WHAT IS OCULOPLASTY?

Oculoplasty is the art and science of plastic surgery around the eye. The eyeball is a delicate structure, protected from harm by eyelids in front and the bony cup (socket) behind. Behind the eyeball run the nerves , arteries and muscles, which carry messages to the brain, move the eyeball, and provide nutrition to the eye. Oculoplasty deals with all these structures surrounding the eyeball.

WHY SHOULD AN EYE SURGEON DO PLASTIC SURGERY?

Oculoplastic surgeons first train as ophthalmologists, when they learn in details about the eye. During further higher training, they start to handle plastic surgery. They have the best knowledge about the eye and its surrounding; as eye surgeons, they are also ready to handle the most delicate of structures. This combination of skills makes the oculoplastic surgeons the best to do plastic surgery around the eye.

Types of Surgeries:

• Ptosis:  Ptosis is drooping of the upper lid. It may be present by birth, or appear later in life. Ptosis is usually corrected by surgery.

• Entropion– Entropion is in-turning of the eyelid. The eyelashes rub on the eye and cause pain and watering; treatment is by surgery, Ectropion– Ectropion is turning outwards of the eyelid margin, causing redness and watering (Link to gallery)Lagophthalmos- where the patient cannot close his eye; this can cause danger to the eye, pain and infection.

• Eyelid tumors: Lid tearrepairs with grafts and flaps

• ORBIT: Orbital fractures– A fracture in the bones around the eye can cause double vision, and a sunken small appearance of the eye. The fracture is repaired with an implant or plate. The best results are obtained in surgery within 2 weeks of injury, but surgery can also be done later.

What is Schizoaffective Disorder?

Hair transplant surgery is surgery that is performed to restore hair to areas of the scalp that are bald or that have thinning hair. There are multiple types of hair replacement surgery. Most commonly, these involve hair transplantation, but flap surgery, tissue expansion of the scalp and scalp reduction surgery, are also methods used for hair replacement. Each of these types of surgeries can be used alone, or in combination, to provide the patient with the best possible outcome for hair replacement.

Hair transplantation involves removing small pieces of hair-bearing scalp from a donor site and using them as grafts to be relocated to a bald or thinning area of the scalp.

Flaps surgeries involve moving hair bearing scalp tissue into bald areas of the scalp.

Tissue expansion allows the hair bearing scalp to be expanded to help cover areas of the scalp that have no hair.

Scalp reduction surgery involves surgically removing bald areas of the scalp and advancing, or bringing together, the hair bearing areas of the scalp.

If you and your surgeon have determined that hair transplant surgery is the best option for you, you can feel comfortable knowing that board-certified plastic surgeons have been successfully performing these types of procedures for more than thirty years.

The truth about hair loss

Baldness is often blamed on poor circulation to the scalp, vitamin deficiencies, dandruff and even excessive hat wearing. All of these theories have been disproved. It’s also untrue that hair loss can be determined by looking at your maternal grandfather, or that 40-year-old men who haven’t lost their hair will never lose it.

Hair loss is primarily caused by a combination of:

• Aging
• A change in hormones
• A family history of baldness

Hair transplantation steps:

Hair transplantation involves removing small punch grafts from the hair bearing scalp or a larger piece of this scalp from a donor area and cutting this into smaller pieces to use as grafts. These grafts are then relocating to a bald or thinning area of the scalp. The grafts created in this manner differ in size and shape. Round-shaped punch grafts usually contain about 10-15 hairs. The much smaller mini-graft contains about two to four hairs; and the micro-graft, one to two hairs. Slit grafts, which are inserted into slits created in the scalp, contain about four to 10 hairs each; strip grafts are long and thin and contain 30-40 hairs.

