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Showing posts with label radiation. Show all posts
Showing posts with label radiation. Show all posts

Monday, October 6, 2008

A Simple Guide to Acoustic neuroma

A Simple Guide to Acoustic neuroma
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What are Acoustic neuroma ?
------------------------------------------------

Acoustic neuroma is a neurofibroma of the eight nerve.


Who are at risk of Acoustic neuroma?
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1.Both sexes are equally affected.

2.Acoustic neuroma occurs more in the 50- 60 age group.

3.It forms 5-10% of the intracranial tumors in adults.


What are the different types of Acoustic neuroma?
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1.Neurofibroma I -
a. Unilateral acoustic neuroma usually
Bilateral acoustic neuromas are not common.

b. occurs in adult life,

c. the tumor involve the 8th nerve,

d. can involve any other cranial nerve or the spinal root.

e.Incidence is usually 90-95%

2.Neurofibroma II -
a. bilateral acoustic neuromas are common

b. occurs before the age of 21.

c. affects the entire nerve

d. autosomal dominant inheritance.

e. Incidence is about 5 to 10%.


What are the Causes of Acoustic neuroma?
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Acoustic neuroma in the adult begins in the Schwann's cells of the vestibular portion of the 8th nerve inside the internal auditory canal.

The tumor grows slowly and can extend into the posterior fossa to occupy the space between the cerebellum and the pons.

Because of its location, it can also compress the 5th, 7th, and less often, the 9th and 10th cranial nerves.

If it grows larger, it may also compress the pons and lateral medulla of the brain, causing blockage of the cerebrospinal fluid and increased intracranial pressure.


What are the symptoms and signs of Acoustic neuroma?
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Symptoms:
--------------
1.unilateral hearing loss

2.tinnitus with unilateral high-pitched ringing sound

3.loss of sense of balance

4.vertigo

5.nausea and vomiting

6.altered gait

7.pressure in the ear

8.rarely headache and altered consciousness.

Signs:
-------------

1.unilateral facial weakness.

2.sensory impairment of the nerve

3.impairment of glandular secretions

4.loss of taste

5.loss of sensation in one side of the face and mouth

6.rarely altered gag or swallowing reflexes.


How are diagnosis of Acoustic neuroma made?
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1.Contrast-enhanced CT will detect almost all acoustic neuromas that are greater than 2.0 cm in diameter

2.MRI with gadolinium enhancement may show even smaller tumors

3.Audiology and vestibular tests are done to check for Nerve versus conduction hearing loss.


What is the Treatment of Acoustic neuroma?
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Treatment of acoustic neuroma is usually by surgery and radiotherapy.

Conservative treatment
--------------------------

In some cases because the neuroma grow so slowly, the tumor is monitored by annual MRI to see its growth.

This method is common among patients over 70 years old.

In rare cases, acoustical neuroma have been known to disappear spontaneously.

Acoustic neuroma may result in gradual hearing loss and tinnitus.


Surgery
-----------------

Surgical removal of acoustic neuroma usually involve microsurgery to remove the tumor.

The superior and inferior vestibular nerves are removed at surgery.

This effectively restores balance in the patient.

Radiation treatment
-----------------------

Radiotherapy using gamma knife radiosurgery or fractionated stereotactic radiotherapy does not remove the tumor but is able to slow or stop its growth.


What is the Prognosis of Acoustic neuroma?
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Prognosis is good in all early diagnosis and small tumors.

Large tumors may give rise to residual neurolgical damage even afer removal.




Thursday, December 20, 2007

A Simple Guide to Burns & Scalds

A Simple Guide to Burns & Scalds
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What are burns and scalds?
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A burn is skin which is damaged most commonly by

1.fire or heat.
2.chemicals,
3.electricity
4.light including sunlight
5.radiation.

A scald is a burn caused by hot liquids or steam.

How do you determine the severity of the burn?
------------------------------------------------------


The following are considered when determining the severity of the burn:

1.Degree of burn

2.Extent of the burn

3.Age of patient

4.Body region burned

5.Other illnesses and injuries

What are the degree of burns and scalds?
--------------------------------------------


First degree Burn:
----------------------

superficial injury only affecting the epidermis
The skin is red, hot and painful.
Damage is superficial and temporary.
There is no blisters.

Second degree burn:
------------------------

first layer of skin is burned through, second layer is damaged
The underlying tissues are not damaged..
The skin is red, hot, swoolen and intensely painful and there is blister formation
.

Third degree Burn:
-----------------------

The full thickness of the skin is damaged including sometimes the underlying tissues.
The skin may appear pale and leathery or charred.
Because the nerves are damaged, there may not be pain.

