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Systemic Lupus Erythematosus (SLE): Symtoms, causes & Treatments

Oct 20, 2016 Posted by admin Uncategorized 0 comments

Common symptoms of LUPUS are:

severe fatigue.
joint pain.
joint swelling.
headaches.
a rash on the cheeks and nose, which is called a “butterfly rash”
hair loss.
anemia.
blood-clotting problems.

What Is Lupus?

Lupus is an autoimmune disease whereby a misdirected immune system leads to inflammation and injury to one’s own body tissues.

Signs of Lupus

Lupus can involve many different parts of the body, including:

Skin
Joints
Heart
Lungs
Kidneys
Brain

There is no specific cure for lupus, but treatments are effective at minimizing lupus damage and improving function. Approximately 80% of lupus patients are women.

Picture of Systemic Lupus Erythematosus 1

Lupus Symptoms: Joint Pain

Though the first signs of the lupus disease can be rash, there are often pains in the muscles and joints. Both sides of the body tend to be affected. Hands, wrists, knees, and feet are commonly affected. The joints can become swollen, warm, and have limited range of motion.

Lupus Symptoms: Butterfly Rash

A classic lupus rash involves the cheeks and over the bridge of the nose. This is referred to as a “butterfly-shaped” lupus rash. It is also common for the skin to be very sensitive to burning and irritation after sun exposure. This is referred to as photosensitivity.

Lupus Symptoms: Nail Changes

Lupus rash can cause a ruddy discoloration of the backs of the hands and fingers. There can also be poor circulation to the nail beds that leads to irregularities of the fingernails. Inflammation at the nail bed can cause swelling and puffiness.

What are risk factors and causes of systemic lupus erythematosus? Is lupus contagious? Is lupus hereditary?

The precise reason for the abnormal autoimmunity that causes lupus is not known. Inherited genes, viruses, ultraviolet light, and certain medications may all play some role.

Lupus is not caused by an infectious microorganism and is not contagious from one person to another.

Genetic factors increase the tendency of developing autoimmune diseases, and autoimmune diseases such as lupus, rheumatoid arthritis, and autoimmune thyroid disorders are more common among relatives of people with lupus than the general population. Moreover, it is possible to have more than one autoimmune disease in the same individual. Therefore, “overlap” syndromes of lupus and rheumatoid arthritis, or lupus and scleroderma, etc., can occur.

Some scientists believe that the immune system in lupus is more easily stimulated by external factors like viruses or ultraviolet light. Sometimes, symptoms of lupus can be precipitated or aggravated by only a brief period of sun exposure.

It also is known that some women with SLE can experience worsening of their symptoms prior to their menstrual periods. This phenomenon, together with the female predominance of SLE, suggests that female hormones play an important role in the expression of SLE. This hormonal relationship is an active area of ongoing study by scientists.

Research has demonstrated evidence that a key enzyme’s failure to dispose of dying cells may contribute the development of SLE. The enzyme, DNase1, normally eliminates what is called “garbage DNA” and other cellular debris by chopping them into tiny fragments for easier disposal. Researchers turned off the DNase1 gene in mice. The mice appeared healthy at birth, but after six to eight months, the majority of mice without DNase1 showed signs of SLE. Thus, a genetic mutation in a gene that could disrupt the body’s cellular waste disposal may be involved in the initiation of SLE.

What is the treatment for systemic lupus?

There is no permanent cure for SLE. The goal of treatment is to relieve symptoms and protect organs by decreasing inflammation and/or the level of autoimmune activity in the body. The precise treatment is decided on an individual basis. Many people with mild symptoms may need no treatment or only intermittent courses of anti-inflammatory medications. Those with more serious illness involving damage to internal organ(s) may require high doses of corticosteroids in combination with other medications that suppress the body’s immune system.

People with SLE need more rest during periods of active disease. Researchers have reported that poor sleepquality was a significant factor in developing fatigue in people with SLE. These reports emphasize the importance for people and physicians to address sleep quality and the effect of underlying depression, lack of exercise, and self-care coping strategies on overall health. During these periods, carefully prescribed exercise is still important to maintain muscle tone and range of motion in the joints.

To protect from sun sensitivity, sunscreens, sun avoidance, and sun protection clothing are used. Certain types of lupus rash can respond to topical cortisone medications.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful in reducing inflammation and pain in muscles, joints, and other tissues. Examples of NSAIDs include aspirin, ibuprofen(Motrin), naproxen (Naprosyn), and sulindac (Clinoril). Since the individual response to NSAIDs varies, it is common for a doctor to try different NSAIDs to find the most effective one with the fewest side effects. The most common side effects are stomach upset, abdominal pain, ulcers, and even ulcer bleeding. NSAIDs are usually taken with food to reduce side effects. Sometimes, medications that prevent ulcers while taking NSAIDs, such as misoprostol (Cytotec), are given simultaneously.

Corticosteroids are more potent than NSAIDs in reducing inflammation and restoring function when the disease is active. Corticosteroids are particularly helpful when internal organs are affected. Corticosteroids can be given by mouth, injected directly into the joints and other tissues, or administered intravenously. Unfortunately, corticosteroids have serious side effects when given in high doses over prolonged periods, and the doctor will try to monitor the activity of the disease in order to use the lowest doses that are safe. Side effects of corticosteroids include weight gain, thinning of the bones and skin, infection, diabetes, facial puffiness, cataracts, and death (necrosis) of the tissues in large joints.

