Corneal diseases

Cornea - a front part of an external fibrous envelope of an eyeball; nonvascular, high-sensitivity, transparent, an optically homogeneous envelope with smooth, a smooth surface. Except for protective and basic function the cornea is the main refracting surface of optical system of an eye.

Diseases of a cornea makes about 25 % of the general number of diseases of eyes, and quite often are the reasons of blindness and lowering of vision.

Diseases of a cornea are rather various. Most often there are inflammatory diseases of a cornea (keratitis), differing greater variety of forms and being one of principal causes of decrease in sight and blindness, and also keratikonus. The Most frequent reasons of keratitis and keratoconjunctivitis are virus and bacterial infections.

Keratikonus - a condition of an eye at which the normal spherical form of a cornea is broken, the cornea is bent. On a surface of an eye the camber similar to a cone that leads to strong easing of sight develops.

Dystrophies and degenerations of a cornea happen primary and secondary. In a basis primary local and general infringements of a metabolism with adjournment in a cornea of products of a pathological exchange lay. Secondary dystrophies develop after transferred keratitis, traumas, burns of eyes.

For the prevention of heavy complications of diseases of a cornea are required: proper diagnostics, duly and active treatment. Various medicinal substances are applied to local treatment in the form of drops, injections. Methods of electrophoresis, phonophoresis, treatment by laser radiation are used also.

For carrying out of purposeful treatment bacterial keratitis definition of sensitivity of microflora to antibiotics by crop of defeat separated from the center is necessary.

Instruction to the patient after change of a cornea

To you the microsurgery of change of a cornea is lead. The thin seam keeping a donor fabric, can long-standing time (about one year) to remain in a cornea. It allows you to start to work with the moderate physical activity earlier. At the same time, it is necessary to remember the periodic medical control over a condition of a seam.
Durable healing of a wound after change of a cornea comes only in 6-10 months after operation. Therefore after an extract from a hospital it is necessary for you to continue the recommended treatment in house conditions. Instilling drops or loading ointments can be made the purest hands before a mirror or in a prone position, as well as by means of relatives, using those receptions with which you have got acquainted in a hospital.

During the first month to sleep it is necessary on a back or on the party opposite to the operated eye. The food can be usual, it is necessary to exclude alcoholic drinks. Surplus of sweets is not desirable. Easy gymnastic exercises without jumps, run and inclinations are useful. During rest and walks during the first year after operation it is necessary to avoid stay on the bright sun. It is impossible to sunbathe. It is possible to use the blacked out glasses. The replaced cornea during several months, and sometimes several years, has the lowered sensitivity. Therefore it is impossible to rub sharply an eye a scarf or a hand, it is necessary to be cautious at washing, to cover the operated eye during a strong wind and to avoid walks in frosty days even on the second or the next years after operation. It will help to save a cornea from damages and freezing injury.

You can watch TV, go to museums, cinema and theatre if it is not connected with difficult and close moving to transport. It is possible to start the usual or limited work in 2-4 months depending on a condition of the operated eye and working conditions. Expansion of the general mode should be carried out one step at a time, however during the first year work with a slope of a head downwards, outdoor games, run, heavy physical work is absolutely counter-indicative. After an output for work do not forget to show to the oculist each 2-3 months within the first year after operation, especially if it is not removed an encircling stitch.

In case of occurrence of reddening and an ache in an eye, and blear-eyedness to you it is necessary for photophobia to see a doctor promptly. Only early the begun treatment can prevent deterioration of vision.

Read More......

Factors and the conditions causing irritation of a dental pulp

The irritation of a pulp of a tooth can arise owing to caries of a teeth, as a result of preparation of a tooth and carious cavities, under influence a filler material, owing to penetration of microorganisms at not tight seal, at an exposure dentin.

Caries of a tooth serves as a principal cause of changes in a pulp and its inflammations. Already at initial damage dentin fibrilloblasts react adjournment secondary and formation of a layer scleroid dentin (adjournment of salts of calcium on walls of dentinal canaliculus) down to full occlusion of dentinal canaliculus. These processes should be considered as display of protective mechanisms of a pulp on action of a cue.

