What is it?
Arthritis, meaning inflammation of a joint, can occur at any joint in the human body. Degenerative arthritis means inflammation of a joint due to wear and tear. This condition is called osteoarthritis. Doctors may also use the term “arthrosis” to describe the condition of a worn-out joint. There are many causes for arthritis, and the term is used to describe inflammatory conditions, such as gout, infection, and rheumatoid arthritis.
Who gets it?
In recent years, there has been increasing evidence that osteoarthritis is genetic and has a tendency to occur in families. Research suggests that osteoarthritis that occurs without any injury may be related to the chemical make-up of the cartilage in the joint.
What are the symptoms?
When the joint sustains an injury, the cartilage holding the joint together becomes damaged. The patient does not typically know that damage has been done, and they may not be experiencing significant pain. When asked if the pain limits their activities, the first answer may be “no”. However, in careful questioning, one would ask a patient “what activities are they doing now that they were doing five years ago that they cannot do now because of discomfort in their ankle”. The patient may be surprised by their response.
Because cartilage does not heal or grow back, this causes a defect in the joint. Over time, these defects fill with scar tissue, causing more pain and instability to the joint. The joint ultimately reaches a point when it is no longer able to properly function without significant pain because of the continual damage, resulting in increased inflammation and severe pain.
Diagnosis
Your orthopaedic physician will obtain a family history, considering all factors important in determining the type of arthritis you may have. He will also conduct a thorough physical examination of the joint to evaluate and determine the type and extent of damage to the joint. In this physical examination, the physician will measure the range of motion at the joint, and may draw fluid from the joint to determine if an infection is present. X-rays will then be taken to assess the amount of damage to the joint and determine the proper diagnosis.
Non-Operative Treatment
Arthritis in its mildest form may not need any treatment whatsoever except simple activity modification – avoiding impact activities such as jumping – and recommending activities that are more controlled with less impact such as swimming, cycling, and walking on cushioned surfaces. When arthritis becomes more severe, then the next appropriate step may be medication such as non-steroidal anti-inflammatories (NSAIDs), or other types of medications which are usually prescribed by a rheumatologist. There are many types of mediations that can be utilized as the first line of defense for arthritis prior to considering any surgical procedure.
For patients with stiff and painful joints, bracing is another form of treatment. The bracing may be simple, such as a brace that one would typically use for an ankle sprain.
Operative Treatment
When all these above measures fail and the patient still has significant arthritis limiting lifestyle, then there are three different types of surgical options that can be undertaken to help the patient improve their quality of life. If the joint destruction is on one side of the joint (asymmetric), then the physician can consider an osteotomy (or cutting the bone to change the weight-bearing surface of the joint and help distribute the weight more evenly). This is usually not successfully performed in the ankle, however, it is sometimes considered.
If you suspect that you may have arthritis, then you should see your family physician or internist, as most problems can be treated effectively with anti-inflammatory medications and/or bracing. However, if it is severe enough for surgical intervention, then you should consider being referred to a surgeon
Thursday, April 2, 2009
Cerebral AVM
Also known as: Cerebral Arteriovenous Malformation; High Flow AVM
What is it?
A Cerebral AVM (arteriovenous malformation) is an abnormal collection of tangled blood vessels. High-pressure blood in distorted abnormal arteries flows directly into large draining veins without the presence of an intervening network of capillaries. These are congenital lesions, which occur in less than 1% of the population. AVMs usually cause medical problems by bleeding or leaking blood. AVMs, may also cause seizures or progressive neurological dysfunction.
Who gets it?
Cerebral AVMs are congenital lesions which arise during fetal development. They occur in less than 1% of the population. AVMs can run in families and can be associated with other vascular lesions of the brain such as cerebral aneurysms.
What causes it?
Cerebral AVMs are the result of abnormal development of cerebral circulation. They result in a “tangle” of abnormal arteries connected to large draining veins, without the benefit of an intervening capillary network. These congenital lesions may then enlarge by recruiting more blood vessels throughout childhood and into adulthood.
What are the symptoms?
Many patients with cerebral AVMs have no symptoms. However, the most common reason brain AVMs come to medical attention is through bleeding (rupture). Common symptoms of a bleeding brain AVM include, severe headache, nausea/vomiting and a new neurological deficit, such as numbness, weakness or paralysis. Patients may also present with seizures or progressive neurological decline in the absence of AVM bleeding.
How is it diagnosed?
Cerebral AVMs can be seen on CT scans, MRI/MRA, and CTAs. Specific sequences on the MRI can further help evaluate these vascular malformations. Cerebral angiography remains the gold standard in the evaluation and grading of cerebral AVMs. Cerebral angiography aids in better understanding the AVM’s inflow and outflow. An angiogram is essential to planning any treatment for the AVM.
What is the treatment?
