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

Interstitial lung disease is a general category that includes many different lung conditions. All interstitial lung diseases affect the interstitium, a part of the lungs’ anatomic structure.

The interstitium is a lace-like network of tissue that extends throughout both lungs. The interstitium provides support to the lungs’ microscopic air sacs (alveoli). Tiny blood vessels travel through the interstitium, allowing gas exchange between blood and the air in the lungs. Normally, the interstitium is so thin it can’t be seen on chest X-rays or CT scans.

Causes of Interstitial Lung Disease

Bacteria, viruses, and fungi are known to cause interstitial pneumonias. Regular exposures to inhaled irritants at work or during hobbies can also cause some interstitial lung disease. These irritants include:

• Asbestos
• Silica dust
• Talc
• Coal dust, or various other metal dusts from working in mining
• Grain dust from farming
• Bird proteins (such as from exotic birds, chickens, or pigeons)

In this article, we will cover the causes, symptoms, and treatment of schizophrenia.

What is schizophrenia?

Schizophrenia most commonly strikes between the ages of 16 and 30, and males tend to show symptoms at a slightly younger age than females. In many cases, the disorder develops so slowly that the individual does not know that they have had it for many years. However, in other cases, it can strike suddenly and develop quickly.

Schizophrenia affects approximately 1 percent of all adults, globally. Experts say schizophrenia is probably many illnesses masquerading as one.

Symptoms of schizophrenia

A sizable proportion of people with schizophrenia have to rely on others because they are unable to hold a job or care for themselves.

Many may also resist treatment, arguing that there is nothing wrong with them.

Some patients may present clear symptoms, but on other occasions, they may seem fine until they start explaining what they are truly thinking.

The effects of schizophrenia reach far beyond the patient – families, friends, and society are affected too.

Symptoms and signs of schizophrenia will vary, depending on the individual.

The symptoms are classified into four categories:

• Positive symptoms – also known as psychotic symptoms. For example, delusions and hallucinations.
• Negative symptoms – these refer to elements that are taken away from the individual. For example, absence of facial expressions or lack of motivation.
• Cognitive symptoms – these affect the person’s thought processes. They may be positive or negative symptoms, for example, poor concentration is a negative symptom.
• Emotional symptoms – these are usually negative symptoms, such as blunted emotions.

Below is a list of the major symptoms:

• Delusions – the patient displays false beliefs, which can take many forms, such as delusions of persecution, or delusions of grandeur. They may feel others are attempting to control them remotely. Or, they may think they have extraordinary powers and abilities.
• Hallucinations – hearing voices is much more common than seeing, feeling, tasting, or smelling things which are not there, however, people with schizophrenia may experience a wide range of hallucinations.
• Thought disorder – the person may jump from one subject to another for no logical reason. The speaker may be hard to follow or erratic.

Other symptoms may include:

• Lack of motivation (avolition) – the patient loses their drive. Everyday actions, such as washing and cooking, are neglected.
• Poor expression of emotions – responses to happy or sad occasions may be lacking, or inappropriate.
• Social withdrawal – when a patient with schizophrenia withdraws socially, it is often because they believe somebody is going to harm them.
• Unawareness of illness – as the hallucinations and delusions seem so real for patients, many of them may not believe they are ill. They may refuse to take medication for fear of side effects, or for fear that the medication may be poison, for example.
• Cognitive difficulties – the patient’s ability to concentrate, recall things, plan ahead, and to organize their life are affected. Communication becomes more difficult.

What are the causes schizophrenia?

Experts believe several factors are generally involved in contributing to the onset of schizophrenia.

Evidence suggests that genetic and environmental factors act together to bring about schizophrenia. The condition has an inherited element, but environmental triggers also significantly influence it.

Below is a list of the factors that are thought to contribute towards the onset of schizophrenia:

Genetic inheritance

If there is no history of schizophrenia in a family, the chances of developing it are less than 1 percent. However, that risk rises to 10 percent if a parent was diagnosed.

Chemical imbalance in the brain

Experts believe that an imbalance of dopamine, a neurotransmitter, is involved in the onset of schizophrenia. Other neurotransmitters, such as serotonin, may also be involved.

Family relationships

There is no evidence to prove or even indicate that family relationships might cause schizophrenia, however, some patients with the illness believe family tension triggers relapses.

Environmental factors

Although there is no definite proof, many suspect trauma before birth and viral infections may contribute to the development of the disease.

Stressful experiences often precede the emergence of schizophrenia. Before any acute symptoms are apparent, people with schizophrenia habitually become bad-tempered, anxious, and unfocused. This can trigger relationship problems, divorce, and unemployment.

These factors are often blamed for the onset of the disease, when really it was the other way round – the disease caused the crisis. Therefore, it is extremely difficult to know whether schizophrenia caused certain stresses or occurred as a result of them.

