Crossed eyes is also called strabismus, a condition in which your eyes don’t line up. If you have this condition, your eyes look in different directions. And each eye will focus on a different object.

The condition is more common in children, but it can also occur later in life. In older children and adults, crossed eyes can be caused by a variety of underlying medical conditions, like cerebral palsy or stroke.

Crossed eyes can usually be corrected with corrective lenses, surgery, or a combination of both.

Symptoms of crossed eyes:

If you have crossed eyes, your eyes might point inward or outward or focus in different directions. You might also have:

• impaired vision
• double vision
• decreased depth perception
• eye strain or headache

Your symptoms may be constant or appear only when you’re tired or not feeling well.

What causes crossed eyes?

Crossed eyes occur either due to nerve damage or when the muscles around your eyes don’t work together because some are weaker than others. When your brain receives a different visual message from each eye, it ignores the signals coming from your weaker eye. If your condition isn’t corrected, you may lose vision in your weaker eye.

Crossed eyes are common in children. Often the underlying cause is unknown. Infantile esotropia is a type of crossed eyes that appears in babies during their first year of life. It runs in families and usually requires surgery to correct. Acquired esotropia occurs in children between the ages of 2 and 5. Eyeglasses can usually correct it.

Crossed eyes can also occur later in life. It’s usually caused by physical disorders, like eye injuries, cerebral palsy, or stroke. You may also develop crossed eyes if you have a lazy eye or are farsighted.

How is crossed eyes diagnosed?

To prevent vision loss, early diagnosis and treatment for crossed eyes is important. If you develop symptoms of crossed eyes, make an appointment with an eye doctor. They will perform a series of tests to check the health of your eyes that may include:

• corneal light reflex test to check for crossed eyes
• visual acuity test to determine how well you can read from a distance
• cover/uncover test to measure your eye movement and deviation
• retina exam to examine the backs of your eyes

If you have other physical symptoms along with crossed eyes, your doctor may examine your brain and nervous system for other conditions. For example, they may conduct tests to check for cerebral palsy or Guillain-Barré syndrome.

It’s common for newborn babies to have crossed eyes. If your baby has crossed eyes that persist beyond 3 months of age, make an appointment with their doctor. Young children should undergo an eye exam before age 3.

Who is at risk of crossed eyes?

You’re more likely to develop crossed eyes if you:

• have family members who have crossed eyes
• have a brain disorder or brain tumor
• have suffered a stroke or brain injury
• have a lazy eye, are farsighted, or have vision loss
• have a damaged retina
• are diabetic

How are crossed eyes treated?

Your recommended treatment plan for crossed eyes will depend on the severity and underlying cause of your condition. If your crossed eyes have resulted from a lazy eye, your doctor may have you wear a patch over your stronger eye to force the muscles of your weaker eye to work harder. They might also prescribe eye drops to blur the vision in your stronger eye. They can also use Botox injections to weaken the muscles of your stronger eye.

Other potential treatments include:

• eye exercises
• corrective lenses, such as eyeglasses or contact lenses
• surgery on certain eye muscles, particularly if corrective lenses haven’t corrected the condition

If your crossed eyes are caused by an underlying medical condition, such as a brain tumor or stroke, your doctor may prescribe medication, surgery, or other treatments.

What is the long-term outlook for crossed eyes?

Often crossed eyes can be corrected with corrective lenses, eye patches, in rare cases surgery, or by other modalities. It’s important to seek treatment right away to lower your risk of vision loss. After you’ve received treatment, watch your eyes for changes. In some cases, the condition may come back.

Gastroesophageal refers to the stomach and esophagus. Reflux means to flow back or return. Therefore, gastroesophageal reflux is the return of the stomach’s contents back up into the esophagus.

In normal digestion, the lower esophageal sphincter (LES) opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the esophagus. Gastroesophageal reflux occurs when the LES is weak or relaxes inappropriately, allowing the stomach’s contents to flow up into the esophagus.

What Is the Role of Hiatal Hernia in GERD?