At processing of a caries and destruction of enamel of a bacterium get in dentin, however the inflammation of a pulp does not arise. It is established, that first signs of an inflammation come, when carious the cavity is separated from a pulp by a layer of 1,1 mm [Reeves R., Stanley H. R., 1996], i.e. the pulp practically is not infected up to an instant of penetration of microorganisms in secondary dentin [Massler, Pawlak J., 1977].

Preparation of a cavity without use of a water spray leads to its damage. Thus probability of damage of the in direct proportion area of preparation and depth of damage. Thus, preparation of a tooth under vinirs or artificial crownwork without due cooling serves a serious risk factor for a dental pulp.

Filler materials. There are the numerous data specifying irritating influence various of filler materials. From cements the most expressed adverse action renders silicate though specify, that it is shown at formation of a clearance between edge of enamel and dentin as microorganisms nestle close in dentin [Brannstrom, 1979].

Composites also are considered as irritating materials. First of all, toxicity of composites of the first generation was marked. Materials let out now as specify numerous supervision, render insignificant influence on a pulp.

During many years use of bondings was studied at sealing. It is proved, that improvement of a compounding bondings has allowed to achieve favorable reaction of a pulp to used composites.

Regional permeability as considers a number of researchers, is a principal cause of irritation of a pulp after sealing. The leading part thus belongs to microorganisms. With the purpose of the prevention of the specified changes in a pulp it is recommended to spend padding fabrics of a tooth and use bonding systems.

The exposure of dentin can occur after loss of a seal, as a result of deleting fabrics, at erosion, etc., that is accompanied by sensitivity action of irritating factors. Sensitivity can arise also at an exposure cervical dentin because canaliculus of dentin become opened.

The sheeting (direct) provides:

1) clarification of a surface of a pulp;

2) drying of a cavity;

3) imposing on the naked pulp of medical paste;

4) a seal from zinc oxide eugenic acid cement;

5) imposing of a constant seal.

Most widely used materials for protection of a pulp contain all calcium hydroxide. As a result of it above a site of an exposure it is postponed secondary dentin, forming the dentin bridge. Consider, that formation of a barrier occurs not due to the calcium containing in a material, closing a pulp.

Read More......

Hip Replacement Dislocation

Hip replacement surgery is very successful; pain relief and increased ability to perform routine activities are among the best benefits of this procedure. Unfortunately, hip replacements have some potential complications. These complications are uncommon, but they do occur--sometimes in unforeseen circumstances. Among the most frequently seen complications of hip replacement surgery is dislocation of the hip replacement. Hip replacement dislocations occur in about 4% of first-time surgeries, and about 15% of revision hip replacements.

How do hip replacements work?

Hip replacements are most commonly performed in patients with severe arthritis of the hip joint. The hip replacement uses a metal and plastic implant to replace the normal ball-and-socket hip joint. By removing the worn out bone and cartilage of the hip joint, and replacing these with metal and plastic, most patients find excellent pain relief and improved motion of the hip joint.

Why do hip replacement dislocations occur?

Normal hip joints have many surrounding structures that help to stabilize the hip joint. These structures include muscles, ligaments, and the normal bony structure of the hip joint. Together, these structures keep the ball (the femoral head) within the socket (the acetabulum). When the hip replacement surgery is performed, the hip becomes less stable. By loosing some of these hip stabilizers, the metal and plastic hip replacement is prone to "coming out of joint," or dislocating.

What happens when a hip replacement dislocation occurs?

Patients who have a hip replacement are instructed on hip precautions. Hip precautions are various maneuvers a patient who has undergone a hip replacement needs to avoid. Hip precautions include:

• Do not cross your legs
• Do not bend our legs up beyond 90 degrees
• Do not sit on sofas or in low chairs
• Do not sleep on your side

Most physicians ease these precautions after rehabilitation, but total hip replacements are less stable than normal hips even years after surgery.

These activities place the hip joint in a position where the ball may fall out of the socket. Sometimes hip replacements are more prone to hip dislocation. Factors that can contribute to hip replacement dislocations include:

• Malpositioning of the hip replacement implants
• Revision hip replacements
• Excessive alcohol intake
• Neuromuscular problems (e.g. Parkinsons disease)
• Developmental hip dysplasia

Sometimes patients have no identifiable cause for their sustaining a dislocation of their hip replacement.

