Mycosis fungoides

Mycosis fungoides (MF), also known as Alibert-Bazin syndrome, is a low-grade type of non-Hodgkin lymphoma in which white blood cells called lymphctyes become cancerous and affect the skin. Mycosis fungoides, named because of the mushroom fungus look of advanced stages of the disease, is a T-cell lymphoma. MF is more common in men than women. Most patients are in their 50s and 60s. MF generally affects the skin, but may progress to internal organs or the lymph nodes.

Common mycosis fungoides symptoms

Mycosis fungoides is the most common type of skin lymphoma. Its symptoms vary from patient to patient. MF is often mistaken for eczema, psoriasis or dermatitis, making it difficult to diagnose at first. Several biopsies may be needed to confirm the diagnosis. Symptoms include:

• Rash
• Tumors
• Skin lesions
• Patches
• Itching

NOTE: These symptoms may be attributed to a number of conditions other than cancer. It is important to consult with a medical professional for an accurate diagnosis.

Advanced treatments for mycosis fungoides

Common mycosis fungoides treatments include:

Chemotherapy: For patients with refractory disease, chemotherapy may be provided as a single drug or a combination of drugs. Some chemotherapy drugs may be used to treat earlier forms of skin lymphoma, as topical ointments or creams applied directly to the skin.

Radiation: External beam radiation therapy (EBRT) may be used to treat mycosis fungoides. One method for delivering the radiation involves treating the skin over the whole body with rays of tiny particles called electrons. Recommendations for radiation therapy delivery depend on the type and stage of the cancer.

Targeted therapy: Targeted therapy drugs are used to attack specific parts of lymphoma cells or to increase the immune system’s response to them. These drugs may work in situations where chemotherapy does not.

Corticosteroids: These drugs are made up of cortisol, a naturally-occurring hormone that may affect immune cells such as lymphocytes. Corticosteroids may be taken as pills and injections, or applied directly to the skin in the form of ointments, gels and creams. They also may be injected directly into skin lesions. When applied to the skin, less of the drug is absorbed, resulting in fewer side effects. Long-term use of topical corticosteroids may cause the skin in that area to thin out.

Immunotherapy: Immune therapy drugs used to treat skin lymphomas are designed to help destroy lesions. The drug is most often delivered in the form of a cream. When applied to skin lesions, the drug is designed to activate the immune system to destroy cancer cells.

Most people have twisted an ankle at some point in their life. But if your ankle gets swollen and painful after you twist it, you have most likely sprained it. This means you have stretched and possibly torn the ligaments in your ankle.

Even though ankle sprains are common, they are not always minor injuries. Some people with repeated or severe sprains can develop long-term joint pain and weakness. Treating a sprained ankle can help prevent ongoing ankle problems.

Most types of ankle sprains happen when you make a rapid shifting movement with your foot planted, such as when you play soccer or get tackled in football. Often the ankle rolls outward and the foot turns inward. This causes the ligaments on the outside of the ankle to stretch and tear. Less often, the ankle rolls inward and the foot turns outward. This damages the ligaments on the inside of the ankle.

An ankle sprain can range from mild to severe, depending on how badly the ligament is damaged and how many ligaments are injured. With a mild sprain, the ankle may be tender, swollen, and stiff. But it usually feels stable, and you can walk with little pain. A more serious sprain might include bruising and tenderness around the ankle, and walking is painful. In a severe ankle sprain, the ankle is unstable and may feel “wobbly.” You can’t walk, because the ankle gives out and may be very painful.

With most sprains, you feel pain right away at the site of the tear. Often the ankle starts to swell immediately and may bruise . The ankle area is usually tender to touch, and it hurts to move it.

In more severe sprains, you may hear and/or feel something tear, along with a pop or snap. You will probably have extreme pain at first and will not be able to walk or even put weight on your foot. Usually, the more pain and swelling you have, the more severe your ankle sprain is and the longer it will take to heal.

Treatments:

Initial treatment for an ankle sprain is summarized as the RICE approach:

• Rest. You may need to use crutches until walking is not painful without them.
• Ice. For the first 48 to 72 hours or until swelling goes down, apply an ice pack for 10 to 20 minutes every 1 to 2 hours during the day. After 48 hours, you can continue with ice or try contrast baths. There is not good scientific evidence that ice or contrast baths help, but they are often used.
• Compression. An elastic compression wrap will help decrease swelling and should be worn for the first 24 to 36 hours. A protective brace should also be worn if you try to bear weight on your injured ankle. Don’t apply the wrap too tightly. Loosen the bandage if it gets too tight. Signs that the bandage is too tight include numbness, tingling, increased pain, coolness, or swelling in the area below the bandage. See instructions on how to wrap an ankle  with an elastic bandage. Compression wraps do not offer protection, except by reminding you to be careful of your ankle.

