Archive for the ‘Health’ Category

What is Otic Barotrauma?

This fancy name merely indicates the discomfort that can occur in the ear when situations creating pressure differentials between the middle ear and the exterior take place. In today’s jet era any people travel by air, and during transit, the problem is most likely to arise. It is far more likely if the person is suffering from a mild head cold, or any infection that may block the patency (openness) of the Eustachian canal. This canal maintains air pressures within the middle ear equal to that on the outside, and this is vital to continued comfort. Other conditions where a similar problems can occur include tunneling, and scuba diving in deep water.

Otic Barotrauma Symptoms

Often in a person who has a cold or upper respiratory tract infection there is sudden onset of pain in the ear(s) as the plane descends. The pain may become extremely acute and may even be excruciating. Examined soon after, the drum may he very red and infected, and on occasion bleeding may result. Fluid may accumulate and deafness occurs.

Otic Barotrauma Treatment

Being sensible and avoiding flying whenever possible if a head infection is present will avert trouble. If this cannot be avoided, or if it is not noticed that there is a mild infection, or if the condition occurs during flight, using this simple maneuver may give prompt relief. This involves holding the nose between the forefinger and thumb, and then trying to blow into the nose.
This may help open the canal, and a “click” to occur, so allowing the pressures to equal. It should be repeated many times over. Sucking sweets may also help by opening the partially blocked canal. If unsuccessful, medical attention may be necessary. The middle ear must be aerated, and this will probably be done by the ENT doctor through Eustachian catheterisation or by paracentesis under antibiotic cover.

A baby or child appears to have had a seizure, it will be important for the physician to know as accurately as possible what actually took place, determine whether an underlying problem(s) provoked the episode, and episode and whether further studies should be done and/or medications given. Some important elements of the evaluation will include the following:

• The history. What actually happened? Did the episode begin gradually or suddenly? Was the whole body or only a limited area (such as a twitching arm or leg) involved? Hose long did it last? (Keep track of the time because seizures always sects to last longer than their true duration.) Did the child lose consciousness? If so, how quickly did he return to normal? If he is old enough to describe what happened, did he notice anything before the episode? Was he incontinent of urine or stool? Did he bite his tongue or sustain any other injury? Was he ill at the time, or was
• there any injury (such as a blow to the head) prior to the episode?
• It may be difficult to keep track of such details during an event as terrifying as a seizure, but all of this information is extremely important for the physician who is evaluating the problem. It will be necessary to decide whether a seizure has actually taken place.
• •Physical examination. This may not be terribly revealing if the episode in question happened last week. But immediately after a lapse in consciousness or in an infant who has just had a febrile convulsion, the physical exam might offer important clues to the diagnosis.
• Laboratory tests. The physician may request that certain blood tests be performed to rule out a metabolic cause for the seizure or to help evaluate any infection that might be in progress.
• A lumbar puncture (spinal tap). This may be recommended if there is any question that a seizure might involve an infection in the central nervous system, most commonly meningitis. It is more likely to be requested in infants and young children (under two years of age) who have had their first febrile seizure, especially when they are younger than three months of age. In this age-group a fever and a seizure may be the only indications that meningitis is present. While it might sound frightening and dangerous, a lumbar puncture is not a highly risky procedure, even in an infant.
• An electroencephalogram (EEG). This study of electrical activity in the brain is a very helpful tool in the investigation of a seizure disorder. It can be particularly useful in distinguishing certain behavioral or physical abnormalities (such as those mentioned below under the SPECIAL NOTE) from true convulsions. Unfortunately, at times the EEG can appear normal in a child who in fact has a seizure disorder.
• The most important use of the EEG, however, is to identify characteristic brain-wave patterns that, when correlated with the child’s symptoms during a seizure, allow the physician to classify the seizure disorder. This helps determine which medications will be most effective in controlling the seizures. An EEG involves attaching electrodes to the scalp but does not deliver any electrical shock and is not painful. In some cases the child may be sedated for the procedure, while in others he will be studied after he has been kept awake all night (a tactic that increases the odds of seeing abnormal activity).
• CT, MRI, or other imaging of the brain. This may be needed if there is a history or evidence of trauma to the head or any concern about other physical abnormalities within the brain that might be causing seizures.

