What is appendicitis?

Appendicitis is a painful inflammation or swelling of the appendix, a 5-10 cm tube of tissue connected to the large intestine.

Appendicitis is a medical emergency and a person should be taken to A&E as soon as possible by car or by ambulance.

The appendix doesn’t seem to do anything useful, and the treatment for appendicitis is an operation to remove the appendix, as the body can live without it.

Left untreated, an inflamed appendix can burst or perforate, spilling infectious materials into the abdominal cavity. This can lead to peritonitis, a serious inflammation of the abdominal cavity’s lining (the peritoneum) that can be fatal unless it is treated quickly with antibiotics.

It’s not contagious. It’s caused by a mutation (change) in a single gene called the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR). This controls the flow of salt and fluids in and out of your cells. If the CFTR gene doesn’t work like it should, a sticky mucus builds up throughout your body.

To get CF, you have to inherit a mutated copy of the gene from both your parents.

If you only inherit one, you won’t have any symptoms. But you’ll be a “carrier” of the disease. That means there’s a chance you could pass it on to your own child one day.

About 10 million Americans are CF carriers. Every time two CF carriers have a baby, there’s a 25%          (1 in 4) chance that their baby will be born with CF.

The lungs aren’t the only part of the body that’s harmed by CF. The disease also affects the following organs:

Pancreas: The thick mucus caused by CF blocks ducts in your pancreas. This stops digestive enzymes (proteins that break down your food) from reaching your intestine. As a result, your body has a hard time absorbing the nutrients it needs. Over time, this can also lead to diabetes.

Liver: If the tubes that remove bile become clogged, your liver gets inflamed and severe scarring (cirrhosis) occurs.

Small intestine: Because breaking down high-acid foods that come from the stomach is a challenge, the lining of the small intestine can erode.

Large intestine: Thick secretions (liquids) in your stomach can make feces (poop) very thick. This can cause blockages. In some cases, the intestine may also start to fold in on itself like an accordion (called “intussusception”).

Bladder: Chronic coughing weakens the bladder muscles. Almost 65% of women with CF have what’s called “stress incontinence.” This means that you leak urine when you cough, sneeze, laugh, or lift something. Though more common in women, men can have it, too.

Kidneys: Some people with CF get kidney stones. These small, hard mineral deposits can cause nausea, vomiting, and pain. If ignored, they can lead to a kidney infection.

Reproductive organs: Excess mucus affects fertility in both men and women. Most men with CF have problems with the tubes that transport their sperm, or what’s called the “vasa deferentia.” Women with CF have very thick cervical mucus, which can make it harder for a sperm to fertilize an egg.

Other parts of the body: CF can also lead to thinning of the bones (osteoporosis) and muscle weakness. Because it upsets the balance of minerals in the blood, it can also bring about low blood pressure, fatigue, a fast heart rate, and a general feeling of weakness.

Although CF is a severe condition that needs daily care, many treatments for it have improved. People who have CF live much longer than they used to and the quality of life has improved as well.

The hands, being composed of many types of tissue, including blood vessels, nerves, skin and skin-related tissues, bones, and muscles/tendons/ligaments, may show changes that reflect a disease that affects other parts of, or even the whole body. These are known as a systemic diseases. The hands may show changes noticed by the patient or his/her hand surgeon even before the disease is detected

Types of Systemic Diseases:

Arthritic swelling of the middle joint of a finger is called a Bouchard’s node.  The swellings at the small finger joints are called Heberden’s nodes.

This case of dactylitis was associated with psoriatic arthritis.  In this photo, the swelling extends from the palm to include the ring finger out to the small joint.  Stiffness is common. There also may be pain.  This swelling may be improved with medicines for the problem causing it.

 
This type of cyst is called a mucous cyst.  If the skin becomes thin, the cyst may break resulting in drainage of a clear sticky fluid.  The resulting break in the skin may allow bacteria to reach the nearby joint, causing a joint or bone infection.

 
The small red dots seen above are in the thin part of the skin around the nail. They may also occur in the thicker pink part. This has been seen in dermatomyositis, systemic lupus, and scleroderma.

Leukonychia can be seen with viral infections, intestinal and kidney diseases, poisoning, and medicines. The nail may come loose from the nail bed because of fungal infections or other causes.

Red streaks seen in the fingernail area can be due to hemorrhage (bleeding).  These are called splinter hemorrhages and have been seen in endocarditis (heart infection), although also reported in psoriasis, and trichinosis.

Psoriasis commonly affects the nail and nail bed.  Pits in the nail, loosening, blood streaks beneath the nail, and other changes may occur.  A psoriasis skin patch is seen in the middle.

