis 2/28/08
A Simple guide to Stress 10/8/07
A Simple Guide to Stroke 2 12/24/07
A Simple Guide to Stroke 12/23/07
A Simple Guide to Stye and Chalazion 8/23/07
A Simple Guide to Syphilis 11/18/07
A Simple Guide to Systemic Lupus Erythematosis 10/6/08
A Simple Guide to Tetanus 5/29/10
A Simple Guide to Testicular torsion 9/15/08
A Simple Guide to Thyroid Nodules 9/8/08
A Simple Guide to Tonsillitis 8/20/07
A Simple Guide to Trichomoniasis 11/15/07
A Simple Guide to Trigeminal Neuralgia 7/11/08
A Simple Guide to Typhoid Fever 12/4/07
A Simple Guide to Ulcerative Colitis 7/29/08
A Simple Guide to Uterine Fibroids 7/2/08
A Simple Guide to Urethritis 3/10/08
A Simple Guide to Urinary Incontinence 5/27/08
A Simple Guide to Urinary Stones 3/25/08
A Simple Guide to Urticaria 2/8/08
A Simple Guide to Uveitis 8/24/07
A Simple Guide to Varicose Veins 1/24/08
A Simple Guide to Vasomotor rhinitis 8/28/07
A Simple Guide to Vitiligo 4/28/09
A Simple Guide to Vulvitis 3/13/08
A Simple guide to Whooping Cough 11/27/07
Best Yahoo Answers to some Medical Conditions 2/19/09
Best Yahoo Answers to Medical Conditions 2/20/09
Best Yahoo Answer to question about Vitamin E 7/2/10
Answer about Sinusitis 11/4/09
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