Not all of the tests just described will necessarily be done as part of an evaluation of possible seizure activity. After a classic febrile seizure, for example, a child may simply be observed for a while in the doctor’s office or emergency room and then sent home. Depending upon the entire picture, however, some or all of these studies may need to be done.

If the diagnosis of a particular type of recurrent seizure disorder is confirmed, it is likely that the physician will recommend that one or more anticonvulsant medications be given over a period of time. These drugs will decrease the likelihood of further seizures (or eliminate them altogether), hopefully without interfering with normal activities or school performance. Febrile convulsions are an exception to this approach and normally are not treated with ongoing preventive medication. Details regarding specific drugs and their potential side effects are beyond the scope of this book but should be carefully reviewed with the prescribing physician. It is very important to take the medications consistently as they have been prescribed. Some children may require periodic blood tests to confirm that drug levels are appropriate and that certain adverse effects are not taking place. All these measures may seem burdensome for children and parents alike, but haphazard use of these medications may allow more seizures to occur or increase the risk of side effects. If your child with seizures is taking one or more medications that you feel are adversely affecting his life (for example, causing excessive drowsiness or poor school performance), you should not change the dose or discontinue any drug without discussing the problem with his physician.

Occasionally seizures that are disruptive and not adequately controlled with medication may be improved with surgery. Extensive evaluation and highly technical procedures are required for this type of treatment, which typically is carried out by a team of specialists at a regional children’s hospital.

Hermaphroditism is a very rare condition in which the person has both ovarian and testicular tissue occurring together. The appearance of the external genitals varies greatly, and the persons have a problem for life. With more recent methods of studying chromosomal anomalies today, many have been found to have aberrations. In some it seems there has been a double fertilization of the ovum by two sperms, one giving female attributes and the other male ones, so producing a final ambiguous picture.

Hermaphroditism Treatment

This depends on how the child was originally brought up, and there is considerable feeling that whatever this has been should be continued. In recent years this has been an emotive topic.

Many teenage girls may fail to menstruate, or normal periods may suddenly cease. This may be due to excessive hormonal production preventing normal monthly ovulation, as well as obsessively over exercising. It may affect one in 20 among young ballet dancers and athletes.

Fortunately, when the vigorous sports are reduced, in most cases ovulation (and normal menstrual periods and the chances of pregnancy) returns to normal levels. This may be a worrying time for many young people. If continuing indefinitely (as with estrogen lack in the blood), calcium may be drawn from the bones, causing osteoporosis, with the high risk of fractures common in older postmenopausal women. It needs careful evaluation.

Two related conditions called female and male pseudohermaphroditism show that genetically a person with a female type chromosomal structure has varying degrees of masculinisation, and vice versa. In women, corticosteroids are used. In males, as there is a high risk of cancer developing in the testes, they may be removed, and plastic surgery carried out (with appropriate prosthetics). Testosterone is given to increase maleness.

What is Ovarian Tumor?

The ovaries are a fairly common site for the development of tumors. They are most frequently detected in women aged 35 years or more. They tend to grow slowly, and are often not discovered until they have grown to a relatively large size.
Often a lump welling up from the pelvic cavity (sometimes believed to be a pregnancy, even though menstruation may still be occurring) is the first indication. But in an obese woman, it may just appear that she is putting on even more weight in the abdominal region, and may be overlooked for a long time.
Many are discovered in the course of a routine pelvic examination for some other reason. (This is another reason in favour of having regular pelvic checks when returning for a repeat prescription of the contraceptive pill. If this is not carried out routinely by your own doctor, it is well worth asking for.) Many tumors are discovered during a laparoscopic examination of the pelvis.
Fortunately, about 95 per cent of ovarian tumors are benign (ie noncancerous). Benign tumors are usually cystic, so that if a cystic swelling is discovered, it usually means that it is a simple, noncancerous one.
However, the remaining 5 per cent still equals a lot, and malignancy in this area is fraught with problems. For cancer tends to grow at a steady rate, silently, and almost symptom-free in the early stages. Often, by the time adequate symptoms have occurred to make the patient seek medical assistance, the cancer has advanced to an incurable state. Once more this indicates the supreme value of regular medical examinations and pelvic checks throughout life. Discovering these disorders early (before symptoms set in) offers about the only chance of a successful outcome.

