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Arthrogryposis: Causes, Symptoms & Treatments

What is Arthrogryposis?

Arthrogryposis is a congenital medical condition in which a child is born with contractures of the joints meaning that some of the joints of the child do not move as fluently as the other more normal joints as if they are stuck in a position. It is also seen in Arthrogryposis that muscles adjacent to the affected joints are quite weak and stiff and in some cases muscles may even be completely missing. There is presence of extra tissues around the joints which make them stuck in one position. These contractures are mostly seen in the arms or the legs but can also be observed in the spine or the jaw. Arthrogryposis is not a single entity but is a feature of many different conditions of which the most common is known as amyoplasia. Children suffering from Arthrogryposis may also suffer from other health conditions impairing the nervous system, heart, kidneys and other vital organs of the body.

What Causes Arthrogryposis?

Arthrogryposis is caused by a condition called as fetal akinesia which means that when the baby is inside the womb of the mother it is not able to move inside as much as it should resulting in underdevelopment of the muscles and joints resulting in Arthrogryposis. When it comes to Fetal Akinesia, this may occur due to the following reasons:

  • Some abnormality in the central nervous system of the child in which the nerve signals do not reach the joints making them move adequately.
  • Another cause may be the womb is not big enough and the baby is cramped up for room and is not able to move adequately inside the womb of the mother.
  • There is an abnormality in the development of the muscles and bones of the tissue.

What are the Symptoms of Arthrogryposis?

Arthrogryposis as stated is a medical condition in which the child is born with joints that are too stiff too move and are stuck in one position. Some of the other accompanying symptoms are:

  • Muscle atrophy or missing muscles
  • Extremely stiff joints
  • Webbing of skin around the affected joints.

Since Arthrogryposis is not a single medical condition hence the child may also have symptoms indicating a problem with the nervous system, heart, kidneys or other vital organs of the body.

How is Arthrogryposis Treated?

The main aim for treating Arthrogryposis is to allow the child to move the affected joints as normally as possible, which means initiating treatments to increase the flexibility of the joint, improving strength of the muscles surrounding the joint, and maintaining a normal alignment of the bones. If the condition has affected the lower extremities then the aim of the treatment is to make the child ambulatory and if the upper extremities are affected then making sure that the child is able to use the hands in as normal way as possible. The following are the treatment strategies adopted for treatment of Arthrogryposis.

Physical/Occupational Therapy for Arthrogryposis: This is the first line of treatment of Arthrogryposis. As soon as the diagnosis of Arthrogryposis is made, the therapy is started to improve the flexibility of the joints affected and to increase strength of the joints. In the initial stage of treatment, the therapist will start with stretching exercises to improve the range of motion and strength of the joint of the child so as to improve their mobility. The therapist will also work on improving the child’s motor skills. In some cases assistive devices may also be needed to help the child become mobile and is able to do things without anybody’s help. Occupational therapists will device strategies to make the child more independent with their movement, writing, eating and the like.

Splinting and Casting: This is the next stage of treatment for Arthrogryposis in which the affected joint is either casted or splinted so that the joints are aligned in a normal way which will help the child move and navigate better and will be able to be independent. The casts and splints allow the joints to remain stretched and thus help prevent development of contractures. The splints that are used may be different for different functions.

It should be noted here that as the child grows the affected joints may not show the same rate of growth as the other muscles and joints of the body and hence ongoing therapy is extremely vital to keep the joints and muscle flexible and strong.

Surgery to Treat Arthrogryposis: This is recommended when the child has maximized improvement with physical therapy and use of splints and casts. The surgery is usually done when the child is a bit older to correct Arthrogryposis. The surgeries performed to correct the condition include osteotomy to align the joints normally for maximal benefits, procedures to release the muscles or tendons which are impairing free movement of the joints, a capsulotomy procedure in case a capsule is restricting the movement, surgeries to treat conditions like scoliosis, clubfoot and the like for treatment of Arthrogryposis.

CAUTI: Causes, Symptoms & Treatments

What Is a Catheter-Associated Urinary Tract Infection (CAUTI)?

A catheter-associated urinary tract infection (CAUTI) is one of the most common infections a person can contract in the hospital. Indwelling catheters are the cause of this infection. An indwelling catheter is a tube inserted into your urethra. It drains urine from your bladder into a collection bag. You may need a catheter if you have had surgery or cannot control your bladder function, and there is a need to closely monitor how much urine your kidneys are producing.

What Are the Symptoms of a CAUTI?

A CAUTI has similar symptoms to a typical urinary tract infection (UTI). These include:

  • cloudy urine
  • blood in the urine
  • strong urine odor
  • urine leakage around your catheter
  • pressure, pain, or discomfort in your lower back or stomach
  • chills
  • fever
  • unexplained fatigue
  • vomiting

CAUTIs can be difficult to diagnose in if you are already hospitalized because similar symptoms may be part of your original illness. In elderly people, changes in mental status or confusion can be signs of a CAUTI.

If you have a catheter and notice any localized discomfort, tell your nurse or doctor right away.

What Causes a CAUTI?

Bacteria or fungi may enter your urinary tract via the catheter. There they can multiply, causing an infection.

There are a number of ways infection can occur during catheterization. For example:

  • the catheter may become contaminated upon insertion
  • the drainage bag may not be emptied often enough
  • bacteria from a bowel movement may get on the catheter
  • urine in the catheter bag may flow backward into the bladder
  • the catheter may not be regularly cleaned

Clean insertion and removal techniques can help lower the risk of a CAUTI. Daily catheter care is required as well. Catheters shouldn’t be left in longer than needed, as longer use is associated with a higher risk of infection.

How Is a CAUTI Diagnosed?

A CAUTI is diagnosed using a urine test. Urinalysis can detect blood cells in your urine. Their presence may signal an infection.

