A Simple Guide to Kidney Cancer

A Simple Guide to Kidney Cancer
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What is Kidney Cancer?
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Kidney Cancer is a malignant disease of the kidney.

What are the causes of Kidney Cancer?
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1.Hereditary- hereditary kidney cancer is related to the Von Lindau syndrome.

2.Smoking. cigarettes smoke chemicals has been known to damage the Kidney cells

3.Uncontrolled hypertension-damage to kidney cells may contribute to Kidney cancer

4.Obesity has been found to have some causal effect

5.Age - more common in in 50-70 age group

6.Long term dialysis for kidney failure.

What are the symptoms and signs of Kidney Cancer?
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Symptoms - non-specific and silent.

In the early stage there is no symptoms.

By the the time the symptoms appeared, the cancer is usually in the advanced stage.

1.painless hematuria or blood in urine

2.pain in the renal flanks

3.Fever

4.weight loss

Signs:

1.tenderness in renal area of backs

2.palpable mass in the side of abdomen

How do you diagnose Kidney Cancer?
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Diagnosis can usually be made by :

History
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1.hematuria

2.Renal flank pain

3.Weight loss

Liver function tests
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may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels) in the absence of liver disease.

Ultrasound or abdominal CT
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may be used to identify tumors.

Kidney Biopsy
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biopsy of kidney may be done to determine types of Kidney cancer:

Clear Cell Type: 75%
Papillary type: 20%
Chromophole type: 4%
Others: 1%

What is the treatment of Kidney Cancer?
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Treatment of Kidney cancer can be
surgery
chemotherapy
radiotherapy
immunotherapy
biological targeted therapy
depending on the stage of the cancer.

Surgery
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If the cancer is localized within the kidney , then it is surgically resectable and curable.

No treatment after surgery has been proven to prevent recurrence.

Depending on the size of the cancer, the recurrence rate varies from
10% in Stage I
60% in Stage III

Once recurrence occur then the cancer is considered as a Stage IV cancer and therefore incurable.

The aim of treatment then is palliative with emphasis to improve overall survival rates and quality of life.

Immunotherapy
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High dose immunotherapy such as interleukin may be able to cure less than 5% of the kidney cancer patients.

It is however toxic and potentially life threatening and is used for patients not suitable for surgery.

Low dose immunotherapy such as interferon is better in that it can relieve symptoms and improve quality of life for an average of 3-6 month in 15% of cases treated.

Despite its low dose the side effects can also affects the treatment of the patients such as fever, chills and loss of appetite.

Biological targeted therapy
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These drugs target the growth of the cancer cells by suppressing the cellular pathways which stimulates the growth of the abnormal tumor blood vessels and the tumor cells .

These treatments have been proven to better in terms of better response and length of the disease control compared to interferon and interleukin.

There has also being an improved overall survival rate with a reduced risk of death by 28%.

Side effects are hypertension, ischemia of heart, fatigue, loss of appetite, diarrhea and loss of weight.

The approved drugs are sorafenib, sumitinib and tensirolimus.

Chemotherapy and radiotherapy
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Chemotherapy and radiotherapy have been found to be ineffective for renal cancer treatment.

What is the Prognosis of Kidney cancer?
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The prognosis of Kidney cancer is poor

1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.

2.Median survival from diagnosis is around 1 year

3.5-year survival is lower than 5%.

4.Kidney cancer has one of the highest mortality of all the cancers.

How to prevent Kidney cancer?
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Avoid smoking

Reduce weight in obese patients

Control high blood pressure to prevent damage to the kidney

Avoid taking toxic substances which may damage or injure the cells of the kidney.

A Simple Guide to Intertrigo

A Simple Guide to Intertrigo
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What is Intertrigo?
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Intertrigo is a moist red seborrheic (oil gland) skin rash affecting body clefts such as armpits and groins.


What are the causes of Intertrigo?
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The seborrheic glands (oil glands) in the skin secretes excessive sebum(oil) especially in areas which tends to rubs against each other such as armpits, groins, skin under the breasts, and navel.

