life

LIPOMA

2008-08-21T22:25:00.000-07:00

A lipoma is a growth of fat cells in a thin, fibrous capsule usually found just below the skin. Lipomas are found most often on the torso, neck, upper thighs, upper arms, and armpits, but they can occur almost anywhere in the body. One or more lipomas may be present at the same time. Lipomas are the most common noncancerous soft tissue growth.

A lipoma may be surgically removed if symptoms develop, such as if the lipoma:

Becomes painful or tender.
Becomes infected or inflamed repeatedly.
Drains foul-smelling discharge.
Interferes with movement or function.
Increases in size.

syndactyly,

2008-06-11T23:32:00.000-07:00

One of the common birth defects is syndactyly, in which two or more fingers are fused together. Surgical correction involves cutting the tissue that connects the fingers, then grafting skin from another part of the body. (The procedure is more complicated if bones are also fused.) Surgery can usually provide a full range of motion and a fairly normal appearance, although the color of the grafted skin may be slightly different from the rest of the hand. Other common congenital defects include short, missing, or deformed fingers, immobile tendons, and abnormal nerves or blood vessels. In most cases, these defects can be treated surgically and significant improvement can be expected.

Medical therapy

Syndactyly requires surgical intervention. Full-term infants can be scheduled for elective surgical procedures as early as 5 or 6 months of age. Surgery before this age can increase anesthetic risks. Prior to that time, there is generally no intervention necessary if there are no problems. If there is an associated paronychia which can occur with complex syndactyly, the parents are given instructions to wash the child's hands thoroughly with soap and water and toa apply a topical antibacterial solution or ointment. Oral antibiotics are given when indicated.

Surgical therapy

The timing of surgery is variable. However, if more fingers are involved and the syndactyly is more complex, release should be performed earlier. Early release can prevent the malrotation and angulation that develops from differential growth rates of the involved fingers.

In persons with complex syndactyly, the author performs the first release of the border digits when the individual is approximately 6 months old. This approach is used because differential growth rates are observed, particularly between the small finger and ring finger or between the thumb and index finger. Prolonged syndactyly between these digits can cause permanent deformities. If more than one syndactyly is present in the same hand, simultaneous surgical release can be performed, provided only one side of the involved fingers is released. For example, in a 4-finger syndactyly involving the index, long, ring, and small fingers, the index finger can be released from the long finger, and the small finger can be released from the ring finger, leaving a central syndactyly involving the long and ring fingers (see Images 27-28). If both hands are involved, bilateral releases can be performed at one operative setting.

Perform bilateral releases whenever feasible to reduce the number of surgeries and the associated risks. Postoperative bilateral immobilization of the upper extremities is well tolerated in the child who is younger than 18 months. The increasingly active child who is older than 18 months has a difficult time with bilateral immobilization. Therefore, in children older than 18 months, any procedures must be staged unilaterally. The remaining syndactyly between the long finger and ring finger can be released approximately 6 months later (see Images 29-30). In an individual with isolated central syndactyly between the long finger and ring finger, the release need not be accomplished until the second year of life because of similar growth rates between the long finger and ring finger. It is preferable to complete all major reconstructions before a child is school age.

However, even if the child is older than the ideal age (which is usually before school age for functional, developmental, and psychological reasons), it is not too late to release the central rays (long and ring fingers) at a later age, as they have similar growth rates. For example, a 5° flexion contracture could eventually improve once the fingers are released. In children, unlike in adults, persistent flexion contractures are rare. The technical details of syndactyly release are similar to the release performed in infants. In older patients, splints are still applied but can be removed earlier, at about 7-10 days, because the patients are more compliant with activity and with dressing changes after the splint is removed

Neurofibromatosis

2008-06-09T23:24:00.000-07:00

Neurofibromatosis is a genetically-transmitted disease in which nerve cells (Schwann cells) grow tumors (neurofibromas) that may be harmless or may cause serious damage by compressing nerves and other tissues.

Neurofibromatosis is inherited through a dominant gene. That means that if a child gets one gene for neurofibromatosis from one parent, and a normal gene from the other parent, that child will have neurofibromatosis. Therefore, if only one parent has neurofibromatosis, his or her children have a 50% chance of developing the condition as well. Disease severity in affected individuals, however, can vary (this is called incomplete penetrance).

Diagnosis and Treatment

Neurofibromatosis is usually diagnosed based on a combination of findings. A child must have at least two of the following signs to be diagnosed with NF1:

café-au-lait spots of a certain number, size, and location
the appearance of two or more neurofibromas (often resembling pea-sized bumps on the skin)
Lisch nodules on the irises
an optic glioma (tumor along the main nerve of the eye that is responsible for sight)
certain skeletal abnormalities
a family member with NF1
freckling under the arms or in the groin

Tests like magnetic resonance imaging (MRI) and X-rays may be used to screen for tumors or evidence of skeletal problems. A child's head circumference will be measured because children with symptoms of NF can have a larger than normal head circumference for a given age. Blood pressure will be monitored. Doctors will also take a detailed personal history, looking for signs of learning difficulties at home or at school.

