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.
Anthrax
Submitted by John N. Goldman, M.D., chief, division of Infectious Diseases, Penn State Hershey Medical Center
What is it?
Anthrax is a disease caused by Bacillus anthracis, bacteria that lives in the soil. Animals such as cattle, sheep and goats are the usual hosts for anthrax and contact with infected animals or animal products infect humans secondarily. It can infect the skin, lungs, and gastrointestinal tract. In the year 2001, terrorists spread anthrax by sending spores through the mail in the United States. A spore is a dormant (inactive) form of bacteria that can survive under poor conditions, such as high temperatures and dryness. When the conditions are right, these spores can then become active again.
Who gets it?
Outbreaks of anthrax among cattle or people are rare in the United States because most animals are vaccinated against the disease. It occurs most often in agricultural regions outside the United States, such as the Caribbean, southern and eastern Europe, South and Central America, Asia, Africa, and the Middle East. People who handle the contaminated animals, such as farmers, veterinarians, or butchers, are more likely to get the disease. However, anthrax spores can be grown in a laboratory, and we have seen that people can contract anthrax when it is used as a weapon in biological warfare.
What are the forms of anthrax and what are the symptoms of each form?
There are three forms of anthrax in humans:
Cutaneous – or skin anthrax
Pulmonary – or inhalation anthrax
Gastrointestinal – or ingested anthrax
The cutaneous, or skin, anthrax results from spores getting on the skin and then getting into a break in the skin. There is a 1-7 day incubation period. In this environment, the spores begin to grow and cause a small raised area – known as a papule – a person may have localized itching that may then form a small blister that then develops into an ulcerated area that becomes covered with a black scab – or eschar in about 2-6 days. The area is commonly seen on the head, forearm and hands. There may be fever, local redness and swollen lymph glands in the area. Even if untreated, skin anthrax has a relatively low mortality and, if treated with antibiotics, is rarely ever fatal. This is the most common form of anthrax.
Pulmonary, or inhalation, anthrax results from inhalation of the spores into the lungs. The incubation period can be from 2-60 days for the symptoms to occur. The spores then grow and get into the local lymph nodes and lymphatic vessels and cause an aggressive inflammation in the tissues of the chest – known as the mediastinum. There may be hemorrhage locally as well as spread of the bacteria to the brain resulting in meningitis in as many as 50% of affected individuals. The earliest symptoms of pulmonary, or inhalation, anthrax are very nonspecific and may resemble the early phases of the flu – with fever, muscle aches and pains, and mild respiratory complaints. If untreated and these symptoms progress, it may lead to death. Pulmonary anthrax has been quite rare in this country with only 18 cases reported prior to the events of September 11th.
The gastrointestinal form of anthrax results from eating meat from infected animals. The incubation period is typcially 1-7 days and includes symptoms such as abdominal pain, nausea, vomiting and fever following ingestion of contaminated food or water bloody diarrhea, and vomiting blood. This results in infected areas of the intestines with death of tissues and is almost always fatal. Gastrointestinal anthrax has never been seen in this country.
Is anthrax contagious?
Anthrax is not contagious, that is, it cannot be spread from person to person. The reason it cannot be spread is because infected persons have only the actively growing bacteria and do not have the infectious spores.
How many spores does it take to get infected?
The best evidence on this suggests that it takes between 8,000 and 40,000 spores to be inhaled, perhaps fewer to cause the cutaneous form of anthrax. One would guess that it takes many more organisms to cause the gastrointestinal form, since it is so rare and since infected meat may contain millions of organisms.
What is the difference between “exposed to” and “infected with” anthrax?
One can be exposed to anthrax without getting infected with the bacteria, and, in fact, this is probably the most common occurrence. One becomes infected only when the spores grow successfully and multiply in tissues. The spores may not grow or the body’s natural defenses may kill the bacteria before they cause disease. Having the spores recovered from the nose or skin indicates exposure only – but unless the bacteria successfully grow in the skin, lungs or gastrointestinal tract, there is no infection.
How is it diagnosed?
To diagnose anthrax, your doctor will evaluate your symptoms, taking into consideration any possibility that you could have had contact with the Bacillus anthracis bacterium. He or she may take samples of any skin infections, or respiratory secretions, called sputum. However, there are no tests that can be used to reliably detect the presence of anthrax in exposed persons. This is because the bacteria are present in only small numbers on the skin or on mucous membranes of the nose or pharynx before an infection is established. Without the locus of infection on the skin or in the lungs, the usual tests are just not sensitive enough to find the organism in a high percentage of those exposed. Some of these tests are used for epidemiological studies to see if any persons within a group that may have been exposed are positive. If any are positive, then one may consider that all of those exposed have been put at risk and treatment of the entire group with prophylactic antibiotics may be considered.
How quickly must a possible exposure be treated?
The usual incubation period of anthrax is from several days to as many as 60 days from a single discrete exposure. This gives several days to assess the risks involved. Assessment by a physician or other person knowledgeable in this area should be undertaken sooner rather than later. No preventative measure needs to be given in these first few days, even for true exposure. This is especially true since all antibiotics, as well as other drugs, have the potential to cause serious side effects in some people.
What is the treatment ?
While anthrax usually kills infected animals, it can be successfully treated in humans if caught in the early stages. Penicillin has been the drug of choice for years and remains effective, even for the infections we have all read about recently. Other drugs from the penicillin family such as amoxicillin should be equally effective. Doxycycline, one of the tetracycline family of antibiotics – and most recently listed as the CDC’s drug of choice in treating anthrax, is also effective. Ciprofloxacin – more commonly known as Cipro – is one of the quinolone antibiotics and is also effective. Cipro has made news since the September 11th terrorist attack and is recommended as the first drug to use until the sensitivities of the organisms are known because the Soviet Union was known to produce anthrax bacilli that were resistant to penicillin and tetracycline in their germ warfare program. The anthrax used in the most recent incidents, however, has all been sensitive to all antibiotics listed above. Lung infections may be treated with intravenous antibiotics. It is important to take the full course of prescribed antibiotics to prevent complications. If untreated, cutaneous anthrax may result in death. Untreated inhalation anthrax always results in death.