There are three major treatment options for cerebral AVMs. These include a combination of open microsurgery, endovascular surgery, and stereotactic radiosurgery. Microsurgery uses traditional open surgical techniques with the help of a microscope and sometimes with computerized image guidance to remove the AVM. Some lesions may be too large, too deep, or located in too important of an area of the brain for safe microsurgical excision. In such cases other treatments may be necessary. In endovascular surgery, treatment is performed from within the affected blood vessel. Specially designed microcatheters are navigated by means of an angiogram into the nidus of the AVM. The lesion is then occluded from the inside using a process of embolization with either particles or glue. Some forms of endovascular treatment may be investigational and therefore require a special consent. Although very effective in reducing the size of an AVM, endovascular embolization is rarely able to completely obliterate all but the smallest of AVMs. Endovascular therapy, therefore, is usually combined with either microsurgery or stereotactic radiosurgery to give the best chance. Stereotactic radiosurgery involves the delivery of a highly focused beam of radiation to the AVM. The two most common forms of radiosurgery are linear accelerator based radiosurgery (also known as LINAC or photon knife) and gamma ray based radiosurgery (gamma knife). Radiosurgery may be less risky when compared to microsurgery, for patients with AVMs that are deep or located in important brain areas. However, the ability of conventional radiosurgery to cure an AVM drops off sharply as the AVM diameter goes above 2.5 cm (1 inch). With radiosurgery cure is not immediate and may take up to two or three years. During this time, the patient may require follow-up tests and will still be at risk for problems from the AVM. For these reasons, radiosurgery is especially appropriate for small lesions that are located in or near critical brain areas or are very deep.
What is it?
A Cerebral AVM (arteriovenous malformation) is an abnormal collection of tangled blood vessels. High-pressure blood in distorted abnormal arteries flows directly into large draining veins without the presence of an intervening network of capillaries. These are congenital lesions, which occur in less than 1% of the population. AVMs usually cause medical problems by bleeding or leaking blood. AVMs, may also cause seizures or progressive neurological dysfunction.
Who gets it?
Cerebral AVMs are congenital lesions which arise during fetal development. They occur in less than 1% of the population. AVMs can run in families and can be associated with other vascular lesions of the brain such as cerebral aneurysms.
What causes it?
Cerebral AVMs are the result of abnormal development of cerebral circulation. They result in a “tangle” of abnormal arteries connected to large draining veins, without the benefit of an intervening capillary network. These congenital lesions may then enlarge by recruiting more blood vessels throughout childhood and into adulthood.
What are the symptoms?
Many patients with cerebral AVMs have no symptoms. However, the most common reason brain AVMs come to medical attention is through bleeding (rupture). Common symptoms of a bleeding brain AVM include, severe headache, nausea/vomiting and a new neurological deficit, such as numbness, weakness or paralysis. Patients may also present with seizures or progressive neurological decline in the absence of AVM bleeding.
How is it diagnosed?
Cerebral AVMs can be seen on CT scans, MRI/MRA, and CTAs. Specific sequences on the MRI can further help evaluate these vascular malformations. Cerebral angiography remains the gold standard in the evaluation and grading of cerebral AVMs. Cerebral angiography aids in better understanding the AVM’s inflow and outflow. An angiogram is essential to planning any treatment for the AVM.
What is the treatment?
There are three major treatment options for cerebral AVMs. These include a combination of open microsurgery, endovascular surgery, and stereotactic radiosurgery. Microsurgery uses traditional open surgical techniques with the help of a microscope and sometimes with computerized image guidance to remove the AVM. Some lesions may be too large, too deep, or located in too important of an area of the brain for safe microsurgical excision. In such cases other treatments may be necessary. In endovascular surgery, treatment is performed from within the affected blood vessel. Specially designed microcatheters are navigated by means of an angiogram into the nidus of the AVM. The lesion is then occluded from the inside using a process of embolization with either particles or glue. Some forms of endovascular treatment may be investigational and therefore require a special consent. Although very effective in reducing the size of an AVM, endovascular embolization is rarely able to completely obliterate all but the smallest of AVMs. Endovascular therapy, therefore, is usually combined with either microsurgery or stereotactic radiosurgery to give the best chance. Stereotactic radiosurgery involves the delivery of a highly focused beam of radiation to the AVM. The two most common forms of radiosurgery are linear accelerator based radiosurgery (also known as LINAC or photon knife) and gamma ray based radiosurgery (gamma knife). Radiosurgery may be less risky when compared to microsurgery, for patients with AVMs that are deep or located in important brain areas. However, the ability of conventional radiosurgery to cure an AVM drops off sharply as the AVM diameter goes above 2.5 cm (1 inch). With radiosurgery cure is not immediate and may take up to two or three years. During this time, the patient may require follow-up tests and will still be at risk for problems from the AVM. For these reasons, radiosurgery is especially appropriate for small lesions that are located in or near critical brain areas or are very deep.
Appendicitis
What is it?
Appendicitis is the inflammation of the appendix. The appendix is a worm-shaped pouch that projects from the cecum, which is the point at which the large intestine joins the small intestine. The appendix is located in the lower right abdomen and is not essential to the body’s function.
Who gets it?
Anyone can get appendicitis, and it is the most common reason for emergency abdominal surgery. Appendicitis is most likely to occur between the ages of 10 and 30. It occurs most often in boys between the ages of 10 and 14 and girls 15 to 19. It is less common in the elderly and infants.d
What causes it?
Researchers are not sure what causes appendicitis, but think it may be a blockage between the large intestine and appendix, or a viral or bacterial infection.
What are the symptoms?