Because of the irritation of the skin and secretion of sebum, a red moist form of rash appears.


What are Signs and symptoms of Intertrigo?
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Symptoms:

1.moist rash

2.red skin

3.may be oily


Signs:

1.Typical red moist macular rash

2.may have sebum present

3.appears mainly at axilla, groin, submammary skin


How is the diagnosis of Intertrigo made?
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1.Symptoms and signs of moist red seborrheic type of rash

2.Skin scraping to exclude fungal infection.



What are the complications of Intertrigo?
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1.Fungal infection

2.bacterial infection


What is the treatment of Intertrigo?
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1.Control of dandruff and other seborrheic conditions

2.Anifungal and antibiotic cream applied to skin lesions.

3.Corticosteroid cream may help reduce inflammation


What is the prognosis of Intertrigo ?
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Generally excellent but may recur.


What are the Preventive measures taken for Intertrigo ?
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1.Lose weight in obese patient(less friction)

2.Good skin hygiene

3.Healthy lifestyle with balanced diet and adequate sleep.

4.Proper skin care of the axilla, groins, submammary ares, navel

A Simple Guide to Varicose Veins

A Simple Guide to Varicose Veins
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What are Varicose Veins?
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Varicose Veins are swollen veins in the legs which has ballooned up over time.
They are more common in women than in men.

What are the causes of Varicose Veins?
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The cause of the Varicose Vein is due to the accumulation and stagnation of blood in the veins over time.
From the heart blood flows easily downwards to the legs into the capillaries to supply nutrient and oxygen to the foot.
From the foot the blood is then pushed up though the veins right up to the heart.
Movement of the blood in the veins is assisted by the contraction of muscles pushing the blood upwards.
When the muscle relaxes, the blood in the veins gravitates downwards but is prevented from going down by valves in the veins.
If the valve in the vein fails, blood begins to accumulates and stagnate in the veins causing ballooning and dilation of the veins.
The distended veins are then called Varicose Veins.

Causes for the failure of the valves in the veins are:
1.Hereditary - some people are born with inherent weakness of the valve of the veins.

2.Prolonged standing -causes gravitation of the blood down the veins

3.Pregnancy - the veins may be partially blocked by weight of the foetus causing stagnation of blood

4.Obesity - the weight of the body causes the blood to slow down and gravitates down wards in the veins.

5.pelvic tumours like ovarian cysts can partially block the blood flow up the veins.

6.Tight stockings- constricts the blood vessels mechanically

7.Smoking- constricts the blood vessel through its chemicals

What are the complications of Varicose Veins?
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Varicose Veins reduces the blood flow in the legs and can give rise to
complications:

1.Phlebitis-
inflmmation of the varicose vein is due to a blood clot stucked in the vein forming a thrombosis.
The skin over the inflammed vein becomes hot, red, swollen and tender.
A thrombosis in the superficial veins are usually not dangerous but a deep vein thrombosis can become detached and lodged in the lungs causing pulmonary embolism.

2.Haemorrhage-
bleeding may occur when a swollen varicose vein with thinned walls burst.
Blood will then flow out.
Trauma or injury of the swollen varicose vein can also cause bleeding.

3.varicose ulcers may occur when the swollen venous wall gradually stretched and breaks without bleeding.
The break may slowly develop into a ulcer becoming larger unless treated.

4.varicose pigmentation results from skin discoloration from an iron containing pigment called hemosiderin from broken down red blood cells stucked in the varicose veins.

What are the symptoms of Varicose Veins?
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1. Swollen blood vessels in the legs
2. Varicose pigmentation
3. Varicose ulcers
4. Phlebitis

What are the investigations needed in assessment of varicose veins?
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The type, size, location and depth of the varicose vein problem can be determined by various non-invasive diagnostic tests:

1.venous doppler,

2.PPG, and

3.color duplex ultrasound.