Another useful test is a urine culture. This test identifies any bacteria or fungi in your urine. Knowing what caused the infection can help your doctor treat it.

Sometimes, your bladder doesn’t move urine out of your body quickly enough. This can happen even with a catheter. Retained urine is more likely to grow bacteria. Infection risk increases the longer urine stays in your bladder. Your doctor may recommend an imaging test of your bladder, such as an ultrasound scan, to see if you’re retaining urine.

Potential Complications of a CAUTI

Prompt treatment of a CAUTI is essential. An untreated UTI can lead to a more serious kidney infection. In addition, people with catheters may already have conditions that compromise their immune systems. Fighting off a CAUTI can cause further immune system stress. This makes you more vulnerable to future infections.

How Is a CAUTI Treated?

CAUTIs tend to be more resistant to treatment than other UTIs. This is true in general for hospital-acquired infections. CAUTIs are dangerous because they can lead to severe kidney infections. This makes prompt diagnosis and treatment vital for your long-term health.

Your doctor will likely prescribe antibiotics to kill off any harmful bacteria. In most cases, these will be oral antibiotics. You may be given antibiotics intravenously in the case of a severe infection. If the infection causes bladder spasms, your doctor may prescribe an anti-spasmodic to lessen bladder pain.

Increasing your fluid intake can also help you feel better by flushing bacteria from your urinary system. Certain fluids should be avoided. These include:

  • alcohol
  • citrus fruit juices
  • caffeinated beverages, such as sodas
How Can CAUTIs Be Prevented?

CAUTIs are one of the most common hospital-related infections. Therefore, many healthcare organizations place great emphasis on prevention.

Your doctor will carefully consider whether a catheter is necessary. They’ll also remove a necessary catheter as soon as possible.

In addition, you or the hospital staff should:

  • clean around the catheter each day
  • clean the skin around the catheter each day
  • keep the drainage bag below your bladder
  • empty the drainage bag several times per day
  • keep the catheter tube from kinking
  • wash your hands before and after touching the catheter or drainage bag
  • change the catheter at least once per month

Frequent hand-washing and good hygiene practices on the part of hospital staff can also help prevent CAUTIs.

Heart palpitations: Causes, Symptoms & treatments

They can be bothersome or frightening. They usually aren’t serious or harmful, though, and often go away on their own. Most of the time, they’re caused by stress and anxiety, or because you’ve had too much caffeine, nicotine, or alcohol. They can also happen when you’re pregnant.

Heart palpitations can be a sign of a more serious heart condition. So, if you have heart palpitations, see your doctor. Get immediate medical attention if they come with symptoms:

  • Shortness of breath
  • Dizziness
  • Chest pain
  • Fainting

After your doctor takes your medical history and looks you over, he may order tests to find the cause. If he finds one, the right treatment can reduce or get rid of the palpitations.

If there’s no underlying cause, lifestyle changes can help, including stress management.


There can be many. Usually, palpitations are either related to your heart or the cause is unknown. Non-heart-related causes include:

  • Strong emotions like anxiety, fear, or stress. They often happen during panic attacks.
  • Vigorous physical activity
  • Caffeine, nicotine, alcohol, or illegal drugs such as cocaine and amphetamines
  • Medical conditions, including thyroid disease, a low blood sugar level, anemia, low blood pressure, fever, and dehydration
  • Hormonal changes during menstruation, pregnancy, or just before menopause. Sometimes, palpitations during pregnancy are signs of anemia.
  • Medications, including diet pills, decongestants, asthma inhalers, and some drugs used to prevent arrhythmias (a serious heart rhythm problem) or treat an underactive thyroid
  • Some herbal and nutritional supplements
  • Abnormal electrolyte levels

Some people have palpitations after heavy meals rich in carbohydrates, sugar, or fat. Sometimes, eating foods with a lot of monosodium glutamate (MSG), nitrates, or sodium can bring them on, too.

If you have heart palpitations after eating certain foods, it could be due to food sensitivity. Keeping a food diary can help you figure out which foods to avoid.

They can also be related to heart disease. When they are, they’re more likely to represent arrhythmia. Heart conditions tied to palpitations include:

  • Prior heart attack
  • Coronary artery disease
  • Heart failure
  • Heart valve problems
  • Heart muscle problems


Hepatocellular carcinoma: Causes, Symptoms& Treatments

Hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer. Hepatocellular carcinoma occurs most often in people with chronic liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection.


Tests and procedures used to diagnose hepatocellular carcinoma include:

  • Blood tests to measure liver function
  • Imaging tests, such as CT and MRI with contrast, and advanced imaging procedures, such as magnetic resonance elastography
  • Liver biopsy, in some cases, to remove a sample of liver tissue for laboratory testing

Liver cancer is cancer that begins in the cells of your liver. Your liver is a football-sized organ that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach.

Several types of cancer can form in the liver. The most common type of liver cancer is hepatocellular carcinoma, which begins in the main type of liver cell (hepatocyte). Other types of liver cancer, such as intrahepatic cholangiocarcinoma and hepatoblastoma, are much less common.

Not all cancers that affect the liver are considered liver cancer. Cancer that begins in another area of the body — such as the colon, lung or breast — and then spreads to the liver is called metastatic cancer rather than liver cancer. And this type of cancer is named after the organ in which it began — such as metastatic colon cancer to describe cancer that begins in the colon and spreads to the liver. Cancer that spreads to the liver is more common than cancer that begins in the liver cells.


Most people don’t have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include:

  • Losing weight without trying
  • Loss of appetite
  • Upper abdominal pain
  • Nausea and vomiting
  • General weakness and fatigue
  • Abdominal swelling
  • Yellow discoloration of your skin and the whites of your eyes (jaundice)
  • White, chalky stools


It’s not clear what causes most cases of liver cancer. But in some cases, the cause is known. For instance, chronic infection with certain hepatitis viruses can cause liver cancer.