Hydroxychloroquine (Plaquenil) is an antimalarial medication found to be particularly effective for SLE people with fatigue, skin involvement, and joint disease. Consistently taking Plaquenil can prevent flare-ups of lupus. Side effects are uncommon but include diarrhea, upset stomach, and eye-pigment changes. Eye-pigment changes are rare but require monitoring by an ophthalmologist (eye specialist) during treatment with Plaquenil. Researchers have found that Plaquenil significantly decreased the frequency of abnormal blood clots in people with systemic lupus. Moreover, the effect seemed independent of immune suppression, implying that Plaquenil can directly act to prevent the blood clots. This fascinating study highlights an important reason for people and doctors to consider Plaquenil for long-term use, especially for those SLE people who are at some risk for blood clots in veins and arteries, such as those with phospholipid antibodies (cardiolipin antibodies, lupus anticoagulant, and false-positive venereal disease research laboratory test). This means not only that Plaquenil reduces the chance for re-flares of SLE, but it can also be beneficial in thinning the blood to prevent abnormal excessive blood clotting. Plaquenil is commonly used in combination with other treatments for lupus.

For resistant skin disease, other antimalarial drugs, such as chloroquine (Aralen) or quinacrine, are considered and can be used in combination with hydroxychloroquine. Alternative medications for skin disease include dapsone and retinoic acid (Retin-A). Retin-A is often effective for an uncommon wart-like form of lupus skin disease. For more severe skin disease, immunosuppressive medications are considered as described below.

Medications that suppress immunity (immunosuppressive medications) are also called cytotoxic drugs. They are sometimes referred to as chemotherapy because they are also used to treat cancer, generally in much higher doses than those used to treat lupus. Immunosuppressive medications are used for treating people with more severe manifestations of SLE, such as damage to internal organ(s). Examples of immunosuppressive medications include methotrexate (Rheumatrex, Trexall), azathioprine (Imuran), cyclophosphamide (Cytoxan), chlorambucil (Leukeran), and cyclosporine (Sandimmune). All immunosuppressive medications can seriously depress blood-cell counts and increase risks of infection and bleeding. Immunosuppressive medications may not be taken during pregnancy or conception because of risk to the fetus. Other side effects are specific for each drug. For examples, methotrexate can cause liver toxicity, while cyclosporine can impair kidney function.

In recent years, mycophenolate mofetil (CellCept) has been used as an effective medication for lupus, particularly when it is associated with kidney disease. CellCept has been helpful in reversing active lupus kidney disease (lupus renal disease) and in maintaining remission after it is established. Its lower side-effect profile has advantage over traditional immune-suppression medications.

In SLE patients with serious brain (lupus cerebritis) or kidney disease (lupus nephritis), plasmapheresis is sometimes used to remove antibodies and other immune substances from the blood to suppress immunity. Plasmapheresis is a process of removing blood and passing the blood through a filtering machine, then returning the blood to the body with its antibodies removed. Rarely, people with SLE can develop seriously low platelet levels, thereby increasing the risk of excessive and spontaneous bleeding. Since the spleen is believed to be the major site of platelet destruction, surgical removal of the spleen is sometimes performed to improve platelet levels. Other treatments have included plasmapheresis and the use of male hormones.

Plasmapheresis has also been used to remove certain harmful proteins (cryoglobulins) that can lead to vasculitis. End-stage kidney damage from SLE requires dialysis and/or a kidney transplant.

Fibromyalgia: Symptoms, causes & Treatments

Oct 19, 2016 Posted by admin Uncategorized 0 comments

Fibromyalgia syndrome affects the muscles and soft tissue. Symptoms include chronic muscle pain, fatigue, sleep problems, and painful tender points or trigger points, which can be relieved through medications, lifestyle changes and stress management.

What Are the Symptoms of Fibromyalgia?

Symptoms of fibromyalgia include:

Chronic muscle pain, muscle spasms, or tightness
Moderate or severe fatigue and decreased energy
Insomnia or waking up feeling just as tired as when you went to sleep
Stiffness upon waking or after staying in one position for too long
Difficulty remembering, concentrating, and performing simple mental tasks (“fibro fog”)
Abdominal pain, bloating, nausea, and constipation alternating with diarrhea (irritable bowel syndrome)
Tension or migraine headaches
Jaw and facial tenderness
Sensitivity to one or more of the following: odors, noise, bright lights, medications, certain foods, and cold
Feeling anxious or depressed
Numbness or tingling in the face, arms, hands, legs, or feet
Increase in urinary urgency or frequency (irritable bladder)
Reduced tolerance for exercise and muscle pain after exercise
A feeling of swelling (without actual swelling) in the hands and feet

When it comes to fibromyalgia treatments, there are drugs, alternative remedies, and lifestyle habits that may help decrease pain and improve sleep. Your fibromyalgia specialist may prescribe pain medication or antidepressants to help treat the pain, fatigue, depression, and anxietythat comes with the disease. In addition, your doctor may recommend physical therapy, moist heat, regular aerobic exercise, relaxation, and stress reduction to help you self-manage your symptoms.

There is no one “pill” that treats or cures fibromyalgia. A multidisciplinary approach that uses both medication and alternative or lifestyle strategies seems to work best to treat fibromyalgia symptoms.

Is Fibromyalgia Pain Similar to Arthritis Pain?

Fibromyalgia can cause symptoms similar to arthritis, bursitis, and tendinitis. Consequently, some experts group fibromyalgia with arthritis and related disorders. The pain associated with these other conditions is typically localized to a single area, while the pain and stiffness of fibromyalgia are very widespread and consists of deep muscle pain, morning stiffness, and painful tender points, making it difficult to exercise or be physically active.

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How Is Fibromyalgia Fatigue Treated?

Along with deep muscle pain and painful tender points, fatigue is a key symptom of fibromyalgia and it can be debilitating. Not only do you feel exhausted and weak, but bed rest does not seem to help. Many people with fibromyalgia report sleeping eight to 10 hours at night and feeling as if they haven’t slept at all.

