Childhood ependymoma is a type of brain tumor. A tumor begins when healthy cells change and grow out of control, forming a mass. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. Ependymoma is a rare, cancerous brain tumor.

Ependymoma starts from radial glial cells, which are a type of cell in the brain. Even though ependymoma can occur in any part of the brain or spine, it most commonly occurs in the cerebellum. The cerebellum is the part of the brain that coordinates the body’s actions.

Symptoms & Causes:

Children with ependymoma may experience the following symptoms or signs. Sometimes, children with ependymoma do not have any of these changes. Or, the cause of a symptom may be another medical condition that is not a tumor.

• Headaches
• Nausea and vomiting
• Changes in vision, such as blurriness
• Difficulty with walking or balance
• Jerky eye movements
• Neck pain
• Reaching childhood developmental milestones more slowly than expected
• Seizures/convulsions, which are sudden involuntary movements of a person’s muscles

If you are concerned about any changes your child experiences, please talk with your child’s doctor. Your doctor will ask how long and how often your child has been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If a brain tumor is diagnosed, relieving symptoms remains an important part of care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your child’s health care team about symptoms your child experiences, including any new symptoms or a change in symptoms.

Treatments:

option: 1-surgery

or

2- Chemotherapy

or

3- Radiation

Parkinson’s disease is a progressive nervous system disorder that affects movement. Symptoms start gradually, sometimes starting with a barely noticeable tremor in just one hand. Tremors are common, but the disorder also commonly causes stiffness or slowing of movement.

In the early stages of Parkinson’s disease, your face may show little or no expression. Your arms may not swing when you walk. Your speech may become soft or slurred. Parkinson’s disease symptoms worsen as your condition progresses over time.

Although Parkinson’s disease can’t be cured, medications might significantly improve your symptoms. Occasionally, your doctor may suggest surgery to regulate certain regions of your brain and improve your symptoms.

Symptoms

Parkinson’s disease signs and symptoms can be different for everyone. Early signs may be mild and go unnoticed. Symptoms often begin on one side of your body and usually remain worse on that side, even after symptoms begin to affect both sides.

Parkinson’s signs and symptoms may include:

• Tremor. A tremor, or shaking, usually begins in a limb, often your hand or fingers. You may a rub your thumb and forefinger back-and-forth, known as a pill-rolling tremor. Your hand may tremor when it’s at rest.
• Slowed movement (bradykinesia). Over time, Parkinson’s disease may slow your movement, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk. It may be difficult to get out of a chair. You may drag your feet as you try to walk.
• Rigid muscles. Muscle stiffness may occur in any part of your body. The stiff muscles can be painful and limit your range of motion.
• Impaired posture and balance. Your posture may become stooped, or you may have balance problems as a result of Parkinson’s disease.
• Loss of automatic movements. You may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk.
• Speech changes. You may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone rather than with the usual inflections.
• Writing changes. It may become hard to write, and your writing may appear small.

Causes

In Parkinson’s disease, certain nerve cells (neurons) in the brain gradually break down or die. Many of the symptoms are due to a loss of neurons that produce a chemical messenger in your brain called dopamine. When dopamine levels decrease, it causes abnormal brain activity, leading to symptoms of Parkinson’s disease.

The cause of Parkinson’s disease is unknown, but several factors appear to play a role, including:

• Your genes. Researchers have identified specific genetic mutations that can cause Parkinson’s disease. But these are uncommon except in rare cases with many family members affected by Parkinson’s disease.However, certain gene variations appear to increase the risk of Parkinson’s disease but with a relatively small risk of Parkinson’s disease for each of these genetic markers.
• Environmental triggers. Exposure to certain toxins or environmental factors may increase the risk of later Parkinson’s disease, but the risk is relatively small.

Researchers have also noted that many changes occur in the brains of people with Parkinson’s disease, although it’s not clear why these changes occur. These changes include:

• The presence of Lewy bodies. Clumps of specific substances within brain cells are microscopic markers of Parkinson’s disease. These are called Lewy bodies, and researchers believe these Lewy bodies hold an important clue to the cause of Parkinson’s disease.
• Alpha-synuclein is found within Lewy bodies. Although many substances are found within Lewy bodies, scientists believe an important one is the natural and widespread protein called alpha-synuclein (a-synuclein). It’s found in all Lewy bodies in a clumped form that cells can’t break down. This is currently an important focus among Parkinson’s disease researchers.

Risk factors

Risk factors for Parkinson’s disease include:

• Age. Young adults rarely experience Parkinson’s disease. It ordinarily begins in middle or late life, and the risk increases with age. People usually develop the disease around age 60 or older.
• Heredity. Having a close relative with Parkinson’s disease increases the chances that you’ll develop the disease. However, your risks are still small unless you have many relatives in your family with Parkinson’s disease.
• Sex. Men are more likely to develop Parkinson’s disease than are women.
• Exposure to toxins. Ongoing exposure to herbicides and pesticides may slightly increase your risk of Parkinson’s disease.