Liver cancer occurs when liver cells develop changes (mutations) in their DNA — the material that provides instructions for every chemical process in your body. DNA mutations cause changes in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor — a mass of cancerous cells.

Risk factors

Factors that increase the risk of primary liver cancer include:

  • Chronic infection with HBV or HCV. Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV) increases your risk of liver cancer.
  • Cirrhosis. This progressive and irreversible condition causes scar tissue to form in your liver and increases your chances of developing liver cancer.
  • Certain inherited liver diseases. Liver diseases that can increase the risk of liver cancer include hemochromatosis and Wilson’s disease.
  • Diabetes. People with this blood sugar disorder have a greater risk of liver cancer than those who don’t have diabetes.
  • Nonalcoholic fatty liver disease. An accumulation of fat in the liver increases the risk of liver cancer.
  • Exposure to aflatoxins. Aflatoxins are poisons produced by molds that grow on crops that are stored poorly. Crops such as corn and peanuts can become contaminated with aflatoxins, which can end up in foods made of these products. In the United States, safety regulations limit aflatoxin contamination. Aflatoxin contamination is more common in certain parts of Africa and Asia.
  • Excessive alcohol consumption. Consuming more than a moderate amount of alcohol daily over many years can lead to irreversible liver damage and increase your risk of liver cancer.


Reduce your risk of cirrhosis

Cirrhosis is scarring of the liver, and it increases the risk of liver cancer. You can reduce your risk of cirrhosis if you:

  • Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount you drink. For women, this means no more than one drink a day. For men, this means no more than two drinks a day.
  • Maintain a healthy weight. If your current weight is healthy, work to maintain it by choosing a healthy diet and exercising most days of the week. If you need to lose weight, reduce the number of calories you eat each day and increase the amount of exercise you do. Aim to lose weight slowly — 1 or 2 pounds (0.5 to 1 kilograms) each week.
  • Use caution with chemicals. Follow instructions on chemicals you use at home or at work.

Get vaccinated against hepatitis B

You can reduce your risk of hepatitis B by receiving the hepatitis B vaccine, which provides more than 90 percent protection for both adults and children. The vaccine can be given to almost anyone, including infants, older adults and those with compromised immune systems.

Take measures to prevent hepatitis C

No vaccine for hepatitis C exists, but you can reduce your risk of infection.

  • Know the health status of any sexual partner. Don’t engage in unprotected sex unless you’re certain your partner isn’t infected with HBV, HCV or any other sexually transmitted infection. If you don’t know the health status of your partner, use a condom every time you have sexual intercourse.
  • Don’t use intravenous (IV) drugs, but if you do, use a clean needle. Reduce your risk of HCV by not injecting illegal drugs. But if that isn’t an option for you, make sure any needle you use is sterile, and don’t share it. Contaminated drug paraphernalia is a common cause of hepatitis C infection. Take advantage of needle-exchange programs in your community and consider seeking help for your drug use.
  • Seek safe, clean shops when getting a piercing or tattoo. Needles that may not be properly sterilized can spread the hepatitis C virus. Before getting a piercing or tattoo, check out the shops in your area and ask staff members about their safety practices. If employees at a shop refuse to answer your questions or don’t take your questions seriously, take that as a sign that the facility isn’t right for you.

Ask your doctor about liver cancer screening

For the general population, screening for liver cancer hasn’t been proved to reduce the risk of dying of liver cancer, so it isn’t generally recommended. The American Association for the Study of Liver Diseases recommends liver cancer screening for those thought to have a high risk, including people who have:

  • Hepatitis B and one or more of the following apply: are Asian or African, have liver cirrhosis, or have a family history of liver cancer
  • Hepatitis C infection and liver cirrhosis
  • Liver cirrhosis from other causes, such as an autoimmune disease, excessive alcohol use, nonalcoholic fatty liver disease and inherited hemochromatosis
  • Primary biliary cirrhosis

Discuss the pros and cons of screening with your doctor. Together you can decide whether screening is right for you based on your risk. Screening typically involves an ultrasound exam every six months.


Which treatment is best for you will depend on the size and location of your hepatocellular carcinoma, how well your liver is functioning, and your overall health.

Hepatocellular carcinoma treatments include:

  • Surgery. Surgery to remove the cancer and a margin of healthy tissue that surrounds it may be an option for people with early-stage liver cancers who have normal liver function.
  • Liver transplant surgery. Surgery to remove the entire liver and replace it with a liver from a donor may be an option in otherwise healthy people whose liver cancer hasn’t spread beyond the liver.
  • Destroying cancer cells with heat or cold. Ablation procedures to kill the cancer cells in the liver using extreme heat or cold may be recommended for people who can’t undergo surgery. These procedures include radiofrequency ablation, cryoablation, and ablation using alcohol or microwaves.
  • Delivering chemotherapy or radiation directly to cancer cells. Using a catheter that’s passed through your blood vessels and into your liver, doctors can deliver chemotherapy drugs (chemoembolization) or tiny glass spheres containing radiation (radioembolization) directly to the cancer cells.
  • Targeted drug therapy. Targeted drugs, such as sorafenib (Nexavar), may help slow the progression of the disease in people with advanced liver cancer.
  • Radiation therapy. Radiation therapy using energy from X-rays or protons may be recommended if surgery isn’t an option. A specialized type of radiation therapy, called stereotactic body radiotherapy (SBRT), involves focusing many beams of radiation simultaneously at one point in your body.
  • Clinical trials. Clinical trials give you a chance to try new liver cancer treatments. Ask your doctor whether you’re eligible to participate in a clinical trial.