What is the treatment for Varicose Veins?
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1. No treatment if condition is mild

2. Elastic stocking- support stockings and pressure bandaging compress the valves of the veins together to prevent backflow and prevent dilation of the veins.
Once the stockings are in place, you should exercise by walking as much as possible. When sitting raise the legs.
While sleeping do not use the stockings.
Raise the bottom of bed or put legs on pillows to elevate the legs.
While stockings can slow down the natural course of the disease and reduce the painful symptoms. they WILL NOT CURE the disease.

3. Medical treatment:

Injection of veins-

a.Traditional Sclerotherapy
Here the veins are injected with a small amount of a solution causing them to collapse and disappear.

b.Ultrasound Guided Sclerotheraphy
By using a Doppler/Duplex Ultrasound system the doctor can get a x-ray-like picture of the deeper vein and inject at strategic locations of the vein.

c.Foam Sclerotherapy
Similar to traditional sclerotherapy, but using a foaming agent, making it more suitable for larger veins.

d.IPL Laser Therapy used mostly for the smallest spider veins.
In this method a light beam is pulsed onto the veins to seal them.

4. Surgical treatment:

a.tying of veins-
The simplest treatment consist of tying the superficial vein in the upper thigh preventing the flow of blood in the superficial vein and deflecting it into the deeper vein.

b.stripping of veins
this consist of removal of the long superficial vein using a instrument called the stripper.
After the removal of the vein, firm pressure is applied to the leg.

c.Ambulatory Phlebectomy
Parts of the vein is removed through tiny incisions leaving only small puncture marks and requires no stitches.

d.Closure(Radiofrequency Occlusion)
A super-thin catheter is inserted in the vein and when removed it closes the vein behind it by the use of radio frequency waves.

e.Endovenous Laser Treatment -same as the Closure Procedure, except the catheter emits laser rays instead of radio frequency waves

How can Varicose Veins be prevented?
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1.Reduce weight

2.Exercise

3.Aviod prolonged standing

4.Put your feet up

A Simple Guide to Obesity Part 2

A Simple Guide to Obesity Part 2
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What is the Treatment of Obesity?
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Motivation:
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Motivation is the key to weight control.

Knowing the dangers of obesity will help to motivate a person to lose weight.

Set realistic goals for losing weight eg. reduce 10% in 6 months
Gradually reduce weight and maintain it at a healthy weight.

Even if you fail to reach your targeted healthy weight, any reduction helps your health and prevents diseases associated with obesity.

Regular Exercise:
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Regular exercise daily, or at least three times a week is good for the body.
It helps to improve blood circulation and breathing.

Start with a regime of walking or cycling or swimming.
Slowly increase the level of activity to more intense physical exercise like jogging.

Lead an active lifestyle.
Do not sit and watch TV all the time.

Diet Control:
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Choose a healthy diet with with reduced calories and which is nutritionally balanced

Take plenty of vegetables and fruits.
Eat less food which is high in fat and sugar

Low Fat and high carbohydrate diets may reduce the weight but may have long term bad effect on your health.

A combination of diet and exercise is more effective in reducing than either one alone.

Medication:
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Two main types of medications are available to help control weight:

1.Appetite suppressants:
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help promote weight loss by reducing appetite or increase the sensation of being full.
They increase serotonin or catecholamine - brain chemicals that affect mood and appetite.

They also help by increasing metabolism thus burning away the fat.
They may have limited effect on weight loss as the patient's weight loss level off after 4 to 6 months.

They have the side effects of irritability, insomnia, palpitations and tachycardia.
They should be avoided in heart disease, anxiety, insomnia, pregnency.

They should be used for short term (6-12 months) as there is also a danger of dependency.

2.Fat absorption suppressant:
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prevents the absorption of fats by interfering with the enzymes which dissolves the fat and absorbs the fat into the body.

Instead the fat is not absorbed into the body and passes out in the stools undigested.
The fat in the body is then used up to provide energy and production of hormones.
Less fat is available for putting on weight.