An inflamed appendix causes mild to severe pain that moves from the navel to the lower right abdomen. The lower right abdomen may be extremely sensitive to touch and the pain is often worse with movement and strain, such as sneezing, coughing, or taking a deep breath. Other symptoms may include nausea, vomiting, loss of appetite, fever, diarrhea, constipation, weight loss, and a swollen abdomen. However, some people may not experience all of these symptoms. An inflamed appendix can become so swollen that it ruptures, spilling its infected contents into the abdominal cavity. This can cause a life-threatening infection called peritonitis. Never treat appendicitis symptoms with laxatives or enemas because they can cause the inflamed appendix to rupture. A ruptured appendix that is not treated immediately can cause death.
How is it diagnosed?
A diagnosis of appendicitis is based upon a physical examination and the patient’s symptoms. The doctor will ask you about the location of the pain and how long you have felt it. He or she will press gently on your abdomen to check for tenderness and swelling in the area of the appendix. The doctor may order blood tests to check for a high white blood count, which is a sign of infection, and ultrasound or computed tomography (CT) scans to check the condition of the appendix. He or she may order additional tests to rule out other disorders, such as urinary tract infections, tubal pregnancies, and bowel obstructions, that can cause similar symptoms. If you are a woman and your doctor suspects a cause other than appendicitis, he or she might recommend a laparoscopic study. A small, lighted viewing tube, called a laparoscope, is inserted into a small incision in the abdomen to check for disorders of the reproductive system.
What is the treatment?
Appendicitis is treated with surgery to remove the appendix, called an appendectomy. This surgery is usually performed as soon as possible after the diagnosis has been made to avoid a rupture. In many cases, appendectomies can be performed with laparoscopic surgery. The surgeon makes a small incision in the abdomen and inserts the laparoscope. The laparoscope is like a tiny video camera that gives the surgeon a clear view of the abdominal area. Other small incisions are made to insert the surgical instruments used to remove the appendix. Because the appendix is not necessary to the body’s function, people who have an appendectomy make a full recovery and are able to continue with life as usual.
Self-care tips
There is no known way to prevent appendicitis. However, a healthy lifestyle, including a diet high in fiber and antioxidants, as well as moderate exercise, goes a long way in preventing illness and disease.
Appendicitis is the inflammation of the appendix. The appendix is a worm-shaped pouch that projects from the cecum, which is the point at which the large intestine joins the small intestine. The appendix is located in the lower right abdomen and is not essential to the body’s function.
Who gets it?
Anyone can get appendicitis, and it is the most common reason for emergency abdominal surgery. Appendicitis is most likely to occur between the ages of 10 and 30. It occurs most often in boys between the ages of 10 and 14 and girls 15 to 19. It is less common in the elderly and infants.d
What causes it?
Researchers are not sure what causes appendicitis, but think it may be a blockage between the large intestine and appendix, or a viral or bacterial infection.
What are the symptoms?
An inflamed appendix causes mild to severe pain that moves from the navel to the lower right abdomen. The lower right abdomen may be extremely sensitive to touch and the pain is often worse with movement and strain, such as sneezing, coughing, or taking a deep breath. Other symptoms may include nausea, vomiting, loss of appetite, fever, diarrhea, constipation, weight loss, and a swollen abdomen. However, some people may not experience all of these symptoms. An inflamed appendix can become so swollen that it ruptures, spilling its infected contents into the abdominal cavity. This can cause a life-threatening infection called peritonitis. Never treat appendicitis symptoms with laxatives or enemas because they can cause the inflamed appendix to rupture. A ruptured appendix that is not treated immediately can cause death.
How is it diagnosed?
A diagnosis of appendicitis is based upon a physical examination and the patient’s symptoms. The doctor will ask you about the location of the pain and how long you have felt it. He or she will press gently on your abdomen to check for tenderness and swelling in the area of the appendix. The doctor may order blood tests to check for a high white blood count, which is a sign of infection, and ultrasound or computed tomography (CT) scans to check the condition of the appendix. He or she may order additional tests to rule out other disorders, such as urinary tract infections, tubal pregnancies, and bowel obstructions, that can cause similar symptoms. If you are a woman and your doctor suspects a cause other than appendicitis, he or she might recommend a laparoscopic study. A small, lighted viewing tube, called a laparoscope, is inserted into a small incision in the abdomen to check for disorders of the reproductive system.
What is the treatment?
Appendicitis is treated with surgery to remove the appendix, called an appendectomy. This surgery is usually performed as soon as possible after the diagnosis has been made to avoid a rupture. In many cases, appendectomies can be performed with laparoscopic surgery. The surgeon makes a small incision in the abdomen and inserts the laparoscope. The laparoscope is like a tiny video camera that gives the surgeon a clear view of the abdominal area. Other small incisions are made to insert the surgical instruments used to remove the appendix. Because the appendix is not necessary to the body’s function, people who have an appendectomy make a full recovery and are able to continue with life as usual.
Self-care tips
There is no known way to prevent appendicitis. However, a healthy lifestyle, including a diet high in fiber and antioxidants, as well as moderate exercise, goes a long way in preventing illness and disease.
Aphasia
What is it?