Hepatocellular Carcinoma: Causes, symptoms & treatments

Hepatocellular carcinoma usually occurs in patients with cirrhosis and is common in areas where infection with hepatitis B and C viruses is prevalent. Symptoms and signs are usually nonspecific. Diagnosis is based on alpha-fetoprotein (AFP) levels, imaging tests, and sometimes liver biopsy. Screening with periodic AFP measurement and ultrasonography is sometimes recommended for high-risk patients. Prognosis is poor when cancer is advanced, but for small tumors that are confined to the liver, ablative therapies are palliative and surgical resection or liver transplantation is sometimes curative.

Hepatocellular carcinoma is the most common type of primary liver cancer, with an estimated 23,000 new cases and about 14,000 deaths expected in 2012 in the US. However, it is more common outside the US, particularly in East Asia and sub-Saharan Africa where the incidence generally parallels geographic prevalence of chronic hepatitis B virus (HBV) infection.

Overview of Hepatocellular Carcinoma


Hepatocellular carcinoma is usually a complication of cirrhosis.

The presence of HBV increases risk of hepatocellular carcinoma by > 100-fold among HBV carriers. Incorporation of HBV-DNA into the host’s genome may initiate malignant transformation, even in the absence of chronic hepatitis or cirrhosis.

Other disorders that cause hepatocellular carcinoma include cirrhosis due to chronic hepatitis C virus (HCV) infection, hemochromatosis, and alcoholic cirrhosis. Patients with cirrhosis due to other conditions are also at increased risk.

Environmental carcinogens may play a role; eg, ingestion of food contaminated with fungal aflatoxins is believed to contribute to the high incidence of hepatocellular carcinoma in subtropical regions.

Symptoms and Signs

Most commonly, previously stable patients with cirrhosis present with abdominal pain, weight loss, right upper quadrant mass, and unexplained deterioration. Fever may occur. In a few patients, the first manifestation of hepatocellular carcinoma is bloody ascites, shock, or peritonitis, caused by hemorrhage of the tumor. Occasionally, a hepatic friction rub or bruit develops.

Occasionally, systemic metabolic complications, including hypoglycemia, erythrocytosis, hypercalcemia, and hyperlipidemia, occur. These complications may manifest clinically.


  • Alpha-fetoprotein (AFP) measurement


  • Imaging (CT, ultrasonography, or MRI)

Clinicians suspect hepatocellular carcinoma if


  • They feel an enlarged liver.
  • Unexplained decompensation of chronic liver disease develops.
  • An imaging test detects a mass in the right upper quadrant of the abdomen during an examination done for other reasons, especially if patients have cirrhosis.

However, screening programs enable clinicians to detect many hepatocellular carcinomas before symptoms develop.

Diagnosis is based on AFP measurement and an imaging test. In adults, AFP signifies dedifferentiation of hepatocytes, which most often indicates hepatocellular carcinoma; 40 to 65% of patients with the cancer have high AFP levels (> 400 μg/L). High levels are otherwise rare, except in teratocarcinoma of the testis, a much less common tumor. Lower values are less specific and can occur with hepatocellular regeneration (eg, in hepatitis). Other blood tests, such as AFP-L3 (an AFP isoform) and des-gamma–carboxyprothrombin, are being studied as markers to be used for early detection of hepatocellular carcinoma.

Depending on local preferences and capabilities, the first imaging test may be contrast-enhanced CT, ultrasonography, or MRI. Hepatic arteriography is occasionally helpful in equivocal cases and can be used to outline the vascular anatomy when ablation or surgery is planned.

If imaging shows characteristic findings and AFP is elevated, the diagnosis is clear. Liver biopsy, often guided by ultrasonography or CT, is sometimes indicated for definitive diagnosis.


If a hepatocellular carcinoma is diagnosed, evaluation usually includes chest CT without contrast, imaging of the portal vein (if not already done) by MRI or CT with contrast to exclude thrombosis, and sometimes bone scanning.

Various systems can be used to stage hepatocellular carcinoma; none is universally used. One system is the TNM system, based on the following (see Table: Staging Hepatocellular Carcinoma*):

  • T: How many primary tumors, how big they are, and whether the cancer has spread to adjacent organs

    N: Whether the cancer has spread to nearby lymph nodes

    M: Whether the cancer has metastasized to other organs of the body

Numbers (0 to 4) are added after T, N, and M to indicate increasing severity.

Staging Hepatocellular Carcinoma*


On increasing number of hepatocellular carcinomas are being detected through screening programs. Screening patients with cirrhosis is reasonable, although this measure is controversial and has not been shown to reduce mortality. One common screening method is ultrasonography every 6 or 12 mo. Many experts advise screening patients with long-standing hepatitis B even when cirrhosis is absent.


  • Transplantation if tumors are small and few

Treatment of hepatocellular carcinoma depends on its stage (1).

For single tumors < 5 cm or  3 tumors that are all  3 cm and that are limited to the liver, liver transplantation results in as good a prognosis as liver transplantation done for noncancerous disorders. Alternatively, surgical resection may be done; however, the cancer usually recurs.

Ablative treatments (eg, hepatic arterial chemoembolization, yttrium-90 microsphere embolization [selective internal radiation therapy, or SIRT], drug-eluting bead transarterial embolization, radiofrequency ablation) provide palliation and slow tumor growth; they are used when patients are awaiting liver transplantation.

If the tumor is large (> 5 cm), is multifocal, has invaded the portal vein, or is metastatic (ie, stage III or higher), prognosis is much less favorable (eg, 5-yr survival rates of about 5% or less). Radiation therapy is usually ineffective. Sorafenib appears to improve outcomes.


Use of vaccine against HBV eventually decreases the incidence, especially in endemic areas. Preventing the development of cirrhosis of any cause (eg, via treatment of chronic hepatitis C, early detection of hemochromatosis, or management of alcoholism) can also have a significant effect.