Complications

Parkinson’s disease is often accompanied by these additional problems, which may be treatable:

• Thinking difficulties. You may experience cognitive problems (dementia) and thinking difficulties. These usually occur in the later stages of Parkinson’s disease. Such cognitive problems aren’t very responsive to medications.
• Depression and emotional changes. You may experience depression, sometimes in the very early stages. Receiving treatment for depression can make it easier to handle the other challenges of Parkinson’s disease.You may also experience other emotional changes, such as fear, anxiety or loss of motivation. Doctors may give you medications to treat these symptoms.
• Swallowing problems. You may develop difficulties with swallowing as your condition progresses. Saliva may accumulate in your mouth due to slowed swallowing, leading to drooling.
• Chewing and eating problems. Late-stage Parkinson’s disease affects the muscles in your mouth, making chewing difficult. This can lead to choking and poor nutrition.
• Sleep problems and sleep disorders. People with Parkinson’s disease often have sleep problems, including waking up frequently throughout the night, waking up early or falling asleep during the day.People may also experience rapid eye movement sleep behavior disorder, which involves acting out your dreams. Medications may help your sleep problems.
• Bladder problems. Parkinson’s disease may cause bladder problems, including being unable to control urine or having difficulty urinating.
• Constipation. Many people with Parkinson’s disease develop constipation, mainly due to a slower digestive tract.

You may also experience:

• Blood pressure changes. You may feel dizzy or lightheaded when you stand due to a sudden drop in blood pressure (orthostatic hypotension).
• Smell dysfunction. You may experience problems with your sense of smell. You may have difficulty identifying certain odors or the difference between odors.
• Fatigue. Many people with Parkinson’s disease lose energy and experience fatigue, especially later in the day. The cause isn’t always known.
• Pain. Some people with Parkinson’s disease experience pain, either in specific areas of their bodies or throughout their bodies.
• Sexual dysfunction. Some people with Parkinson’s disease notice a decrease in sexual desire or performance.

Prevention

Because the cause of Parkinson’s is unknown, proven ways to prevent the disease also remain a mystery.

Some research has shown that regular aerobic exercise might reduce the risk of Parkinson’s disease.

Some other research has shown that people who drink caffeine — which is found in coffee, tea and cola — get Parkinson’s disease less often than those who don’t drink it. However, it is still not known whether caffeine actually protects against getting Parkinson’s, or is related in some other way. Currently there is not enough evidence to suggest drinking caffeinated beverages to protect against Parkinson’s. Green tea is also related to a reduced risk of developing Parkinson’s disease.

What are the results of thymectomy?

The goal of a thymectomy is to remove the source of abnormal antibody production causing the disease thus leading to resolution of symptoms. The benefits of thymectomy are not realized immediately after surgery, thus patients will continue with there medical regimen after the procedure with the goal of weaning those medications over time. Individual response to thymectomy varies depending on the patient’s age, response to prior medical therapy, the severity of the disease and how long the patient has had myasthenia gravis. In general, 70 percent of patients have complete remission or significant reduction in medication needs within a year of the procedure. The other 30 percent of patients who have thymectomy experience no change in their symptoms.

How does a doctor determine which patients with myasthenia gravis should undergo thymectomy?

Thymectomy is recommended for all patients with thymomas and for patients under 60 who have mild to moderate muscle weakness due to myasthenia gravis. Thymectomy generally is not used for treating patients with myasthenia gravis that affects only their eyes.Thymectomy appears to be most effective when it is performed six to 12 months after the onset of symptoms. It is important to talk to your doctor early in your diagnosis about thymectomy as an option for treatment.

How is thymectomy performed?

Thymectomy can be performed by several different surgical techniques:

Transsternal thymectomy: In this procedure, the incision is made in the skin over the breastbone (sternum), and the breastbone is divided (sternotomy) to expose the thymus. This approach is commonly used for heart surgery. The surgeon removes the thymus through this incision as well as any residual fat in the center of the chest which may harbor extra thymic cells. This approach is commonly used when the patient has a thymoma.

Transcervical thymectomy: In this procedure the incision is made across the lower part of the neck, just above the breastbone(sternum). The surgeon removes the thymus through this incision without dividing the sternum. This is mostly used in patients without thymoma with certain body-types.