How do you estimate the extent of the Burn or scald?
-----------------------------------------------------


The rule of nines give a rough estimate of the extent of the burn:
Each of the following represents 9% of body surface:
head and neck
each upper limb
the front of each lower limb
the back of each lower limb
the chest
the abdomen
the upper back
the lower back and buttocks

These constitute 99% of the body surface.
The remainder 1% is assigned to the genitals
.

Age of the Patient:
----------------------


The infant and young child have a surface area greater in proportion to the whole body compared with a older child or adult. There is therefore more body fluid loss and more danger.

An older adult above 55 years has less ability for his tissues to heal from any burns as compared to an younger adult.

Region of body burned
----------------------


Face- burn to the face is serious because it may involve the airway or injury to the eyes.
Hands and feet - burns are also of special concern because scarring may mean loss of movement of the fingers and toes.
Groins,buttocks
- burns here are particularly prone to bacterial infection
Circumferential burns- encircle the body or body part and can block circulation to the tissues distal to the burn.

Other illnesses and injuries
----------------------------


Illness such as those below can aggravate the severity of the burns and affect the healing:

Respiratory diseases
Diabetes
Heart disease
Injuries like fractures


The source of the Burn-
is also important.
A minor burn caused by nuclear radiation is more dangerous than one caused by heat.
Chemical burns are particularly more serious because the chemicals may remain on the skin and burn for hours and may enter the bloodstream causing toxic reactions.

What is the treatment for burns and scalds?
---------------------------------------------------


Superficial(first degree) burns and scalds, and partial-thickness(2nd degree) ones which does not involve an area smaller than that of the victim's palm can be treated at home:
1.Remove all jewelry and clothing at the burn area

2.Put the injured part under cold running water for a few minutes to ease the pain.
Dry by patting with a clean cloth.

3.Apply a soothing cream or lotion for scalds and burns.

4.Try not to break a blister. If a blister is already broken, apply an antiseptic lotion.

5.Painkillers may be necessary for pain.

More severe cases should be treated in a hospital:

1.the burn or scald is full-thickness (3rd degree).

2.the mouth or throat, eyes, ears, entire face or genital area is involved .

3.chemical or any corrosive substance burns.

4.electric current or lightning burns .

5.thick smoke or hot air inhalation with breathing difficulty

6.the burn or scald gets infected(
fever, pus formation and increasing pain, redness and swelling).

7.partial-thickness burn affects an area larger than the victim's palm.

8.medical illnesses such as diabetes, heart attack and stroke are present

Tuesday, October 2, 2007

A Simple Guide to Menorrhagia


A Simple Guide to Menorrhagia
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What is Menorrhagia?
-----------------

Menorrhagia
is defined as excessively heavy or prolonged bleeding through the vagina either during menstrual period or any time between menses or after menopause in women.
It is a symptom not an illness.

What is the cause of Menorrhagia?
------------------------------

The cause of Menorrhagia is abnormal uterine bleeding.
The most common causes are

1.hormonal imbalances.
During a normal menstrual cycle, there is a balance between estrogen and progesterone, two female hormones in the body. These regulate the buildup of the endometrium which is the lining of blood and tissuein the wall of the uterus and which is shed each month during menstruation.
Menorrhagia can occur because of an imbalance between estrogen and progesterone.
As a result of this imbalance, the endometrium keeps building up. When it is eventually shed, there is heavy bleeding.
Hormone imbalances are often present in adolescents and in women approaching menopause. This type of menorrhagia also known as Dysfunctional Uterine Bleeding is fairly common in these groups.

2.fibroids and benign tumour of the uterus
Another frequent cause of menorrhagia is uterine fibroids (benign tumours of the lining of the womb).
Together, hormone imbalances and fibroids account for about 80% of menorrhagia cases.

Other causes include

3.cancer of the uterus(endometrial cancer) or cervix

4.inflammation or infection of the vagina, cervix, or pelvic organs

5.polyps which are small growths on the cervical or uterine wall

6.thyroid diseases

7.liver, kidney diseases

8.blood bleeding diseases,

9.the use of blood-thinning drugs

10.stress affects the hormonal imbalance

11.injury or disease of the vaginal opening as a result of intercourse, infection, polyp, genital warts, ulcer, or varicose veins.

12.vaginal injury from insertion of foreign objects, from malignancy, or from infection

13.dry vaginal walls from lack of estrogen after menopause

14.abortion spontaneous or induced

15.stopping and starting birth control pills or estrogens

16.low thyroid function

17.IUD or intrauterine device use for contraception can cause occasional spotting

18.abnormal pregnancy eg.ectopic pregnancy

19.drugs such as oral contraceptives and anticoagulants

20.cervical conization or cauterization procedures

Bleeding may be more serious in women over 50 (post-menopausal) or younger than 12 (prepubertal).