Some drugs may help ease the fatigue associated with fibromyalgia. In addition, aerobic exercise can help ease fatigue, minimize pain, improve quality of sleep, and improve mood.

How Does Exercise Help Fibromyalgia Symptoms?

Numerous studies show that exercise is one of the most important treatments for fibromyalgia. Many people with fibromyalgia are are not physically fit. They avoid exercise because they fear increased pain. Yet aerobic or conditioning exercise can actually help relieve pain and depression.

Regular exercise increases the body’s production of endorphins, natural painkillers that also boost mood. Starting slowly and gradually increasing the duration and intensity of exercise can help you enjoy the benefits of exercise without feeling more pain.

Vasculitis: Symptoms, causes & Tratments

Oct 18, 2016 Posted by admin Uncategorized 0 comments

Vasculitis is a general term for a group of uncommon diseases that feature inflammation of the blood vessels. The blood vessels of the body are referred to as the vascular system. The blood vessels are comprised of arteries that pass oxygen-rich blood to the tissues of the body and veins that return oxygen-depleted blood from the tissues to the lungs for oxygen. Vasculitis is characterized by inflammation in and damage to the walls of various blood vessels.

Each of the vasculitis diseases is defined by certain patterns of distribution of blood vessel involvement, particular organ involvement, and laboratory test abnormalities. As a group, these diseases are referred to as vasculitides.

The word vasculitis is derived from the Latin “vasculum”, vessel + “- itis”, inflammation. Another term for vasculitis is angiitis. When arteries are the inflamed blood vessels, the condition is also referred to as arteritis. When the veins are inflamed, it is referred to as venulitis.

What causes vasculitis, and what are examples of diseases with vasculitis?

The actual cause of these vasculitis diseases is usually not known. However, immune system abnormality and inflammation of blood vessels are common features. Each form of vasculitis has its own characteristic pattern of symptoms, much of which depends on what particular organs are affected.

Examples of vasculitis include:

Kawasaki disease,
Behçet’s disease,
polyarteritis nodosa,
Wegener’s granulomatosis,
Cryoglobulinemia,
Takayasu’s arteritis,
Churg-Strauss syndrome,
Giant cell arteritis (temporal arteritis), and
Henoch-Schönlein purpura.

What causes vasculitis, and what are examples of diseases with vasculitis?

Examples of vasculitis include:

Kawasaki disease,
Behçet’s disease,
polyarteritis nodosa,
Wegener’s granulomatosis,
Cryoglobulinemia,
Takayasu’s arteritis,
Churg-Strauss syndrome,
Giant cell arteritis (temporal arteritis), and
Henoch-Schönlein purpura.

Vasculitis can also accompany:

Infections (such as hepatitis B),
Exposure to chemicals (such as amphetamines and cocaine),
Medications,
Cancers (such as lymphomas and multiple myeloma), and
Rheumatic diseases (such as rheumatoid arthritis and systemic lupus erythematosus

Treatments:

The treatment of the various forms of vasculitis is based on the severity of the illness and the organs involved. Treatments are generally directed toward stopping the inflammation and suppressing the immune system. Typically, cortisone-related medications, such as prednisone , are used. Additionally, other immune suppression drugs, such as cyclophosphamide (Cytoxan) and others, are considered. Additionally, affected organs (such as the heart or lungs) may require specific medical treatment when the disease is active.

The management of vasculitis is an evolving field in medicine. The ideal programs for monitoring and treatment will continue to improve as disease patterns and causes are defined by medical research.

Craniosynostosis : Symptoms, Causes & Treatments

Oct 17, 2016 Posted by admin Uncategorized 0 comments

Craniosynostosis (kray-nee-o-sin-os-TOE-sis) is a birth defect in which one or more of the joints between the bones of your baby’s skull close prematurely, before your baby’s brain is fully formed. When your baby has craniosynostosis, his or her brain can’t grow in its natural shape and the head is misshapen.

Craniosynostosis can affect one or more of the joints in your baby’s skull. In some cases, craniosynostosis is associated with an underlying brain abnormality that prevents the brain from growing properly.

Treating craniosynostosis usually involves surgery to separate the fused bones. If there’s no underlying brain abnormality, the surgery allows your baby’s brain adequate space to grow and develop.

Craniosynostosis symptoms:

Signs of craniosynostosis include:

A misshapen skull, with the shape depending on which of the cranial sutures are affected
An abnormal feeling or disappearing “soft spot” (fontanel) on your baby’s skull
Slow or no growth of the head as your baby grows
Development of a raised, hard ridge along affected sutures
Increased pressure within the skull (intracranial pressure)

The signs of craniosynostosis may not be noticeable at birth, but they become apparent during the first few months of your baby’s life.

Craniosynostosis types and characteristics

There are many different types of craniosynostosis. The term given to each type depends on what sutures are affected. Some of the most common types of craniosynostosis are:

Sagittal synostosis (scaphocephaly). Premature fusion of the suture at the top of the head (sagittal suture) forces the head to grow long and narrow, rather than wide. Scaphocephaly is the most common type of craniosynostosis.
Coronal synostosis (anterior plagiocephaly). Premature fusion of a coronal suture — one of the structures that run from each ear to the sagittal suture on top of the head — may force your baby’s forehead to flatten on the affected side. It may also raise the eye socket and cause a deviated nose and slanted skull.
Bicoronal synostosis (brachycephaly). When both of the coronal sutures fuse prematurely, your baby may have a flat, elevated forehead and brow.