Key Points:


  • Hepatocellular carcinoma is usually a complication of cirrhosis and is most common in parts of the world where hepatitis B is prevalent.
  • Consider the diagnosis if physical examination or an imaging test detects an enlarged liver or if chronic liver disease worsens unexpectedly.
  • Diagnose hepatocellular carcinoma based on the AFP level and liver imaging results, and stage it using chest CT without contrast, portal vein imaging, and sometimes bone scanning.
  • Consider liver transplantation if tumors are small and few.
  • Prevention involves use of the hepatitis B vaccine and management of disorders that can cause cirrhosis.

DCR: Details of treatment

What is nasolacrimal duct obstruction?

Tears normally drain away from the eye through small holes on the eyelid called puncta, then through the tear duct which opens into the nose. If the passageway is narrow (stenosed) or blocked, excessive tearing may result. Irrigation of the drainage system is performed in office to determine whether the tear duct is blocked.

What are treatments for nasolacrimal duct obstruction?

The main treatments for blocked tear duct include stenting with silicone tube (usually for partial blockage) and dacryocystorhinostomy (DCR, usually for more severe blockage).

What is silicone intubation?

A very thin silicone tube is passed through the openings of the tear drain in the upper and lower eyelids, passed down the tear duct, and secured with a suture to the inside of the nostril. The silicone tube is kept in place after the procedure to help open the drainage pathway. The procedure is performed in an operating room under sedation or anesthesia and usually takes less than 1 hour.

How long does the silicone tube stay in after the surgery?

The silicone tube will usually stay in place for 3-6 months and sometimes up to 9 months, depending on the degree and location of blockage. The tube will then be removed in office. Silicone tube Diagram of silicone intubation of the left eye Silicone tube is tied to the inside the nostril with a suture The only visible part of the silicone tube is at the corner of the eye Lacrimal sac Lacrimal gland Tear duct Tear flows across the eye.

What should I do after the silicone intubation procedure?

You should use antibiotics/steroids drops and sometimes ointment as instructed by your doctor, usually tapered over 3 weeks after the procedure. You may experience some bloody discharge from your nose for a few days after the surgery. Please avoid rubbing the inner corner of your eye, forceful nose blowing, nose picking or poking at the tube. This could cause the silicone tube to come out sooner than planned, and limit the effectiveness of the procedure.

What should I do if my nose is congested after the silicone intubation?

You can use over-the-counter nasal saline  as needed to relieve the nasal congestion. Afrin® may be used as well, but no longer than 3 days to prevent unwanted side effects. What does it look like to have a silicone tube in place? You may notice a clear plastic tube connecting at the inner corner of your eye. It is barely noticeable for most people. Why am I still tearing after I had a silicone intubation procedure? Most patients will notice a significant improvement in tearing shortly after silicone intubation. However, a subset of patients will have continued watering until the tube is removed. For a small group of patients (approximately 10%), the tearing is actually worse when the tubing is in place. Most, but not all, patients eventually notice improvement in the excess tearing by the time the tubing has been removed. Photo 2: Photograph of the right eye 1 week after silicone intubation. Please note the clear silicone tube at the inside corner of the right eye. If the silicone tube comes out, what should I do? Generally the tube will stay in place without problems. If the tube becomes dislodged, you may notice a loop of silicone tube coming out from the corner of your eye. You should tape the loop to your nose and call the doctor’s office as soon as possible. Do not pull it out or cut it.

Psoriasis: Causes, Symptoms & Treatments


Most types of psoriasis are mild to moderate.

Psoriasis is a skin condition that causes skin cells to form too quickly. Because new skin cells grow faster than the body sheds existing skin cells, thick, scaly patches of skin form.

There are several types of psoriasis. Most types of psoriasis tend to be mild to moderate. However, some types of psoriasis are more likely to be severe.

Psoriasis on back of hand.

Types of the condition include:

  • plaque psoriasis
  • psoriasis of the scalp
  • guttate psoriasis
  • inverse psoriasis
  • pustular psoriasis
  • erythrodermic psoriasis

People with psoriasis may develop one type of psoriasis and then develop another type at a later point in time.

General symptoms

While symptoms vary with the type of psoriasis a person has, most people with psoriasis will experience some combination of the following symptoms:

  • itchy skin
  • burning, sore, or painful areas on the skin
  • patches of thick skin with silvery scales
  • small scaly spots
  • swollen or stiff joints

Psoriasis symptoms tend to be cyclical. This means that they will often become more intense during what are called flares and lessen at other times.

During flares, symptoms may be more severe even in cases of mild psoriasis. At other times, symptoms may be minimal.

Plaque psoriasis

Plaque psoriasis

Plaque psoriasis may itch or burn, and covers the skin with dry, red lesions that may appear “scaly.”

Plaque psoriasis, also known as psoriasis vulgaris, is the most common form of psoriasis. It is marked by areas of plaque buildup on the skin.

Plaque is the thickened areas of skin that often have a white or silvery, scaled appearance. They tend to appear most on elbows, knees, and lower back but may form anywhere on the body.

Plaque psoriasis tends to be mild to moderate. Mild plaque psoriasis covers less than 3 percent of the body, and moderate plaque psoriasis covers less than 10 percent of the body.


Symptoms of plaque psoriasis vary from person to person. These symptoms can include the following:

  • areas of dry, red skin lesions covered with silvery scales
  • plaques that itch or burn
  • problems that affect the nails

Areas of plaque may appear anywhere on the body but are most common on the knees and elbows.


Treatment of mild or moderate plaque psoriasis varies and often requires trial and error before determining the best treatment combination for that person.