To diagnose NF2, doctors will check for any evidence of hearing loss. They'll order audiometry (hearing tests) as well as imaging tests to look for tumors in the nerves of the ears, spinal cord, or brain. They'll also determine if there's a family history of NF2.

Genetic testing is now available for people with a family history of either NF1 or NF2, though such testing is still not 100% sensitive. Amniocentesis can sometimes determine if a woman's unborn child has the condition.

Treatment for NF1 includes removal of the neurofibromas for cosmetic purposes, treating the complications (see below), and getting intervention for children with learning disabilities. Kids will be referred to appropriate medical specialists to monitor and treat any complications from the disease

click for more :
http://www.nlm.nih.gov/medlineplus/ency/article/000847.htm

Benign Prostatic Hyperplasia (BPH)

2008-06-08T22:48:00.000-07:00

Benign prostatic hyperplasia (BPH) is not simply a case of too many prostate cells. Prostate growth involves hormones, occurs in different types of tissue (e.g., muscular, glandular), and affects men differently. As a result of these differences, treatment varies in each case. There is no cure for BPH and once prostate growth starts, it often continues, unless medical therapy is started.

The prostate grows in two different ways. In one type of growth, cells multiply around the urethra and squeeze it, much like you can squeeze a straw. The second type of growth is middle-lobe prostate growth in which cells grow into the urethra and the bladder outlet area. This type of growth typically requires surgery.

Some signs to look for include:

 * Weak urinary stream
 * Prolonged emptying of the bladder
 * Abdominal straining
 * Hesitancy
 * Irregular need to urinate
 * incomplete bladder emptying
 * Post-urination dribble
 * Irritation during urination
 * Frequent urination
 * Nocturia– need to urinate during the night
 * Urgency
 * Incontinence-involuntary leakage of urine.
 * Bladder pain
 * Dysuria– painful urination

Medications

Alpha blockers (α₁-adrenergic receptor antagonists) provide symptomatic relief of BPH symptoms. Available drugs include doxazosin, terazosin, alfuzosin and tamsulosin. Older drugs, phenoxybenzamine and prazosin are not recommended for treatment of BPH.^[5] Alpha-blockers relax smooth muscle in the prostate and the bladder neck, and decrease the degree of blockage of urine flow. Alpha-blockers may cause ejaculation back into the bladder (retrograde ejaculation).

The 5α-reductase inhibitors (finasteride and dutasteride) are another treatment option. This medication inhibits 5a-reductase, which in turn inhibits production of DHT, a hormone responsible for enlarging the prostate. When used together with alpha blockers a reduction of BPH progression to acute urinary retention and surgery has been noted in patients with larger prostates.

Though former research indicated the efficacy of Serenoa repens (saw palmetto) fruit extracts in alleviating mild-to-moderate BPH symptoms, a recent double-blind study did not demonstrate any efficacy greater than that of a placebo for moderate-to-severe symptoms.^[ Herbal medicines that have research support in systematic reviews include beta-sitosterol from Hypoxis rooperi (African star grass) and pygeum (extracted from the bark of Prunus africana), while there is less substantial support for the efficacy of Cucurbita pepo (pumpkin) seed and Urtica dioica (stinging nettle) root. At least one double-blind trial has also supported the efficacy of rye flower pollen.

Surgery

If medical treatment fails, transurethral resection of prostate (TURP) surgery may need to be performed. This involves removing (part of) the prostate through the urethra. There are also a number of new methods for reducing the size of an enlarged prostate, some of which have not been around long enough to fully establish their safety or side effects. These include various methods to destroy or remove part of the excess tissue while trying to avoid damaging what's left. Transurethral electrovaporization of the prostate (TVP), laser TURP, visual laser ablation (VLAP), Transurethral microwave thermotherapy (TUMT), TransUrethral Needle Ablation (TUNA), ethanol injection, and others are studied as alternatives.

Newer techniques involving lasers in urology have emerged in the last 5-10 years, starting with the VLAP technique involving the Nd:YAG laser with contact on the prostatic tissue. A similar technology called Photoselective Vaporization of the Prostate (PVP) with the GreenLight (KTP) laser have emerged very recently. This procedure involves a high powered 80 Watt KTP laser with a 550 micrometre laser fiber inserted into the prostate. This fiber has an internal reflection with a 70 degree deflecting angle. It is used to vaporize the tissue to the prostatic capsule. KTP lasers target haemoglobin as the chromophore and typically have a penetration depth of 2.0mm (four times deeper than holmium).