According to the American Medical Association and other authorities, physicians should not prescribe antibiotics for patients as a preventive measure against anthrax. This may lead patients to initiate unnecessary treatment and could contribute to the development of antibiotic resistant organisms.
Is there an anthrax vaccine?
The vaccine is a cell-free filtrate vaccine, which means it contains no dead or live bacteria in the preparation. Anthrax vaccines intended for animals should not be used on humans. The vaccine is reported to be 93 percent effective in protecting against anthrax and is not recommended for the general public.
Self-care tips
People who work in professions that involve frequent contact with animals or animal products that could be infected with anthrax can get an anthrax vaccine that is highly effective against the disease. People who will be visiting countries where there is poor control of the disease should not eat meat that has not been properly prepared or cooked, and should avoid contact with animals or animal products that could be contaminated.
What is it?
Anthrax is a disease caused by Bacillus anthracis, bacteria that lives in the soil. Animals such as cattle, sheep and goats are the usual hosts for anthrax and contact with infected animals or animal products infect humans secondarily. It can infect the skin, lungs, and gastrointestinal tract. In the year 2001, terrorists spread anthrax by sending spores through the mail in the United States. A spore is a dormant (inactive) form of bacteria that can survive under poor conditions, such as high temperatures and dryness. When the conditions are right, these spores can then become active again.
Who gets it?
Outbreaks of anthrax among cattle or people are rare in the United States because most animals are vaccinated against the disease. It occurs most often in agricultural regions outside the United States, such as the Caribbean, southern and eastern Europe, South and Central America, Asia, Africa, and the Middle East. People who handle the contaminated animals, such as farmers, veterinarians, or butchers, are more likely to get the disease. However, anthrax spores can be grown in a laboratory, and we have seen that people can contract anthrax when it is used as a weapon in biological warfare.
What are the forms of anthrax and what are the symptoms of each form?
There are three forms of anthrax in humans:
Cutaneous – or skin anthrax
Pulmonary – or inhalation anthrax
Gastrointestinal – or ingested anthrax
The cutaneous, or skin, anthrax results from spores getting on the skin and then getting into a break in the skin. There is a 1-7 day incubation period. In this environment, the spores begin to grow and cause a small raised area – known as a papule – a person may have localized itching that may then form a small blister that then develops into an ulcerated area that becomes covered with a black scab – or eschar in about 2-6 days. The area is commonly seen on the head, forearm and hands. There may be fever, local redness and swollen lymph glands in the area. Even if untreated, skin anthrax has a relatively low mortality and, if treated with antibiotics, is rarely ever fatal. This is the most common form of anthrax.
Pulmonary, or inhalation, anthrax results from inhalation of the spores into the lungs. The incubation period can be from 2-60 days for the symptoms to occur. The spores then grow and get into the local lymph nodes and lymphatic vessels and cause an aggressive inflammation in the tissues of the chest – known as the mediastinum. There may be hemorrhage locally as well as spread of the bacteria to the brain resulting in meningitis in as many as 50% of affected individuals. The earliest symptoms of pulmonary, or inhalation, anthrax are very nonspecific and may resemble the early phases of the flu – with fever, muscle aches and pains, and mild respiratory complaints. If untreated and these symptoms progress, it may lead to death. Pulmonary anthrax has been quite rare in this country with only 18 cases reported prior to the events of September 11th.
The gastrointestinal form of anthrax results from eating meat from infected animals. The incubation period is typcially 1-7 days and includes symptoms such as abdominal pain, nausea, vomiting and fever following ingestion of contaminated food or water bloody diarrhea, and vomiting blood. This results in infected areas of the intestines with death of tissues and is almost always fatal. Gastrointestinal anthrax has never been seen in this country.
Is anthrax contagious?
Anthrax is not contagious, that is, it cannot be spread from person to person. The reason it cannot be spread is because infected persons have only the actively growing bacteria and do not have the infectious spores.
How many spores does it take to get infected?
The best evidence on this suggests that it takes between 8,000 and 40,000 spores to be inhaled, perhaps fewer to cause the cutaneous form of anthrax. One would guess that it takes many more organisms to cause the gastrointestinal form, since it is so rare and since infected meat may contain millions of organisms.
What is the difference between “exposed to” and “infected with” anthrax?
One can be exposed to anthrax without getting infected with the bacteria, and, in fact, this is probably the most common occurrence. One becomes infected only when the spores grow successfully and multiply in tissues. The spores may not grow or the body’s natural defenses may kill the bacteria before they cause disease. Having the spores recovered from the nose or skin indicates exposure only – but unless the bacteria successfully grow in the skin, lungs or gastrointestinal tract, there is no infection.
How is it diagnosed?
To diagnose anthrax, your doctor will evaluate your symptoms, taking into consideration any possibility that you could have had contact with the Bacillus anthracis bacterium. He or she may take samples of any skin infections, or respiratory secretions, called sputum. However, there are no tests that can be used to reliably detect the presence of anthrax in exposed persons. This is because the bacteria are present in only small numbers on the skin or on mucous membranes of the nose or pharynx before an infection is established. Without the locus of infection on the skin or in the lungs, the usual tests are just not sensitive enough to find the organism in a high percentage of those exposed. Some of these tests are used for epidemiological studies to see if any persons within a group that may have been exposed are positive. If any are positive, then one may consider that all of those exposed have been put at risk and treatment of the entire group with prophylactic antibiotics may be considered.