This “Pincer” nail with an abnormal side-to-side shape curve can be seen at birth or simply due to aging.  However, it can also be caused by changes in the bone beneath because of disease (gout in this case).

Pyogenic Granuloma:

This is a fleshy, moist, easily bleeding mass/lump that can affect the fingers, although it has been reported in many other body areas.  In the fingers, it is commonly found after trauma to the skin.  If there are multiple or recurring lumps, it may be due to the effects of medications or pregnancy. The most effective treatment is surgery to remove the lump, but if it is due to medication, stopping the use of the medication can help.

Terry’s Nails :

Fingernails will appear milky white/opaque, except for a small band of pink/red at the end of the nail bed.  This appearance was first reported to be associated with liver disease and has also been reported with congestive heart failure, type II diabetes and aging.

Stuttering  also called stammering or childhood-onset fluency disorder — is a speech disorder that involves frequent and significant problems with normal fluency and flow of speech. People who stutter know what they want to say, but have difficulty saying it. For example, they may repeat or prolong a word, a syllable, or a consonant or vowel sound. Or they may pause during speech because they’ve reached a problematic word or sound.

Sometimes, however, stuttering is a chronic condition that persists into adulthood. This type of stuttering can have an impact on self-esteem and interactions with other people.

Children and adults who stutter may benefit from treatments such as speech therapy, using electronic devices to improve speech fluency or cognitive behavioral therapy.

Symptoms

Stuttering signs and symptoms may include:

• Difficulty starting a word, phrase or sentence
• Prolonging a word or sounds within a word
• Repetition of a sound, syllable or word
• Brief silence for certain syllables or words, or pauses within a word (broken word)
• Addition of extra words such as “um” if difficulty moving to the next word is anticipated
• Excess tension, tightness, or movement of the face or upper body to produce a word
• Anxiety about talking
• Limited ability to effectively communicate

The speech difficulties of stuttering may be accompanied by:

• Rapid eye blinks
• Tremors of the lips or jaw
• Facial tics
• Head jerks
• Clenching fists

Stuttering may be worse when the person is excited, tired or under stress, or when feeling self-conscious, hurried or pressured. Situations such as speaking in front of a group or talking on the phone can be particularly difficult for people who stutter.

However, most people who stutter can speak without stuttering when they talk to themselves and when they sing or speak in unison with someone else.

When to see a doctor or speech-language pathologist

It’s common for children between the ages of 2 and 5 years to go through periods when they may stutter. For most children, this is part of learning to speak, and it gets better on its own. However, stuttering that persists may require treatment to improve speech fluency.

Call your doctor for a referral or contact a speech-language pathologist directly for an appointment if stuttering:

• Lasts more than six months
• Occurs with other speech or language problems
• Becomes more frequent or continues as the child grows older
• Occurs with muscle tightening or visibly struggling to speak
• Affects the ability to effectively communicate at school, at work or in social interactions
• Causes anxiety or emotional problems, such as fear or avoidance of situations where speaking is required
• Begins as an adult

Causes

Researchers continue to study the underlying causes of developmental stuttering. A combination of factors may be involved. Possible causes of developmental stuttering include:

• Abnormalities in speech motor control. Some evidence indicates that abnormalities in speech motor control, such as timing, sensory and motor coordination, may be involved.
• Genetics. Stuttering tends to run in families. It appears that stuttering can result from inherited (genetic) abnormalities.

Stuttering resulting from other causes

Speech fluency can be disrupted from causes other than developmental stuttering. A stroke, traumatic brain injury, or other brain disorders can cause speech that is slow or has pauses or repeated sounds (neurogenic stuttering).

Speech fluency can also be disrupted in the context of emotional distress. Speakers who do not stutter may experience dysfluency when they are nervous or feeling pressured. These situations may also cause speakers who stutter to be less fluent.

Speech difficulties that appear after an emotional trauma (psychogenic stuttering) are uncommon and not the same as developmental stuttering.

Risk factors

Males are much more likely to stutter than females are. Factors that increase the risk of stuttering include:

• Delayed childhood development. Children who have developmental delays or other speech problems may be more likely to stutter.
• Having relatives who stutter. Stuttering tends to run in families.
• Stress. Stress in the family, high parental expectations or other types of pressure can worsen existing stuttering.

Complications

Stuttering can lead to:

• Problems communicating with others
• Being anxious about speaking
• Not speaking or avoiding situations that require speaking
• Loss of social, school, or work participation and success
• Being bullied or teased
• Low self-esteem

Treatments:

After a comprehensive evaluation by a speech-language pathologist, a decision about the best treatment approach can be made. Several different approaches are available to treat children and adults who stutter. Because of varying individual issues and needs, a method — or combination of methods — that’s helpful for one person may not be as effective for another.