  Sprained Ankle: Using a Compression Wrap

• Elevation. Raise your ankle above the level of your heart for 2 to 3 hours a day if possible to decrease swelling and bruising.

If you are not taking any prescription pain relievers, you may want to take an over-the-counter pain reliever such as ibuprofen or naproxen to reduce pain and swelling. Be safe with medicines. Read and follow all instructions on the label.

It may help to wear hiking boots or other high-top, lace-up shoes for support. But use caution. Don’t force your foot into a boot if you feel a lot of pain or discomfort.

The pancreas is a large gland behind the stomach and next to the small intestine. The pancreas does two main things:

1. It releases powerful digestive enzymes into the small intestine to aid the digestion of food.
2. It releases the hormones insulin and glucagon into the bloodstream. These hormones help the body control how it uses food for energy.

Pancreatitis is a disease in which the pancreas becomes inflamed. Pancreatic damage happens when the digestive enzymes are activated before they are released into the small intestine and begin attacking the pancreas.

There are two forms of pancreatitis: acute and chronic.

Acute pancreatitis. Acute pancreatitis is a sudden inflammation that lasts for a short time. It may range from mild discomfort to a severe, life-threatening illness. Most people with acute pancreatitis recover completely after getting the right treatment. In severe cases, acute pancreatitis can result in bleeding into the gland, serious tissue damage, infection, and cystformation. Severe pancreatitis can also harm other vital organs such as the heart, lungs, and kidneys.

Chronic pancreatitis. Chronic pancreatitis is long-lasting inflammationof the pancreas. It most often happens after an episode of acute pancreatitis. Heavy alcohol drinking is another big cause. Damage to the pancreas from heavy alcohol use may not cause symptoms for many years, but then the person may suddenly develop severe pancreatitis symptoms.

Symptoms of acute pancreatitis:

• Upper abdominal pain that radiates into the back; it may be aggravated by eating, especially foods high in fat.
• Swollen and tender abdomen
• Nausea and vomiting
• Fever
• Increased heart rate

The symptoms of chronic pancreatitis are similar to those of acute pancreatitis. Patients frequently feel constant pain in the upper abdomen that radiates to the back. In some patients, the pain may be disabling. Other symptoms are weight loss caused by poor absorption (malabsorption) of food. This malabsorption happens because the gland is not releasing enough enzymes to break down food. Also, diabetes may develop if the insulin-producing cells of the pancreas are damaged.

In most cases, acute pancreatitis is caused by gallstones or heavy alcohol use. Other causes include medications, infections, trauma, metabolic disorders, and surgery. In up to 15% of people with acute pancreatitis, the cause is unknown.

In about 70% of people, chronic pancreatitis is caused by long-time alcohol use. Other causes include gallstones, hereditary disorders of the pancreas, cystic fibrosis, high triglycerides, and certain medicines. In about 20% to 30% of cases, the cause of chronic pancreatitis is unknown.

Pancreatitis can happen to anyone, but it is more common in people with certain risk factors.

Risk factors of acute pancreatitis include:

• Gallstones
• Heavy alcohol drinking

Acute pancreatitis may be the first sign of gallstones. Gallstones can block the pancreatic duct, which can cause acute pancreatitis.

Risk factors for chronic pancreatitis include:

• Heavy alcohol drinking for a long time
• Certain hereditary conditions, such as cystic fibrosis
• Gallstones
• Conditions such as high triglycerides and lupus

People with chronic pancreatitis are usually men between ages 30 and 40, but chronic pancreatitis also may occur in women.

To diagnose acute pancreatitis, doctors measure levels in the blood of two digestive enzymes, amylase and lipase. High levels of these two enzymes strongly suggest acute pancreatitis.

Doctors may also use other tests, such as:

• Pancreatic function test to find out if the pancreas is making the right amounts of digestive enzymes
• Glucose tolerance test to measure damage to the cells in the pancreas that make insulin
• Ultrasound, CT scan, and MRI, which make images of the pancreas so that problems may be seen
• ERCP to look at the pancreatic and bile ducts using X-rays
• Biopsy, in which a needle is inserted into the pancreas to remove a small tissue sample for study

Treatment for acute pancreatitis

People with acute pancreatitis are typically treated with IV fluids and pain medications in the hospital. In some patients, the pancreatitis can be severe and they may need to be admitted to an intensive care unit (ICU). In the ICU, the patient is closely watched because pancreatitis can damage the heart, lungs, or kidneys. Some cases of severe pancreatitis can result in death of pancreatic tissue. In these cases, surgery may be necessary to remove the dead or damaged tissue if an infection develops.