What is the treatment of a hip replacement dislocation?

Hip replacement dislocation treatment depends on several factors. The first step is usually to reposition the hip joint. This procedure, called a reduction of the hip replacement, is performed under anesthesia--either light sedation in the emergency room, or general anesthesia in the operating room. During the procedure, your orthopedic surgeon will pull on the leg to reposition the hip within the socket.

Most often the hip "pops" back into position. X-rays will be obtained to ensure the hip is repositioned and to see if there is any identifiable reason for the dislocation. If multiple dislocations occur, surgery may be necessary to prevent further dislocations. The implants can be repositioned, or special implants can be used to try to prevent further dislocations. You will need to discuss with your orthopedic surgeon the cause of your dislocation, and what treatments are available for the problem.

_Sources:

_{Soong M, et al. "Dislocation After Total Hip Arthroplasty" J. Am. Acad. Ortho. Surg., September/October 2004; 12: 314 - 321.}

Read More......

Hernias at children: inguinal, umbilical, a hernia of a white line of a stomach. Symptoms. Methods of treatment.

Hernia is an outwandering bodies from a cavity in norm them borrowed through properly existing or pathologically generated aperture with conservation of an integrity of envelopes, their covering, or availability of conditions for this purpose.
Let's consider a hernia of a forward belly wall of a stomach. It is the most widespread surgical pathologies at children. An original cause of progress of hernias - defect of progress of a belly wall. However there are some features which we shall consider separately.

Umbilical hernia. For 4-5 day after a birth of the child the umbilical cord disappears. The umbilical ring consists of two parts. The bottom part where pass umbilical arteries and a uric channel, are well reduced and form a dense cicatricial fabric. In the top part there passes a umbilical vein. Its walls thin, have no muscular environment, are badly reduced in the further. Quite often at weak peritoneal band and patent to a umbilical vein the umbilical hernia is formed. Except for it the major factor promoting occurrence of this pathology, frequent increase of intrabelly pressure is. It can be caused, for example, frequent we cry the child.
The aperture in the top part of a umbilical ring can be wide, and not trouble the child. But in case of small defect with firm edges concern of the child probably. As a rule, a umbilical hernia always can be reduced. The restrained umbilical hernia to meet in an adult practice more often. However we quite often should operate children with unreducible hernias (when hernial contents are attached to an internal wall of a leather of a forward belly wall by solderings).

Experience of out-patient supervision of children with the umbilical hernias diagnosed at early age, allows to tell with confidence, that to 5-7 years age often there comes self-healing. Liquidation of a hernia is assisted with strengthening a belly wall. It certainly massage, laying of children on a tummy, gymnastics. Surgical treatment it is begun not earlier than 5 years age. Properly and accurately lead operation, allows to eliminate a hernia with good cosmetic effect. As a rule, relapses does not happen.

Hernia of "a white line" stomach (anteperitoneal adipoma). If to lead a line between omphalus and ensiform shoot of a brest is and there is "a white line" stomach. At a direct muscle of the stomach, shaping given area, is from 3-6 tendinous crosspieces. In seat of intersection of these crosspieces and "a white line" stomach sometimes there are small defects. In them it is often stuck out anteperitoneal fat. If they settle down in immediate proximity from a umbilical ring, them name paraumbilical (periomphalic) hernias. Unfortunately, these hernias are not inclined to spontaneous closing. Treatment only operative, similar to operation at a umbilical hernia.