How quickly must a possible exposure be treated?
The usual incubation period of anthrax is from several days to as many as 60 days from a single discrete exposure. This gives several days to assess the risks involved. Assessment by a physician or other person knowledgeable in this area should be undertaken sooner rather than later. No preventative measure needs to be given in these first few days, even for true exposure. This is especially true since all antibiotics, as well as other drugs, have the potential to cause serious side effects in some people.
What is the treatment ?
While anthrax usually kills infected animals, it can be successfully treated in humans if caught in the early stages. Penicillin has been the drug of choice for years and remains effective, even for the infections we have all read about recently. Other drugs from the penicillin family such as amoxicillin should be equally effective. Doxycycline, one of the tetracycline family of antibiotics – and most recently listed as the CDC’s drug of choice in treating anthrax, is also effective. Ciprofloxacin – more commonly known as Cipro – is one of the quinolone antibiotics and is also effective. Cipro has made news since the September 11th terrorist attack and is recommended as the first drug to use until the sensitivities of the organisms are known because the Soviet Union was known to produce anthrax bacilli that were resistant to penicillin and tetracycline in their germ warfare program. The anthrax used in the most recent incidents, however, has all been sensitive to all antibiotics listed above. Lung infections may be treated with intravenous antibiotics. It is important to take the full course of prescribed antibiotics to prevent complications. If untreated, cutaneous anthrax may result in death. Untreated inhalation anthrax always results in death.
According to the American Medical Association and other authorities, physicians should not prescribe antibiotics for patients as a preventive measure against anthrax. This may lead patients to initiate unnecessary treatment and could contribute to the development of antibiotic resistant organisms.
Is there an anthrax vaccine?
The vaccine is a cell-free filtrate vaccine, which means it contains no dead or live bacteria in the preparation. Anthrax vaccines intended for animals should not be used on humans. The vaccine is reported to be 93 percent effective in protecting against anthrax and is not recommended for the general public.
Self-care tips
People who work in professions that involve frequent contact with animals or animal products that could be infected with anthrax can get an anthrax vaccine that is highly effective against the disease. People who will be visiting countries where there is poor control of the disease should not eat meat that has not been properly prepared or cooked, and should avoid contact with animals or animal products that could be contaminated.
Anorexia Nervosa
What is it?
Anorexia nervosa is an eating disorder often marked by an unnatural fear of weight gain, compulsive exercising, self-starvation, a distorted body image, and amenorrhea, or absence of at least three consecutive menstrual cycles. There are two sub-types of anorexia nervosa – restricting and binge-purge. Restricting anorexia nervosa is characterized by strict diet and exercise. Binge-purge is marked by periods of compulsive eating with or without self-induced vomiting and the use of laxatives or enemas. Although many diagnosed with anorexia nervosa recover, the disorder can lead to death.
Who gets it?
About 90 percent of those with anorexia nervosa are young women ages 14 to 18. But men and women through their 40s are also at risk. Anorexia nervosa was once considered a disorder of the upper and middle classes. But, more recent studies show that cases of anorexia are becoming more common among young women of all races and social classes in the United States. Adolescents who aspire to be models, professional athletes or performers appear to be at higher risk for developing anorexia nervosa. Anorexia nervosa may be found in people also suffering with depression, anxiety disorders and obsessive-compulsive disorder.
What causes it?
The precise cause of anorexia is not known but is probably the result of a combination of psychological factors, social influences and occupational goals. The changes caused by puberty appear to be a strong influence. Some girls may have difficulty accepting the changes in their bodies in adolescence, especially fat accumulation. This may be coupled with teasing by peers. Other psychological contributors may include reactions to sexual abuse, a desire to appear weak and fragile to the opposite sex, family dysfunction, and an overemphasis on control and independence.
Socially, young women from an early age are conditioned by the media and other sources to believe that only very thin women are considered beautiful.
Many of the risk factors for women are the same for men, a group in which the number of cases is rising especially among homosexuals.
What are the symptoms?
One important sign that someone may be suffering from anorexia nervosa is grossly distorted body image, meaning that the person feels they are overweight and, in fact, appear thin. Other symptoms may include unnatural fear of weight gain, compulsive exercising, self-starvation, loss of energy, and, in girls who have started menstruating, amenorrhea, or absence of at least three consecutive menstrual cycles. Those with anorexia nervosa may begin to appear emaciated.
Over time, the disorder may cause serious health problems including sudden death, congestive heart failure, dental problems, growth retardation, stomach rupture, swelling of the salivary glands, anemia, abnormalities of the blood, loss of kidney function and osteoporosis.
Diagnosis
Many anorexics deny that they have a problem and are usually brought for treatment by a family member.
A physician may look for the following signs that a patient has anorexia nervosa: emaciated body, dry or yellowish skin, abnormally low blood pressure, history of amenorrhea, abdominal pin, constipation and lack of energy. The patient may also have developed lanugo, a soft, downy hair that grows on the arms and chest. If a patient has been vomiting, she may have eroded tooth enamel and Russell’s sign, or scars on the back of the hand. The physician will also assess whether a patient’s weight loss is less than 85 percent of ideal body weight.
Other health concerns that present similar symptoms will need to be ruled out through a series of tests. Those other health conditions may include metabolic disorders, brain tumors, diseases of the digestive tract and mesenteric artery syndrome.
Treatment
The disorder has different levels of severity. The most critical cases may require hospitalization with group and individual therapy and, in some cases, force-feeding. Those with less severe cases may require outpatient psychotherapy and nutrition counseling. Family counseling may also be recommended. Although treatment with medications is debated among physicians, medications including antidepressants, anti-anxiety drugs or others may be recommended.