Another procedure termed Holmium Laser Ablation of the Prostate (HoLAP) has also been gaining acceptance around the world. Like KTP the delivery device for HoLAP procedures is a 550um disposable side-firing fiber that directs the beam from a high powered 100 Watt laser at a 70degree from the fiber axis. The holmium wavelength is 2,140nm, which falls within the infrared portion of the spectrum and is invisible to the naked eye. Where KTP relies on haemoglobin as a chromophore, water within the target tissue is the chromophore for Holmium lasers. The penetration depth of Holmium lasers is <0.5mm>

Decubitus Ulcers

2008-06-07T00:35:00.000-07:00

The terms decubitus ulcer and pressure sore often are used interchangeably in the medical community. Decubitus, from the Latin decumbere, means "to lie down." Decubitus ulcer, therefore, does not adequately describe ulceration that occurs in other positions, such as prolonged sitting (eg, the commonly encountered ischial tuberosity ulcer). Because the common denominator of all such ulcerations is pressure, pressure sore is the better term to describe this condition.

Many factors contribute to the development of pressure sores, but pressure leading to ischemia is the final common pathway. Tissues are capable of withstanding enormous pressures when brief in duration, but prolonged exposure to pressures slightly above capillary filling pressure initiates a downward spiral towards ulceration.

Impaired mobility is an important contributing factor. Patients who are neurologically impaired, heavily sedated, restrained, or demented are incapable of assuming the responsibility of altering their position to relieve pressure. Moreover, this paralysis leads to muscle and soft tissue atrophy, decreasing the bulk over which these bony prominences are supported.

Contractures and spasticity often contribute by repeatedly exposing tissues to pressure through flexion of a joint. Contractures rigidly hold a joint in flexion, while spasticity subjects tissues to considerable repeated friction and shear forces.

Sensory loss also contributes to ulceration by removing one of the most important warning signals, pain.

Paralysis and insensibility also lead to atrophy of the skin with thinning of this protective barrier. The skin becomes more susceptible to minor traumatic forces, such as friction and shear forces, exerted during the moving of a patient. Trauma causing deepithelialization leads to transdermal water loss, creating maceration and adherence of the skin to clothing and bedding, which raises the coefficient of friction for further insult.

Malnutrition, hypoproteinemia, and anemia reflect the overall status of the patient and can contribute to vulnerability of tissue and delays in wound healing. Poor nutritional status certainly contributes to the chronicity often observed with these lesions. Anemia indicates poor oxygen-carrying capacity of the blood. Vascular disease also may impair blood flow to the region of ulceration.

Bacterial contamination from improper skin care or urinary or fecal incontinence, while not truly an etiological factor, is an important factor to consider in the treatment of pressure sores and can delay wound healing.

The first step in resolution is to reduce or eliminate the cause, that is, pressure.
Regardless of the choice of support surface, turning and repositioning the patient remain the cornerstones of prevention and treatment. This should be performed every 2 hours, even in the presence of a specialty surface or bed.
Even with optimal medical management, many patients require a trip to the operating room for debridement, diversion of urinary or fecal stream, release of flexion contractures, wound closure, or amputation.

clock for more :
http://www.emedicine.com/med/topic2709.htm

Keloid

2008-06-05T04:35:00.000-07:00

A keloid is a type of scar which results in an overgrowth of tissue at the site of a healed skin injury. Keloids are firm, rubbery lesions or shiny, fibrous nodules, and can vary from pink to flesh-colored or red to dark brown in color. A keloid scar is benign, non-contagious, and usually accompanied by severe itchiness, sharp pains, and changes in texture. In severe cases, it can affect movement of skin. Keloids should not be confused with hypertrophic scars, which are raised scars that do not grow beyond the boundaries of the original wound and may reduce over time.

Keloids are mostly found on earlobes, the sternum, shoulders, the upper back and any place where abrasion has occurred. These are usually the result of pimples, insect bites, scratching, burns, or other skin trauma. Certain procedures are known to cause keloid formation such as within post-operative surgical scars or on earlobes following piercing and behind the ears after otoplasty

People of all ages can develop a keloid. Children under 11 are less likely to develop keloids, even when they get their ears pierced. Keloids may also develop from pseudofoliculitis barbae, continued shaving when one has razor bumps will cause irritation to the bumps, infection and over time keloids will form. It would thus be wise for a man with razor bumps to stop shaving for a while and have the skin repair itself first before undertaking any form of hair removal.

No treatment for keloids is considered to be 100% effective. Some of the treatments that are currently available are described below. These treatments have varying degrees of effectiveness. All the invasive methods of treatment like surgery carry a serious risk of the keloid recurring and becoming bigger than it previously was.

Tea Tree Oil.

Crushed Aspirin Paste.