Aphasia is the partial or total loss of the ability to understand words and use language because of a brain injury
Who gets it?
Aphasia often occurs in people who have had a stroke. In fact, 20% of all people who have a stroke each year, develop some type of aphasia. People who have suffered brain damage from a head injury, infection (such as encephalitis), or brain tumor may develop aphasia. Aphasia also occurs in people with Alzheimer's disease. Researchers have found no connection between aphasia and age, gender, or race.
What causes it?
To understand what causes aphasia, it helps to know a little bit about the structure of the brain. The main portion of the brain, the cerebrum, is divided into halves called the left and right hemispheres. The cerebrum is further divided into lobes, the frontal, parietal, occipital, and temporal. In most people, language control is located in the left hemisphere of the brain, called the language dominant area of the brain. It is here that we store information about word meaning, how to formulate spoken and written language, and how and when to use words properly. So, damage to the left hemisphere most often results in the symptoms of aphasia. However, research has shown that many left-handed people have language areas in both the left and right hemispheres of the brain. These people can develop aphasia from damage to either side of the brain. Injuries that result in aphasia can be caused by stroke, head injury, brain tumor, or infection.
Types of aphasia are classified according to the area of the brain that is injured. One type, called Broca's aphasia, results from damage to the frontal lobe of the language-dominant area of the brain. Wernicke's aphasia is caused by damage to the temporal lobe, or the side portion, of the language-dominant area of the brain. Global aphasia is caused by damage to both the left temporal and frontal lobes. Transcortical aphasia is caused by damage to the language areas of the left hemisphere that are outside the primary language areas. Subcortical aphasia results from damage to areas of the brain that are not language-dominant areas.
What are the symptoms?
The symptoms of aphasia may be temporary or permanent, depending upon the amount of brain damage. Aphasia affects one or more of a person's language functions. These could include speech, naming, repetition, hearing comprehension, reading, and writing. The functions affected depend upon the type of aphasia an individual has. For example, people with Broca's aphasia may not be able to speak at all. Or they may be able to use single-word statements or full sentences after great effort. They frequently omit words that are conjunctions and articles (and, or, but, the, a), which results in speech that sounds abrupt and choppy. People with Broca's aphasia can understand and process what others are saying, so they often become depressed and frustrated by their own inability to communicate. They may have difficulty reading, and weakness on the right side of the body may make writing difficult. Broca's aphasia is also called motor aphasia.
People with Wernicke's aphasia speak in long, run-on sentences that include words that aren't needed, difficult to understand, or simply made up. These patients are completely unaware of their language difficulties, and may not even understand what other people say at all. While they may still be able to write, what they write may not be understandable. People with Wernicke's aphasia also have difficulty reading. Because global aphasia affects more than one area of the brain, it can affect all language areas, and is the most severe form of aphasia. However, symptoms vary depending on the location and extent of injury.
There are three types of transcortical aphasia: transcortical motor aphasia, transcortical sensory aphasia, and mixed transcortical aphasia. People with transcortical aphasia suffer partial or total loss of the ability to communicate verbally or use written words, but can still repeat words, phrases, or sentences. Subcortical aphasia results in either the partial or total loss of the ability to speak or use written words. It is typical of a person who has had a stroke or other injury to the brain to have difficulty naming people or objects. This is called anomic or nominal aphasia. The patient might describe the object or person instead of naming it. All other language functions are unaffected. People with conduction, or associative, aphasia cannot repeat words, sentences, and phrases. While they can understand what others say, they may have difficulty finding the right words when speaking, and so may correct themselves frequently and skip or repeat words. Conduction aphasia is uncommon. Aphasia is rare in children, but the symptoms can begin with speech delays and progress to the loss of communication skills in all areas.
How is it diagnosed?
Anyone who has suffered a stroke or any type of brain injury is assessed for any effects on language skills. The doctor will listen to the patient speak, and ask him or her to identify and name common objects, repeat words or phrases, and demonstrate understanding of things that are said. It is important to determine whether the patient is having difficulty with speaking or difficulty with understanding. The patient will also be asked to write down some thoughts to assess written language skills. Standardized tests, administered by a speech pathologist or neuropsychologist, are often used in the diagnosis. These tests might include the Boston Diagnostic Aphasia Examination, the Western Aphasia Battery, and the Porch Index of Speech Ability. Test results are used to pinpoint the area of the brain that has been injured and to develop a speech therapy program best suited to the patient. Magnetic resonance imaging (MRI) and computed tomography scans (CT) are also helpful in mapping the area of the brain that is affected and to diagnose a brain tumor.
What is the treatment?
The primary treatment for most causes of aphasia is speech therapy, which is begun as soon as the patient's condition allows. There are no drugs available to cure or treat aphasia. The speech therapist works with the patient to strengthen his or her remaining language skills and to find ways to compensate for the skills that have been lost. Techniques might include exercising the facial muscles, repetition of words, using flash cards to improve memory of object names, using pictures of objects and activities to communicate with others, completing reading and writing exercises in workbooks, and using computer programs to aid in speech, hearing, and reading comprehension, as well as recall. Recovery from aphasia depends upon the severity of the brain injury. More than half of the patients who have symptoms of aphasia after a stroke, infection, head injury, or as a result of a brain tumor will recover. While people who are left handed are more likely to develop aphasia after a brain injury, they tend to recover more fully. This is because they have language centers on the right and left side of the brain so language abilities can be recovered from either side. Surgery is only used to treat the cause of aphasia, such as to reduce pressure from a brain tumor or to reduce swelling from head trauma.