They should be avoided in malabsorrption syndrome, liver disease or pregnancy.
The side effects of these medicines are usually diarrhoea due to the fat passed out in the stools.

They can be taken for a longer peroid of 2 years.

Surgery:
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Surgical treatment may be required for the severely obese (those with a BMI of 40 or greater) or with other health problems.

Surgery should be used only drug therapy, diet, exercise have failed.

Minor surgery may involve liposuction (sucking out the fats in the abdominal wall,under the chin, buttocks and other obvious parts of the body.

Lapband surgery is done for the very obese when other methods have failed and there is a risk of obesity related disease.
A band is placed over the middle of the stomach making it narrow and not capable of taking much food.

Surgery has some complications such as infections.

How do you prevent recurrence of Obesity?
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Many studies showed that most people will regain weight within 5 years.

You can maintain your weight by
1.eating a low calorie diet, low in fats

2.maintaining a healthy exercise regime

3.maintaining motivation and self esteem

4.monitoring your weight food intake and exercise

A Simple Guide to Obesity

A Simple Guide to Obesity
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What is obesity?
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Obesity is defined as having a weight 20% above the desirable weight which is having a BMI (Body Mass Index) of 22 or less.
It is a chronic medical condition where fat accumulates in the body due to excess calories.
Obesity is harmful to the person's health and well being.

What causes obesity?
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Many factors contributes to obesity:

Genetic factors
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Obesity runs in the family and is hereditary.
Family members who share the same diet and lifestyle may have the same overweight condition.

Environmental factors
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The environment is an important factor in determining obesity.
1.Overeating -
many people have an increased craving for food.
It has found that these people lack a hormone called serotonin in the brain which acts to decreased appetite.

2.low metabolism -
some people has a lower metabolic rate tends to accumulate the excess energy from food as fats in the body.
Classic example is hypothyroidism where the low thyroid hormone reduce the capacity of the body to burn off energy so they become lethargic and fat.

3.lack of exercise -
Exercise helps to burn up calories.
People who tend to have a sedentary life without exercise tends to be overweight

4.Certain medications:
some medications like corticosteroids, female hormones aand antidepressants tends to cause increased appetite and water retention and contributes to weight gain.

Psychological factors
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Psychological factors may be the cause of tendency to overindulge in food.
Some people eats more out of boredom, sadness, or anger.
Others overeat as a way of dealing with stress or depression.

Rare illnesses:
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Some rare illnesses like hypothyroidism, Cushing's syndrome, depression, and certain neurological problems can lead to overeating.
These conditions are believed to be responsible for only about one percent of all obesity cases.

What is the criteria for diagnosis of Obesity?
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The most widely used method is the body mass index (BMI).
BMI is the gauge of the amount of body fat in adults.

BMI = Your Weight (kg)
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Height (metres) x Height (metres)

The risk of developing heart disease and diabetes begins at BMI values of 23 kg/m2 and above.
BMI (kg/m2) (for adults):
Risk of Heart Disease and Diabetes

27.5 and above
High Risk

23.0 - 27.4
Moderate Risk

18.5 - 22.9
Low Risk (healthy range)

Less than 18.5
Risk of nutritional deficiency diseases and osteoporosis

Knowing your BMI will motivate you to lower your weight.

What are the Complications from obesity?
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Health hazards
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Obesity is not just a cosmetic problem.
Many serious medical conditions are associated with it:
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1.High blood pressure

2.High blood cholesterol

3.Diabetes

4.Coronary heart disease

5.Stroke

6.Gallbladder disease

7.Liver disease

8.Degenerative joint disease

9.Cancer (colon, uterine, breast and other cancers).

10.Gout,caused by high levels of uric acid in the blood from the high purine
proteins consumed.

11.Sleep apnoea

Emotional effects:
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1.Feelings of rejection, shame, or depression

2.Feeling undesirable compared with a slim person.

3.Some face prejudice or discrimination.

4.Some may be seen as lazy or lacking in self-control.

Treatment of Obesity will follow in A Simple Guide to Obesity Part 2