Generally, several surgical sessions may be needed to achieve satisfactory fullness, and a healing interval of several months is usually recommended between each session. It may take up to two years before you see the final result with a full transplant series. The amount of coverage you’ll need is partly dependent upon the color and texture of your hair. Coarse, gray or light-colored hair affords better coverage than fine, dark-colored hair. The number of large plugs transplanted in the first session varies with each individual, but the average is about 50. For mini-grafts or micro-grafts, the number can be up to 700 per session.

Just before surgery, the “donor area” will be trimmed short so that the grafts can be easily accessed and removed. For punch grafts, your doctor may use a special tube-like instrument made of sharp carbon steel that punches the round graft out of the donor site so it can be replaced in the area to be covered—generally the frontal hairline. For other types of grafts, your doctor will use a scalpel to remove small sections of hair-bearing scalp, which will be divided into tiny sections and transplanted into tiny holes or slits within the scalp. When grafts are taken, your doctor may periodically inject small amounts of saline solution into the scalp to maintain proper skin strength. The donor site holes may be closed with stitches—for punch grafts, a single stitch may close each punch site; for other types of grafts, a small, straight-line scar will result. The stitches are usually concealed with the surrounding hair.

To maintain healthy circulation in the scalp, the grafts are placed about one-eighth of an inch apart. In later sessions, the spaces between the plugs will be filled in with additional grafts. Your doctor will take great care in removing and placement of grafts to ensure that the transplanted hair will grow in a natural direction and that hair growth at the donor site is not adversely affected.

After the grafting session is complete, the scalp will be cleansed and covered with gauze. You may have to wear a pressure bandage for a day or two. Some doctors allow their patients to recover bandage-free.

Tissue Expansion

Another technique used in the treatment of baldness is called tissue expansion. Plastic surgeons are the leaders in tissue expansion, a procedure commonly used in reconstructive surgery to repair burn wounds and injuries with significant skin loss. Its application in hair transplant surgery has yielded dramatic results-significant coverage in a relatively short amount of time.

In this technique, a balloon-like device called a tissue expander is inserted beneath hair-bearing scalp that lies next to a bald area. The device is gradually inflated with salt water over a period of weeks, causing the skin to expand and grow new skin cells. This causes a bulge beneath the hair-bearing scalp, especially after several weeks.

When the skin beneath the hair has stretched enough-usually about two months after the first operation-another procedure is performed to bring the expanded skin over to cover the adjacent bald area. For more information about tissue expansion, ask your plastic surgeon for the American Society of Plastic Surgeons, Inc. brochure entitled, Tissue Expansion: Creating New Skin from Old.

Flap Surgery

Flap surgery on the scalp has been performed successfully for more than 20 years. This procedure is capable of quickly covering large areas of baldness and is customized for each individual patient. The size of the flap and its placement are largely dependent upon the patient’s goals and needs. One flap can do the work of 350 or more punch grafts.

A section of bald scalp is cut out and a flap of hair-bearing skin is lifted off the surface while still attached at one end. The hair-bearing flap is brought into its new position and sewn into place, while remaining “tethered” to its original blood supply. As you heal, you’ll notice that the scar is camouflaged—or at least obscured—by relocated hair, which grows to the very edge of the incision.

In recent years, plastic surgeons have made significant advances in flap techniques, combining flap surgery and scalp reduction for better coverage of the crown; or with tissue expansion, to provide better frontal coverage and a more natural hairline.

Scalp Reduction

This technique is sometimes referred to as advancement flap surgery because sections of hair-bearing scalp are pulled forward or “advanced” to fill in a bald crown.

Scalp reduction is for coverage of bald areas at the top and back of the head. It’s not beneficial for coverage of the frontal hairline. After the scalp is injected with a local anesthetic, a segment of bald scalp is removed. The pattern of the section of removed scalp varies widely, depending on the patient’s goals. If a large amount of coverage is needed, doctors commonly remove a segment of scalp in an inverted Y-shape. Excisions may also be shaped like a U, a pointed oval or some other figure.