The majority of anorexics will recover. However, some studies report that about one in 10 may die from complications of anorexia nervosa. Those causes of death include starvation, electrolyte imbalance, heart failure and suicide.
Self care tips
Families should encourage healthy attitudes towards food, body image and exercise and be mindful of the symptoms of anorexia nervosa.
Anorexia nervosa is an eating disorder often marked by an unnatural fear of weight gain, compulsive exercising, self-starvation, a distorted body image, and amenorrhea, or absence of at least three consecutive menstrual cycles. There are two sub-types of anorexia nervosa – restricting and binge-purge. Restricting anorexia nervosa is characterized by strict diet and exercise. Binge-purge is marked by periods of compulsive eating with or without self-induced vomiting and the use of laxatives or enemas. Although many diagnosed with anorexia nervosa recover, the disorder can lead to death.
Who gets it?
About 90 percent of those with anorexia nervosa are young women ages 14 to 18. But men and women through their 40s are also at risk. Anorexia nervosa was once considered a disorder of the upper and middle classes. But, more recent studies show that cases of anorexia are becoming more common among young women of all races and social classes in the United States. Adolescents who aspire to be models, professional athletes or performers appear to be at higher risk for developing anorexia nervosa. Anorexia nervosa may be found in people also suffering with depression, anxiety disorders and obsessive-compulsive disorder.
What causes it?
The precise cause of anorexia is not known but is probably the result of a combination of psychological factors, social influences and occupational goals. The changes caused by puberty appear to be a strong influence. Some girls may have difficulty accepting the changes in their bodies in adolescence, especially fat accumulation. This may be coupled with teasing by peers. Other psychological contributors may include reactions to sexual abuse, a desire to appear weak and fragile to the opposite sex, family dysfunction, and an overemphasis on control and independence.
Socially, young women from an early age are conditioned by the media and other sources to believe that only very thin women are considered beautiful.
Many of the risk factors for women are the same for men, a group in which the number of cases is rising especially among homosexuals.
What are the symptoms?
One important sign that someone may be suffering from anorexia nervosa is grossly distorted body image, meaning that the person feels they are overweight and, in fact, appear thin. Other symptoms may include unnatural fear of weight gain, compulsive exercising, self-starvation, loss of energy, and, in girls who have started menstruating, amenorrhea, or absence of at least three consecutive menstrual cycles. Those with anorexia nervosa may begin to appear emaciated.
Over time, the disorder may cause serious health problems including sudden death, congestive heart failure, dental problems, growth retardation, stomach rupture, swelling of the salivary glands, anemia, abnormalities of the blood, loss of kidney function and osteoporosis.
Diagnosis
Many anorexics deny that they have a problem and are usually brought for treatment by a family member.
A physician may look for the following signs that a patient has anorexia nervosa: emaciated body, dry or yellowish skin, abnormally low blood pressure, history of amenorrhea, abdominal pin, constipation and lack of energy. The patient may also have developed lanugo, a soft, downy hair that grows on the arms and chest. If a patient has been vomiting, she may have eroded tooth enamel and Russell’s sign, or scars on the back of the hand. The physician will also assess whether a patient’s weight loss is less than 85 percent of ideal body weight.
Other health concerns that present similar symptoms will need to be ruled out through a series of tests. Those other health conditions may include metabolic disorders, brain tumors, diseases of the digestive tract and mesenteric artery syndrome.
Treatment
The disorder has different levels of severity. The most critical cases may require hospitalization with group and individual therapy and, in some cases, force-feeding. Those with less severe cases may require outpatient psychotherapy and nutrition counseling. Family counseling may also be recommended. Although treatment with medications is debated among physicians, medications including antidepressants, anti-anxiety drugs or others may be recommended.
The majority of anorexics will recover. However, some studies report that about one in 10 may die from complications of anorexia nervosa. Those causes of death include starvation, electrolyte imbalance, heart failure and suicide.
Self care tips
Families should encourage healthy attitudes towards food, body image and exercise and be mindful of the symptoms of anorexia nervosa.
Angiogram
What is it?
An angiogram is an x-ray picture of the inside of a blood vessel. The procedure used to take an angiogram is called angiography.
Who needs this procedure?
An angiogram shows whether a blood vessel is abnormal in any way, such as blocked, bulging, inflamed, or narrowed. When a patient’s symptoms point to any of these possibilities, angiography is useful in diagnosing the cause. An angiogram can reveal heart disease, atherosclerosis, kidney disorders, brain tumors, problems with the retina, aneurysms, blood clots, and abnormal formations of arteries and veins. It helps determine whether the patient is at risk of stroke or heart attack.
How do I prepare for this procedure?
Your doctor will explain the entire process to you and tell you not to eat or drink anything for a period of time before your angiogram. If you have had an angiogram in the past and know you are allergic to the dye or have an iodine allergy, tell your doctor. Also inform your doctor if you have a history of kidney disease because the dye can make your condition worse. Angiography may not be recommended for people with blood clotting disorders.
bAngiography is usually performed as an outpatient procedure. You may receive a sedative, if necessary, and an intravenous (IV) line in case any medications are needed during the procedure. A healthcare professional called a radiologist will inject a special dye into one of your arteries or veins. The exact location of the injection and the method in which it is injected depends upon the area being studied. The area where the dye is injected will be numbed, and you should feel no more than mild to moderate discomfort. Then, x-ray pictures are bthe dye flows through the blood vessels. The angiogram will reveal anything blocking the path of the dye or other abnormalities along the way. You may feel warm or flushed as the dye spreads through your body. Some patients experience other side effects, such as headache, dizziness, or chest pain just after the dye is injected, but these should pass quickly. After the angiogram is complete, the radiologist will remove the instrument used to inject the dye and apply pressure to the site of the injection. You will need to stay for observation for a period of time after the procedure. Some patients are hospitalized overnight, depending upon the area studied.