Causes:

Craniosynostosis is often classified as nonsyndromic or syndromic. Nonsyndromic craniosynostosis is the most common type of craniosynostosis, and its cause is unknown.

However, syndromic craniosynostosis is a complication caused by certain genetic syndromes, such as Apert syndrome, Pfeiffer syndrome and Crouzon syndrome, which can affect your baby’s skull development. Besides craniosynostosis, other conditions also may accompany such syndromes — including hand and foot deformities, dental abnormalities, and heart problems.

Treatments and drugs:

Mild cases of craniosynostosis — those that involve only one suture and no underlying syndrome — may require no treatment. Skull abnormalities may become less obvious as your baby grows and develops hair. Or your doctor might recommend a specially molded helmet to help reshape your baby’s head and allow room for your baby’s brain growth.

Surgery:

For most babies, however, surgery is the primary treatment for craniosynostosis. The type and timing of surgery depend on the type of craniosynostosis and whether there’s an underlying syndrome that needs treatment.

The purpose of surgery is to relieve pressure on the brain, create room for the brain to grow normally and improve your child’s appearance. A team that includes a specialist in surgery of the head and face (craniofacial surgeon) and a specialist in brain surgery (neurosurgeon) often performs the procedure.

Traditional surgery. The surgeon makes an incision in your baby’s scalp and cranial bones, then reshapes the affected portion of the skull. Sometimes plates and screws, often made of material that is absorbed over time, are used to hold the bones in place. Surgery, which is performed during general anesthesia, usually takes hours.After surgery, your baby remains in the hospital for at least three days. Some children may require a second surgery later because the craniosynostosis recurs. Also, children with facial deformities often require future surgeries to reshape their faces.
Endoscopic surgery. This less invasive form of surgery isn’t an option for everyone. But in certain cases, the surgeon may use a lighted tube (endoscope) inserted through one or two small scalp incisions over the affected suture. The surgeon then opens the suture to enable your baby’s brain to grow normally. Endoscopic surgery usually takes about an hour, causes less swelling and blood loss, and shortens the hospital stay, often to one day after surgery.

If your baby has an underlying syndrome, your doctor may recommend regular follow-up visits after surgery to monitor head growth and check for increased intracranial pressure. Head growth will be routinely monitored at well-child visits.

Aneurysm: Symptoms, treatment & Prevention

Oct 15, 2016 Posted by admin Uncategorized 0 comments

What is an aneurysm?

An aneurysm is an arterial condition in which the wall of an artery weakens, creating a bulge, or distension of the artery.

A comparison between an artery with an aneurysm and two different types of artery. Note the cross-section showing a thinner artery wall in the third diagram for aneurysm, compared with normal and narrowed arteries.

An aneurysm can occur in important arteries such as those supplying blood to the brain, and the aorta; the large artery that originates at the left ventricle of the heart and passes down through the chest and abdominal cavities.

The normal diameter of the aorta is around 0.8 inches. This width can bulge to beyond 2 inches with an aneurysm, a width that would typically necessitate surgical treatment.

An aneurysm can also occur in peripheral arteries – usually behind the knee (popliteal aneurysms) – although rupture of these is relatively uncommon.

The two most important common locations for aneurysms are:

In the artery directly leaving the heart – an aortic aneurysm (including thoracic and, further down, abdominal aortic aneurysms)
In an artery in the brain – a cerebral aneurysm.

Thoracic aortic aneurysm is often abbreviated to TAA, and abdominal aortic aneurysm to AAA. Brain aneurysms are often termed intracranial aneurysms, as well as “berry aneurysms” on account of their size and shape.

Two other examples of aneurysm are mesenteric artery aneurysm (affecting the artery supplying the intestines of the gut) and splenic artery aneurysm (occurring in the spleen, an abdominal organ).

Symptoms of aneurysm:

Most aneurysms do not themselves cause any symptoms.

Even if an aneurysm does not rupture, however, a large aneurysm may obstruct circulation to other tissues. An aneurysm can also contribute to the formation of blood clots that then obstruct smaller blood vessels, potentially causing ischemic stroke or other serious problems; this is known as thromboembolism.

Back pain can be a symptom of an aneurysm although most aneurysms are asymptomatic.

Abdominal aneurysms are sometimes associated with symptoms if they grow rapidly. Some people report abdominal or lower back pain, or a pulsating sensation in the abdomen.

Similarly, thoracic aneurysms can cause symptoms by affecting nearby tissues, including nerves and other blood vessels.

If an aneurysm compresses the laryngeal or vagus nerve, it can cause chest or back pain and symptoms such as coughing, wheezing and difficulty swallowing. Compression of the coronary artery can also cause chest pain.

Otherwise, aneurysms tend to produce symptoms only when there are complications such as rupture.

Symptoms can also be related to the cause of the aneurysm rather than the aneurysm itself. In the case of infection or vasculitis (blood vessel inflammation), for example, there may be fever, malaise or weight loss.

Complications of aneurysm

If an aneurysm has remained undetected, the first sign of it could be when there is a complication – in particular, a rupture – with symptoms resulting from this rather than the aneurysm itself.

The majority of people living with an aneurysm do not suffer any of the complications in the following list. Managing the risk factors is important, however, because all of these possibilities are serious.

Complications of aneurysm include:

Brain aneurysm can lead to subarachnoid hemorrhage; a symptom of this stroke bleed is a sudden extreme headache.