Robotic thymectomy and Video-assisted thorascopic thymectomy (VATS): These Minimally invasive techniques use several tiny incisions in the chest. A camera is inserted through one of the incisions and the surgery is performed with video guidance. The surgeon removes the thymus by using special surgical tools inserted into the other incisions. In a robotic-assisted procedure, the surgeon uses robotic arms to perform the surgery. The goal is to provide the same result as the more invasive transsternal approach with less post-operative discomfort and a quicker recovery.

What type of thymectomy is the best?

The transsternal thymectomy is the most commonly performed procedure, however there are no proven differences in outcomes with less invasive approaches. Your neurologist and surgeon will guide you in making a decision about the type of thymectomy you should have. Your surgeon will make a recommendation based on whether a thymoma is present and other factors related to your history and anatomy.There currently is no scientific evidence that proves one type of thymectomy is better than the other in terms of outcomes. To make the best decision for yourself, you should be informed about the different types of thymectomy and consult with your neurologist and surgeon. You also may want to seek a second opinion.

What is an Epiretinal Membrane?

The macula is the special area at the center of the retina, which is responsible for clear, detailed vision. The macula normally lies flat against the back of the eye, like film lining the back of a camera. An epiretinal membrane is a condition where a thin sheet of scar tissue grows on the surface of the retina. This scar tissue can contract causing the macula to become wrinkled and may result in swelling of the retina and vision changes. This condition is also known as “macular pucker”, “cellophane maculopathy”, or “premacular fibrosis”.

What Causes an Epiretinal Membrane and who is at Risk?
Epiretinal membranes typically occur in those over age 50. They are often related to the degeneration of the vitreous, a normal aging process inside of the eye. As the vitreous to pulls away from the retina a scar-like tissue may develop. If this scar-like tissue contracts, it can causes the retina to wrinkle or pucker. Many other eye conditions can be associated with the formation of an epiretinal membrane including trauma, diabetic retinopathy, retinal tears, prior retinal detachment, and ocular inflammation (uveitis). The condition can affect both eyes in approximately 25% of cases.

Pic. showing epiretinal membrane overlying on retina

What are the Symptoms of Epiretinal Membrane?
The condition is mild in most cases with very few symptoms. In more severe cases the vision becomes blurred and distorted, just as one would expect a picture to appear distorted from a camera with wrinkled film. Straight lines, like doorways or telephone poles, often appear wavy. Vision loss can vary from barely noticeable to severe. For most people, vision remains stable and does not get progressively worse.

How is an Epiretinal Membrane Diagnosed?
Your retina specialist can detect macular pucker by examining your retina using a dilated eye exam. A retinal scan called and optical coherence tomography (OCT) is used to document how extensive the scar tissue is and can help provide information about how much retinal damage exists (figure 2). OCT can also be used to follow the growth and contraction of the epiretinal membrane and its response to treatment. A photographic test called a fluorescein angiogram may be done in order to tell the extent of damage to the macula. This technique is also useful for evaluating possible underlying causes of an epiretinal membrane.

How is an Epiretinal Membrane Treated?
Treatment is not necessary if symptoms are mild. When an epiretinal membrane causes vision loss or the symptoms start to interfere with a persons normal daily activities then surgery is recommended. Vitrectomy surgery is the only treatment for effectively removing the membrane and improving the symptoms. During this procedure micro-forceps are used to gently remove the membrane that is wringing the macula. Following removal of the membrane, the retinal architecture usually returns to a more normal state and the symptoms slowly improve (figure 3). Approximately 80-90% of patients have improvement in blurred vision and distortion, though the vision usually does not return all the way to normal.

What is the long-term impact of an Epiretinal Membrane on my vision?
Approximately 90% of epiretinal membranes do not grow or cause progressive blurring or distortion of vision. Mild epiretinal membrane is causing only minimal symptoms typically do not progressively get worse. In the 10% of cases where the epiretinal membranes causes a progressive decrease in vision, the vision loss can be profound and permanent without treatment. Once the epiretinal membrane has been surgically removed the vision is typically stable. It is unusual for an epiretinal membrane to reoccur once it has been removed.

What is a macular hole?

 

It’s a cycle that’s vital to life — we eat food, digest it, and excrete what we can’t use.

Excretion, though often a subject of disgust or humor, is very important. It usually begins on the first day of a baby’s life, when the newborn passes his first stool, called the meconium.

But some babies have trouble. If a baby can’t have a bowel movement, he may have Hirschsprung’s disease, a condition in which there are missing nerve cells in the large intestine.

Hirschsprung’s disease is congenital — that is, it develops during pregnancyand is present at birth. Some congenital conditions happen because of the mother’s diet, or because of an illness she had during her pregnancy. Others are because of genes the parents pass on to the newborn.

Researchers don’t know why some people have Hirschsprung’s disease, though they believe the disease is related to flaws in DNA instructions. Though the disease can be deadly, modern medicine is able to fix the problem with surgery, and children who have been treated can live normal, healthy lives.