Treatment options include the following:

  • exposing the skin to ultraviolet (UV) light
  • creams and ointments applied to affected areas to slow down skin growth

Drugs that affect the whole body are rarely used for mild psoriasis. However, these drugs may be used if other treatments fail.

Scalp psoriasis

Scalp psoriasis under hair.

Scalp psoriasis may be treated with medicated shampoo or ointments.

When psoriasis appears on the scalp, it is known as scalp psoriasis. It can appear on the forehead, or back of the head and extend down the neck or behind the ears.


Scalp psoriasis usually has the same symptoms as plaque psoriasis. In scalp psoriasis, the plaques appear on the scalp and under the hair.

A person with scalp psoriasis can have psoriasis on other parts of their body at the same time.

Other symptoms of scalp psoriasis include:

  • red patches of thick skin on the scalp
  • silvery dandruff-like flakes on the scalp
  • itching and bleeding scalp
  • a dry scalp
  • temporary hair loss during flares


Treatment for scalp psoriasis often involves more than one method at a time. As with plaque psoriasis, it may take some time to find the best approach for the individual.

Treatment options for scalp psoriasis include:

  • medicated shampoos and ointments
  • UV light therapy
  • injections
  • scalp therapy

In more severe cases, drugs that affect the whole body may be added to a treatment plan.

Guttate psoriasis

Guttate psoriasis causing red dots.

Guttate psoriasis commonly appears after an infection during childhood.

Guttate psoriasis is characterized by red dots and spots spread throughout the skin. The dots and spots are not as thick as plaques in plaque psoriasis.

This type of psoriasis often starts in childhood or young adulthood and appears after an infection.


Most often, guttate psoriasis is mild psoriasis. In some cases, however, it may cause moderate to severe symptoms. Symptoms may include the following:

  • small, red spots on the skin
  • potentially hundreds of red dots on skin
  • a rash that can appear anywhere but mostly on the trunk
  • sudden onset of a rash after illness or infection


Most doctors consider topical treatments very effective for guttate psoriasis. However, people with guttate psoriasis may find applying the cream on so many individual spots very tiring, so topical treatments may be used more when the rash is confined to a smaller area.

Other treatment options include light therapy. Doctors rarely use drugs affecting the whole body for guttate psoriasis.

Inverse psoriasis

Inverse psoriasis on neck skin.

Inverse psoriasis usually appears in the armpits or groin.

Inverse psoriasis appears as red marks that are most often found in the folds of the skin, such as in the armpits and groin.

People with inverse psoriasis often have other forms of psoriasis elsewhere on their body.


Areas of the body that are most likely to be affected by inverse psoriasis include:

  • armpits
  • groin
  • under the breasts
  • behind the knee

Areas affected by inverse psoriasis rarely have scaly plaques that are common with other forms of psoriasis.


The areas of the body that are most often affected by inverse psoriasis tend to be quite sensitive and have thinner skin than other areas. This can make treating this type of psoriasis more difficult.

Steroid creams and ointments are effective, but the risk of side effects is higher due to the thinness of the skin.

Pustular psoriasis

Pustular psoriasis on child's feet.

Palmoplantar pustulosis is a form of pustular psoriasis, which forms on the palms of the hands or soles of the feet.

This type of psoriasis is marked by white blisters that contain pus. This pus is not infectious and is made of white blood cells.


The blisters that are caused by pustular psoriasis can be limited to one area of the body or appear more generally across the whole body.

Before the blisters appear, the skin tends to redden. Once the blisters have gone away, the skin may become scaly.

A specific kind of pustular psoriasis called palmoplantar pustulosis causes blisters to form on the palms and soles of the feet. These blisters form in a studded pattern. Over time, the blisters turn brown and become crusty.


Some forms of pustular psoriasis can be difficult to treat. Doctors will often switch between oral medications and light therapy, to reduce the risk of side effects.

Acitretin and methotrexate are two drugs that can treat the condition quickly and clear up the affected areas of skin.

Pustular psoriasis that only affects one area of the body may also be treated with medication applied to the skin.

Erythrodermic psoriasis: need to see a doctor

While most forms of psoriasis tend to be mild or moderate, erythrodermic psoriasis is severe and can be a life-threatening medical emergency.

This type of inflammatory psoriasis covers most of the body in a red, peeling, extremely painful rash that looks as if it has been caused by a burn.



Unlike symptoms of the types of psoriasis that are usually mild, symptoms of erythrodermic psoriasis tend to be very serious. They may include a combination of the following:

  • widespread area of inflamed, red skin
  • skin that peels off in sheets
  • skin that looks as if it has been burned
  • severe itching, pain, or burning
  • faster heart rate
  • fever or lower body temperature
  • swelling in feet or ankles

People suffering from erythrodermic psoriasis are prone to infection. They may also experience other serious problems, including heart failure and pneumonia.


People with erythrodermic psoriasis are often hospitalized. Unlike in cases of mild or moderate psoriasis, topical creams are not the first line of treatment. Instead, most people with erythrodermic psoriasis need drugs that affect the whole body.


Most types of psoriasis tend to be mild to moderate except erythrodermic psoriasis, which can be a life-threatening medical emergency.

Psoriasis varies in its appearance and symptoms, but most treatment approaches are very similar.

People who suspect that they have psoriasis should consult their doctor before beginning treatment. People with symptoms of erythrodermic psoriasis should seek immediate medical attention.

Skin Tags: Details & Treatments

A skin tag is a small piece of soft, hanging skin that may have a peduncle, or stalk. They can appear anywhere on the body, but especially where skin rubs against other skin or clothing.

Other names are an acrochordon, cutaneous papilloma, cutaneous tag, fibroepithelial polyp, fibroma molluscum, fibroma pendulum, soft fibroma, and Templeton skin tags.

Skin tags are very common and generally occur after midlife. They affect men and women equally.

Fast facts on skin tagsHere are some key points about skin tags. More detail is in the main article.