Ovarian Tumor Symptoms

Benign tumors never cause pain, unless some sort of complication occurs, and rarely do they affect menstrual function. Symptoms can take place if the tumor is on a lengthy stalk (pedicle), and it becomes twisted on itself. If the cystic swelling suddenly bursts. symptoms may also take place.
Princess Anne of Britain was in the news some years ago when it appeared that she had an ovarian cyst that had suddenly developed this complication. Sometimes a surgical emergency may arise. But with small cysts, a slight discomfort may be all that a woman experiences.
Very large tumors may produce symptoms from pressure on surrounding structures. Abdominal discomfort, lack of appetite and/or nausea may occur when the abdominal contents are squeezed by mechanical pressure. Malignant tumors of the ovaries are often associated with pain, particularly in the later stages when surrounding structures have become involved. Fluid in the pelvic cavity and weight loss are also other ominous signs.
Diagnosis of ovarian tumors may be simple, or they may be extremely difficult. Sometimes radiology and ultrasound aids are needed to help in distinguishing it from other possible diagnoses.

Ovarian Tumor Treatment

The course of action depends on the nature and severity of the symptoms being produced. If severe bleeding is occurring, particularly in an older woman, surgical removal of the uterus is often undertaken. If troublesome pressure symptoms are encountered, a similar approach is frequently made.
In younger women (especially those under the age of 40), and those still desirous of maintaining their reproductive function, myomectomy may be advised. One important flow-on benefit is that a substantial number of women who appeared to be infertile (presumably due to the presence of the tumor) subsequently become pregnant after this operation.
Treatment of most ovarian tumors is surgical. In young women, every effort is made to preserve as much of the normal ovary (if there is any left) as possible. This help ensure continuation of the system’s hormonal supply, and so help maintain a feeling of normality.
As there is a risk of benign cysts turning cancerous, they are usually removed. Smaller ones are either ruptured or removed alone or with the ovary through the operating laparoscope. as seen in full colour by the doctor on a VDU screen, which sits next to the patient. It can sometimes be difficult to know if a tumor is in fact cancerous or not until it has been thoroughly examined by the pathologist under the microscope. Any parts that are removed must always be scrutinised by the experts for a full report.
In older women, frequently a greater amount of tissue is removed, for there is often an increased risk of cancer. Ovarian cancer is a serious disease and follow-up therapy is usually carried out. Development of Taxol, from the yew tree, holds hope for the future. Time will tell.
The main point in this section is the need to recognise that ovarian tumors are relatively common. While most are noncancerous, there is a real risk that malignancy may develop.
The sooner diagnosis is made and treatment undertaken, the better. There is also a case for regular pelvic examinations throughout life in order to detect any such abnormality as early as possible.

Endometrial Ablation

New technology continues to improve the lot of many women undergoing surgery. In many cases, in women with heavy bleeding for no obvious cause, the traditional D and C or hysterectomy (womb removal) is being replaced by endometrial ablation. This is carried out in hospital under a general anaesthetic. A camera looks inside the womb, and this is displayed on a VDU screen nearby, and the surgeon works from this, gently manipulating the instruments. A “rollerball” or laser beam then systematically removes the endometrial lining of the womb. This goes deeply, so that subsequent scar tissue will prevent new tissue lining from growing.
In most cases, bleeding is dramatically reduced. Pregnancy is usually no longer possible. The patient normally recovers quickly. It is a much lesser operation than womb removal, and the patient may return home and back to normal duties fairly quickly.

Laparoscopic Hysterectomy

The laparoscopic method is being used for an increasing range of surgical operations. Many gynaecologists use it for womb removal (hysterectomy) Tubes (one containing a camera and lights) are inserted via tiny 1 cm incisions called portals low down in the pelvis. This is shown up on the VDU screen, and the surgeon gently dissects away the unwanted parts.
Finally, the womb (and other organs if need be) is removed via an incision high up in the vaginal canal. Recovery is claimed to be quicker, although the operation still takes a considerable period of time, and specialised surgical skills and equipment are required.