Surgery — Surgery requires great care during and after the operation. Keloids that return after being excised may be larger than the original. There is a 50% chance of recurrence after surgical removal. However, keloids are less likely to return if surgical removal is combined with other treatments. Surgical or laser excision may be followed by intralesional injections of a corticosteroid. Plastic closure of the skin including techniques such as v-plasty or w-plasty to reduce skin tension are known to reduce recurrence of keloids following excision.

Dressings
Steroid injections — Steroid injections are best used as the scar begins to thicken or if the person is a known keloid former. A series of injections with triamcinolone acetonide or another corticosteroid may reduce keloid size and irritation. However, injections are often uncomfortable and in large and/or hard scars can be difficult to perform, requiring local anesthetic for people over 16, and full anesthetic for people under. The treatment area can become very painful as the anesthetic wears off.

Compression — Compression bandages applied to the site over several months, sometimes for as long as six to twelve months, may lead to a reduction in the size of the keloid. This is the best treatment for preventing new scars.

Cryosurgery

Radiation therapy
Laser therapy

Newer treatments —alpha-interferon, 5-fluorouracil and bleomycin. However, there is a need for further study and evaluation of this treatment technique

click for more :
http://en.wikipedia.org/wiki/Keloid

Fibroadenoma

2008-06-05T04:11:00.000-07:00

Fibroadenomas are benign tumors that represent a hyperplastic or proliferative process in a single terminal ductal unit; their development is considered to be an aberration of normal development. The cause of these tumors is unknown. Approximately 10% of fibroadenomas disappear spontaneously each year, and most stop growing after they reach 2-3 cm.

Fibroadenomas may involute in postmenopausal women, and coarse calcifications may develop. Conversely, fibroadenomas may grow rapidly during pregnancy, during hormone replacement therapy, or during immunosuppression, in which case they can simulate malignancy. In immunosuppressed patients, the etiology of multiple or growing fibroadenomas appears to be related to Epstein-Barr virus infection.

On clinical examination, fibroadenomas are oval, freely mobile, rubbery masses that may be nonpalpable or palpable. Their size varies from smaller than 1 cm in diameter to as large as 15 cm in diameter in the giant forms. Most commonly, the tumors are removed surgically when they are 2-4 cm in diameter. In young women, the tumors are usually palpable. In older women, the tumors typically appear as a mass on mammograms and may be palpable or nonpalpable.

In approximately 50% of women who receive cyclosporine after renal transplantation, fibroadenomas develop, and these tumors are often multiple and bilateral. The size of fibroadenomas also can vary during the menstrual cycle and during pregnancy. During postmenopause, tumors regress and often develop calcifications. Cancer may arise in a fibroadenoma, occurring in about 2.9% of cases; an increase in size, a change or irregularity in the margin, the development of small pleomorphic calcifications, and the presence of cystic spaces all suggest a developing malignancy.

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http://www.emedicine.com/radio/TOPIC109.HTM

Basal Cell Carcinoma

2008-06-05T03:20:00.000-07:00

Basal cell carcinoma (BCC) is the most common cutaneous malignancy in humans. These tumors typically appear on sun-exposed skin, are slow growing, and rarely metastasize. Neglected tumors can lead to significant local destruction and even disfigurement.

Although the exact etiology of BCC is unknown, a well-established relationship exists between BCC and the pilosebaceous unit, as tumors are most often discovered on hair-bearing areas. Tumors are currently believed to arise from pluripotent cells (which have the capacity to form hair), sebaceous glands, and apocrine glands. Tumors usually arise from the epidermis or the outer root sheath of a hair follicle.

Patients often complain of a slowly enlarging lesion that does not heal and that bleeds when traumatized. As tumors most commonly occur on the face, patients often give a history of an acne bump that occasionally bleeds.

Patients often have a history of chronic sun exposure.

Recreational sun exposure (eg, sunbathing, outdoor sports, fishing, boating)

Occupational sun exposure (eg, farming, construction)

Occasionally, patients have a history of exposure to ionizing radiation. X-ray therapy for acne was commonly used until 1950.

Occasionally, patients have a history of arsenic intake; arsenic is found in well water in some parts of the United States.

Medical Care: In nearly all cases, the recommended treatment modality for BCC is surgery. While newer, nonsurgical therapeutic modalities are future possibilities, currently available medical modalities are considered to be experimental, with cure rates less than that of surgical modalities.

5-fluorouracil applied twice daily for 2-12 weeks of treatment can be effective in treating superficial BCC, with a reported cure rate as high as 93%. The use of 5-fluorouracil for other types of BCC is generally not recommended because it may not penetrate deeply enough into the dermis to eradicate all tumor cells. Irritation and crusting is common and expected, although significant irritation and discomfort are not uncommon.