Self-care tips
The types of events that cause aphasia, such as stroke and head injury, are difficult to predict or prevent. For this reason, there are no guidelines for preventing aphasia. However, individual and family commitment to a physician-guided speech therapy program can result in full to partial recovery.
Aphasia is the partial or total loss of the ability to understand words and use language because of a brain injury
Who gets it?
Aphasia often occurs in people who have had a stroke. In fact, 20% of all people who have a stroke each year, develop some type of aphasia. People who have suffered brain damage from a head injury, infection (such as encephalitis), or brain tumor may develop aphasia. Aphasia also occurs in people with Alzheimer's disease. Researchers have found no connection between aphasia and age, gender, or race.
What causes it?
To understand what causes aphasia, it helps to know a little bit about the structure of the brain. The main portion of the brain, the cerebrum, is divided into halves called the left and right hemispheres. The cerebrum is further divided into lobes, the frontal, parietal, occipital, and temporal. In most people, language control is located in the left hemisphere of the brain, called the language dominant area of the brain. It is here that we store information about word meaning, how to formulate spoken and written language, and how and when to use words properly. So, damage to the left hemisphere most often results in the symptoms of aphasia. However, research has shown that many left-handed people have language areas in both the left and right hemispheres of the brain. These people can develop aphasia from damage to either side of the brain. Injuries that result in aphasia can be caused by stroke, head injury, brain tumor, or infection.
Types of aphasia are classified according to the area of the brain that is injured. One type, called Broca's aphasia, results from damage to the frontal lobe of the language-dominant area of the brain. Wernicke's aphasia is caused by damage to the temporal lobe, or the side portion, of the language-dominant area of the brain. Global aphasia is caused by damage to both the left temporal and frontal lobes. Transcortical aphasia is caused by damage to the language areas of the left hemisphere that are outside the primary language areas. Subcortical aphasia results from damage to areas of the brain that are not language-dominant areas.
What are the symptoms?
The symptoms of aphasia may be temporary or permanent, depending upon the amount of brain damage. Aphasia affects one or more of a person's language functions. These could include speech, naming, repetition, hearing comprehension, reading, and writing. The functions affected depend upon the type of aphasia an individual has. For example, people with Broca's aphasia may not be able to speak at all. Or they may be able to use single-word statements or full sentences after great effort. They frequently omit words that are conjunctions and articles (and, or, but, the, a), which results in speech that sounds abrupt and choppy. People with Broca's aphasia can understand and process what others are saying, so they often become depressed and frustrated by their own inability to communicate. They may have difficulty reading, and weakness on the right side of the body may make writing difficult. Broca's aphasia is also called motor aphasia.
People with Wernicke's aphasia speak in long, run-on sentences that include words that aren't needed, difficult to understand, or simply made up. These patients are completely unaware of their language difficulties, and may not even understand what other people say at all. While they may still be able to write, what they write may not be understandable. People with Wernicke's aphasia also have difficulty reading. Because global aphasia affects more than one area of the brain, it can affect all language areas, and is the most severe form of aphasia. However, symptoms vary depending on the location and extent of injury.
There are three types of transcortical aphasia: transcortical motor aphasia, transcortical sensory aphasia, and mixed transcortical aphasia. People with transcortical aphasia suffer partial or total loss of the ability to communicate verbally or use written words, but can still repeat words, phrases, or sentences. Subcortical aphasia results in either the partial or total loss of the ability to speak or use written words. It is typical of a person who has had a stroke or other injury to the brain to have difficulty naming people or objects. This is called anomic or nominal aphasia. The patient might describe the object or person instead of naming it. All other language functions are unaffected. People with conduction, or associative, aphasia cannot repeat words, sentences, and phrases. While they can understand what others say, they may have difficulty finding the right words when speaking, and so may correct themselves frequently and skip or repeat words. Conduction aphasia is uncommon. Aphasia is rare in children, but the symptoms can begin with speech delays and progress to the loss of communication skills in all areas.
How is it diagnosed?
Anyone who has suffered a stroke or any type of brain injury is assessed for any effects on language skills. The doctor will listen to the patient speak, and ask him or her to identify and name common objects, repeat words or phrases, and demonstrate understanding of things that are said. It is important to determine whether the patient is having difficulty with speaking or difficulty with understanding. The patient will also be asked to write down some thoughts to assess written language skills. Standardized tests, administered by a speech pathologist or neuropsychologist, are often used in the diagnosis. These tests might include the Boston Diagnostic Aphasia Examination, the Western Aphasia Battery, and the Porch Index of Speech Ability. Test results are used to pinpoint the area of the brain that has been injured and to develop a speech therapy program best suited to the patient. Magnetic resonance imaging (MRI) and computed tomography scans (CT) are also helpful in mapping the area of the brain that is affected and to diagnose a brain tumor.
What is the treatment?