An inguinal hernia. Very frequent surgical disease at children. As a rule, all hernias at children of early age congenital. What reasons of occurrence of this pathology? It is a lot of opinions in this occasion at children's surgeons. It and weakness of a forward belly wall and feature of a structure inguinal areas and nonclosure vaginal a shoot abdominal membrane and a heredity. We shall try under the order, on an example of an congenital inguinal at the boy.
About from 6-th month of intra-uterine progress of the boy orchis fall from a belly cavity in marsupium on inguinal to the channel. Therefore these hernias name slanting. For presentation present itself, that on a tube (vaginal to a shoot abdominal membrane) as on the lift, orchis, conducted by the lowering mechanism from a belly cavity goes down in marsupium. Then under the plan there is a closing a pipe (vaginal shoot abdominal membrane) and by that the termination of the message between belly completely and marsupium. If it does not occur, at increase of intrabelly pressure in the nonclosure vaginal shoot of abdominal membrane leaves contents of a belly cavity. It is an inguinal hernia.
What for to an organism to strain and stretch a stomach when there is an opportunity to dump a superfluous pressure in "hernial contents". And frequently the child grows and … increases hernial bulge. Treatment of the given pathology only operative. Technically to carry out it at the child easier is more senior 1 year. However quite often operation is shown to the child at once at statement of the diagnosis. To wait dangerously. Occurrence of terrible complication - infringement inguinal hernias is possible. Hernial bulge in inguinal areas earlier that arising disappearing suddenly became firm, the child has begun to worry and has begun to cry, there was a vomiting, refusal of meal. At touch up to firm "bulla" in a groin to the child it is very painfull!!!
Most likely, there was an infringement inguinal hernias. To not give food, not give water and it is urgent to bring the child to the hospital. Muscles of a stomach have restrained contents of a hernial bag. It can be a site of a gut, a bladder or ootheca at girls. If urgently to not help the child after a while the site, deprived blood supplies, can be sphacelous, i.e. become lifeless. In that case treatment very heavy and long. In my practice there were 2 cases, hernial contents at the restrained hernia were a site of a blind gut with again changed an appendicular shoot. It was necessary to lead simultaneously with celotomy.

Believe, it is better to not lead up to infringement. To operate the child with a hernia it is necessary healthy, with good analyses and in the daytime. And it is possible only at scheduled operation. Every year in our branch, about to 500 children with the given pathology, scheduled operative interventions are spent. Operations last about 15-20 minutes, pass under a mask narcosis and the control of skilled anaesthesiologists. And here, after the small period of rehabilitation - your child is completely healthy. We have made all in time and properly.

Read More......

Peptic Ulcers

Description An in-depth report on the causes, diagnosis, treatment, and prevention of stomach and GI ulcers.

Alternative Names Duodenal Ulcers; Gastric Ulcers; H. Pylori; Nonsteroidal Anti-inflammatory Drugs, or NSAIDs

Causes Before the discovery of the bacterium Helicobacter (H.) pylori, the stomach was believed to be a sterile environment. Now, H. pylori is known to be a major cause of peptic ulcers. The bacteria appears to trigger ulcers in the following way: H. pylori's corkscrew shape enables it to penetrate the mucous layer of the stomach or duodenum so that it can attach itself to the lining. It survives its highly acidic environment by producing urease, an enzyme that generates ammonia and neutralizes the acid. H. pylori then produces a number of toxins and factors that in certain individuals cause inflammation and damage to the lining, leading to ulcers. It also alters certain immune factors that allow it to evade detection and cause persistent inflammation for a person's lifetime--even without invading the mucous membrane.

Even if ulcers do not develop, the bacterium is now considered to be a major cause of active chronic inflammation in the stomach (gastritis) and in the upper part of the small intestine (duodenitis).

It is also strongly linked to stomach (gastric) cancer and possibly other non-intestinal problems.

Factors That Trigger Ulcers in H. pylori Carriers. It should be noted that H. pylori is found in about 25% of people who do not have peptic ulcers. The magnitude of H. pylori infection, particularly in older people, may not always predict the presence or absence of peptic ulcers. Other variables, then, need to be present to actually trigger ulcers. They may include the following:

• Genetic Factors. Some people harbor genetic strains of H. pylori that may make the bacteria more dangerous and increase the risk for ulcers in infected individuals. The most intensively investigated genetic factor is cytotoxin-associated gene A (CagA), which has been associated with both gastric and duodenal ulcers as will as with stomach cancer. Other genetic types that may also increase bacterial severity are called vacuolating cytotoxin (vacA) and antigen-binding adhesin (BabA) genotypes. Some of these genetic factors may be more or less important for development of ulcers depending on ethnicity.
• Immune Abnormalities. Some experts suggest that certain individuals have abnormalities in the immune response in the intestine that allow the bacteria to become injurious to the lining.
• Lifestyle Factors. Although lifestyle factors (e.g., chronic stress, coffee-drinking, smoking) were long believed to be the primary cause of ulcers, it is now thought they only increase susceptibility to them in some H. pylori carriers.