Some doctors believe a hiatal hernia may weaken the LES and increase the risk for gastroesophageal reflux. Hiatal hernia occurs when the upper part of the stomach moves up into the chest through a small opening in the diaphragm (diaphragmatic hiatus). The diaphragm is the muscle separating the abdomen from the chest. Recent studies show that the opening in the diaphragm helps support the lower end of the esophagus. Many people with a hiatal hernia will not have problems with heartburn or reflux. But having a hiatal hernia may allow stomach contents to reflux more easily into the esophagus.

Coughing, vomiting, straining, or sudden physical exertion can cause increased pressure in the abdomen resulting in hiatal hernia. Obesity and pregnancy also contribute to this condition. Many otherwise healthy people age 50 and over have a small hiatal hernia. Although considered a condition of middle age, hiatal hernias affect people of all ages.

Hiatal hernias usually do not require treatment. However, treatment may be necessary if the hernia is in danger of becoming strangulated (twisted in a way that cuts off blood supply, called a paraesophageal hernia) or is complicated by severe GERD or esophagitis (inflammation of the esophagus). The doctor may perform surgery to reduce the size of the hernia or to prevent strangulation.

Aplastic anemia is a rare, potentially fatal disease in which the bone marrow doesn’t make enough blood cells. The bone marrow is the central portion of the bones that is responsible for making:

• Red blood cells, which carry oxygen
• White blood cells, which fight infection
• Platelets, which help blood to clot

The bone marrow releases the cells and platelets into the blood stream.

A complete blood count (CBC) is a blood test that measures the number of red cells, white cells and platelets circulating in the blood stream. People with aplastic anemia have low levels of all three types of blood cells that are normally manufactured in the bone marrow.

Aplastic anemia is a problem with cells in the bone marrow called stem cells. Stem cells are the basic “mother cells” that develop into the three types of blood cells. In aplastic anemia, something either destroys the stem cells or drastically changes the environment of the bone marrow so that the stem cells can’t develop properly. Several factors can cause this problem, including:

• Exposure to radiation (radiation sickness)
• Chemotherapy
• Environmental toxins (insecticides, benzene, nitrogen mustards)
• Many different medications, including chloramphenicol (Chloromycetin), phenylbutazone (Butazolidin), sulfonamides (Gantanol and others), anticonvulsants, cimetidine (Tagamet) and others
• Certain viral infections, including viral hepatitis B, parvovirus B19, HIV and infectious mononucleosis (Epstein-Barr viral infection)
• Autoimmune disease, where the body inappropriately attacks its own blood stem cells

Some people are more likely to develop aplastic anemia because of their genetic (inherited) makeup. Fanconi’s anemia is an inherited condition that causes aplastic anemia and also physical abnormalities. Some women develop a mild form of aplastic anemia during pregnancy, but it tends to disappear after delivery. In 50% to 65% of patients with aplastic anemia, the cause of the illness is not clear.

Symptoms

Symptoms and Signs of aplastic anemia include:

• Pale skin
• Fatigue
• Weakness
• Dizziness
• Lightheadedness
• Rapid pulse
• Heart murmur
• Bruising and tiny areas of bleeding in the skin
• Abnormal bleeding from the gums, nose, vagina or gastrointestinal tract, or blood in the urine
• Infections

Diagnosis

Your doctor will review your medical history and ask you to describe your symptoms. Other questions may include:

• Do you live or work in an area where you are exposed to toxic chemicals or radiation?
• What medications do you take?
• Have you ever had hepatitis, mononucleosis or another viral infection?
• Is there a family history of aplastic anemia or other blood disorders?

On occasion, the presence of aplastic anemia can predate the development of some forms of leukemia.

Your doctor will examine you to look for the signs of aplastic anemia. This will be followed by blood tests to measure levels of red blood cells, white blood cells and platelets. Aplastic anemia is suspected when the tests show that levels of all three blood cell types are extremely low, but the cells themselves look normal. A test called a bone marrow biopsy is needed to confirm the diagnosis.

During a bone marrow biopsy, a small sample of bone marrow is taken by inserting a needle into the large pelvic bone just below the waist on either side of the spine. This bone marrow sample is examined in a laboratory. A hematologist (doctor who specializes in blood disorders) usually will confirm the diagnosis based on the results of bone marrow findings and basic blood tests.