What can I expect after the procedure?
While the injection site may feel sore for a while after the procedure, most people experience no side effects from angiography. However, if you experience a drop in blood pressure and/or breathing problems, you are having an allergic reaction to the dye and should contact your doctor immediately. Some patients may develop a hard mass, called a hematoma, around the injection site. Your doctor should monitor this condition because it could mean there is bleeding in that area. If you have had angiography on the retina of your eye, you should protect your eyes from direct sunlight for a time specified by your doctor.
Self-care tips
Give yourself a few days to rest after angiography. Call your doctor if you have any pain, swelling, or bleeding around the site where the dye was injected; or experience dizziness or chest pain.
An angiogram is an x-ray picture of the inside of a blood vessel. The procedure used to take an angiogram is called angiography.
Who needs this procedure?
An angiogram shows whether a blood vessel is abnormal in any way, such as blocked, bulging, inflamed, or narrowed. When a patient’s symptoms point to any of these possibilities, angiography is useful in diagnosing the cause. An angiogram can reveal heart disease, atherosclerosis, kidney disorders, brain tumors, problems with the retina, aneurysms, blood clots, and abnormal formations of arteries and veins. It helps determine whether the patient is at risk of stroke or heart attack.
How do I prepare for this procedure?
Your doctor will explain the entire process to you and tell you not to eat or drink anything for a period of time before your angiogram. If you have had an angiogram in the past and know you are allergic to the dye or have an iodine allergy, tell your doctor. Also inform your doctor if you have a history of kidney disease because the dye can make your condition worse. Angiography may not be recommended for people with blood clotting disorders.
bAngiography is usually performed as an outpatient procedure. You may receive a sedative, if necessary, and an intravenous (IV) line in case any medications are needed during the procedure. A healthcare professional called a radiologist will inject a special dye into one of your arteries or veins. The exact location of the injection and the method in which it is injected depends upon the area being studied. The area where the dye is injected will be numbed, and you should feel no more than mild to moderate discomfort. Then, x-ray pictures are bthe dye flows through the blood vessels. The angiogram will reveal anything blocking the path of the dye or other abnormalities along the way. You may feel warm or flushed as the dye spreads through your body. Some patients experience other side effects, such as headache, dizziness, or chest pain just after the dye is injected, but these should pass quickly. After the angiogram is complete, the radiologist will remove the instrument used to inject the dye and apply pressure to the site of the injection. You will need to stay for observation for a period of time after the procedure. Some patients are hospitalized overnight, depending upon the area studied.
What can I expect after the procedure?
While the injection site may feel sore for a while after the procedure, most people experience no side effects from angiography. However, if you experience a drop in blood pressure and/or breathing problems, you are having an allergic reaction to the dye and should contact your doctor immediately. Some patients may develop a hard mass, called a hematoma, around the injection site. Your doctor should monitor this condition because it could mean there is bleeding in that area. If you have had angiography on the retina of your eye, you should protect your eyes from direct sunlight for a time specified by your doctor.
Self-care tips
Give yourself a few days to rest after angiography. Call your doctor if you have any pain, swelling, or bleeding around the site where the dye was injected; or experience dizziness or chest pain.
Angina
What Is it?
Angina is a temporary pain or tightness that may start in the chest and will sometimes spread to other parts of your upper body. It may start suddenly and may last only a few minutes. Angina will usually occur when there are extra demands placed on the heart, such as during exercise, exposure to extreme hot or cold conditions, windy weather, or during periods of emotional stress. Some people may develop angina at rest or after eating large meals when blood flow must increase to aid in the digestion of foods.
What Are the Symptoms?
The symptoms of angina may vary from person to person. The symptoms may even vary with each episode. They can include a tightness, pressure, aching, or burning behind the breastbone. This sensation may spread or radiate to the arms, neck, jaw, back, or between the shoulder blades.
Other symptoms may include nausea, sweating, shortness of breath, or weakness.
What Causes It?
Angina is caused by a shortage of oxygen and other nutrients reaching the heart muscle. The pain of angina is produced when the heart muscle is starved for oxygen, a condition called ischemia.
Angina occurs most often when the coronary arteries of your heart become narrowed or clogged with deposits of fatty plaque-like substances. This disease is called atherosclerosis.
What Should You Do if You Experience Angina?
If you think you are having angina, you should follow these steps:
STOP what you are doing. SIT DOWN AND REST.
If the symptoms are not gone in 2 to 3 minutes, place a nitroglycerin tablet under your tongue and let it dissolve. You may feel a slight sense of stinging or burning under your tongue,this means the nitroglycerin is working to help relieve your angina.
Wait 3 to 5 minutes. If your angina is still present, take a second nitroglycerin tablet.
Again, wait 3 to 5 minutes. If the symptoms remain, take a third nitroglycerin tablet.
If your angina has not subsided after the third nitroglycerin tablet or after 15 minutes since you first began experiencing discomfort, call an ambulance or have someone drive you to the nearest emergency room.
DO NOT IGNORE THESE WARNING SYMPTOMS!!!!
Helpful Hints about Nitroglycerin tablets.The burning sensation described earlier is not always an indication that the tablet is fresh. The best way to know if your tablets are fresh is to replace them approximately every 6 months.
Another helpful hint is to "check mark" the bottle every time you open it. Once you get to six "check marks" replace the bottle.