The primary treatment for most causes of aphasia is speech therapy, which is begun as soon as the patient's condition allows. There are no drugs available to cure or treat aphasia. The speech therapist works with the patient to strengthen his or her remaining language skills and to find ways to compensate for the skills that have been lost. Techniques might include exercising the facial muscles, repetition of words, using flash cards to improve memory of object names, using pictures of objects and activities to communicate with others, completing reading and writing exercises in workbooks, and using computer programs to aid in speech, hearing, and reading comprehension, as well as recall. Recovery from aphasia depends upon the severity of the brain injury. More than half of the patients who have symptoms of aphasia after a stroke, infection, head injury, or as a result of a brain tumor will recover. While people who are left handed are more likely to develop aphasia after a brain injury, they tend to recover more fully. This is because they have language centers on the right and left side of the brain so language abilities can be recovered from either side. Surgery is only used to treat the cause of aphasia, such as to reduce pressure from a brain tumor or to reduce swelling from head trauma.
Self-care tips
The types of events that cause aphasia, such as stroke and head injury, are difficult to predict or prevent. For this reason, there are no guidelines for preventing aphasia. However, individual and family commitment to a physician-guided speech therapy program can result in full to partial recovery.
Congenital Aortic Valve Stenosis
What is it?
Aortic valve stenosis is a narrowing of the aortic valve. The aortic valve opens to allow blood to flow from the left ventricle of the heart to the aorta, and then to the body. Because the opening is narrowed, the left ventricle has to pump extra hard to propel blood through the valve. This causes the left ventricle to become enlarged. The valve may also have two leaflets, instead of three, or may have an abnormal funnel shape. The narrowed valve may not be a problem during infancy, but becomes one as the child grows and the heart cannot keep up with the body’s demand for blood. “Congenital” aortic valve stenosis means the condition is present at birth.
Who gets it?
Males are four times more likely to get this disease. Aortic valve stenosis accounts for approximately 7% of all cases of congenital heart disease.
What causes it?
Aortic valve stenosis can run in families or may be due to something that happened to the fetus during pregnancy.
Unless it is severe, the condition is often not detected until later in life.
What are the symptoms?
Most children with aortic valve stenosis have no symptoms, so it’s difficult to detect. In general, many patients will be easily fatigued, but show no other symptoms until their thirties to fifties. A small number of children may be prone to dizziness and fainting (syncope) within the first ten years of life. If the obstruction is great, infants may suffer from severe heart failure. Sudden death is uncommon, but possible. Adolescents with hypertrophic cardiomyopathy, a type of aortic stenosis where the left ventricle is noticeably enlarged, have the greatest risk of sudden heart failure. How is it diagnosed? Children with aortic valve stenosis usually have a heart murmur that can be heard with a stethoscope. A doctor can also detect pulse abnormalities and will see irregularities on an electrocardiogram (ECG). A chest x-ray may also show an enlarged left ventricle. An echocardiogram may also be ordered. This technique uses ultrasound waves to create an image of the heart and its function. In cases where severe blockage is suspected and surgery most likely, doctors may do a left heart cardiac catheritization. In this procedure, a thin tube (catheter) is inserted through an artery and moved into the heart chambers. This procedure will measure the pressure difference between the left ventricle and the aorta.
What is the treatment?
Children with aortic valve stenosis require close medical supervision and should undergo yearly exercise testing after the age of six. Most children with mild to moderate aortic valve stenosis can engage in normal physical activities. Surgery is only performed in cases of severe obstruction. The most common treatments are surgical valve repair and balloon valvuloplasty. A balloon-tipped catheter is inserted into the aortic valve. The balloon is then inflated to expand the valve opening. Some forms of aortic valve stenosis require medical management with beta-blockers or calcium channel blockers.
Self-care tips
If your child has been diagnosed with aortic valve stenosis, follow your doctor’s recommendations for treatment and physical activity.
Aortic valve stenosis is a narrowing of the aortic valve. The aortic valve opens to allow blood to flow from the left ventricle of the heart to the aorta, and then to the body. Because the opening is narrowed, the left ventricle has to pump extra hard to propel blood through the valve. This causes the left ventricle to become enlarged. The valve may also have two leaflets, instead of three, or may have an abnormal funnel shape. The narrowed valve may not be a problem during infancy, but becomes one as the child grows and the heart cannot keep up with the body’s demand for blood. “Congenital” aortic valve stenosis means the condition is present at birth.
Who gets it?
Males are four times more likely to get this disease. Aortic valve stenosis accounts for approximately 7% of all cases of congenital heart disease.
What causes it?
Aortic valve stenosis can run in families or may be due to something that happened to the fetus during pregnancy.
Unless it is severe, the condition is often not detected until later in life.
What are the symptoms?