Hepatitis inflammation of the liver is nearly always caused by a viral infection. (Inflammation of the liver caused by drugs or toxic substances may also be called hepatitis, but most commonly the term indicates an infectious origin.) Depending upon the type of virus involved and the individual’s response to it, the inflammation may go undetected or at the other extreme produce profound illness. A child or adolescent with clinically significant hepatitis will typically experience fever, flulike symptoms, fatigue, jaundice (yellow orange skin and yellow color in the white area of the eyes), light or gray stools, and dark urine.

Many forms of viral hepatitis have been identified, and undoubtedly more will be discovered in the future. Of these, A and B are by far the most common.

Hepatitis A (previously called infectious hepatitis) is transmitted through contaminated food or water and is often acquired during foreign travel. The time from exposure to onset of symptoms is usually 15 to 40 days. The illness usually begins with five to ten days of nonspecific flulike symptoms, which may be followed by jaundice. (Fewer than 10 percent of children under age six who have hepatitis A develop jaundice. Among older children with hepatitis A infection, about half become jaundiced.) In the vast majority of cases, this infection resolves without complications in about a month, with rest as the primary treatment. Severe illness (or death) resulting from hepatitis A is extremely uncommon.

People who have ongoing close contact with the infected person may benefit from an injection of immune (gamma) globulin given within one or two weeks after exposure. This provides temporary protection that may prevent or minimize the impact of infection. Equally if not more important is good hygiene, including frequent hand washing, especially after any contact with stool from the infected individual. Children and infants may shed the virus in stool for several weeks after the illness has begun.

People who are planning to travel to high-risk areas (especially in developing countries) should consider obtaining specific hepatitis A vaccine, which is safe and nearly always effective, prior to departure.

Hepatitis B (formerly called serum hepatitis transmitted in ways similar to those that HIV/AIDS:

• From an infected mother to her baby before or x the time of birth.
• Through shared needles during intravenous drug use or through improperly cleaned tattoo needles that have been in contact with an infected person.
• Through contaminated blood products during transfusion. (Careful screening of donors and blood products has virtually eliminated this type of transmission.)
• Through an accidental needle stick of a healthcare worker who is drawing or processing blood from an infected person.
• Through sexual contact with an infected individual.
• In as many as one in three cases, the source of infection is unknown.

The incubation period for hepatitis B is longer—to 150 days—than for hepatitis A. The initial signs may be minimal or nonspecific, such as fever, vomiting, and fatigue. In some cases, jaundice is the first sign that the infection is present. Rarely do life-threatening illnesses occur. At the outset of about 90 percent of cases, the infection resolves in about two weeks without any specific treatment or long-term problems. However, one in ten individuals develop a chronic form of the infection, which after a number of years poses a risk for cancer or scarring (cirrhosis 3 the liver). In addition, those with chronic hepatitis B transmit the virus through sexual contact. They should never donate blood because even a tiny amount of it will infect another person.

Infants who acquire hepatitis B from an infected mother before birth are at higher risk for complication in the future. However, newborn hepatitis B infections can be prevented if an injection of hepatitis B immune globulin (or HBIG) is given within twelve hours of birth. To anticipate births at which this treatment will be necessary, pregnant women are now screened hepatitis B virus as part of routine prenatal care.

Specific treatment for chronic hepatitis B is expensive and unpredictable in its effectiveness. However, a vaccine that is both safe and highly effective in preventing this infection has been available for the past few years. Because of the significant number of new cases of hepatitis B that continue to occur each year and its potency for causing serious long-term consequences, immunization of all children against this virus is now widely recommended and in many states required for school entry. The vaccine may be given at any age, starting at birth, and involves three injections – the second given one month after the first, and the third injection at least four months after the second.