All formations of nitroglycerin should be kept at room temperature. The sublingual (under your tongue) tablets are especially susceptible to moisture. They should NOT be kept in bathrooms or kitchens because of higher degrees of moisture there.
If carrying nitroglycerin sublingual tablets with you, you may want to check with your pharmacist for devices to aid you in carrying your nitroglycerin bottle (e.g. a metal cylinder on a chain around your neck).
When Should You Contact Your Family Physician?
Call your physician WITHIN 24 HOURS for any of the following:
· This is the first time you have ever experienced angina.
· You experience angina while resting.
· Your angina is occurring more frequently, has changed location, or is more severe than in the past.
· The nitroglycerin tablets do not work as quickly as they have in the past.
· Your angina has awakened you during the night.
· If your angina has reoccurred following a cardiac catheterization, angioplasty, or open heart surgery procedure(s).
What Can You Do to Avoid Angina?
Many people can control their angina by following their medication regimen prescribed by their physician and by making life-style changes that lower the heart's workload and reduce stress. Other things you can do may include:
Stop smoking (smoking makes the heart work harder)
Lose excess weight
Start an exercise program
Lower your blood cholesterol levels
Avoid eating heavy meals and rest after eating
AVOID outside activities on EXTREMELY HOT OR COLD DAYS
Reduce your stress.
Angina is a temporary pain or tightness that may start in the chest and will sometimes spread to other parts of your upper body. It may start suddenly and may last only a few minutes. Angina will usually occur when there are extra demands placed on the heart, such as during exercise, exposure to extreme hot or cold conditions, windy weather, or during periods of emotional stress. Some people may develop angina at rest or after eating large meals when blood flow must increase to aid in the digestion of foods.
What Are the Symptoms?
The symptoms of angina may vary from person to person. The symptoms may even vary with each episode. They can include a tightness, pressure, aching, or burning behind the breastbone. This sensation may spread or radiate to the arms, neck, jaw, back, or between the shoulder blades.
Other symptoms may include nausea, sweating, shortness of breath, or weakness.
What Causes It?
Angina is caused by a shortage of oxygen and other nutrients reaching the heart muscle. The pain of angina is produced when the heart muscle is starved for oxygen, a condition called ischemia.
Angina occurs most often when the coronary arteries of your heart become narrowed or clogged with deposits of fatty plaque-like substances. This disease is called atherosclerosis.
What Should You Do if You Experience Angina?
If you think you are having angina, you should follow these steps:
STOP what you are doing. SIT DOWN AND REST.
If the symptoms are not gone in 2 to 3 minutes, place a nitroglycerin tablet under your tongue and let it dissolve. You may feel a slight sense of stinging or burning under your tongue,this means the nitroglycerin is working to help relieve your angina.
Wait 3 to 5 minutes. If your angina is still present, take a second nitroglycerin tablet.
Again, wait 3 to 5 minutes. If the symptoms remain, take a third nitroglycerin tablet.
If your angina has not subsided after the third nitroglycerin tablet or after 15 minutes since you first began experiencing discomfort, call an ambulance or have someone drive you to the nearest emergency room.
DO NOT IGNORE THESE WARNING SYMPTOMS!!!!
Helpful Hints about Nitroglycerin tablets.The burning sensation described earlier is not always an indication that the tablet is fresh. The best way to know if your tablets are fresh is to replace them approximately every 6 months.
Another helpful hint is to "check mark" the bottle every time you open it. Once you get to six "check marks" replace the bottle.
All formations of nitroglycerin should be kept at room temperature. The sublingual (under your tongue) tablets are especially susceptible to moisture. They should NOT be kept in bathrooms or kitchens because of higher degrees of moisture there.
If carrying nitroglycerin sublingual tablets with you, you may want to check with your pharmacist for devices to aid you in carrying your nitroglycerin bottle (e.g. a metal cylinder on a chain around your neck).
When Should You Contact Your Family Physician?
Call your physician WITHIN 24 HOURS for any of the following:
· This is the first time you have ever experienced angina.
· You experience angina while resting.
· Your angina is occurring more frequently, has changed location, or is more severe than in the past.
· The nitroglycerin tablets do not work as quickly as they have in the past.
· Your angina has awakened you during the night.
· If your angina has reoccurred following a cardiac catheterization, angioplasty, or open heart surgery procedure(s).
What Can You Do to Avoid Angina?
Many people can control their angina by following their medication regimen prescribed by their physician and by making life-style changes that lower the heart's workload and reduce stress. Other things you can do may include:
Stop smoking (smoking makes the heart work harder)
Lose excess weight
Start an exercise program
Lower your blood cholesterol levels
Avoid eating heavy meals and rest after eating
AVOID outside activities on EXTREMELY HOT OR COLD DAYS
Reduce your stress.
Cerebral Aneurysm
Also known as: Brain Aneurysm; Berry Aneurysm
What is it?
Cerebral aneurysms are abnormal saccular outpouchings of blood vessels occurring on blood vessels of the brain. Aneurysms usually at artery branch points and may take a variety of shapes and sizes. According to some studies, approximately 5% of the population may harbor brain aneurysms. Twenty percent of patients with one cerebral aneurysm will have additional aneurysms. Aneurysms usually cause medical problems by bleeding (rupture) or by putting pressure on near by brain structures.
Who gets it?
Most cerebral aneurysms are sporadic, in other words they are not related to any particular disease or inherited trait. Long-standing hypertension (high blood pressure) and smoking are risk factors for the development and rupture of brain aneurysms. Less commonly, aneurysms can occur in patients with a history of blood vessel wall abnormalities seen in such diseases as Marfan’s syndrome, polycystic kidney disease, fibromuscular dysplasia, connective tissue disorders and coarctation of the aorta. can also predispose patients to intracranial aneurysms. collagen vascular disorders. Aneurysms are usually not hereditary and most do not run in families. However, if a person has a family history of two or more first-degree relatives (e.g. sibling, parent or child) with cerebral aneurysms, the risk of having an aneurysm is increased. In such people, screening for an aneurysm with an MRI/MRA is generally recommended.