The risk of cancer increases with
1.age.

2.obesity,

3.taking estrogen (without progestin),

4.young women who have not established a regular ovulation cycle,

5.approaching menopause.

What are the Signs of Menorrhagia?
-------------------------------------------

The most common sign is excessive bleeding per vagina.
Make sure that bleeding is coming from the vagina and not from the rectum or in the urine.

Some women may experience paleness and fatigue (anaemia)due to loss of blood.

Women with menses which consistently last more than seven days or whose periods are less than 21 days apart (unless that's normal for the woman) may be required to have a medical examination.

For a married woman or non-virgins,
1.a pelvic exam (examination of the internal reproductive organs),

2.a Pap smear test.

3.blood tests for hormonal changes and bleeding tendencies

4. urine and stool tests for conditions of the gastrointestinal and urinary systems.

5.investigations to determine ovulation

6.pregnancy test may be done if you are sexually active.

7.tests for any sexually transmitted diseases.

8.colposcopy- examination of the inside ot the uterus with a small amount of tissue taken from the endometrium may be taken for testing for canceror hormonal disorders.

Cancer should be ruled out in older women (aged 35-40) or in younger women with longer duration of exposure to unopposed estrogen.

For a non-married woman or virgin, the same examination may be done except care is taken to avoid damaging the hymen.

What is the Treatment of Menorrhagia?
----------------------------------------------

Any underlying medical condition (eg infection,bleeding disease)causing menorrhagia should be treated first.

If a hormone imbalance is responsible for Menorrhagia, hormonal treatment or replacement may be started.

Polyps are generally removed.

Anti-bleeding drugs such as daflon, dicyclone, etc can be given but may not necessarily work.

If the bleeding do not stop in spite all these measures, hysterectomy sometimes may be your only option.
Recently there is a procedure makes use of lasers or microwave technology to remove the lining of the womb (which is the part that bleeds) while leaving the rest of the womb intact.

Fibroids may require myomectomy or hysterectomy.

Hysterectomy and radiation are the usual treatment for endometrial cancer.

Bed rest may be recommended if bleeding is heavy.
The number of pads or tampons used should be recorded (so that the doctor can determine the amount of bleeding). Change tampons regularly, at least twice a day.

To help in relieving menstrual cramps, nonsteroidal anti-inflammatory drugs e.g. mefenemic acid and ibuprofen are prescribed.

The menstrual cycle is not the same for every woman. Menstrual flow occurs about every 28 days, lasts about 5 days, and produces an average of 30 - 40 mls (six to eight teaspoons) total blood loss. The menses may be regular, irregular, light, heavy, painful, pain-free, long, or short, and still be normal. Any variation in the menstrual cycle is medically less important than bleeding, pain, or discharge between menses.

The best prevention of Menorrhagia is having annual pelvic examinations with a cervical smear test (Pap smear).

Saturday, September 29, 2007

A Simple Guide to Blood Cancer

A Simple Guide to Blood Cancer
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What are Blood Cancer?

----------------------------

Blood cancer consists of mainly lymphoma, leukaemia and multiple myeloma.

These cancers developed either in the bone marrow or the lymphatic tissues of the body. These three types of blood cancers all involve an uncontrolled growth of abnormal cells within the blood and bone marrow.

Who is at risk of getting Blood Cancers?
-----------------------------------------------

The risk of developing blood cancers increases with age.

Adults therefore are more prone to blood cancer than children.

The acute leukemia tends to affect children.

The chronic leukemia is more common in adults.

However children and adults can develop any kind of leukaemia.

In Multiple myeloma, the average onset is at age 60.

Lymphoma
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(refer to my blog on A Simple Guide to Lymphoma)

Lymphoma is a cancer of the lymphoid tissues which are composed of several types of immune-system cells that work together to fight infections.

Lymphoma usually begins in a lymph node as a primary cancer.

It can also begin in the stomach, intestines, skin or any other organ that contains lymphoid tissue.

Leukaemia
--------------

Leukaemia is a cancer that affects the blood-forming system of the body which include the bone marrow and the lymphatic system.

Leukaemia can be classified as either acute or chronic.

The acute leukemia tends to affect children while the chronic leukemia is more common in adults.

Acute leukaemia
--------------------

In acute leukaemia, immature blood cells reproduce quickly in the bone marrow, slowly killing the normal cells.

These abnormal cells can also spread to other organs, ultimately leading to disruption and distortion of these organ functions.

Acute leukaemia can be further divided into two types according to the predominant type of cells affected:

1.Lymphoblasts are immature cells that normally develop into lymphocytes, a type of white blood cell

2.myeloblasts are immature cells that normally develop into other cells such as neutrophils, another type of white blood cell.