In the past Hepatitis C was usually acquired from infusions, but now sexual contact and the use of illegal intravenous drugs are the typical modes of transmission. Since blood products are now routinely screenedtin evidence of hepatitis C infection, the risk for acquiring the virus from a transfusion is now extremely low. Hepatitis C causes acute symptoms such as fever, fatigue, and jaundice in fewer than 25 percent of cases. It’s more likely to cause no immediate illness but smolder for years as a chronic infection. Fifty percent of infected adults develop chronic infection, and of these, 20 percent cirrhosis of the liver. Less is known about medical long-term outcome in children.

Very often the first indication of a prior hepatitis C infection is an abnormal blood test found during a physical routine later in life or more often noted among the screening tests done when an adolescent or young adult donates blood. Whenever such abnormalities are found, the donated blood is never given to a patient, and the potential donors notified of his or her results so that further evaluation can be carried out.

What is Paralytic Ileus?
This is a type of bowel obstruction, but instead of being caused by some mechanical means, it is simply due to intestinal immobility. Normally peristaltic waves of contraction constantly move along the length of the bowel, pushing the fluid contents forwards at all times.
However, under certain circumstances, most commonly following surgical operations on the abdomen, a portion of the bowel suddenly ceases to pass on the waves of contraction. This probably occurs to a small extent after most abdominal operations, but it invariably reverts to normal function after a short time, with no adverse aftermath.
Accidents and a variety of other less commonly encountered causes may also produce the complication.
Paralytic Ileus Symptoms
There is usually a history of recent operation, accident or precipitating cause. Vomiting usually occurs, and constipation is the rule. Peristalsis is usually markedly diminished or absent. This is evidenced by complete silence when the abdomen is checked with a stethoscope. Abdominal distension is present, and soreness may or may not occur. X-rays show distension of the bowel with gas throughout (different from an obstruction where only the part above the obstruction shows distension).
Paralytic Ileus Treatment
Most patients are already in hospital, recuperating from a surgical operation. Treatment involves supplying adequate fluids, restricting the oral intake of food, decompressing the bowel (it may be necessary to intubate the patient, by passing a tube into the bowel) and dealing with any suspected underlying disorder. Most cases respond well to these measures, and the paralysed intestine soon resumes normal function.

The ulcer may suddenly perforate, or penetrate the wall of the stomach or duodenum. If this is not sealed off by an adjacent organ, it constitutes an abdominal emergency. This is more likely to occur with a duodenal ulcer than a gastric ulcer (5:1 in men, but only 2:1 in women). The ulcer may be an acute or chronic (long-standing) one. There is a decided high-mortality risk with this complication, and this is related to the time loss from its occurrence to the time it is successfully treated. The longer the delay, the greater the risk.

Perforated Peptic Ulcers Symptoms

The clinical picture is usually straightforward. There is sudden onset of acute abdominal pain, aggravated by movement, and in fifty percent of cases the pain is referred to the shoulder. The majority, about seventy percent give a history of dyspepsia. Often there is nausea and some vomiting. The abdominal wall, normally soft, becomes hard and rigid. Paleness, increased heart rate and sweating also occur.

Perforated Peptic Ulcers Treatment

This requires immediate emergency surgical intervention, and over-sewing of the perforation or perhaps surgical removal of the ulcer itself. The patient must be hospitalized as quickly as possible.

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What is Prostate Cancer?

Cancer of the prostate gland is relatively common in older males. In the United Kingdom, almost 4000 men die from this each year. When related to the population at risk, this works out at about one for every 1700 men over the age of 50 being in the “at risk” age group. This is a very high rate, although in the upper age group the death rate for all forms of disease is gradually increasing, and this tempers the figure a little.

Prostate Cancer Symptoms

About 80 per cent of cases present with symptoms of general prostatic hypertrophy that has just been discovered. In fact, the symptoms may be identical. As with that condition, the decision to seek medical attention may have been delayed.

The other 20 per cent come with symptoms relating not to the primary cancer, but to symptoms attributable to its spread, so-called metastases. Commonly these affect bones, and pain is a prominent symptom. Those seeking treatment in this group very commonly have widespread dissemination of the disease, probably all through the body, and the original site is not the primary concern, either for symptoms or treatment.