Most children with aortic valve stenosis have no symptoms, so it’s difficult to detect. In general, many patients will be easily fatigued, but show no other symptoms until their thirties to fifties. A small number of children may be prone to dizziness and fainting (syncope) within the first ten years of life. If the obstruction is great, infants may suffer from severe heart failure. Sudden death is uncommon, but possible. Adolescents with hypertrophic cardiomyopathy, a type of aortic stenosis where the left ventricle is noticeably enlarged, have the greatest risk of sudden heart failure. How is it diagnosed? Children with aortic valve stenosis usually have a heart murmur that can be heard with a stethoscope. A doctor can also detect pulse abnormalities and will see irregularities on an electrocardiogram (ECG). A chest x-ray may also show an enlarged left ventricle. An echocardiogram may also be ordered. This technique uses ultrasound waves to create an image of the heart and its function. In cases where severe blockage is suspected and surgery most likely, doctors may do a left heart cardiac catheritization. In this procedure, a thin tube (catheter) is inserted through an artery and moved into the heart chambers. This procedure will measure the pressure difference between the left ventricle and the aorta.
What is the treatment?
Children with aortic valve stenosis require close medical supervision and should undergo yearly exercise testing after the age of six. Most children with mild to moderate aortic valve stenosis can engage in normal physical activities. Surgery is only performed in cases of severe obstruction. The most common treatments are surgical valve repair and balloon valvuloplasty. A balloon-tipped catheter is inserted into the aortic valve. The balloon is then inflated to expand the valve opening. Some forms of aortic valve stenosis require medical management with beta-blockers or calcium channel blockers.
Self-care tips
If your child has been diagnosed with aortic valve stenosis, follow your doctor’s recommendations for treatment and physical activity.
Wednesday, April 1, 2009
Aortic Aneurysm
What is it?
An aneurysm is an area of enlargement of a blood vessel due to the weakening of the vessel wall thus causing a bulge. If the aneurysm remains undetected, the area could rupture which is referred to as a dissection. In Cardiothoracic Surgery we specifically deal with aneurysms in the chest (thorax), not abdominal aneurysms. [These may be referred to as an ascending aortic aneurysm, or an aortic arch aneurysm] The type of aneurysm refers to its location in the chest. For example, an aortic arch aneurysm is a bulge along the arch of the aorta.
What are the symptoms?
The symptoms of an aneurysm are often vague, or nonexistent. In some instances if the aneurysm grows rapidly, the patient may experience chest or back pain.
Aneurysms are often without any definitive symptoms. However, if the patient should have a pre-existing medical condition such as Marfan's Syndrome, they should be checked regularly with chest x-ray or CT scan.
Diagnosis
Aneurysms are associated with certain medical conditions, such as Marfan's Syndrome or untreated hypertension. In the case of Marfan's, the patient should be evaluated regularly with chest x-ray or CT scan since aneurysms are very often without definitive symptoms. In most instances aneurysms are usually detected as a result of a chest x-ray done for some other medical evaluation. It will show up as a mass. A CT scan or an MRI is then used to determine the exact size and location of the aneurysm.
Treatment
If an aneurysm is diagnosed, a surveillance protocol is initiated to chart the size of the aneurysm along with medical management which may include a combination of diet, exercise, and medication aimed at reducing blood pressure. If the aneurysm continues to grow and reaches the calculated size (usually 6 cm) indicative of possible rupture, then surgery is discussed with the patient. Surgery is the only cure for an aortic aneurysm. However, the timing of surgery is based on the risk of surgery versus the risk of rupture.
Surgical repair of the aneurysm is done through an incision made along the left side of the chest, under the arm (left lateral thoracotomy) and the repair is made. Recovery from this procedure is usually 5 to 7 day stay in the hospital with a 4 to 6 week complete recovery.
An aneurysm is an area of enlargement of a blood vessel due to the weakening of the vessel wall thus causing a bulge. If the aneurysm remains undetected, the area could rupture which is referred to as a dissection. In Cardiothoracic Surgery we specifically deal with aneurysms in the chest (thorax), not abdominal aneurysms. [These may be referred to as an ascending aortic aneurysm, or an aortic arch aneurysm] The type of aneurysm refers to its location in the chest. For example, an aortic arch aneurysm is a bulge along the arch of the aorta.
What are the symptoms?
The symptoms of an aneurysm are often vague, or nonexistent. In some instances if the aneurysm grows rapidly, the patient may experience chest or back pain.
Aneurysms are often without any definitive symptoms. However, if the patient should have a pre-existing medical condition such as Marfan's Syndrome, they should be checked regularly with chest x-ray or CT scan.
Diagnosis
Aneurysms are associated with certain medical conditions, such as Marfan's Syndrome or untreated hypertension. In the case of Marfan's, the patient should be evaluated regularly with chest x-ray or CT scan since aneurysms are very often without definitive symptoms. In most instances aneurysms are usually detected as a result of a chest x-ray done for some other medical evaluation. It will show up as a mass. A CT scan or an MRI is then used to determine the exact size and location of the aneurysm.
Treatment
If an aneurysm is diagnosed, a surveillance protocol is initiated to chart the size of the aneurysm along with medical management which may include a combination of diet, exercise, and medication aimed at reducing blood pressure. If the aneurysm continues to grow and reaches the calculated size (usually 6 cm) indicative of possible rupture, then surgery is discussed with the patient. Surgery is the only cure for an aortic aneurysm. However, the timing of surgery is based on the risk of surgery versus the risk of rupture.
Surgical repair of the aneurysm is done through an incision made along the left side of the chest, under the arm (left lateral thoracotomy) and the repair is made. Recovery from this procedure is usually 5 to 7 day stay in the hospital with a 4 to 6 week complete recovery.