What Causes Hirschsprung’s Disease?

It begins to take hold in a baby in the early months of pregnancy.

Usually, as the baby develops, nerve cells are created throughout the entire digestive system, from the esophagus — which leads from the mouth to the stomach — all the way to the rectum. Normally, a person will have up to 500 million of these types of nerve cells. Among other roles, they move food through your digestive system from one end to the other.

In a baby with Hirschsprung’s, the nerve cells stop growing at the end of the large intestine, just before the rectum and anus. In some children, the cells are missing at other places in the digestive system as well.

That means the body can’t sense when waste material reaches a certain point. So the waste material gets stuck and forms a block in the system.

Hirschsprung’s disease affects about one in every 5,000 newborns. Children with other congenital conditions, such as Down syndrome and heart defects, are more likely to have the disease. Parents who carry the code for Hirschsprung’s disease in their genes, especially mothers, may pass it on to their children. Boys get it more than girls.

Symptoms

For the vast majority of people with Hirschsprung’s disease, symptoms usually begin within the first 6 weeks of life. In many cases, there are signs within the first 48 hours.

You may see swelling in your child’s abdomen. Other symptoms you might see include:

No bowel movements: You should be concerned if the newborn does not produce a stool or the meconium in the first couple of days. Older children with Hirschsprung’s may have chronic (ongoing) constipation.

Bloody diarrhea: Children with Hirschsprung’s may also get enterocolitis, a life-threatening infection of the colon, and have bad cases of diarrhea and gas.

Vomiting: The vomit may be green or brown.

In older children, symptoms may include growth issues, fatigue, and severe constipation

Treatments

Hirschsprung’s disease is a very serious condition. But if found quickly, it can almost always be cured by surgery.

Doctors will usually do one of two types of surgery:

Pull-through procedure: This surgery simply cuts out the part of the large intestine with the missing nerve cells. Then the rest of the intestine is connected directly to the anus.

Ostomy surgery: This surgery routes the intestine to an opening made in the body. The doctor then attaches an ostomy bag to the outside of the opening to hold the waste from the intestine. Ostomy surgery is usually a temporary measure until the child is ready for the pull-through procedure.

After surgery, some children may have issues with constipation, diarrhea, or incontinence (lack of control over bowel movements or urination).

A handful may get enterocolitis. Signs include rectal bleeding, fever, vomiting, and a swollen abdomen. If that happens, take your child to the hospital at once.

But with proper care — especially a proper diet and plenty of water — these conditions usually take care of themselves. Within a year of treatment, 95% of children should be cured of Hirschsprung’s disease.

The functions of the spleen normally include clearance of invading organisms in the blood (bacteria) from the circulation, production of antibodies for the immune system, and removal of abnormal blood cells.

The spleen can enlarge by performing its normal functions in response to another medical condition. Certain infections, diseases affecting blood cells, increased splenic blood flow, and diseases invading the spleen are some common reasons for the spleen to enlarge. Splenomegaly is not always abnormal, and spleen size may not necessarily say much about its function.

A normal-sized spleen cannot be palpated (felt) during the physical examination of the abdomen, except in slender people. Enlarged spleen (splenomegaly) may be easier to palpate during careful abdominal examination. A small percentage of the normal American population may have a palpable or enlarged spleen.

A spleen weighing up to 500 grams (1.1 pounds) or between 11 to 20 cm (4.3 to 8 inches) in its longest dimension is considered enlarged. Splenomegaly greater than 1000 gm (2 lb 3.3 oz) or longer than 20 cm (8 inches) is considered severe or massive.

Picture of the spleen

A lung transplant surgery is undertaken to remove diseased lung in an individual and replace the same with a healthy lung, sourced from a deceased donor. A last resort, the surgery is typically undertaken for patients with end-stage lung failure to improve longevity and quality of the life.

A transplant may remove one or both lungs, and in some cases the surgery is combined with a heart transplant as well, in which case it is termed the heart-lung transplant. Lung transplant is carried out to treat certain life-threatening diseases, such as COPD, Pulmonary Hypertension, Cystic fibrosis, Scaring and inflammation of the bronchioles. The Lung Transplantation program at Gleneagles Global Hospitals is one of the best in India. Staffed with the best transplant surgeons and specialized equipment, the facility has pioneered several complicated and innovative transplant surgeries with exceptional success rate.

A number of respiratory diseases are treated and lung transplantations are offered for various lung disorders. They are:

• End stage lung disease
• Cystic fibrosis
• Pulmonary hypertension
• Pulmonary hypertension
• Pulmonary vasodilators
• Chronic obstructive pulmonary disease (COPD)
• Interstitial lung disease