Treatment

How you are treated for aplastic anemia depends on its cause and severity. If it is a short-term condition related to medication, pregnancy, low-dose radiation or infectious mononucleosis, then you probably will recover without treatment. However, the symptoms can be treated. For example, bleeding episodes can be treated with transfusions of platelets and red blood cells, while infections can be treated with antibiotics. Women with mild forms of aplastic anemia also may be given oral contraceptives so that their monthly menstrual flow is not excessive.

At home, you will need to use antiseptic soaps, shave with electric razors instead of blades to avoid unnecessary bleeding from nicks, and avoid participating in contact sports. Also, your doctor may prescribe a stool softener to make sure you don’t have hard bowel movements, which can make you bleed from your rectum.

The two main treatments for aplastic anemia that is severe and long-lasting are bone marrow transplantation and immunosuppressive therapies.

Most treatments for aplastic anemia require medications that severely impair the normal function of the immune system. This puts patients at risk for infections, often unusual ones. These infections may occur before the bone marrow has had a chance to recover and before the treatments have had their effect. It thus becomes very important to be under the care of specialists in blood disorders and if necessary, specialists in infectious disease.

A bone marrow transplant is the most effective therapy, but the possibility of dying from the treatment increases with age, so it is most ideal for children, adolescents and young adults. In addition, the treatment is safest when the patient has a sibling (brother or sister) with a similar bone marrow type and can be used as a donor. Only about 30 percent of people who need the procedure have siblings who can be donors. In some cases, a donor who is a match but is not related to the patient will be used. However, the rate of complications is higher when the donor is not a sibling.

 

Tuberculosis is an infection caused by bacteria. It’s spread through the air—when an infected person coughs, sneezes, laughs, etc. However, it is not easy to become infected with tuberculosis. Usually a person has to be close to someone with TB disease for a long period of time.

Symptoms of TB:

Hepatitis A

This is caused by eating infected food or water. The food or water is infected with a virus called HAV (hepatitis A virus). Anal-oral contact during sex can also be a cause. Nearly everyone who develops Hepatitis A makes a full recovery – it does not lead to chronic disease.

Hepatitis B

This is an STD (sexually transmitted disease). It is caused by the virus HBV (hepatitis B virus) and is spread by contact with infected blood, semen, and some other body fluids. You get hepatitis B by:

• Unprotected sexual intercourse with an infected person (unprotected sex means without using a condom) Using a syringe that was previously used by an infected person (most commonly happens with drug addicts and people who inject steroids).
• Having your skin perforated with unsterilized needles, as might be the case when getting a tattoo, or being accidentally pricked. People who work in health care risk becoming infected by accident in this way. Sharing personal items, such as a toothbrush or razor, with an infected person.
• A baby can become infected through his mother’s milk if she is infected.
• Being bitten by someone who is infected.

The liver of a person infected with hepatitis B swells. The patient can suffer serious liver damage due to infection, resulting in cancer. For some patients the hepatitis becomes chronic (very long-term or lifelong). Donated blood is always tested for hepatitis B.

Hepatitis C

Hepatitis C is usually spread through direct contact with the blood of a person who has the disease. It is caused by the virus HCV (hepatitis C Virus). The liver can swell and become damaged. In hepatitis C, unlike hepatitis B, liver cancer risk is only increased in people with cirrhosis and only 20% of hep C patients get cirrhosis. Feces is never a route of transmission in hepatitis C. Donated blood is also tested for hepatitis C.

Misuse of anesthesia can result in the transmission of hepatitis B and hepatitis C viruses, researchers reported in the journal Gastroenterology. The cause of infection tends to be from anesthesia contamination, and not endoscopy contamination. Experts say that more effort is needed to better educate the health care community about the importance of strict sterile techniques when using any type of anesthesia.

Hepatitis D

Only a person who is already infected with hepatitis B can become infected with hepatitis D. It is caused by the virus HDV (Hepatitis D Virus). Infection is through contact with infected blood, unprotected sex, and perforation of the skin with infected needles. The liver of a person with Hepatitis D swells.

Hepatitis E

A person can become infected by drinking water that contains HEV (hepatitis E virus). The liver swells but there is no long-term consequence. Infection is also possible through anal-oral sex.