In a small study by Greenway et al, 1.5 million IU interferon alfa-2b injected intralesionally 3 times per week for 3 weeks resulted in clearing 3 cases of primary nonrecurrent BCC and 5 cases of primary superficial BCC. Because larger studies are needed, most practitioners consider this an experimental therapeutic modality. Acetaminophen can be administered to patients who experience the flulike symptoms associated with this therapy.

Imiquimod cream has been used recently for the treatment of BCC. Small studies have shown cure rates of up to 88% for superficial BCC and nodular BCC. Studies for other histologic types of BCC are currently underway. Imiquimod is only FDA approved for the treatment of superficial BCC. Treatment is usually initiated 3 times per week and advanced as tolerated to once daily and even twice daily if tolerated to maintain mild-to-moderate skin irritation.

Surgical Care: The goal of therapy for patients with BCC is removal of the tumor with the best possible cosmetic result. By far, surgical modalities are the most studied, most effective, and most used treatments for BCC. The effectiveness of surgical modalities depends heavily on the surgeon's skills; considerable differences in cure rates have been observed among surgeons. Modalities used include electrodesiccation and curettage, excisional surgery, Mohs micrographically controlled surgery, and cryosurgery. Ionizing radiation, although a nonsurgical modality, should be considered in select patients and is discussed below

Click for more :

http://www.emedicine.com/MED/topic214.htm

Thyroid cancer

2008-06-05T03:08:00.000-07:00

Occasionally, symptoms such as hoarseness, neck pain, and enlarged lymph nodes do occur in people with thyroid cancer.. Although as much as 75 % of the population will have thyroid nodules, the vast majority are benign. That's right, most of us have nodule in our thyroid glands! Young people usually don't have thyroid nodules, but as we get older, more and more of us will develop a nodule. By the time we are 80, 90% of us will have at least one nodule. Far less than 1% of all thyroid nodules are malignant. A nodule which is cold on scan (shown in photo outlined in red and yellow) is more likely to be malignant, nevertheless, the majority of these are benign as well.

Most thyroid cancers are very curable. In fact, the most common types of thyroid cancer (papillary and follicular) are the most curable. In younger patients, both papillary and follicular cancers can be expected to have better than 97% cure rate if treated appropriately. Both papillary and follicular cancers are typically treated with complete removal of the lobe of the thyroid which harbors the cancer, PLUS, removal of most or all of the other side. The bottom line, most thyroid cancers are papillary thyroid cancer, and this is one of the most curable cancers of ALL cancers that humans get. As we often tell our patients, if you must choose a type of cancer to have, papillary cancer would be your choice. Treat it correctly and the cure rate is extremely high!

Overview of typical Thyroid cancer treatment

Usually diagnosed by sticking a needle into a thyroid nodule or removal of a worrisome thyroid nodule by a surgeon.
The removed thyroid nodule is looked at under a microscope by a pathologist who will then decide if the nodule is benign (95 - 99% of all nodules that are biopsied) or malignant (way less than 1% of all nodules, and about 1 - 5 % of nodules that are biopsied).
The pathologist decides which type of thyroid cancer it is: papillary, follicular, mixed papilofollicuar, medullary, or anaplastic.
The entire thyroid is removed by a competent surgeon (sometimes this is done during the same operation where the biopsy takes place). He/she will assess the lymph nodes in the neck to see if they need to be removed also. In the case of anaplastic thyroid cancer, a decision will be made regarding the possibility of a tracheostomy.
About 4-6 weeks after the thyroid has been removed, the patient will undergo radioactive iodine treatment. This is very simple and consists of taking a single pill. The pill will contain the radioactive iodine in the dose that has been calculated for that individual. The patient goes home, avoids contact with other people for a couple of days (so they are not exposed to the radioactive materials), and that's it.
A week or two after the radioactive iodine treatment the patient is started on a thyroid hormone pill. You can't live without thyroid hormone and since you don't have a thyroid anymore, the patient will take one pill per day for the rest of their life. This is very simple and a very common medication (example of drug names are: Synthroid, Levoxyl, Armour Thyroid, etc).
Every 6 - 12 months the patient returns to his endocrinologist for blood tests to determine if the dose of daily thyroid hormone is correct and to make sure that the thyroid tumor is not coming back. The frequency of these follow up tests and which tests to get will vary greatly from patient to patient. Endocrinologists are typically quite good at this and will typically be the type of doctor that follows this patient long-term.

click for more :
http://www.endocrineweb.com/thyroidca.html

Cleft Lip

2008-06-05T02:50:00.000-07:00

Oral clefting occurs when the tissues of the lip and/or palate of a fetus don't grow together early in pregnancy. Children with clefts often don't have enough tissue in their mouths, and the tissue they do have isn't fused together properly to form the roof of their mouths.