The skin surrounding the cut-out area is loosened and pulled, so that the sections of hair-bearing scalp can be brought together and closed with stitches. It’s likely that you’ll feel a strong tugging at this point, and occasional pain.

Procedure Steps

Before: Hair transplant candidates should have some noticeable hair loss with healthy hair growth at the back and sides of the head to serve as donor areas.

Step 1: A tube-like instrument punches round grafts from the donor site to be placed in the area where hair replacement is desired.

Step 2: A tube-like instrument punches round grafts from the donor site to be placed in the area where hair replacement is desired.

Step 3: When the skin beneath the hair has stretched enough, it is surgically placed over the bald area.

Step 4: During flap surgery, a section of bald scalp is cut out and a flap of hair-bearing skin is sewn into its place.

Step 5: The patterns used in scalp reduction vary widely, yet all meet the goal of bringing hair and scalp together to cover bald areas.

After: The results of hair transplant surgery can enhance your appearance and self-confidence.

Umbilical Hernia

Causes of umbilical hernia in adults

Umblical hernia that is acquired happens due to intra-abdominal pressure from lifting heavy objects, multiple pregnancies, long history of coughing and obesity.

During pregnancy, the umbilical cord traverses through a little opening or belly button in the baby’s abdominal muscles. This slit normally closes just prior to the birth. If the muscles do not join properly in the middle line of the abdomen, the weakness of the abdominal wall can result in umbilical hernia either at that time or later in life.

Complications of umbilical hernia in adults

Adults who have umbilical hernia are likely to experience intestinal obstruction. In such a case, emergency surgery may be needed. In case of children, the complications are not so common, and they happen only when the abdominal tissue is incarcerated and cannot be retracted into the abdominal cavity. This results in reduced blood supply to the trapped intestine leading to pain in the umbilical area and damage.

Umbilical hernia in adults diagnosis

In the physical exam, the doctor will ask you to do blood tests and imaging studies like an X-ray or abdominal ultrasound may be done to find out complications.

Importantly this type of hernia must be distinguished from a paraumbilical hernia, which occurs in adults and involves a defect in the midline near to the umbilicus, and from omphalocele.

Umblical Hernia in adults Treatment

When the hole is small, say less than 1 or 2 centimeters, it is believed that 90 percent of umbilical hernia cases close in three years. If hernias do not enlarge or are asymptomatic, then there may or may not be a need for surgery.

Spigelian hernias often begin around the tissue line which is located on either side of the Rectus Abdominis. One among many other reasons of such kind of hernia is weakening of the abdominal wall. Such kind of weakness occur especially later in life. Other causes can include injury or because of prolonged periods of physical stress.

Mostly spigelian hernia is confuse with another type of problem abdominally. As mentioned above, this type of hernia develop through a weakness between the muscle fibres of the abdominal wall. This protrusion may contain a section of the intestines but in other cases it takes the form of an empty sac. it often develop on the right hand side of the abdomen. Du e to its location, no obvious swelling or lump is there which can make it almost impossible to detect. As a consequent, many people with this type of hernia do not even realize that they actually developed a hernia which means that it may remains undetected for a long period of time.

Spigelian hernia is considered rare type of hernia which occurs in both men and women alike. It often develops later on in life when the abdominal muscles are not strong and becoming weak. Beside this, they may occur from the same causes of other types of hernias which include any sport that involve excessive twisting or turning, Chronic coughing e.g. from smoking as well as overweight. They are normally located in between the layers of muscles in the wall of the abdomen and easily can be overlooked due to obesity in this area.

Spigelian Hernia Symptoms

The major issue that is generally associated with hernia is their location to develop. Almost all types of hernia are located subcutaneously beneath the fat layers. Although their identification is also difficult but swelling can show that here is something abnormal. But in case of spigelian hernia, it is more complex, because it is found inside the muscles of the walls of the abdomen. Since it is a hernia that is sub-muscular, there is not any external swelling sign or bump with this type of hernia.