Thromboembolism – depending on where the clot has traveled to, thromboembolism can cause pain in the extremities or the abdomen. If a clot travels to the brain, it can cause a stroke
Dissection of the aorta – see below for more detail
Severe chest and/or back pain – if a silent or diagnosed aortic aneurysm in the chest ruptures, severe chest or back pain may arise. Such symptoms may help hospital medical staff diagnose an aneurysm.
Angina – certain types of aneurysm can lead to angina, another type of chest pain; the pain is related to narrowed arteries supplying the heart itself (causing myocardial ischemia and possibly heart attack).
Sudden extreme headache – if a brain aneurysm leads to subarachnoid hemorrhage (a kind of stroke), the main symptom is sudden extreme headache; often so severe that it is unlike any previous experience of head pain.
Other symptoms – with any aneurysm rupture there may be pain, low blood pressure, a rapid heart rate, and light-headedness.

Again, most people with an aneurysm will not suffer any of these complications, and the risk can be reduced by taking preventive steps.

Treatments for aneurysm

Not all cases of unruptured aneurysm need active treatment, but when an aneurysm ruptures, emergency surgery is needed.

More details follow for the treatment options against the two main types of aneurysm.

Aortic aneurysm treatment options

An aortic aneurysm, whether abdominal or thoracic, may not need any active treatment and instead may just be monitored regularly. Medications and preventive measures may form part of conservative management or they may accompany active surgical treatment – through open or endovascular surgery.

Aortic aneurysm surgery can be performed as open surgery or as endovascular surgery.

Aneurysms that rupture require emergency surgery. Without immediate repair, a ruptured aneurysm is always fatal in the thoracic aorta, and almost always fatal in the abdominal aorta.

The decision to operate on an unruptured aneurysm in the aorta depends on a number of factors related to the individual patient, as well as to features of the aneurysm itself:

Individual factors – age, general health, coexisting conditions and personal choice
The aneurysm’s characteristics – size relative to location in the thorax or abdomen and the rate of growth
Other factors – chronic abdominal pain or risk of thromboembolism may make surgery a good option.

An aortic aneurysm that has a larger diameter (about 2 inches or 5 cm) is more likely to prompt a recommendation of surgery, as is an aneurysm which is growing more quickly (a little less than 1/4 inch over the last 6-12 months).

For both elective unruptured and emergency ruptured cases, surgery can take one of two forms:

Open surgery to fit a synthetic or stent graft
Endovascular stent-graft surgery.

Endovascular surgery involves accessing the blood vessels through a small incision near the hip. In stent-graft surgery, an endovascular graft is inserted through this incision using a catheter and is positioned in the aorta to seal off the aneurysm.

In the emergency of a ruptured abdominal aortic aneurysm, the decision over which procedure to perform will be urgent. For elective operations to repair unruptured aneurysms, a review published in 2014 sought to determine the relative risks and benefits of open vs. endovascular surgery.

The review found that while there was a lack of robust studies comparing the two options directly, similar rates of complication were reported for both types of surgery.

The evidence suggested that endovascular aneurysm repair (EVAR) was “less invasive,” but the procedure did “not always significantly alter the postoperative course or length of hospital stay for patients.”

The authors concluded that open surgery still had a role for those patients who were not suitable for endovascular surgery.

Endovascular surgery has become the generally preferred method of aortic aneurysm surgery because of:

Shorter operative times
Often shorter hospital stays
Better levels of surgical experience
A perceived lower risk of disease or death surrounding surgery compared with laparoscopic surgery (although the review found this could be more perception than reality).

Endovascular surgery for the repair of aortic aneurysms does carry the following risks however, in addition to the usual risks of surgery:

Bleeding around the graft (which requires additional surgery)
Bleeding before or after the procedure
Blockage of the stent
Nerve damage, resulting in weakness, pain or numbness in the leg
Kidney failure
Reduced blood supply to the legs, kidneys or other organs
Erectile dysfunction
Unsuccessful surgery that then requires open surgery
Slippage of the stent.

Cerebral aneurysm treatment options

Surgical treatment of an aneurysm in the brain is reserved for cases that present a high risk of rupture.

Aneurysms that are less likely to burst are not treated surgically because of the potential risk of brain-damage resulting from possible surgical complications.

In lieu of surgery, patients are given guidance on how to monitor and modify, where possible, the risk factors for rupture of a brain aneurysm. This will likely involve monitoring blood pressure – see prevention below.

Where a ruptured brain aneurysm has led to a subarachnoid hemorrhage (a medical emergency), a patient may be admitted to hospital and undergo brain surgery.

Such a procedure would aim to close off the artery that ruptured due to the aneurysm, in the hope of preventing another bleed.

Prevention of aneurysm

The single most important way a person can reduce their risk of developing an aneurysm is to not smoke or to quit if already smoking. Smoking is not only the strongest risk factor for the development of an aortic aneurysm, it is also one of the greatest risk factors for an aneurysm growing and rupturing.

Smoking is the strongest risk factor for both the development and rupture of aneurysms.

Smoking is a greater risk factor for aneurysm than it is for atherosclerosis, the cardiovascular disease where fatty deposits accumulate on the arterial wall and which can weaken artery walls.

The fact that smoking is also a big risk factor for atherosclerosis is directly relevant, however, because most aneurysms are caused by weakening of the artery wall brought on by atherosclerosis:

Studies have shown that continued smoking induces a significantly faster expansion of aortic aneurysms – by about 0.4 millimeters a year).

Brain aneurysms are not always possible to avoid to the same extent as aortic aneurysms because ruptured brain aneurysms causing subarachnoid hemorrhage stroke can be congenital – present at birth.

Brain aneurysm has both genetic and environmental risk factors, and a history of brain aneurysms in the family is an established risk factor, as is increasing age. However, known risk factors also include, alongside hypertension (high blood pressure), smoking.