A cleft lip appears as a narrow opening or gap in the skin of the upper lip that extends all the way to the base of the nose. A cleft palate is an opening between the roof of the mouth and the nasal cavity. Some children have clefts that extend through both the front and rear part of the palates, while others have only partial clefting.

There are generally three different kinds of clefts:

cleft lip without a cleft palate
cleft palate without a cleft lip
cleft lip and cleft palate togeth

Doctors don't know exactly why a baby develops cleft lip or cleft palate, but believe it may be a combination of genetic (inherited) and environmental factors (such as certain drugs, illnesses, and the use of alcohol or tobacco while a woman is pregnant). The risk may be higher for kids whose sibling or parents have a cleft or who have a history of clefting in their families. Both mothers and fathers can pass on a gene or genes that cause cleft palate or cleft lip.

A child with a cleft lip or palate tends to be more susceptible to colds, hearing loss, and speech defects. Dental problems - such as missing, extra, malformed, or displaced teeth, and cavities - also are common in children born with cleft palate.

Many children with clefts are especially vulnerable to ear infections because their eustachian tubes don't drain fluid properly from the middle ear into the throat. Fluid accumulates, pressure builds in the ears, and infection may set in. For this reason, a child with cleft lip or palate may have special tubes surgically inserted into his or her ears at the time of the first reconstructive surgery.

Feeding can be another complication for an infant with a cleft lip or palate. A cleft lip can make it more difficult for a child to suck on a nipple, while a cleft palate may cause formula or breast milk to be accidentally taken up into the nasal cavity. Special nipples and other devices can help make feeding easier; you will probably be given information on how to use them and where to buy them before you take your baby home from the hospital. And in some cases, a child with a cleft lip or palate may need to wear a prosthetic palate called an obturator to help him or her eat properly.

Members of a child's cleft lip and palate treatment team usually include:

a geneticist
a plastic surgeon
an ear, nose, and throat physician (otolaryngologist)
an oral surgeon
an orthodontist
a dentist
a speech pathologist (often called a speech therapist)
an audiologist
a nurse coordinator
a social worker and/or psychologis

Surgery is usually performed during the first 12 to 18 months to repair cleft lip and/or cleft palate. Both types of surgery are performed in the hospital under general anesthesia.

Cleft palate surgery involves drawing tissue from either side of the mouth to rebuild the palate. It requires 2 or 3 nights in the hospital, with the first night spent in the intensive care unit. The initial surgery is intended to create a functional palate, reduce the chances that fluid will develop in the middle ears, and help the child's teeth and facial bones develop properly. In addition, this functional palate will help your child's speech development and feeding abilities.

Click for more :

http://www.kidshealth.org/parent/system/surgical/cleft_lip_palate.html

Rectal Cancer

2008-06-05T02:12:00.000-07:00

Approximately 135,000 new cases of colorectal cancer occur in the United States each year, resulting in approximately 55,000 deaths per year. Two thirds of these cases occur in the colon and one third in the rectum. The incidence and epidemiology, etiology, pathogenesis, and screening recommendations are common to both colon cancer and rectal cancer. These areas are addressed together.

Adenocarcinomas (98%) comprise most rectal cancers and are the focus of this discussion. Other rare rectal cancers, including carcinoid (0.1%), lymphoma (1.3%), and sarcoma (0.3%), are not discussed. Squamous cell carcinomas may develop in the transition area from rectum to anal verge and are considered anal carcinomas. Very rare cases of squamous cell carcinoma of the rectum have been reported.

The lifetime risk of developing a colorectal malignancy is approximately 5.9% in the general population.

Race

Western nations tend to have a higher incidence than Asian and African countries; however, within the United States, little difference in incidence exists among whites, African Americans, and Asian Americans.
Among religious denominations, colorectal cancer occurs more frequently in the Jewish population.

Sex

The incidence of colorectal malignancy is slightly higher in males than in females.

Age

Incidence peaks in the seventh decade; however, cases have been reported in young children

History

All patients should undergo a complete history, including a family history and assessment of risk factors for the development of rectal cancer.
Many rectal cancers produce no symptoms and are discovered during digital or proctoscopic screening examinations.
Bleeding

This is the most common symptom of rectal cancer and occurs in 60% of patients.
Bleeding often is attributed to other causes (eg, hemorrhoids), especially if the patient has a history of other problems.
Profuse bleeding and anemia are rare.
Bleeding may be accompanied by the passage of mucus, which warrants further investigation.

Change in bowel habits

Present in 43% of patients, this symptom has several different presentations. Often, it occurs in the form of diarrhea, particularly if the tumor has a large villous component.
These patients may have hypokalemia on laboratory studies.
The capacity of the rectal reservoir may mask the presence of a small lesion.
Some patients experience a change in caliber of the stool.
Large tumors can cause obstructive symptoms.
Tumors located low in the rectum can cause a feeling of incomplete evacuation and tenesmus.