Besides having no swelling, this kind of hernia is normally very tiny, adding to the difficulty in identifying. The common indicators of this type of hernia are intermittent mass as well as abdominal discomfort. The only sign that make them a bit obvious is pain, only noticeable sign in the actual location. Pain comes and goes on a repeated basis. In terms of size, it is small, and the external soft tissue mass or lump may be felt by the individual, who has little fat in the area that is affecting the abdomen. In addition to pain, which is the only obvious symptom, Irregular or decrease bowel and this tends to remain for more than only one day, can also be a symptom in some patients.

Spigelian Hernia Diagnoses

Because of the absence of obvious symptoms, this medical problem is extremely hard to diagnose. Mostly it stays concealed for a longer period of time. Usually a good medical exam along with imaging tests are done to diagnose it. Imaging tests are essential to eliminate the doubt for other health conditions. CT scan results can confirm its presence.

Spigelian Hernia Causes

Following are some important causes of Spigelian Hernia:

• They are also known as spontaneous hernias since they often created suddenly after trauma or injury to the abdomen area.
• Chronic coughing can also cause Spigelian hernia.
• Over weight is generally considered as one major cause of this type of hernia. So keep yourself away from obesity.
• Tough sport like heavy weight lifting can also cause this medical condition.
• An inborn defect of connecting tissue, post-surgery infection, pregnancy, abdominal fluid as well as straining during bowel movement or urination are some other causes which may relate with its causes.

Spigelian Hernia Treatment

Surgery is only treatment that can repair this type of hernia, since it is prone to strangulation. Conventional or laparoscopic surgery might be carried out to put any organs that were displaced back in correct place once the contents are detached from the hernia for suturing. The abdominal wall that is injured is toughened with a surgical mesh to stop any recurrence. If this mesh is not in place, the hernia will be more likely to return.

Patient’s recovery time is relatively short , usually two weeks. The laparoscopic method is usually favored in order to minimize any chances of infection as well as reduce the stay in the hospital. A post-surgery follow-up exam with the attending surgeon is common in order to avoid any complications.

Feeling bloated, irritable, or just not your best? A hormone imbalance could be to blame. Hormones are chemical “messengers” that impact the way your cells and organs function. It’s normal for your levels to shift at different times of your life, such as before and during your period or a pregnancy, or during menopause. But some medications and health issues can cause them to go up or down, too.

Irregular Periods

Most women’s periods come every 21 to 35 days. If yours doesn’t arrive around the same time every month, or you skip some months, it might mean that you have too much or too little of certain hormones (estrogen and progesterone). If you’re in your 40s or early 50s — the reason can be perimenopause — the time before menopause. But irregular periods can be a symptom of health problems like polycystic ovarian syndrome (PCOS).

Sleep Problems

If you aren’t getting enough shut-eye, or if the sleep you get isn’t good, your hormones could be at play. Progesterone, a hormone released by your ovaries, helps you catch zzz’s. If your levels are lower than usual, that can make it hard to fall and stay asleep. Low estrogen can trigger hot flashes and night sweats, both of which can make it tough to get the rest you need.

Chronic Acne

A breakout before or during your period is normal. But acne that won’t clear up can be a symptom of hormone problems. An excess of androgens (“male” hormones that both men and women have) can cause your oil glands to overwork. Androgens also affect the skin cells in and around your hair follicles. Both of those things can clog your pores and cause acne.

Memory Fog

Experts aren’t sure exactly how hormones impact your brain. What they do know is that changes in estrogen and progesterone can make your head feel “foggy” and make it harder for you to remember things. Some experts think estrogen might impact brain chemicals called neurotransmitters. Attention and memory problems are especially common during perimenopause and menopause. But they can also be a symptom of other hormone-related conditions, like thyroid disease. Let your doctor know if you’re having trouble thinking clearly.