What causes it?
Cerebral aneurysms have been thought to develop from weaknesses in blood vessel walls especially at branching. Smoking, high blood pressure and certain connective tissue disorders appear to promote the development of aneurysms. Less commonly, aneurysms may be traumatic in nature secondary to blood vessel injury. Rarely, infectious causes can lead to what are referred to as mycotic aneurysms.
What are the symptoms?
Many patients with cerebral aneurysms have no symptoms. However, the most common reason brain aneurysms come to medical attention is through bleeding (rupture). The typical symptoms of brain aneurysm bleeding include, severe headache (usually described as the worst headache of the patient’s life), a stiff neck, light irritating the eyes and nausea/vomiting. In the absence of aneurysm bleeding, patients may develop focal neurological problems as a growing or changing aneurysm compresses normal brain structures.
How is it diagnosed?
Cerebral aneurysms can be noted on diagnostic imaging studies such as CT scans or MRI/MRA. However, the current gold standard for evaluation of cerebral aneurysms is cerebral angiography. During a cerebral angiogram a catheter is navigated into the arteries feeding the brain and x-ray pictures are obtained while contrast dye is injected through the catheter. Cerebral angiography is usually necessary prior to treatment of an aneurysm. In some situations a CT angiogram, which uses a CT scanner and intravenously injected contrast (no catheter), may be used to assist in delineating some features of the aneurysm.
What is the treatment?
The two major methods of aneurysm treatment are microsurgery and endovascular surgery. Microsurgical treatment for aneurysms involves an open surgical procedure to expose the aneurysm by slipping under and around the brain using delicate instruments and high-powered magnification. Once the aneurysm has been located, a titanium clip is placed across the neck (base) of the aneurysm. The clip stops blood from entering the aneurysm, thereby preventing it from bleeding. In endovascular surgery, a catheter is introduced into a patient's peripheral artery and navigated, using an angiogram as a "road map" to the area where the aneurysm is located. Once found, the aneurysm is then filled from the inside with tiny platinum “coils.” The coils react with the surrounding blood causing it to clot thereby obliterating the aneurysm. Both techniques are effective and each method has certain advantages and disadvantages that vary depending on the size, configuration and location of the aneurysm.
Currently, there are no medicines available to treat brain aneurysms. However, in some instances, depending on the patient’s age and general medical health, as well as the characteristics of the aneurysm itself, it is possible that no treatment will be recommended.
What is it?
Cerebral aneurysms are abnormal saccular outpouchings of blood vessels occurring on blood vessels of the brain. Aneurysms usually at artery branch points and may take a variety of shapes and sizes. According to some studies, approximately 5% of the population may harbor brain aneurysms. Twenty percent of patients with one cerebral aneurysm will have additional aneurysms. Aneurysms usually cause medical problems by bleeding (rupture) or by putting pressure on near by brain structures.
Who gets it?
Most cerebral aneurysms are sporadic, in other words they are not related to any particular disease or inherited trait. Long-standing hypertension (high blood pressure) and smoking are risk factors for the development and rupture of brain aneurysms. Less commonly, aneurysms can occur in patients with a history of blood vessel wall abnormalities seen in such diseases as Marfan’s syndrome, polycystic kidney disease, fibromuscular dysplasia, connective tissue disorders and coarctation of the aorta. can also predispose patients to intracranial aneurysms. collagen vascular disorders. Aneurysms are usually not hereditary and most do not run in families. However, if a person has a family history of two or more first-degree relatives (e.g. sibling, parent or child) with cerebral aneurysms, the risk of having an aneurysm is increased. In such people, screening for an aneurysm with an MRI/MRA is generally recommended.
What causes it?
Cerebral aneurysms have been thought to develop from weaknesses in blood vessel walls especially at branching. Smoking, high blood pressure and certain connective tissue disorders appear to promote the development of aneurysms. Less commonly, aneurysms may be traumatic in nature secondary to blood vessel injury. Rarely, infectious causes can lead to what are referred to as mycotic aneurysms.
What are the symptoms?
Many patients with cerebral aneurysms have no symptoms. However, the most common reason brain aneurysms come to medical attention is through bleeding (rupture). The typical symptoms of brain aneurysm bleeding include, severe headache (usually described as the worst headache of the patient’s life), a stiff neck, light irritating the eyes and nausea/vomiting. In the absence of aneurysm bleeding, patients may develop focal neurological problems as a growing or changing aneurysm compresses normal brain structures.
How is it diagnosed?
Cerebral aneurysms can be noted on diagnostic imaging studies such as CT scans or MRI/MRA. However, the current gold standard for evaluation of cerebral aneurysms is cerebral angiography. During a cerebral angiogram a catheter is navigated into the arteries feeding the brain and x-ray pictures are obtained while contrast dye is injected through the catheter. Cerebral angiography is usually necessary prior to treatment of an aneurysm. In some situations a CT angiogram, which uses a CT scanner and intravenously injected contrast (no catheter), may be used to assist in delineating some features of the aneurysm.
What is the treatment?