Drug induced schizophrenia

Marijuana and LSD are known to cause schizophrenia relapses. Additionally, for people with a predisposition to a psychotic illness such as schizophrenia, usage of cannabis may trigger the first episode.

Some researchers believe that certain prescription drugs, such as steroids and stimulants, can cause psychosis.

Treatments for schizophrenia

Ensuring the patient continues with medication is the key to successful treatment.

With proper treatment, patients can lead productive lives.

Treatment can help relieve many of the symptoms of schizophrenia. However, the majority of patients with the disorder have to cope with the symptoms for life.

Psychiatrists say the most effective treatment for schizophrenia patients is usually a combination of:

• medication
• psychological counseling
• self-help resources

Anti-psychosis drugs have transformed schizophrenia treatment. Thanks to them, the majority of patients are able to live in the community, rather than stay in a hospital.

The most common schizophrenia medications are:

• Risperidone (Risperdal) – less sedating than other atypical antipsychotics. Weight gain and diabetes are possible side effects, but are less likely to happen, compared with Clozapine or Olanzapine.
• Olanzapine (Zyprexa) – may also improve negative symptoms. However, the risks of serious weight gain and the development of diabetes are significant.
• Quetiapine (Seroquel) – risk of weight gain and diabetes, however, the risk is lower than Clozapine or Olanzapine.
• Ziprasidone (Geodon) – the risk of weight gain and diabetes is lower than other atypical antipsychotics. However, it might contribute to cardiac arrhythmia.
• Clozapine (Clozaril) – effective for patients who have been resistant to treatment. It is known to lower suicidal behaviors in patients with schizophrenia. The risk of weight gain and diabetes is significant.
• Haloperidol – an antipsychotic used to treat schizophrenia. It has a long-lasting effect (weeks).

The primary schizophrenia treatment is medication. Sadly, compliance (following the medication regimen) is a major problem. People with schizophrenia often come off their medication for long periods during their lives, at huge personal costs to themselves and often to those around them.

The patient must continue taking medication even when symptoms are gone. Otherwise they will come back.

The first time a person experiences schizophrenia symptoms, it can be very unpleasant. They may take a long time to recover, and that recovery can be a lonely experience. It is crucial that a person living with schizophrenia receives the full support of their family, friends, and community services when onset appears for the first time.

What is polycystic kidney disease?

Polycystic kidney disease (also called PKD) causes numerous cysts to grow in the kidneys. These cysts are filled with fluid. If too many cysts grow or if they get too big, the kidneys can become damaged. PKD cysts can slowly replace much of the kidneys, reducing kidney function and leading to kidney failure.

What other organs besides the kidney are affected by PKD?

PKD can affect other organs besides the kidney. People with PKD may have cysts in their liver, pancreas, spleen, ovaries, and large bowel. Cysts in these organs usually do not cause serious problems, but can in some people. PKD can also affect the brain or heart. If PKD affects the brain, it can cause an aneurysm. An aneurysm is a bulging blood vessel that can burst, resulting in a stroke or even death. If PKD affects the heart, the valves can become floppy, resulting in a heart murmur in some patients.

What are the clues that someone has PKD?

Most people do not develop symptoms until they are 30 to 40 years old. The first noticeable signs and symptoms may include:

• Back or side pain
• An increase in the size of the abdomen
• Blood in the urine
• Frequent bladder or kidney infections
• High blood pressureHigh blood pressure is the most common sign of PKD. Occasionally, patients may develop headaches related to high blood pressure or their doctors may detect high blood pressure during a routine physical exam. Because high blood pressure can cause kidney damage, it is very important to treat it. In fact, treatment of high blood pressure can help slow or even prevent kidney failure.
• Fluttering or pounding in the chestAbout 25% of PKD patients have a so-called floppy valve in the heart, and may experience a fluttering or pounding in the chest as well as chest pain. These symptoms almost always disappear on their own but may be the first hint that someone has PKD.

How is PKD diagnosed?

Ultrasound is the most reliable, inexpensive and non-invasive way to diagnose PKD. If someone at risk for PKD is older than 40 years and has a normal ultrasound of the kidneys, he or she probably does not have PKD. Occasionally, a CT scan (computed tomography scan) and MRI (magnetic resonance imaging) may detect smaller cysts that cannot be found by an ultrasound. MRI is used to measure and monitor volume and growth of kidneys and cysts.

In some situations, genetic testing might also be done. This involves a blood test that checks for abnormal genes that cause the disease.  Genetic testing is not recommended for everyone. The test is costly, and it also fails to detect PKD in about 15% of people who have it. However, genetic testing can be useful when a person:

• has an uncertain diagnosis based on imaging tests
• has a family history of PKD and wants to donate a kidney
• is younger than 30-years old with a family history of PKD and a negative ultrasound, and is planning to start a family

Does everyone with PKD develop kidney failure?