 Belly Problem

Your gut is lined with tiny cells called receptors that respond to estrogen and progesterone. When these hormones are higher or lower than usual, you might notice changes in how you’re digesting food. That’s why diarrhea, stomach pain, bloating, and nausea can crop up or get worse before and during your period. If you’re having digestive woes as well as issues like acne and fatigue, your hormone levels might be off.

Ongoing Fatigue

Are you tired all the time? Fatigue is one of the most common symptoms of a hormone imbalance. Excess progesterone can make you sleepy. And if your thyroid — the butterfly-shaped gland in your neck — makes too little thyroid hormone, it can sap your energy. A simple blood test called a thyroid panel can tell you if your levels are too low. If they are, you can get treated for that.

Mood Swings and Depression

Researchers think drops in hormones or fast changes in their levels can cause moodiness and the blues. Estrogen affects key brain chemicals like serotonin, dopamine, and norepinephrine. But other hormones, that travel the same paths as neurotransmitters, also play a part in how you feel.

Appetite and Weight Gain

When you’re feeling blue or irritated, as you can be when your estrogen levels dip, you may want to eat more. That might be why drops in the hormone are linked to weight gain. The estrogen dip can also impact your body’s levels of leptin, a hormone that helps regulate food intake.

Headaches

Lots of things can trigger these. But for some women, drops in estrogen bring them on. That’s why it’s common for headaches to strike right before or during your period, when estrogen is on the decline. Regular headaches or ones that often surface around the same time each month can be a clue that your levels of this hormone might be shifting.

Vaginal Dryness

It’s normal to have this occasionally. But if you often notice that you’re dry or irritated down there, low estrogen may be the reason. The hormone helps vaginal tissue stay moist and comfortable. If your estrogen drops because of an imbalance, it can reduce vaginal fluids and cause tightness.

Loss of Libido

Most people think of testosterone as a male hormone, but women’s bodies make it, too. If your testosterone levels are lower than usual, you might have less of an interest in sex than you usually do.

Breast Changes

A drop in estrogen can make your breast tissue less dense. And an increase in the hormone can thicken this tissue, even causing new lumps or cysts. Talk to your doctor if you notice breast changes, even if you don’t have any other symptoms that concern you.

Central nervous system lymphoma is a rare non-Hodgkin lymphoma in which malignant (cancer) cells from lymph tissue form in the brain and/or spinal cord (primary CNS) or spread from other parts of the body to the brain and/or spinal cord (secondary CNS). Because the eye is so close to the brain, primary CNS lymphoma can also start in the eye (called ocular lymphoma). The cancer can also involve the spinal fluid that bathes the spinal cord and brain. This is called leptomeningeal lymphoma.

Both primary and secondary CNS lymphomas are rare diseases. The cancer is a form of extranodal, high-grade non-Hodgkin B-cell lymphoma. Most forms of CNS lymphoma (about 90 percent) are diffuse large B-cell lymphomas; the remaining ten percent are poorly characterized low-grade lymphomas, Burkitt lymphomas and T-cell lymphomas.

Central nervous system lymphoma is more common in men than women. The median age of diagnosis is 55; the median age of AIDS-infected patients with primary CNS lymphoma is 35.

Causes and Risk Factors

Although the exact causes of CNS lymphoma are not known, there are several factors that may increase a person’s risk for developing the disease, such as having a compromised immune system due to acquired immunodeficiency syndrome (AIDS), other disorders of the immune system, or chronic immunosuppression (a reduced function of the immune system) as a result of organ transplantation.

Symptoms

The symptoms of CNS lymphoma depend on the location of the tumor. Patients may experience nausea and vomiting, leg and arm weakness, seizures, headaches, changes in mental alertness or confusion, facial weakness, double vision and hearing loss and/or swallowing difficulties. Patients with ocular lymphoma may notice blurry vision and patients with lymphoma involving their spinal cord or spinal fluid may experience back pain, leg weakness or incontinence.