  • Skin tags are benign tumors of the skin.
  • They commonly occur in creases or folds of the skin.
  • They are not dangerous, but they can be removed for aesthetic and cosmetic reasons.
  • Methods of skin tag removal include over the counter (OTC) therapies, excision, and cryotherapy.

What are skin tags?

Skin tags, Grook Da Oger, own work, 2012 (wikicommons)

Skin tags are harmless and often removed for cosmetic reasons. 

Skin tags are benign, noncancerous, tumors of the skin. They consist of a core of fibers and ducts, nerve cells, fat cells, and a covering or epidermis.

They may appear on the:

  • eyelids
  • armpits
  • under the breasts
  • groin
  • upper chest
  • neck, in the case of papilloma colli

They often go unnoticed, unless they are in a prominent place or are repeatedly rubbed or scratched, for example, by clothing, jewelry, or when shaving.

Some people may have skin tags and never notice them. In some cases, they rub off or fall off painlessly. Very large skin tags may burst under pressure.

The surface of skin tags may be smooth or irregular in appearance. They are often raised from the surface of the skin on fleshy peduncles, or stalks. They are usually flesh-colored or slightly brownish.

Skin tags start small, flattened like a pinhead bump. Some stay small, and some grow bigger. They can range in diameter from 2 millimeters (mm) to 1 centimeter (cm), and some may reach 5cm.


As skin tags are usually harmless, removal is normally for aesthetic or cosmetic reasons.

Large skin tags, especially in areas where they may rub against something, such as clothing, jewelry or skin, may be removed due to irritation.

Removing a large skin tag from the face or under the arms can make shaving easier.


The following procedures may be used:

  • Cauterization: The skin tag is burned off using electrolysis
  • Cryosurgery: The skin tag is frozen off using a probe containing liquid nitrogen
  • Ligation: The blood supply to the skin tag is interrupted
  • Excision: The tag is cut out with a scalpel

These procedures should only be done by a dermatologist, or specialist skin doctor, or a similarly trained medical professional.

Skin tags on the eyelid, especially those close to the eyelid margin, may have to be removed by an ophthalmologist, or specialist eye doctor.

Removing a skin tag at home is not normally recommended, due to a risk of bleeding and possible infection.

However, very small tags can be removed by tying dental floss or thin cotton thread around the base of the tag to cut off circulation to the tag.

Temporomandibular disorders (TMD): Causes, Symptoms & treatments

What Causes TMD?

We don’t know what causes TMD. Dentists believe symptoms arise from problems with the muscles of your jaw or with the parts of the joint itself. Injury to your jaw, the joint, or the muscles of your head and neck — like from a heavy blow or whiplash — can lead to TMD. Other causes include:

  • Grinding or clenching your teeth, which puts a lot of pressure on the joint
  • Movement of the soft cushion or disc between the ball and socket of the joint
  • Arthritis in the joint
  • Stress, which can cause you to tighten facial and jaw muscles or clench the teeth.

What Are the Symptoms?

TMD often causes severe pain and discomfort. It can be temporary or last many years. It might affect one or both sides of your face. More women than men have it, and it’s most common among people between the ages of 20 and 40.

Common symptoms include:

  • Pain or tenderness in your face, jaw joint area, neck and shoulders, and in or around the ear when you chew, speak, or open your mouthwide
  • Problems when you try to open your mouth wide
  • Jaws that get “stuck” or “lock” in the open- or closed-mouth position
  • Clicking, popping, or grating sounds in the jaw joint when you open or close your mouth or chew. This may or may not be painful.
  • A tired feeling in your face
  • Trouble chewing or a sudden uncomfortable bite — as if the upper and lower teeth are not fitting together properly
  • Swelling on the side of your face

You may also have toothaches, headaches, neck aches, dizziness, earaches, hearing problems, upper shoulder pain, and ringing in the ears (tinnitus).

How Is TMD Diagnosed?

Many other conditions cause similar symptoms — like tooth decay, sinusproblems, arthritis, or gum disease. To figure out what’s causing yours, the dentist will ask about your health history and conduct a physical exam.

He’ll check your jaw joints for pain or tenderness and listen for clicks, pops, or grating sounds when you move them. He’ll also make sure your jaw works like it should and doesn’t lock when you open or close your mouth. Plus he’ll test your bite and check for problems with your facial muscles.

Your dentist may take full face X-rays so he can view your jaws, temporomandibular joints, and teeth to rule out other problems. He may need to do other tests, like magnetic resonance imaging (MRI) or computer tomography (CT). The MRI can show if the TMJ disc is in the proper position as your jaw moves. A CT scan shows the bony detail of the joint.

You may get referred to an oral surgeon (also called an oral and maxillofacial surgeon) for further care and treatment. This doctor specializes in surgery in and around the entire face, mouth, and jaw area. You may also see an orthodontist to ensure your teeth, muscles, and joints work like they should.

Traditional Treatments

Talk to your dentist about these tried-and-true treatments for TMD:

Medications. Your dentist can prescribe higher doses of NSAIDs if you need them for pain and swelling. He might suggest a muscle relaxer to relax your jaw if you grind or clench your teeth. Or an anti-anxiety medication to relieve stress, which may bring on TMD. In low doses they can also help reduce or control pain. Muscle relaxants, anti-anxiety drugs, and antidepressants are available by prescription only.

A splint or night guard. These plastic mouthpieces fit over your upper and lower teeth so they don’t touch. They lessen the effects of clenching or grinding and correct your bite by putting your teeth in a more correct position. What’s the difference between them? You wear night guards while you sleep. You use a splint all the time. Your dentist will tell you which type you need.Dental work. Your dentist can replace missing teeth and use crowns, bridges, or braces to balance the biting surfaces of your teeth or to correct a bite problem.