When H. pylori was first identified as the major cause of peptic ulcers, it was found in 90% of people with duodenal ulcers and in about 80% of people with gastric ulcers. As more people are being tested and treated for the bacteria, however, the rate of H. pylori associated ulcers has declined. For example, a 2001 study suggested that about half of ulcers are not caused by H. pylori. Instead, they tend to be due to regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), which include aspirin and other common pain relievers. Genetic factors, or, rarely, Crohn's disease or Zollinger-Ellison syndrome also cause ulcers.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) is the second most common cause of ulcers and the rate of NSAID-caused ulcers is increasing. About 20 million people take prescription NSAIDs regularly, and over 25 billion tablets of over-the-counter brands are sold each year in America. The most common NSAIDs are aspirin, ibuprofen (Advil), and naproxen (Aleve, Naprosyn), although many others are available.

Their damaging effects appears to rest primarily on actions that block an enzyme called cyclooxygenase (COX), which is involved in the production of prostaglandins. The COX enzyme has two forms:

• COX-2 causes intestinal contractions and inflammation. When NSAIDs block this enzyme, they help reduce pain and inflammation. This is their primary benefit.
• COX-1 also protects the stomach by its release of prostaglandins that protect the mucous layer, maintain normal bicarbonate levels, and keep blood flowing in the intestinal tract. When NSAIDs block COX-2, they expose the mucous lining to attack.

Standard NSAIDs block both COX-1 and COX-2. Even if an NSAID is injected intravenously, the drug will still inhibit prostaglandins in the stomach and duodenum. NSAIDs are mild acids and can cause some injury by direct exposure to the lining of the stomach. Their primary damaging effects, however, are from their actions against COX-1. Studies suggest the following risks:

• An analysis of controlled trials reported that about 1% of patients taking aspirin over a 28 month period will experience gastrointestinal bleeding. A significant risk existed even at low doses or with the use of modified-release formulations.
• Of further concern was a 1998 study indicating that taking NSAIDs for only six months posed a risk for symptomatic ulcers that was greater than 1%.

The risk for bleeding is continuous for as long as a patient is on these drugs and may even persist for about a year after taking them. Taking short courses of NSAIDs for temporary pain relief should not cause major problems because the stomach has time to recover and repair any damage that has occurred.

Read More......

Herpes simplex

Definition

Herpes simplex is an infection that mainly affects the mouth or genital area.

Causes

There are two different strains of herpes simplex viruses:

• Herpes simplex virus type 1 (HSV-1) is usually associated with infections of the lips, mouth, and face. It is the most common herpes simplex virus and most people develop it in childhood. HSV-1 often causes lesions inside the mouth, such as cold sores (fever blisters), or infection of the eye (especially the conjunctiva and cornea). It can also lead to infection of the lining of the brain (meningoencephalitis). It is transmitted by contact with infected saliva. By adulthood, up to 90% of people will have antibodies to HSV-1.
• Herpes simplex virus 2 (HSV-2) is sexually transmitted. Symptoms include genital ulcers or sores. In addition to oral and genital sores, the virus can also lead to complications such as infection of the lining of the brain and the brain itself (meningoencephalitis) in neonatal infants due to infection during birth. However, some people have HSV-2 but do not show symptoms. Up to 30% of U.S. adults have antibodies against HSV-2. Cross-infection of type 1 and 2 viruses may occur from oral-genital contact.

A finger infection, called herpetic whitlow, is another form of herpes. It usually affects health care providers who are exposed to saliva during procedures. Sometimes, young children also can get the disease.

The herpes virus can infect the fetus and cause abnormalities. A mother who is infected with herpes may transmit the virus to her newborn during vaginal delivery, especially if the mother has an active infection at the time of delivery.

It's possible for the virus to be transmitted even when there are no symptoms or visible sores.