Cigarette smoke is also a major source of free radicals which cause oxidative stress. Oxidative stress and resulting tissue damage can occur due to higher production or reduced removal of free radicals. Oxidative stress can also increase inflammation, which contributes to the formation and rupture of cerebral aneurysms.

TOS : Symptoms, causes and treatments

Oct 14, 2016 Posted by admin Uncategorized 0 comments

Thoracic outlet syndrome (TOS) is a condition whereby symptoms are produced (such as numbness in fingers, pain in shoulder, arm, and neck) due to compression of nerves and/or blood vessels in the upper chest. The passageway for these nerves and blood vessels to exit the chest and supply the upper extremities is referred to as the thoracic outlet. Muscle, bone, and other tissues border the thoracic outlet. Any condition that results in enlargement or movement of these tissues of or near the thoracic outlet can cause the thoracic outlet syndrome. These conditions include muscle enlargement (such as fromweight lifting), injuries, an extra rib extending from the neck (cervical rib), weight gain, and rare tumors at the top of the lung. Often no specific cause is detectable.

Thoracic outlet syndrome is a condition whereby symptoms are produced from compression of nerves or blood vessels, or both, because of an inadequate passageway through an area (thoracic outlet) between the base of the neck and the armpit.

Picture of thoracic outlet syndrome (TOS) showing symptom areas

Thoracic outlet syndrome symptoms include

neck pain,
shoulder pain,
arm pain,
numbness and tingling of the fingers, and
impaired circulation to the extremities (causing discoloration).

What causes thoracic outlet syndroms?

An inadequate passageway for nerves and blood vessels as they pass through an area (thoracic outlet) between the base of the neck and the armpit causes thoracic outlet syndrome. This can be constant or intermittent. Thoracic outlet syndrome can be caused by weight lifting, obesity, tumors in the chest, and extra ribs extending from the seventh cervical vertebra at the base of the neck.

What are thoracic outlet syndrome risk factors?

Risk factors include occupations that involve heavy usage of the upper extremities against resistance, including jack-hammer operators and dental hygienists, weight lifting, pregnancy, and obesity. Any condition that causes encroachment of the space for the brachial plexus at the thoracic outlet can lead to thoracic outlet syndrome, including poor posture.

What are thoracic outlet syndrome symptoms and signs?

Symptoms include neck, shoulder, and arm pain, numbness in the fingers, or impaired circulation and flushed sensations to the extremities (causing discoloration). The involved upper extremity can feel weak. Often symptoms are reproduced or worsened when the arm is positioned above the shoulder or extended. Patients can have a wide spectrum of symptoms from mild and intermittent to severe and constant. Pains can extend to the fingers and hands, causing weakness.

What types of doctors treat thoracic outlet syndrome?

Doctors who treat thoracic outlet syndrome include general physicians, such as general-medicine doctors, family medicine doctors, and internists, as well as rheumatologists, physical-medicine doctors, and chest surgeons.

What is the prognosis for thoracic outlet syndrome?

Most people with thoracic outlet syndrome can have complete resolution of symptoms with conservative measures, including exercises specific for thoracic outlet syndrome, physical therapy, and avoiding stressing the tissues of the thoracic outlet. It can be helpful to avoid sleeping with the arms extended above the head. Rarely, surgical intervention can be necessary to take pressure off of involved nerves and blood vessels. Complications include embolization to the hand and nerve damage to the extremity involved.

Is it possible to prevent thoracic outlet syndrome?

It’s possible to prevent thoracic outlet syndrome by maintaining relaxed tissues of the upper chest. This can involve prevention exercises, stretches, and therapies designed to loosen the tissues around the shoulders and neck.

Endometrial Polyps: Symptoms, Causes & Treatments

Oct 13, 2016 Posted by admin Uncategorized 0 comments

Definition

Endometrial polyps or uterine polyps are growths attached to the interior wall of the uterus that expand into the uterine cavity. Excess growth of cells in the endometrium leads to the formation of endometrial polyps. They are by and large noncancerous, though they could turn out to be cancerous in future.

Uterine polyps vary in size from a few millimeters to a number of centimeters. They affix to the uterine wall by a big base or a thin stalk.

A woman can have one or several endometrial polyps. They usually stay enclosed within the uterus, but seldom, they slide down through the gap of the uterus into the vagina. Endometrial polyps generally occur in women who are in the course of or have attained menopause, though younger women can get them too.

Symptoms

Signs of endometrial polyps consist of:

Irregular period bleeding
Bleeding between the menstrual periods
Extreme heavy menstrual periods
Vaginal bleeding post menopause
Infertility

Risk Factors

Risk factors for developing uterine polyps include:

Being perimenopausal or postmenopausal
High blood pressure
Obesity
Intake of tamoxifen, a drug cure for breast cancer

Diagnosis

If the doctor suspects uterine polyps, one of the following will be performed:

Transvaginal ultrasound
Hysteroscopy
Endometrial biopsy

Most endometrial polyps are benign. Nevertheless, some precancerous changes of the uterus or uterine cancers appear as endometrial polyps. The doctor will suggest removal of the polyp and will send a tissue sample for lab examination.

Treatment

For endometrial polyps, the doctor might recommend:

Watchful Waiting: Undersized polyps without signs might resolve on their own. Treatment of small polyps is unnecessary unless there is a risk of uterine cancer.

Medication

Some hormonal medications, including progestins and gonadotropin-releasing hormone agonists, may reduce the symptoms. But taking such medications is usually a short-term solution at best as the symptoms reappear once medication is stopped.

Surgery

Polyps can be removed during hysteroscopy, and sent for histopathological analysis. Depending on the result, further action can be taken.