Diagnosis

Tests that examine the eyes, brain and spinal cord are used to find and diagnose CNS lymphoma. These tests may include

• Physical exam and history
• Neurological exam to check mental status, coordination, ability to walk normally and how well the muscles, senses and reflexes work
• Slit-lamp eye exam – This test uses a special microscope with a bright, narrow slit of light to check the outside and inside of the eye.
• Vitrectomy – A surgical procedure in which some of the vitreous humor (the gel-like fluid inside the eyeball) is removed and examined under a microscope to check for cancer cells.
• Chest x-ray and CT scans of the chest and abdomen
• MRI scans of the brain and spinal cord
• Blood and urine tests
• Lumbar puncture (or spinal tap)
• Stereotactic biopsy, in which a computer and a three-dimensional scanning device are used to find a tumor and guide the removal of tissue for examination under a microscope to look for cancer cells.

Staging

After CNS lymphoma is diagnosed, a series of tests may be done to determine whether the cancer has spread. The information is then used to stage the disease and plan treatment. At this time, patients may also want to schedule a consultation with an ophthalmologist (eye doctor).

Some tests used to stage CNS lymphoma include:

• CT scan
• PET scan
• Bone marrow aspiration and biopsy

• Slit-lamp eye exam
• Vitrectomy
• Testicular examination in men

Prognostic Factors

There are certain factors that affect prognosis (the chance of recovery) and treatment options for CNS lymphoma. These include

• The patient’s age and overall health
• Performance status
• Lactate dehydrogenase level
• Unusually higher or lower level of certain substances in the blood and cerebrospinal fluid
• Location of the tumor in the central nervous system
• Whether the patient has AIDS

Treatment

There is no standard treatment for CNS lymphoma. Your doctor will discuss the best treatment option for you. As CNS lymphoma only affects a small number of people, it is important to be treated by a hematologist/oncologist who is knowledgeable about non-Hodgkin lymphoma. It is important to consider getting a second opinion with a NHL expert to make sure you are aware of all treatment options.

Possible treatment options are listed below. Methotrexate-based combinations have been the most successful for CNS lymphoma patients. These are usually given at high doses and require that the patient be hospitalized while giving the chemotherapy. For patients over age 60 years, radiation treatment can be extremely neurotoxic and it is important to speak to your doctor before receiving this treatment. Patients who have relapsed or refractory CNS lymphoma, cytarabine and topotecan may also be an option. Talk to your doctor about the best care for you.

Treatment options for CNS lymphoma not related to AIDS include:

• Chemotherapy
• Chemotherapy followed by radiation therapy
• Steroid therapy
• Whole brain radiation therapy
• A clinical trial of high-dose chemotherapy with stem cell transplant

Treatment options for AIDs-related CNS lymphoma include:

• Steroids with or without radiation
• Radiation
• Chemotherapy followed by radiation therapy

Treatment for recurrent (the cancer comes back) CNS lymphoma includes:

• Chemotherapy or radiation (if not received as first-line treatment)
• Chemotherapy and radiation
• A clinical trial

For some patients, taking part in a clinical trial may be the best treatment choice. There are also several clinical trials available nationally that are examining the role of radiation and the role of bone marrow transplantation for the treatment of primary CNS lymphoma. Your doctor can discuss if these clinical trials are appropriate or available for you. For information about clinical trials for CNS lymphoma, please call our Information Specialists or click here for an online clinical-trial search service supported by LLS that offers patients and caregivers immediate access to listings of blood cancer clinical trials.

Treatment Outcomes

Treatment of CNS lymphoma is most effective when the tumor has not spread outside the cerebrum (the largest part of the brain) and the patient is under age 60, able to maintain daily functions and does not have AIDS or other diseases that weaken the immune system.

As you get older, you may begin to notice rough, scaly spots appearing on your hands, arms, or face. These spots are called actinic keratoses, but they’re commonly known as sunspots or age spots.

What Causes Bow Legged?