Occult bleeding: This is detected on screening fecal occult blood test (FOBT) in 26% of cases.
Abdominal pain

Partial large-bowel obstruction may cause colicky abdominal pain and bloating and is present in 20% of cases.
Back pain is usually a late sign caused by a tumor invading or compressing nerve trunks.
Urinary symptoms may occur if the tumor is invading or compressing the bladder or prostate.

Malaise: This nonspecific entity is the presenting symptom in 9% of cases.
Bowel obstruction: Complete obstruction of the large bowel is rare and is the presenting symptom in 9% of cases.
Pelvic pain: This late symptom usually indicates nerve trunk involvement and is present in 5% of cases.
Other presentations include emergencies such as peritonitis from perforation (3%) or jaundice, which may occur with liver metastases ( <1%)

Click for more :

http://www.emedicine.com/MED/topic1994.htm

Appendicitis

2008-06-05T01:47:00.000-07:00

Appendicitis is an inflammation of the appendix that occurs most often in people between the ages of 10 and 30. The condition is considered a medical emergency, and treatment often involves surgery to remove the appendix. If treatment is delayed, the appendix can burst, causing infection and even death. Possible symptoms of appendicitis include abdominal pain, fever, and constipation.

In most cases, feces will cause a blockage inside of the appendix. However, a bacterial or viral infection in the digestive tract can lead to swelling of the lymph nodes, which squeezes the appendix and causes obstruction. This is known as lymphoid hyperplasia. In rare cases, traumatic injury to the abdomen, or even genetics, may also cause blockage inside of the appendix.

People who have appendicitis may not have all of the common appendicitis symptoms, especially people with certain medical conditions, women who are pregnant, children, and the elderly. Symptoms of appendicitis can also be caused by other medical conditions, which is why people who experience possible appendicitis symptoms should see their doctor immediately, because only a doctor can diagnose and treat the problem.

Pain in the abdomen can be an early symptom of appendicitis. The pain may first appear around the belly button and then move toward the lower right area of the abdomen.

Other common appendicitis symptoms include:

Pain that intensifies when moving, taking deep breaths, coughing, or sneezing
Loss of appetite
Nausea
Vomiting
Constipation or diarrhea
Inability to pass gas
Low fever that begins after other symptoms
Abdominal swelling
Feeling that a bowel movement will relieve the discomfort.

Acute appendicitis treatment consists of surgery to remove the appendix. This operation may be performed through a standard small incision in the lower-right part of the abdomen, or it may be performed using a laparoscope, which requires three to four smaller incisions. If other conditions are suspected in addition to appendicitis, they may be identified using laparoscopy. In some patients, laparoscopy is preferable to open surgery as an appendicitis treatment because the incision is smaller, recovery time is quicker, and less pain medication is required.

Recovery from an appendectomy takes a few weeks. Doctors usually prescribe pain medication and ask patients to limit physical activity. Recovery from laparoscopic appendectomy is generally faster, but limiting strenuous activity may still be necessary for 4 to 6 weeks after surgery. Most people who are treated for appendicitis recover excellently and rarely need to make any changes in their diet, exercise, or lifestyle.

Click for more :

http://digestive-system.emedtv.com/appendicitis/appendicitis-treatment.html

Breast Cancer

2008-06-05T01:30:00.000-07:00

Also called: Breast carcinoma

The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.

Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.

The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen. .

Age and health history can affect the risk of developing breast cancer.

Anything that increases your chance of getting a disease is called a risk factor. Risk factors for breast cancer include the following:

Older age.
Menstruating at an early age.
Older age at first birth or never having given birth.
A personal history of breast cancer or benign (noncancer) breast disease.
A mother or sister with breast cancer.
Treatment with radiation therapy to the breast/chest.
Breast tissue that is dense on a mammogram.
Taking hormones such as estrogen and progesterone.
Drinking alcoholic beverages.
Being white.

Breast cancer is sometimes caused by inherited gene mutations (changes).

The genes in cells carry the hereditary information that is received from a person’s parents. Hereditary breast cancer makes up approximately 5% to 10% of all breast cancer. Some altered genes related to breast cancer are more common in certain ethnic groups.

Women who have an altered gene related to breast cancer and who have had breast cancer in one breast have an increased risk of developing breast cancer in the other breast. These women also have an increased risk of developing ovarian cancer, and may have an increased risk of developing other cancers. Men who have an altered gene related to breast cancer also have an increased risk of developing this disease..

Tests have been developed that can detect altered genes. These genetic tests are sometimes done for members of families with a high risk of cancer. See the following:

Tests that examine the breasts are used to detect (find) and diagnose breast cancer.