Symptoms

• Mouth sores
• Genital lesions -- there may first be a burning or tingling sensation
• Blisters or ulcers -- most often on the mouth, lips and gums, or genitals
• Fever blisters
• Fever -- especially during the first episode
• Enlarged lymph nodes in the neck or groin

Exams and Tests

Many times, doctors can tell whether you have a herpes-simplex infection simply by looking at the lesions. However, certain tests may be ordered to be sure of the diagnosis. These tests include:

• Blood test
• Viral culture of the lesion
• Direct fluorescent antibody (DFA) test

Treatment

Some cases are mild and may not need treatment.

People who have severe or prolonged cases, immune system problems, or frequent recurrences may need to take antiviral medications such as acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex).

People who have more than 6 recurrences of genital herpes per year may need to continue taking antiviral medications to reduce recurrences.

Support Groups

Support groups and dating services are available for people with genital herpes.

Outlook (Prognosis)

The oral or genital lesions usually heal on their own in 7 to 10 days. The infection may be more severe and last longer in people who have a condition that weakens the immune system.

Once an infection occurs, the virus spreads to nerve cells and stays in the body for the rest of a person's life. It may come back from time to time and cause symptoms, or flares. Recurrences may be triggered by excess sunlight, fever, stress, acute illness, and medications or conditions that weaken the immune system (such as cancer, HIV/AIDS, or the use of corticosteroids).

Possible Complications

• Meningitis
• Encephalitis
• Eczema herpetiform (widespread herpes across the skin)
• Infection of the eye -- keratoconjunctivitis
• Prolonged, severe infection in immunosuppressed individuals
• Pneumonia
• Infection of the trachea

When to Contact a Medical Professional

Call your health care provider if you develop symptoms which appear to be herpes infection. There are many different conditions that can cause similar lesions (especially in the genital area).

If you have a history of herpes infection and develop similar lesions, tell your health care provider if they do not get better after 7 to 10 days, or if you have a condition that weakens your immune system.

Prevention

Preventing herpes simplex is difficult since people can spread the virus even when they don't have any symptoms of an active outbreak.

Avoiding direct contact with an open lesion will lower the risk of infection.

People with genital herpes should avoid sexual contact when they have active lesions. Safer sex behaviors, including the use of condoms, may also lower the risk of infection.

People with active herpes lesions should also avoid contact with newborns, children with eczema, or people with suppressed immune systems, because these groups are at higher risk for more severe disease.

To decrease the risk of infecting newborns, a cesarean delivery (C-section) is recommended for pregnant women who have an active herpes simplex infection at the time of delivery.

References

Workowski KA, Berman SM. Sexually Transmitted Diseases Treatment Guidelines, 2006. MMWR Morb Mortal Wkly Rep. August 4, 2006;55(RR-11):1-94.

Stoopler ET. Oral herpetic infections (HSV 1-8). Dent Clin North Am. 2005 Jan;49(1):15-29, vii.

Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, Pa: Churchill Livingstone; 2000.

Read More......

Cranial mononeuropathy III - compression type

Definition

Cranial mononeuropathy III is a problem with the function of the third cranial nerve, which is located behind the eye.

Alternative Names

Third cranial nerve palsy; Oculomotor palsy; Pupil-involving third cranial nerve palsy

Causes

Cranial mononeuropathy III - compression type is a mononeuropathy, which means that only one nerve is affected. It affects the third cranial (oculomotor) nerve, one of the cranial nerves that controls eye movement. Local tumors or swelling can press down on and damage the nerve.

Causes may include:

• Brain aneurysms
• Disorders such as mononeuritis multiplex
• Infections
• Poorly formed blood vessels (vascular malformations)
• Sinus thrombosis
• Tissue damage from loss of blood flow (infarction)
• Trauma (from head injury or caused accidentally during surgery)
• Tumors or other lesions (especially tumors at the base of the brain and pituitary gland)

Rarely, people with migraine headaches may have a temporary problem with the oculomotor nerve. This is probably due to a spasm of the blood vessels. In some cases, no cause can be found.