An acute attack of pancreatitis usually lasts a few days. An acute attack of pancreatitis caused by gallstones may require removal of the gallbladder or surgery of the bile duct. After the gallstones are removed and the inflammation goes away, the pancreas usually returns to normal.

Treatment for chronic pancreatitis

Chronic pancreatitis can be difficult to treat. Doctors will try to relieve the patient’s pain and improve the nutritionproblems. Patients are generally given pancreatic enzymes and may need insulin. A low-fat diet may also help.

Serous cystadenoma of pancreas is a benign tumor of pancreas. This cystic neoplasm is made up of several small cysts spread into a honeycomb like appearance. Serous cystadenoma of pancreas is mainly present in women, especially over the age of 60 years. The size of tumor is usually small. This type of cystic neoplasm of pancreas does not produce any signs and symptoms in majority of cases.

If symptoms occur, they are abdominal pain, loss of appetite, and indigestion.

In many patients this tumor is an incidental finding. It is detected accidentally when the patient undergoes radiological tests for some other medical condition. The neoplasm generally is located in body or tail of pancreas. Pancreatic gland is divided into head, body and tail.

Serous cystadenoma of pancreas is a benign tumor.

It does not transform into malignant cancer. Usually no treatment is necessary, unless it gets enlarge in size. In such case the tumor may need surgical removal.

Causes Of Pancreatic Serous Cystadenoma

Pancreas is an important gland which produces digestive juices as well as insulin and glucagon hormone needed for maintaining optimum level of sugar in the blood. Pancreas is an abdominal organ. Serous cystadenoma of pancreas is an uncommon form of cystic tumor of pancreas.

The exact cause is yet not completely understood. It accounts for approximately 1% of all types of pancreatic tumor. Both males and females can be affected with this tumor; however, there is a strong predilection for females. It usually occurs in people over the age of 60 years.

The particular risk factors for development of serous cystadenoma of pancreas is not known, but common risk factors that attribute development of any pancreatic tumor are also suspected to be the cause. This includes elderly age, cigarette smoking, alcoholism, obesity, poorly controlled diabetes, chronic pancreatitis, exposure to environmental pollutants, and cirrhosis of liver.

Signs And Symptoms Of Serous Cystadenoma Of Pancreas

The signs and symptoms of serous cystadenoma of pancreas depend on its size. Almost one third of patients suffering from this condition do not reveal any symptoms. In majority of cases the size is very small typically less than 10mm. It is a solitary tumor with network of several tiny cysts that gives a morphological appearance of honeycomb. The serous cyst is present in either tail or body of pancreas.

If the serous cystadenoma of pancreas enlarges in its size, it can give rise to following symptoms;

• Unwarranted loss of weight.
• Pain in middle of back, exactly just below the space between two scapula.
• Pain in abdomen
• Loss of appetite
• Indigestion
• Nausea and vomiting
• A large tumor can cause obstruction in flow of bile and enzymatic juices. This may result in jaundice or yellow discoloration of eyes, skin and nail.
• When jaundice is present the color of urine becomes dark yellow.
• There may be black tarry stool. In medical terminology it is referred as malena.

Serous cystadenoma of pancreas is well demarcated tumor. It mostly occurs as a single entity. Its size may be less than 10mm. But the tumor has potential to enlarge in size.

Serous Cystadenoma Of Pancreas Complications

Normally there are no complications associated with serous cystadenoma of pancreas. However, when they occur it is because of its enlarged size. Complications may not be life threatening but often cause extreme discomfort to the patient.

• A large tumor can cause obstruction in gastric and intestinal motility.
• It can cause obstruction in the pathway of biliary tract resulting in jaundice.
• A large tumor can cause interference with the organs located nearby pancreas. This may create problems in the functioning of the affected organ.
• If the pancreatic cells are destroyed in large numbers due to enlargement of serous cystadenoma, it may give rise to diabetes.

Treatment Of Serous Cystadenoma Of Pancreas

Pancreatic serous cystadenoma is typically small and benign tumor. A giant serous cystadenoma is a rare event. It is more found in females of elderly age. Most patients remain asymptomatic due to the small size and slow growth. Both these factors do not exert pressure on the adjacent organs and tissues. Hence majority of doctors recommend wait and watch approach to the patients. However, regular follow up is always necessary in such cases.

If there is a giant sized serous cystadenoma of pancreas which adheres or infiltrates the nearby tissues causing symptoms, it may need to be removed through complete surgical excision of the growth. Even after surgical removal of the tumor, patient needs regular check up with the doctor. The prognosis of this condition is good with treatment.

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.