Generalized Anxiety Disorder
What is it?
Generalized anxiety disorder is the name for excessive worry and fear about common activities or things, such as work, money, or health. Often, this anxiety is not linked to a specific cause or situation. Anxiety can become so overwhelming that it is difficult to carry on with normal daily activities. If you spend the majority of your time feeling anxious and even have difficulty sleeping because of unrealistic fear and worry, you may have generalized anxiety disorder.
Who gets it?
Generalized anxiety disorder affects between 2 to 3% of people of all ages, even children and teenagers. Women are twice as likely as men to experience generalized anxiety.
What causes it?
A number of events can cause generalized anxiety disorder, although it is believed that some people are genetically predisposed to developing it. Other causes can include childhood psychological traumas, moving, changing jobs, divorce, or the death of a loved one. People who grow up in a family where constant worrying is the norm may learn this behavior. Sometimes a chemical imbalance in the brain cause problems with two neurotransmitters called dopamine and serotonin. Neurotransmitters are the brains chemical message carriers, but sometimes their messages can’t get through because the nerve cells they talk to can’t answer for some reason. This causes an imbalance, and an imbalance of dopamine and serotonin can cause anxiety.
What are the symptoms?
The symptoms of generalized anxiety disorder range from feelings of being tense, constantly tired, afraid, and being unable to make decisions, to feeling restless and irritable. You may also have physical symptoms, such as nausea, vomiting, diarrhea, stomach pain, lack of appetite, shortness of breath, chest pain, shaking, sweating, or muscle tension. Symptoms can cause difficulty with concentration, loss of sleep, missed work, and avoidance of social activities.
How is it diagnosed?
Generalized anxiety disorder is diagnosed when symptoms are observed for six months or longer. Your doctor will perform a complete physical exam and may order tests to rule out other possible causes, such as thyroid disease, hypoglycemia, heart-related conditions, high caffeine intake, depression, or drug or alcohol abuse.
What is the treatment?
Generalized anxiety disorder can be treated very effectively with drugs and psychotherapy. Anti-anxiety drugs called benzodiazepinescan help ease the anxiety very quickly but are generally prescribed for only a short time, then tapered off slowly to prevent addiction. Antidepressant drugs may also be used. Psychotherapy can be very effective because it helps people look to the source of the anxiety and solve their underlying problems. You may also find relaxation and biofeedback techniques very helpful.
Self-care tips
While it is normal and even motivating to sometimes feel anxious, especially before an important event, you should see your doctor if you feel that anxiety is taking over your life. You can help manage normal anxiety by using relaxation techniques, breathing exercises, and changing your focus to something else.
Generalized anxiety disorder is the name for excessive worry and fear about common activities or things, such as work, money, or health. Often, this anxiety is not linked to a specific cause or situation. Anxiety can become so overwhelming that it is difficult to carry on with normal daily activities. If you spend the majority of your time feeling anxious and even have difficulty sleeping because of unrealistic fear and worry, you may have generalized anxiety disorder.
Who gets it?
Generalized anxiety disorder affects between 2 to 3% of people of all ages, even children and teenagers. Women are twice as likely as men to experience generalized anxiety.
What causes it?
A number of events can cause generalized anxiety disorder, although it is believed that some people are genetically predisposed to developing it. Other causes can include childhood psychological traumas, moving, changing jobs, divorce, or the death of a loved one. People who grow up in a family where constant worrying is the norm may learn this behavior. Sometimes a chemical imbalance in the brain cause problems with two neurotransmitters called dopamine and serotonin. Neurotransmitters are the brains chemical message carriers, but sometimes their messages can’t get through because the nerve cells they talk to can’t answer for some reason. This causes an imbalance, and an imbalance of dopamine and serotonin can cause anxiety.
What are the symptoms?
The symptoms of generalized anxiety disorder range from feelings of being tense, constantly tired, afraid, and being unable to make decisions, to feeling restless and irritable. You may also have physical symptoms, such as nausea, vomiting, diarrhea, stomach pain, lack of appetite, shortness of breath, chest pain, shaking, sweating, or muscle tension. Symptoms can cause difficulty with concentration, loss of sleep, missed work, and avoidance of social activities.
How is it diagnosed?
Generalized anxiety disorder is diagnosed when symptoms are observed for six months or longer. Your doctor will perform a complete physical exam and may order tests to rule out other possible causes, such as thyroid disease, hypoglycemia, heart-related conditions, high caffeine intake, depression, or drug or alcohol abuse.
What is the treatment?
Generalized anxiety disorder can be treated very effectively with drugs and psychotherapy. Anti-anxiety drugs called benzodiazepinescan help ease the anxiety very quickly but are generally prescribed for only a short time, then tapered off slowly to prevent addiction. Antidepressant drugs may also be used. Psychotherapy can be very effective because it helps people look to the source of the anxiety and solve their underlying problems. You may also find relaxation and biofeedback techniques very helpful.
Self-care tips
While it is normal and even motivating to sometimes feel anxious, especially before an important event, you should see your doctor if you feel that anxiety is taking over your life. You can help manage normal anxiety by using relaxation techniques, breathing exercises, and changing your focus to something else.
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