Sarcoglycanopathy: Symptoms & Treatments

Sep 29, 2016 Posted by admin Uncategorized 0 comments

Sarcoglycanopathy: A form of limb-girdle muscular dystrophy involving abnormalities of the sarcoglycan protein which results in progressive muscle weakness. The severity is greatly variably from wheelchair confinement at the age of 9 years to asymptomatic adults. Most tend to live to their third decade. More detailed information about the symptoms, causes, and treatmentsof Sarcoglycanopathy is available below.

Symptoms of Sarcoglycanopathy:The list of signs and symptoms mentioned in various sources for Sarcoglycanopathyincludes the 18 symptoms listed below:

Delayed motor milestones
Calf muscle hypertrophy
Abnormal curvature of the spine
Weakness of pelvic muscles
Weakness of shoulder muscles
Wasting of pelvic muscles
High creatine kinase level
Toe walking
Muscle pain
Muscle cramps
Foot drop
Loss of mobility
Lordosis
Wasting of front of thigh
Wasting of back of thighs
Wasting of shoulder girdle muscles
Hip flexion contractures
Unusual smile

Treatments:

Family Practice
Pediatrics (Child Health Specialist)
Adolescent Medicine (Teen Health)
Geriatric Medicine (Senior Health)
Internal Medicine
Critical Care Medicine
Public Health

Doctors and specialists in areas related to Sarcoglycanopathy:

Muscle and Orthopedic Specialists:
- Neuromusculoskeletal Medicine
- Orthopedic Surgery

Pyeloplasy: Symptoms & Procedure

Sep 28, 2016 Posted by admin Uncategorized 0 comments

Pyeloplasty is an operation to correct a blockage that has occurred between the kidney and the ureter. The ureter is the tube which drains the kidney into the bladder. Removing the blockage allows urine to drain freely from the kidney to the bladder.

What is a Laparoscopic Pyeloplasty ? A Laparoscopic Pyeloplasty is a minimally invasive surgical procedure to correct a blockage or narrowing (puj obstruction) of the junction of the kidney to the tube draining urine.Why is Laparoscopic Pyeloplasty performed ?

Obstruction of the ureteropelvic junction (UPJ) can be caused by congenital abnormalities like horseshoe kidney, fibrous scarring due to stone or previous operation, a blood vessel which may cause it to kink or a stone that gets impacted in the upper part of ureter. This can cause damage to kidney tissue and eventually lead to pain, stones, infection, high blood pressure, deterioration of kidney function and kidney failure. Laparoscopic Pyeloplasty is the procedure of choice to relieve all these symptoms.

Who is an ideal candidate for Laparoscopic Pyeloplasty ?

If you have obstruction of the ureteropelvic junction (UPJ) which can be caused by congenital abnormalities like horseshoe kidney, fibrous scarring due to stone or previous operation, or if you have a blood vessel which may cause your ureteropelvic junction (UPJ) to kink or if you have a stone that gets impacted in the upper part of ureter, then you are an ideal candidate for Laparoscopic Pyeloplasty.

Preparation for surgery:

Medications to Avoid Prior to Surgery

Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx, Plavix and some other arthritis medications can cause bleeding and should be avoided 1 week prior to the date of surgery (Please contact your surgeon’s office if you are unsure about which medications to stop prior to surgery. Do not stop any medication without contacting the prescribing doctor to get their approval).

Bowel Preparation and Clear Liquid Diet

Do not eat or drink anything after midnight the night before the surgery and drink one bottle of Magnesium Citrate (can be purchased at your local pharmacy) the evening before your surgery.Drink only clear fluids for a 24-hour period prior to the date of your surgery. Clear liquids are liquids that you are able to see through. Please follow the diet below.

Clear Liquid Diet
Remember not to eat or drink anything after midnight the evening before your surgery. Clear liquids are liquids that you are able to see through.

Please follow the diet below :

Water
Clear Broths (no cream soups, meat, noodles etc.)
Chicken broth
Beef broth
Juices (no orange juice or tomato juice)
Apple juice or apple cider
Grape juice
Cranberry juice
Tang
Hawaiian punch
Lemonade
Kool Aid
Gator Aid
Tea (you may add sweetener, but no cream or milk)
Coffee (you may add sweetener, but no cream or milk)
Clear Jello (without fruit)
Popsicles (without fruit or cream)
Italian ices or snowball (no marshmallow)

Q. How is the operation done ?

Laparoscopic Pyeloplasty India Surgery offers info on Laparoscopic Pyeloplasty India, Laparoscopic Pyeloplasty Surgery India

Figure : an illustration of the kidney and ureter before, during and following the procedure.

The first part of the operation is to give you an anaesthetic (put you to sleep) so that you will not be aware of anything whilst the operation is being performed.

The operation can take 3-4 hours, but can vary depending upon the individual. Three small cuts (approximately 1cm) are made in your stomach to perform the operation. A small plastic tube (stent) is placed inside the pipe leading from the kidney (ureter) at the beginning of the operation to bridge the surgical repair and help urine to drain freely from the kidney involved.

The tube will be left inside for 4-6 weeks and you will return as a day case to have this removed. This is done under local anaesthesia through the passage where you pass urine.

A tube (catheter) is placed into your bladder to allow urine to drain whilst you recover from your operation. The urine may have blood in it but this is normal and will clear in a day or two. The tube (catheter) will be removed once you are walking around, in a day or two.

You may also have a wound drain in your stomach to drain away any blood. This will be removed when there is little or no fluid draining from it.

Laparoscopic Pyeloplasty Surgery India, Cost Laparoscopic Pyeloplasty Surgery India

Figure: Traditional open kidney surgery is performed through an 8-12 inch incision extending from the ribs towards the abdomen. A portion of one of the ribs is usually removed as part of the surgery.