The two major methods of aneurysm treatment are microsurgery and endovascular surgery. Microsurgical treatment for aneurysms involves an open surgical procedure to expose the aneurysm by slipping under and around the brain using delicate instruments and high-powered magnification. Once the aneurysm has been located, a titanium clip is placed across the neck (base) of the aneurysm. The clip stops blood from entering the aneurysm, thereby preventing it from bleeding. In endovascular surgery, a catheter is introduced into a patient's peripheral artery and navigated, using an angiogram as a "road map" to the area where the aneurysm is located. Once found, the aneurysm is then filled from the inside with tiny platinum “coils.” The coils react with the surrounding blood causing it to clot thereby obliterating the aneurysm. Both techniques are effective and each method has certain advantages and disadvantages that vary depending on the size, configuration and location of the aneurysm.
Currently, there are no medicines available to treat brain aneurysms. However, in some instances, depending on the patient’s age and general medical health, as well as the characteristics of the aneurysm itself, it is possible that no treatment will be recommended.
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.
Sickle Cell Anemia
What is it?
Sickle cell anemia is an inherited blood disorder that causes red blood cells to be abnormally shaped. The condition can cause anemia, painful events and various complications.
Who gets it?
Sickle cell anemia primarily affects people of African, Mediterranean, Middle Eastern, and Asian Indian ancestry. In the United States, the disease occurs in one out of every 600 African-Americans.
What causes it?
Sickle cell anemia is cause by a genetic change in hemoglobin, the oxygen-carrying protein inside the red blood cells. This causes the cells to take on a sickle-shape and have a shorter life span, which can cause anemia. Sickle cells are also less flexible and stickier than normal red blood cells, and can become trapped in small blood vessels preventing blood flow and starving tissues and organs. This compromises the delivery of oxygen, which may result in damage to associated tissues and organs. The disease is often inherited.
What are the symptoms?
Symptoms of sickle cell anemia include paleness of skin as the anemia worsens, especially on the insides of eyelids, under fingernails and in the creases of the palm of the hand. The skin may also turn yellow (jaundiced). If the anemia is severe, the shortage of normal red blood cells may cause weakness, shortness of breath, or even heart failure. The symptoms of shock caused by heart failure are low blood pressure, rapid pulse, and decreasing consciousness.
How is it diagnosed?
Sickle cell anemia may be diagnosed through a test called hemoglobin electrophoresis. This blood test detects the sickle cell hemoglobin S. It can also be used to find carriers of the sickle cell trait. In addition, the doctor may order a complete blood count to confirm the effects or complications of sickle cell anemia. During this test, red blood cells are counted under a microscope and checked for abnormal shapes.
What is the treatment?
There is no cure for sickle cell anemia, so treatment focuses on lessening a patient’s symptoms and prolonging their lives. Recent studies have shown that the drug hydroxyurea may reduce pain attacks in people with sickle cell anemia. It also has been shown to prolong the lives of patients diagnosed with sickle cell anemia. Patients with sickle cell anemia are more likely to have serious infections such as the flu or pneumonia. Prevention of serious infections is an important part of treatment. The doctor may recommend immunizations are kept up-to-date, get a flu shot each year, and take antibiotics to prevent infections.
Blood transfusions are not usually given on a regular basis but may be used to treat patients who experience frequent and severe painful events, severe anemia, and other emergencies.
Self care tips
Couples who have sickle cell anemia or who are carriers of the disease may consider not having children to prevent the spread of the disease. Screening tests can be used to find carriers. Couples who find that they are carriers should seek genetic counseling.
Sickle cell anemia is an inherited blood disorder that causes red blood cells to be abnormally shaped. The condition can cause anemia, painful events and various complications.
Who gets it?
Sickle cell anemia primarily affects people of African, Mediterranean, Middle Eastern, and Asian Indian ancestry. In the United States, the disease occurs in one out of every 600 African-Americans.
What causes it?
Sickle cell anemia is cause by a genetic change in hemoglobin, the oxygen-carrying protein inside the red blood cells. This causes the cells to take on a sickle-shape and have a shorter life span, which can cause anemia. Sickle cells are also less flexible and stickier than normal red blood cells, and can become trapped in small blood vessels preventing blood flow and starving tissues and organs. This compromises the delivery of oxygen, which may result in damage to associated tissues and organs. The disease is often inherited.
What are the symptoms?
Symptoms of sickle cell anemia include paleness of skin as the anemia worsens, especially on the insides of eyelids, under fingernails and in the creases of the palm of the hand. The skin may also turn yellow (jaundiced). If the anemia is severe, the shortage of normal red blood cells may cause weakness, shortness of breath, or even heart failure. The symptoms of shock caused by heart failure are low blood pressure, rapid pulse, and decreasing consciousness.
How is it diagnosed?
Sickle cell anemia may be diagnosed through a test called hemoglobin electrophoresis. This blood test detects the sickle cell hemoglobin S. It can also be used to find carriers of the sickle cell trait. In addition, the doctor may order a complete blood count to confirm the effects or complications of sickle cell anemia. During this test, red blood cells are counted under a microscope and checked for abnormal shapes.
What is the treatment?
There is no cure for sickle cell anemia, so treatment focuses on lessening a patient’s symptoms and prolonging their lives. Recent studies have shown that the drug hydroxyurea may reduce pain attacks in people with sickle cell anemia. It also has been shown to prolong the lives of patients diagnosed with sickle cell anemia. Patients with sickle cell anemia are more likely to have serious infections such as the flu or pneumonia. Prevention of serious infections is an important part of treatment. The doctor may recommend immunizations are kept up-to-date, get a flu shot each year, and take antibiotics to prevent infections.
Blood transfusions are not usually given on a regular basis but may be used to treat patients who experience frequent and severe painful events, severe anemia, and other emergencies.
Self care tips
Couples who have sickle cell anemia or who are carriers of the disease may consider not having children to prevent the spread of the disease. Screening tests can be used to find carriers. Couples who find that they are carriers should seek genetic counseling.
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