1. Acute lymphoid leukaemia (ALL) -
here the lymphoblasts reproduce without developing into normal blood cells.

These immature lymphoblasts block out the healthy blood cells and frequently congregate in the lymph nodes, causing a swelling in that area.

2. Acute myeloid leukaemia (AML) -

here the myeloblasts reproduce without developing into normal blood cells.

The immature blast cells gather in the bone marrow and upset the production of healthy normal cells.

Anaemia results due to lack of sufficient red blood cells.

Frequent infections occurs due to the low levels of white blood cells which fight infections.

Chronic leukaemia
-----------------------

Chronic leukaemia occurs when there is over-production of blood cells that appear to be mature. Unfortunately these cells actually lack the normal functions of mature blood cells.

Chronic leukaemia usually has a slower, less dramatic course than acute leukaemia.

Chronic leukaemia can also be broken into two groups:

(a) Chronic lymphoid leukaemia (CLL) -
Here there is production of too many apparently mature lymphocytes in the bone marrow. The abnormal cells appear to be fully developed lymphocytes, but cannot fight infections as well as normal lymphocytes.

(b) Chronic myeloid leukaemia (CML) -
here the over-production of apparently mature but defective myeloid cells, reach a point where almost no healthy cells remain.


Multiple Myeloma
----------------------
(refer to my blog on A Simple Guide to Multiple Myeloma)

Multiple myeloma is cancer of the bone marrow which occurs from the uncontrolled growth of plasma cells, a form of immune-protective white blood cells.

Normally plasma cells make antibodies to fight infections.

In multiple myeloma, there is a malignant proliferation of plasma cells.

What are the Symptoms of Blood Cancer?
-------------------------------------------------

All three blood cancers have similar symptoms.

Among the common warning signs are:

1.weight loss,

2.constant infections such as flu and diarrhoea,

3.bleeding of gums or nose and slow healing cuts or frequent bruises

In addition to the above,

4.severe kidney problems,

5.general numbness of the skin

6.pain in the bones
may indicate the existence of multiple myeloma and leukemia as the disease progresses.
The pain can radiate to the back, ribs and arms of the victims. The pain is a result of an increase in the number of myeloma cells where the bone marrow is being damaged.

7.swelling of lymph nodes in the neck, the armpits or in the groin may indicate more likely a diagnosis of lymphoma

8.Persistent fever

9.loss of appetite

10.generalised weakness and pallour

What are the Causes of Blood Cancer?
--------------------------------------------

1.Exposure to excessive radiation

2.hazardous chemicals like benzene, asbestos, herbicides and pesticides are known to be the primary causes of blood cancer. Avoid these harmful materials as much as possible.

3.certain genetic abnormalities, such as Down Syndrome and the inheritance of a particular chromosome called the Philadelphia chromosome, have also been linked to the development of specific forms of leukaemia. This is controversial.

How do you diagnose Blood Cancer?
------------------------------------------

1.a full medical history and full examination especially for signs of:
anaemia,
enlarged liver and spleen,
bleeding tendencies in the skin such as petechie and ecchymoses
enlarged lymph nodes

2.a full blood and urine test should be done to examine the blood cells under the microscope for cancer cells as well as to assess the patient's kidney, liver functions and the severity of anaemia.

3.A bone marrow aspirate using a syringe and needle can be examined for further evidence of blood and bone marrow cell abnormailties.

The presence of the Philadelphia chromosome may suggest evidence of leukemia.

What is the Treatment of Blood Cancer?
------------------------------------------------

Before any cancer treatment is done, because of the patients's anaemia and bleeding tendency, blood transfusions are usually given to improve the general health and resistance of the patient.

Chemotherapy and radiation therapy have always been used to treat blood cancer effectively.

Besides these treatments, stem cells infusion and bone-marrow transplants also give patients and their families another source for a cure.
Unlike chemotherapy and radiation therapy that are used to treat all the three kinds of blood cancer, bone-marrow transplants are more frequently used to cure lymphoma and leukaemia only .

It is also more successful for younger patients and when the disease is in the early stage.
Patients shuold know that dangers and side effects of bone-marrow transplants exist.

In extreme cases when the transplant fail, death may occur.

What are the Prevention measures for Blood Cancer?
--------------------------------------------------------------

1.When exposed to dangerous chemicals and radiation, take extra precautions by wearing protective and appropriate clothing.

2.The threat of contracting lymphoma can be reduced by avoiding the risk of HIV. Patients infected with HIV are known to have a higher rate of lymphoma because of their low immune-system cells to fight infections.

3.Any family member of a leukemia patient should go for genetic testing and regular check-ups to spot the symptoms early.

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