Diagnosis

This may be difficult, as it usually starts with a general examination, followed by a rectal one that may give some indication. A hard indurate area may be felt that is often highly indicative of the disease. X-ray examination, radionuclide scanning, CT and ultrasound can often yield valuable evidence, particularly of the spread of the disease. Besides confirming the diagnosis, these tests will give some indication as to the suitability of the patient for probable surgery.

Various laboratory tests are available. Most important is the PSA (short for prostate specific antigen.) The figure (normally 0.1 to 0.4) often rises significantly with an enlarged prostate and prostate cancer, although low readings do not always exclude cancer. It is the best single biochemical screening test currently available. The serum alkaline phosphatase is another test suggesting prostatic pathology. Unfortunately it is not very specific for early disease.

Digital examination and trans-rectal ultrasound and prostate biopsy have revolutionised early diagnosis. The prostate can be felt and also clearly seen, section by section, on the ultrasound screen. A needle biopsy is taken of suspect areas, and cancer can he quickly and accurately diagnosed.

Prostate Cancer Treatment

This presents a major problem, and a course will be worked out in every case. Often radical prostatectomy (removal of the prostate gland) forms only a small part of the overall therapy. This may remove the primary site, but as metastases may be widespread, and probably are causing the major symptoms, little relief may be gained.

However, if there is obstruction, and problems relating to urination, this may be the first step. Sad to say, the outlook is often a hopeless one. “In the vast majority of cases, by the time symptoms have drawn attention to the primary focus, only palliative relief treatment is practical,” Ferguson says in the British Medical Journal. “Other methods of treatment can often achieve a reasonable period of’ survival in comfort without resort to major operations.”

The use of endocrine therapy plus super voltage radiotherapy can be offered the patient, and “this has now overcome many of the disadvantages of earlier techniques and offers an acceptable alternative for local treatment.” Therefore, endocrine therapy and radiotherapy are at present, the mainstay of treatment.

In younger men, say those under 65 years, “the activity of the disease is likely to be greater and early energetic treatment may he indicated.” Once again, the crux of this lies in the absolute necessity for early assessment by the doctor if any telltale symptoms of urinary obstruction are apparent. They must never be neglected or delayed. Seeing your family doctor is probably the best starting point. From here, referral to a urologist, or a major urological clinic in a large hospital where all facilities are available, is essential.

The retinal vessels are both interesting and important. They are the only place in the body where the doctor can sec blood vessels under direct vision. When the back of the eye is examined with a device called the ophthalmoscope, the doctor can actually see the intact vessels coursing over the retina. As certain diseases unrelated to the eye give typical patterns in blood vessels, it can greatly assist in diagnosing various medical conditions.

Diabetes and elevated blood pressure are just a couple of important examples. Light enters the eyeball through the window (cornea), traverses the anterior chamber filled with fluid, passes through the transparent lens, on through the clear fluid of the vitreous, to strike the light-sensitive retina.

The point of focus at the back of the eye is called the macula, and the central, most sensitive part of this is the fovea. Normally the lens is (mite transparent, but with advancing years, following trauma, and with certain diseases (most notably diabetes) it may cloud over and vision is impaired. This is termed cataract formation, and can sometimes be seen from a casual inspection as a whitish haze in the normally clear lens.

The vitreous is likewise clear, but sometimes foreign material can gain access. This may be interpreted by the brain as a foreign particle appearing 30 centimetres or so in front of the eyes. Generally these arc annoying, but are not serious. In time, the “floater” (as it is called) tends to gravitate below the field of vision, and will disappear, much to the relief of the patient.

ECC is not something that can be learned from a book. It should be given only by trained operators. Correct technique is important because of the risk of injury, for ECC, even when expertly administered, provides less than half the normal blood flow to the brain.

If a casualty being given EAR has no pulse, the procedure is as follows:

1. Give 15 compressions in 10 – 12 seconds.
2. Give 2 ventilations within 3 – 5 seconds. (The cycle should not take more than 15 seconds.)
3. Continue at 4 cycles per minute, checking the carotid pulse (neck) and breathing every two minutes.
4. If circulation is restored, stop FCC but continue EAR.
5. If breathing is restored, stop EAR. Place the casualty in the stable side position and ensure that airway is kept clear.