No. About 50 percent of people with PKD will have kidney failure by age 60, and about 60 percent will have kidney failure by age 70. People with kidney failure will need dialysis or a kidney transplant. Certain people have an increased risk of kidney failure including:

• men
• patients with high blood pressure
• patients with protein or blood in their urine
• women with high blood pressure who have had more than three pregnancies

How is PKD treated?

At present, there is no cure for PKD. However, a lot of research is being done. Recent studies suggest that drinking plain water throughout the day and avoiding caffeine in beverages can slow the growth of cysts. Research is also helping us understand the genetic basis of PKD.

Studies also suggest that some treatments may slow the rate of kidney disease in PKD, but further research is needed before these treatments can be used in patients. In the meantime, many supportive treatments can be done to control symptoms, help slow the growth of cysts, and help prevent or slow down the loss of kidney function in people with PKD.  These include:

• careful control of blood pressure
• prompt treatment with antibiotics of a bladder or kidney infection
• lots of fluid when blood in the urine is first noted
• medication to control pain (talk to your doctor about which over-the-counter medicines are safe to take if you have kidney disease)
• a healthy lifestyle with regard to smoking cessation, exercise, weight control and reduced salt intake
• drinking lots of plain water throughout the day
• avoiding caffeine in all beverages

Should people with PKD take a special diet?

At present, no specific diet is known to prevent cysts from developing in patients with PKD. Reducing salt intake helps control blood pressure in PKD patients who have high blood pressure. A diet low in fat and moderate in calories is recommended to maintain a healthy weight. Speak to your doctor or a dietitian about other changes to your diet, such as avoiding caffeine.

Is exercise recommended for people with PKD?

Absolutely. However, exercises that are potentially harmful to the kidney, such as contact sports, should be avoided. It is important not to become too dehydrated during any physical activity.

Who is at risk for developing PKD?

PKD runs in families. It is an inherited disorder that is passed from parents to children through genes. Genes are the basic elements of heredity. At conception, children receive a set of genes from each parent. They determine many characteristics such as hair color and eye color. Genes can also determine the likelihood of developing a disease.

A genetic disease can happen if one or both parents pass abnormal genes to a child. This happens through something called dominant inheritance or recessive inheritance.

• Dominant inheritance

If one parent has the disease and passes an abnormal gene to the child, it is called dominant inheritance. Each child has a 50% chance of getting the disease. The risk is the same for every child, regardless of how many children develop the disease.

• Recessive inheritance

If both parents carry the abnormal gene, and both parents pass an abnormal gene to the child, it is called recessive inheritance. In this situation, every child has a 25% chance of getting the disease.

Are there different types of PKD?

Yes. The three main types of PKD are:

• Autosomal Dominant PKD
  (also called PKD or ADPKD)This form of the disease is passed from parent to child by dominant inheritance. In other words, only one copy of the abnormal gene is needed to cause the disease. Symptoms usually begin between the ages of 30 and 40, but they can begin earlier, even in childhood. ADPKD is the most common form of PKD. In fact, about 90 percent of all PKD cases are ADPKD.
• Infantile or Autosomal Recessive PKD
  (also called ARPKD)This form of the disease is passed from parent to child by recessive inheritance. Symptoms can begin in the earliest months of life, even in the womb. It tends to be very serious, progresses rapidly, and is often fatal in the first few months of life. This form of ARPKD is extremely rare. It occurs in 1 out of 25,000 people.
• Acquired Cystic Kidney Disease
  (also called ACKD)ACKD can happen in kidneys with long-term damage and severe scarring, so it is often associated with kidney failure and dialysis. About 90 percent of people on dialysis for 5 years develop ACKD. People with ACKD usually seek help because they notice blood in their urine. This is because the cysts bleed into the urinary system, which discolors urine.

Should people with PKD have children?

Individuals with PKD who are concerned about passing the disease to their children may want to consult a genetics counselor to help them with family planning. Many university medical centers have this service.

Should women with PKD get pregnant?

Most of the women with PKD (80 percent) have successful and uneventful pregnancies. However, some women with PKD have an increased risk for serious complications for themselves and their babies. This includes women with PKD who also have:

• high blood pressure
• decreased kidney function

Women who have PKD with high blood pressure develop pre-eclampsia (or toxemia) in 40 percent of pregnancies. This is a life-threatening disorder for both the mother and baby, and it can develop suddenly and without warning. Therefore, all women with PKD, particularly those who also have high blood pressure, should be followed closely during their pregnancy by their doctor.