Other Treatments

If the treatments listed above don’t help, your dentist may suggest one or more of the following:

Transcutaneous electrical nerve stimulation (TENS). This therapy uses low-level electrical currents to provide pain relief by relaxing your jaw joint and facial muscles. It can be done at the dentist’s office or at home.

Ultrasound. Deep heat applied to the joint can relieve soreness or improve mobility.

Trigger-point injections. Pain medication or anesthesia is injected into tender facial muscles called “trigger points” to give relief.

Radio wave therapy. Radio waves stimulate the joint, which increases blood flow and eases pain.

Low-level laser therapy. This lowers pain and inflammation and helps you move your neck more freely and open your mouth wider.

Surgery for TMD:

If other treatments can’t help you, surgery is an option. Once it’s done, it can’t be undone, so get a second or even third opinion from other dentists.

There are three types of surgery for TMD. The type you need depends on the problem.

Arthrocentesis is used if you have no major history of TMJ but your jaws are locked. It’s a minor procedure that your dentist can do in his office. He’ll give you general anesthesia, then insert needles into the joint and wash it out. He may use a special tool to get rid of damaged tissue or dislodge a disc stuck in the joint, or to unstick the joint itself.

Arthroscopy is surgery done with an arthroscope. This special tool has a lens and a light on it. It lets your doctor see inside your joint. You’ll get general anesthesia, then the doctor will make a small cut in front of your ear and insert the tool. It’ll be hooked up to a video screen, so he can examine your joint and the area around it. He may remove inflamed tissue or realign the disc or joint. This type of surgery, known as minimally invasive, leaves a smaller scar, has fewer complications, and requires a shorter recovery time than a major operation.

Open-joint surgery. Depending on the cause of the TMD, arthroscopy may not be possible. You may need this type of surgery if:

  • The bony structures in your jaw joint are wearing down
  • You have tumors in or around the joint
  • Your joint is scarred or full of bone chips

You’ll get general anesthesia, then the doctor will open up the entire area around the joint so he can get a full view and better access. You’ll need longer to heal after open-joint surgery, and there is a greater chance of scarring and nerve injury.

Neurogenic Bladder: Causes, Symptoms & Treatments

What is neurogenic bladder?

When neurological (nervous system) conditions affect the bladder, it is called neurogenic bladder. There are two major types of bladder control problems that are associated with a neurogenic bladder. Depending on the nerves involved and nature of the damage, the bladder becomes either overactive (spastic or hyper-reflexive) or underactive (flaccid or hypotonic).

What is the bladder?

The bladder is a hollow organ located in the pelvis, or lower abdomen. The bladder has two important functions:

  • It stores urine.
  • It removes urine from the body through a complex communication circuit in the spinal cord and brain.

Urinary incontinence occurs when a person cannot control the flow of urine. The storage of urine can be a problem if the bladder is unable to empty fully or if it begins to empty itself before the person reaches the bathroom (a condition known as overactive bladder). Leakage can occur if the bladder cannot empty (overflow incontinence), if the sphincter controlling urination doesn’t work (stress incontinence), or if bladder spasms cause the bladder to shrink before the person reaches the toilet (urge incontinence).


What causes neurogenic bladder?

Neurogenic bladder can be congenital (present at birth). Birth defects that can cause neurogenic bladder include:

  • Spina bifida (myelomeningocele): This disorder occurs when the fetus’ spine does not completely develop during the first month of pregnancy. Babies born with myelomeningocele often have paralysis or weakness that affects how the bladder works.
  • Sacral agenesis: This is a condition in which parts of the lower spine are missing.
  • Cerebral palsy: Cerebral palsy is a group of chronic (long-term) disorders that weaken a person’s ability to control body movement and posture. These disorders result from injury to the motor areas of the brain. The problem causing cerebral palsy may occur while the infant is still in the womb or after birth. Cerebral palsy is not always found during a child’s first year of life.

Various medical conditions can cause neurogenic bladder, including the following:

  • Stroke
  • Parkinson’s disease
  • Multiple sclerosis
  • Spinal cord injuries
  • Spinal surgeries
  • Erectile dysfunction
  • Trauma/accidents
  • Central nervous system tumors
  • Heavy metal poisoning

What are the symptoms of neurogenic bladder?

The most common symptom of neurogenic bladder is being unable to control urination. Other symptoms include:

  • A weak or dribbling urinary stream
  • Frequent urination (urinating eight or more times daily)
  • Urgency (a feeling or need to urinate immediately)
  • Painful urination, which may mean there is a urinary tract infection

How is neurogenic bladder treated?

The main treatments for neurogenic bladder are the following:

  • Clean intermittent catheterization (CIC): Catheters are thin, flexible tubes that can be inserted through the urethra and into the bladder to drain urine.
  • Drugs: These include anticholinergic medications (oxybutynin, tolterodine, and others.)
  • Injections of botulinum A toxin (Botox): A doctor injects Botox into the bladder or urinary sphincters.
  • Bladder augmentation (augmentation cystoplasty): This is a surgery in which segments of the intestine (sigmoid colon) are removed and attached to the walls of the bladder. This reduces the bladder’s internal pressure and increases its ability to store urine.
  • Ileal conduit: Part of the small bowel is used to make a urine stoma. This stoma drains to a bag attached to the outside of the body.
  • Lifestyle changes: These might include avoiding certain foods or drinks that can irritate the bladder. These include certain caffeinated drinks like coffee, carbonated beverages, spicy foods, and citrus fruit. Losing weight can ease stress on the bladder. A behavioral treatment called delayed voiding may help some people with urine control.

Absorbent undergarments, pads, panty shields, panty liners, and adult diapers can help prevent wetness and odors while protecting skin and clothing. Bed pads can protect sheets and mattresses.