Hepatitis X

If a hepatitis cannot be attributed to the viruses of hepatitis A, B, C, D, or E, it is called hepatitis X. In other words, hepatitis of an unknown virus.

Hepatitis G

This is a type of hepatitis caused by the hepatitis G virus (HGV). Usually there are no symptoms. When there are symptoms, they are very mild.

What exactly are PNET?  Are they the same as medulloblastomas?

Yes and no. Under a microscope, PNET tumors appear to be similar to a tumor called medulloblastoma, and some will classify medulloblastoma as “PNET (cerebellum).” However, it has been demonstrated that medulloblastomas behave differently than PNET in other locations in the brain.

According to the World Health Organization (WHO), all undifferentiated tumors—regardless of location—are derived from common cells and are therefore classified as PNET.  To differentiate, their location is frequently indicated in parentheses. This separates medulloblastoma (PNET cerebellum) and pineoblastoma (PNET in the pineal region) from other PNET such as PNET in the supratentorial compartment (meaning occurring in the cerebrum) or in the spine.

What causes a PNET?

Researchers have not been able to find an identifiable cause or risk factors for PNET. There doesn’t appear to be a genetic predisposition, meaning the disease does not seem to run in families.

What are the symptoms of a PNET?

The symptoms of a PNET depend on the location of the tumor, and each child may experience symptoms differently.  Symptoms of a PNET in the supratentorial compartment usually arise quickly and last up to several weeks. These tumors are often seen in the older child or teenager.

Some common symptoms occur due to increased pressure within the brain, including:

• headache (generally upon awakening in the morning)
• vomiting
• fatigue/lethargy
• seizures

Pineoblastomas (PNET in the pineal region, a tiny organ near the center of the brain) are usually seen in young children. Common symptoms may include increased pressure in the brain, resulting in:

• headache (generally upon awakening in the morning)
• vomiting
• fatigue/lethargy
• eye movement problems and/or complaints of double vision, since the tumor is close to the nuclei (centers in the brain) that regulate eye movements and coordination

Symptoms of PNET of the spine may include:

• back and/or leg pain
• slow development of weakness in the legs
• impairment of bowel and/or bladder function, including incontinence

The symptoms of a PNET may resemble other conditions or medical problems. Always consult your child’s physician for a diagnosis.

 What are the treatments for PNET?

What is myopathy?

Myopathy refers to any disease that affects muscle tissue. Diseases of the muscle result in weakness, inflammation, tetany (spasms), or paralysis. Myopathy can be the result of either inherited or acquired causes.

Acute “acquired” myopathies, such as acute stiffness, spasm, or cramp, are common. Others are linked to exposure to an infectious agent, such as viruses or bacteria, or are inherited. However, certain cases of myopathy have no known associated risk factors.

What are the symptoms of myopathy?

Myopathy causes dysfunction of the muscles due to inflammation or disease and can cause a number of symptoms. The symptoms can vary in intensity among individuals.

 

What is HIPEC?

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery.

Unlike systemic chemotherapy delivery, which circulates throughout the body, HIPEC delivers chemotherapy directly to cancer cells in the abdomen. This allows for higher doses of chemotherapy treatment. Heating the solution may also improve the absorption of chemotherapy drugs by tumors and destroy microscopic cancer cells that remain in the abdomen after surgery.

How it works

Before patients receive HIPEC treatment, doctors perform cytoreductive surgery to remove visible tumors within the abdomen. Cytoreductive surgery is accomplished using various surgical techniques. Once as many tumors as possible have been removed, the heated, sterilized chemotherapy solution is delivered to the abdomen to penetrate and destroy remaining cancer cells. The solution is 41 to 42 degrees Celsius, about the temperature of a warm bath. It’s circulated throughout the abdomen for approximately 1 ½ hours. The solution is then drained from the abdomen and the incision is closed.

HIPEC is a treatment option for people who have advanced surface spread of cancer within the abdomen, without disease involvement outside of the abdomen.

Advantages of HIPEC

• Allows for high doses of chemotherapy
• Enhances and concentrates chemotherapy within the abdomen
• Minimizes the rest of the body’s exposure to the chemotherapy
• Improves chemotherapy absorption and susceptibility of cancer cells
• Reduces some chemotherapy side effects