• Improve speech fluency
• Develop effective communication
• Participate fully in school, work and social activities

A few examples of treatment approaches — in no particular order of effectiveness — include:

• Speech therapy. Speech therapy can teach you to slow down your speech and learn to notice when you stutter. You may speak very slowly and deliberately when beginning speech therapy, but over time, you can work up to a more natural speech pattern.
• Electronic devices. Several electronic devices are available to enhance fluency. Delayed auditory feedback requires you to slow your speech or the speech will sound distorted through the machine. Another method mimics your speech so that it sounds as if you’re talking in unison with someone else. Some small electronic devices are worn during daily activities. Ask a speech-language pathologist for guidance on choosing a device.
• Cognitive behavioral therapy. This type of psychotherapy can help you learn to identify and change ways of thinking that might make stuttering worse. It can also help you resolve stress, anxiety or self-esteem problems related to stuttering.
• Parent-child interaction. Parental involvement in practicing techniques at home is a key part of helping a child cope with stuttering, especially with some methods. Follow the guidance of the speech-language pathologist to determine the best approach for your child.

Medication

Although some medications have been tried for stuttering, no drugs have been proved yet to help the problem.

Autism spectrum disorder (ASD) is a developmental disorder that appears in the first 3 years of life. ASD affects the brain’s normal development of social and communication skills.

Causes

Autism spectrum disorder (ASD) is a physical condition linked to abnormal biology and chemistry in the brain. The exact causes of these abnormalities are not known. There is likely a combination of factors that lead to ASD. It may run in some families, and research shows that a number of genes may be involved.

Many other possible causes have been suspected, but not proven. Some researchers believe that damage to a specific part of the brain, called the amygdala, may be involved. Other researchers are looking at whether a virus may trigger symptoms.

Some parents have heard that vaccines children receive may cause ASD. Several research studies have found no connection between vaccines and ASD. The American Academy of Pediatrics and the Centers for Disease Control and Prevention report that there is no link between ASD and vaccines.

Some doctors think the increase in the number of children with ASD is due to better diagnosis and newer definitions of ASD. The term autism spectrum disorder now includes conditions that used to be diagnosed separately:

• Autistic disorder
• Asperger syndrome
• Childhood disintegrative disorder
• Pervasive developmental disorder

Symptoms

A number of infectious agents and infection-related conditions can contribute to hair loss.

Surprisingly, ringworm has nothing to do with worms, but is a fungal infection that can occur anywhere on the body. If it develops on the scalp, it can cause patches of hair loss and is known to doctors as “tinea capitis.” Ringworm is the same thing as athlete’s foot, and the same kind of fungal infection that can affect the nails too.

On the scalp, ringworm usually begins as a small pimple that progressively expands in size, leaving scaly patches of temporary baldness. The fungus gets into the hair fibers in the affected area and these hairs become brittle and break off easily, leaving a bald patch of skin. Affected areas are often itchy, red, and inflamed, with scaly patches that may blisterand ooze. The patches are usually redder around the outside with a more normal skin tone in the center. This may create the appearance of a ring — hence the name, ringworm.

The fungus Microsporum gypseum can also sometimes cause tinea capitis. This fungus is common in soil and may be transferred to humans by contact with infected animals. You can also get ringworm from pets that carry the fungus, and cats in particular are common carriers. Ringworm is contagious. It can be passed from one person to the next by direct skin-to-skin contact. You can also catch ringworm through contact with contaminated items such as combs, unwashed clothing, and shower or pool surfaces.

Treatment for ringworm varies depending on the particular fungus involved. Some types of ringworm infection will go away spontaneously and no treatment is given. However, most commonly, griseofulvin, an anti-fungal, is used. Griseofulvin is very effective against fungi in hair and skin but it is not so good at treating yeast or bacterial infections. The drug gradually accumulates in the skin and hair. It especially likes to bind with keratin, which is a key component of hair, skin, and nails, and blocks the fungus from infecting the keratin.

More recently, some fungi that cause tinea capitis show some resistance to the drug, which means higher doses and longer courses of treatment. As an alternative to griseofulvin, newer anti-fungal drugs like terbinafine, itraconazole, and fluconazole can be prescribed.

There are several treatments for seborrheic dermatitis. The simplest involves medicated anti-dandruff type shampoos to control the skin proliferation and scaling. Several shampoos might be recommended for alternating use on different days and each with its own particular activity.

Shampoos for seborrheic dermatitis may contain sulfur, selenium sulfide, zinc pyrithione, tar, salicylic acid, or oil of cade. These shampoos have been available for many years. More recently azole-based shampoos (such as ketoconazole [brand name: Nizoral]) have been made available over the counter. All can be effective in treating seborrheic dermatitis.