A doctor should be seen if changes in the breast are noticed. The following tests and procedures may be used:

Mammogram: An x-ray of the breast.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, the doctor may need to remove a small piece of the lump. Four types of biopsies are as follows:

Excisional biopsy: The removal of an entire lump of tissue.
Incisional biopsy: The removal of part of a lump or a sample of tissue.
Core biopsy: The removal of tissue using a wide needle.
Fine-needle aspiration (FNA) biopsy: The removal of tissue or fluid, using a thin needle.

Estrogen and progesterone receptor test: A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If cancer is found in the breast, tissue from the tumor is checked in the laboratory to find out whether estrogen and progesterone could affect the way cancer grows. The test results show whether hormone therapy may stop the cancer from growing.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

The stage of the cancer (the size of the tumor and whether it is in the breast only or has spread to lymph nodes or other places in the body).
The type of breast cancer.
Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
Whether the cells have high levels of human epidermal growth factor type 2 receptors (HER2/neu).
How fast the tumor is growing.
A woman’s age, general health, and menopausal status (whether a woman is still having menstrual periods).
Whether the cancer has just been diagnosed or has recurred (come back).

Click for more :

http://www.cancer.gov/cancertopics/pdq/treatment/breast/patient

Modern surgery

2008-06-05T01:14:00.000-07:00

Modern surgery developed rapidly with the scientific era. Ambroise Paré (sometimes spelled "Ambrose"^[5]) pioneered the treatment of gunshot wounds, and the first modern surgeons were battlefield doctors in the Napoleonic Wars. Naval surgeons were often barber surgeons, who combined surgery with their main jobs as barbers. Three main developments permitted the transition to modern surgical approaches - control of bleeding, control of infection and control of pain (anaesthesia).

Bleeding

Before modern surgical developments, there was a very real threat that a patient would bleed to death before treatment, or during the operation. Cauterization (fusing a wound closed with extreme heat) was successful but limited - it was destructive, painful and in the long term had very poor outcomes. Ligatures, or material used to tie off severed blood vessels, are believed to have originated with Abulcasis^[6] in the 10th century and improved by Ambroise Paré in the 16th century. Though this method was a significant improvement over the method of cauterization, it was still dangerous until infection risk was brought under control - at the time of its discovery, the concept of infection was not fully understood. Finally, early 20th century research into blood groups allowed the first effective blood transfusions.

Infection

The concept of infection was unknown until relatively modern times. The first progress in combating infection was made in 1847 by the Hungarian doctor Ignaz Semmelweis who noticed that medical students fresh from the dissecting room were causing excess maternal death compared to midwives. Semmelweis, despite ridicule and opposition, introduced compulsory handwashing for everyone entering the maternal wards and was rewarded with a plunge in maternal and fetal deaths, however the Royal Society in the UK still dismissed his advice. Significant progress came following the work of Pasteur, when the British surgeon Joseph Lister began experimenting with using phenol during surgery to prevent infections. Lister was able to quickly reduce infection rates, a reduction that was further helped by his subsequent introduction of techniques to sterilize equipment, have rigorous hand washing and a later implementation of rubber gloves. Lister published his work as a series of articles in The Lancet (March 1867) under the title Antiseptic Principle of the Practice of Surgery. The work was groundbreaking and laid the foundations for a rapid advance in infection control that saw modern aseptic operating theatres widely used within 50 years (Lister himself went on to make further strides in antisepsis and asepsis throughout his lifetime).

Pain

Modern pain control through anesthesia was discovered by two American dental surgeons, Horace Wells (1815-1848) and William Morton. Before the advent of anesthesia, surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize patient suffering. This also meant that operations were largely restricted to amputations and external growth removals. Beginning in the 1840s, surgery began to change dramatically in character with the discovery of effective and practical anaesthetic chemicals such as ether and chloroform, later pioneered in Britain by John Snow. In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal regions of the human body. In addition, the discovery of muscle relaxants such as curare allowed for safer applications.

Click for more :

en.wikipedia.org/wiki/Surgery - 151k

surgery

2008-06-05T01:03:00.000-07:00

Surgery

Surgery (from the Greek: χειρουργική cheirourgikē, via Latin: chirurgiae, meaning "hand work") is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, to help improve bodily function or appearance, or sometimes for some other reason. An act of performing surgery may be called a surgical procedure, operation, or simply surgery. In this context, the verb operating means performing surgery. The adjective surgical means pertaining to surgery; e.g. surgical instruments or surgical nurse. The patient or subject that the surgery is being performed on can be a person or an animal. A surgeon is a person who performs operations on patients. Persons described as surgeons are commonly medical practitioners, but the term is also applied to podiatrists, dentists and veterinarians. Surgery can last from minutes to hours, but is typically not an ongoing or periodic type of treatment. The term surgery can also refer to the place where surgery is performed, or simply the office of a physician, dentist, or veterinarian.