Laparoscopic Pyeloplasty India Surgery offers info on Laparoscopic Pyeloplasty India, Cost Laparoscopic Pyeloplasty Surgery India

Figure : An illustration of 3 incisions during the procedure

Advantages over open surgery

Less pain
Shorter hospital stay
Quicker recovery
Better cosmetic result

Q. What is the recovery period like following Laparoscopic Pyeloplasty ?

You will spend the next few hours following Laparoscopic Pyeloplasty, in the recovery room to monitor your vital signs and observe for any immediate post-operative complications. You will be hospitalized for 24 – 48 hours following Laparoscopic Pyeloplasty. Pain medication and antibiotics will be given post-operatively.

The stent will be removed 4 – 6 weeks after Laparoscopic Pyeloplasty. Avoid performing strenuous activities like lifting something heavy, jogging, treadmill or playing sports for at least 2 weeks after Laparoscopic Pyeloplasty. You will be instructed to move around, avoid getting constipated, do some very simple breathing exercises to help prevent respiratory infections. You will be able to perform all your routine daily activities in about 2 – 4 weeks time after Laparoscopic Pyeloplasty.

Potential Risks and Complications

Although this procedure has proven to be very safe, as in any surgical procedure there are risks and potential complications. The safety and complication rates are similar when compared to the open surgery.

Potential risks include : -

Bleeding : – Blood loss during this procedure is typically minor (less than 100 cc) and a blood transfusion is rarely required. If you are still interested in autologous blood transfusion (donating your own blood) prior to your surgery, you must make your surgeon aware. When the packet of information is mailed or given to you regarding your surgery, you will receive an authorization form for you to take to the Red Cross in your area.

Infection : – All patients are treated with broad-spectrum intravenous antibiotics prior to starting the surgery to decrease the chance of infection from occurring after surgery. If you develop any signs or symptoms of infection after the surgery (fever, drainage from your incision, urinary frequency, discomfort, pain or anything that you may be concerned about) please contact us at once.

Hernia : – Hernias at incision sites rarely occur since all keyhole incisions are closed carefully at the completion of your surgery.

Tissue / organ injury : – Although uncommon, possible injury to surrounding tissue and organs including bowel, vascular structures, spleen, liver, pancreas and gallbladder could require further surgery. Injury could occur to nerves or muscles related to positioning.

Conversion to open surgery : – this surgical procedure may require conversion to the standard open operation if extreme difficulty is encountered during the laparoscopic procedure. This could result in a larger standard open incision and possibly a longer recuperation period.

Failure to correct UPJ obstruction : – Roughly 3 % of patients undergoing this operation will have persistent blockage due to recurrent scarring. If this occurs additional surgery may be necessary.

Q. What is the outcome of Laparoscopic Pyeloplasty ?

Laparoscopic Pyeloplasty almost has a success rate of 95%, there is reduced hospital stay (one day in younger, healthy patients), faster healing and quicker return to normal activity and work.

Trigeminal neuralgia: Symptoms, Causes and Treatments

Sep 27, 2016 Posted by admin Uncategorized 0 comments

What Is Trigeminal Neuralgia?

Trigeminal neuralgia (TN), also called tic douloureux, is a condition that is characterized by intermittent, shooting pain in the face.

Trigeminal neuralgia affects the trigeminal nerve, one of the largest nerves in the head. The trigeminal nerve sends impulses of touch, pain, pressure, and temperature to the brain from the face, jaw, gums, forehead, and around the eyes.

What Causes Trigeminal Neuralgia?

The most frequent cause of trigeminal neuralgia is a blood vessel pressing on the nerve near the brain stem. Over time, changes in the blood vessels of the brain can result in blood vessels rubbing against the trigeminal nerve root. The constant rubbing with each heartbeat wears away the insulating membrane of the nerve, resulting in nerve irritation.

What Are the Symptoms of Trigeminal Neuralgia?

Trigeminal neuralgia causes a sudden, severe, electric shock-like, or stabbing pain that lasts several seconds. The pain can be felt on the face and around the lips, eyes, nose, scalp, and forehead. Symptoms can be brought on when a person is brushing the teeth, putting onmakeup, touching the face, swallowing, or even feeling a slight breeze.

Trigeminal neuralgia is often considered one of the most painful conditions seen in medicine. Usually, the pain is felt on one side of the jaw or cheek, but some people experience pain at different times on both sides. The attacks of pain may be repeated one after the other. They may come and go throughout the day and last for days, weeks, or months at a time. At times, the attacks can disappear for months or years. The disorder is more common in women than in men and rarely affects anyone younger than age 50.

How Is Trigeminal Neuralgia Diagnosed?

Magnetic resonance imaging (MRI) can be used to determine whether a tumor or multiple sclerosis is irritating the trigeminal nerve. Otherwise, no test can determine with certainty the presence of trigeminal neuralgia. Tests can, however, help rule out other causes of facial disorders. Trigeminal neuralgia usually is diagnosed based on the patient’s description of the symptoms.

How Is Trigeminal Neuralgia Treated?

Trigeminal neuralgia can be treated with antiseizure drugs such as Tegretol (carbamazepine) or Neurontin (gabapentin). The medications Klonopin (clonazepam) and Depakote (divalproex sodium) may also be effective and may be used in combination with other drugs to achieve pain relief. Some antidepressant drugs also have significant pain relieving effects.

If medications are ineffective or if they produce undesirable side effects, neurosurgical procedures are available to relieve pressure on the nerve or to reduce nerve sensitivity.

Surgery : Micro vascular decompression so patient will be free of all symptoms.

Some patients report having reduced or relieved pain by means of alternative medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis, or meditation.

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