Some dermatologists may also prescribe antibiotics to control the skin flora and in doing so indirectly reduce the inflammation. The inflammation may be directly treated using a corticosteroid cream or lotion to control the body’s immune response. Seborrheic dermatitis can be very persistent once it starts, so staying with treatment is required and preventative treatment is useful even when the symptoms are gone.

Apraxia is a poorly understood neurological condition. People who have it find it difficult or impossible to make certain motor movements, even though their muscles are normal. Milder forms of apraxia are known as dyspraxia.

Apraxia can occur in a number of different forms. One form is orofacial apraxia. People with orofacial apraxia are unable to voluntarily perform certain movements involving facial muscles. For instance, they may not be able to lick their lips or wink. Another form of apraxia affects a person’s ability to intentionally move arms and legs.

With apraxia of speech a person finds it difficult or impossible to move his or her mouth and tongue to speak. This happens, even though the person has the desire to speak and the mouth and tongue muscles are physically able to form words.

There are two forms of apraxia of speech — acquired apraxia and developmental apraxia. Acquired apraxia can occur in people of all ages. Typically, though, it is found in adults. This condition causes people to lose the speech-making abilities they once possessed.

Developmental apraxia of speech is also known as childhood apraxia of speech. This condition is present from birth, and it affects a child’s ability to form sounds and words. Children with speech apraxia often have far greater abilities to understand speech than to express themselves with spoken words.

The majority of children with developmental apraxia will experience significant improvement, if not complete recovery, with the correct treatment.

Apraxia is sometimes confused with aphasia, another communication disorder. That confusion can be complicated by the fact that the two conditions can occur together.

People with apraxia and aphasia might both have difficulty expressing themselves with words. There are, though, distinct differences between the two. Aphasia describes a problem in a person’s ability to understand or use words in and of themselves. This may make it hard for someone with the condition to speak, read, or write. But apraxia does not describe a problem with language comprehension. Apraxia refers to the difficulty someone has initiating and performing the movements needed to make speech. This difficulty arises despite the fact that there is no weakness in the necessary muscles.

There are a variety of speech-related symptoms that can be associated with apraxia, including:

• Difficulty stringing syllables together in the appropriate order to make words, or inability to do so
• Minimal babbling during infancy
• Difficulty saying long or complex words
• Repeated attempts at pronunciation of words
• Speech inconsistencies, such as being able to say a sound or word properly at certain times but not others
• Incorrect inflections or stresses on certain sounds or words
• Excessive use of nonverbal forms of communication
• Distorting of vowel sounds
• Omitting consonants at the beginnings and ends of words
• Seeming to grope or struggle to make words

Childhood apraxia of speech rarely occurs alone. It is often accompanied by other language or cognitive deficits, which may cause:

• Limited vocabulary
• Grammatical problems
• Problems with coordination and fine motor skills
• Difficulties chewing and swallowing
• Clumsiness

Acquired apraxia results from brain damage to those areas of the brain that control the ability to speak. Conditions that may produce acquired apraxia include head trauma, stroke, or a brain tumor.

Experts do not yet understand what causes childhood apraxia of speech. Some scientists believe that it results from signaling problems between the brain and the muscles used for speaking.

Ongoing research is focusing on whether brain abnormalities that cause apraxia of speech can be identified. Other research is looking for genetic causes of apraxia. Some studies are trying to determine exactly which parts of the brain are linked to the condition.

In some cases of acquired apraxia, the condition resolves spontaneously. This is not the case with developmental apraxia of speech, which does not go away without treatment.

There are various treatment approaches used for apraxia. How effective they are can vary from person to person. For the best results, apraxia treatment must be developed to meet a given individual’s needs. Most children with apraxia of speech benefit from meeting one on one with a speech-language pathologist three to five times a week. They may also need to work with their parents or guardians to practice the skills they are developing.

Therapy for childhood apraxia of speech aims to improve speech coordination. Exercises may include:

• Repeatedly practicing the formation and pronunciation of sounds and words
• Practicing stringing together sounds to make speech
• Working with rhythms or melodies
• Using multisensory approaches, such as watching in a mirror while trying to form words or touching the face while talking

Many therapists believe that sign language is beneficial for children who have difficulty being understood. They often recommend that children attempt to say the words they are signing to practice making the necessary movements with their mouths.

People with more extreme cases of acquired apraxia may also benefit from sign language. Or they may use assistive electronic devices, including computers that can be used to produce words and sentences.

Very few studies have been done to determine the relative effectiveness of various treatment approaches for childhood apraxia of speech. This may be due, in part, to ongoing debate among experts as to which symptoms and characteristics merit a diagnosis of apraxia.