Symptoms

• Double vision
• Drooping of one eyelid
• Headache or eye pain

Other symptoms may occur if the cause is a tumor or trauma. Decreasing consciousness is a serious sign, because it could indicate brain damage or death.

Exams and Tests

An eye examination may show:

• Enlarged (dilated) pupil of the affected eye
• Eye movement abnormalities
• Eyes that are not aligned (dysconjugate gaze)

A complete medical and nervous system (neurological) examination can show whether any other parts of the body are affected.

Other tests may include:

• Blood tests
• CT angiogram
• CT scan
• MRI
• Spinal tap (lumbar puncture)

Treatment

Some cases may get better without treatment. Treating the cause (if it can be found) may relieve the symptoms in many cases.

Treatment may include:

• Corticosteroid medications to reduce swelling and relieve pressure on the nerve
• Surgery to treat eyelid drooping or eyes that are not aligned
• Wearing an eye patch or prisms

Outlook (Prognosis)

Some cranial nerve dysfunctions will respond to treatment. A few cases result in some permanent loss of function. If the problem is caused by brain swelling due to a tumor or stroke, those conditions may be life-threatening.

Possible Complications

• Permanent eyelid drooping
• Permanent vision changes

When to Contact a Medical Professional

Call the local emergency number (such as 911) or go to the emergency room if you have:

• Double vision
• No feeling in or control over parts of your body
• Signs of changed consciousness
• Unusual headache

Prevention

Quickly treating disorders that could press down on the nerve may reduce the risk of developing cranial mononeuropathy III.

Read More......

Colitis - a problem of intestines

Very often at people the wrong opinion concerning such disease as colitis is created. They assume, that colitis is a gripe. However, this incorrect assumption. The word colitis has occurred from the Greek word "kolon" which is translated as a large gut. Actually colitis is an inflammatory disease of a mucous membrane of thick intestines.

Colitis in sharp forms pass very violently, but during too time it is very fast. Chronic colitis in turn proceed very long and languidly. Sharp colitis are very often accompanied by an inflammation of thin guts and a stomach. The medicine knows some types of colitis. Among them: ulcer, infectious, ischemic, medicinal, radiating and some other types of colitis. Ulcer colitis it is accompanied by occurrence of chancres in paries of intestines. At ischemic prick blood badly reaches intestines.

There is a big number of the reasons of occurrence colitis. It can be intestinal infections, an infection in a bilious bubble or a pancreas, long application of antibiotics, infringement of blood supply of a gut. If to speak about a wrong feed it also influences formation of colitis. More often this abusing flour and animal food, also a spicy food and alcohol. If at you a dysbacteriosis of intestines, worms, a bad heredity or a food allergy, quite probably, that you become "hostage" of colitis. One more very frequent factor of occurrence of colitis is the wrong mode of day, a frequent mental or physical overstrain.

The basis of any colitis includes damage of a mucous membrane of a gut. If colitis is caused by an intestinal infection then disease passes with rough influence on an organism. During the moment of disease various bacteria and parasites get on a mucous membrane of a gut and start it to damage. During this moment in a gut of the patient there is an inflammatory process. Because of it the wall of a gut swells. The gut cannot normally function any more. The wrong operating mode causes desires on defecation, a diarrhea and painful sensations in a stomach. At the patient at prick constantly the temperature raises.

First attributes of colitis are a pain in the field of a stomach and a unstable chair. Rumbling and a swelling of a stomach can disturb the patient. In a dung there can be a slime or blood. The person with colitis feels slackness, weakness. The given disease proceeds more often, approximately, some weeks.

If happens you got a colitis, it is necessary for you to address necessarily to the gastroenterologist. Only him can put you the correct diagnosis. Also you should hand over the analysis кала and to pass some researches on various devices.

Treatment of any kind of colitis requires a special diet. All other treatment is appointed depending on the reasons of disease. If at you has appeared colitis because of an intestinal infection then to you will necessarily appoint antibiotics. In case of if you became the owner of this disease because of application of a plenty of medicines then all medical products are canceled.

Medicinal therapy, physiotherapy, psychotherapy – all this methods of treatment colitis. Sanatorium treatment of this disease very well helps.

Colitis, as well as all other diseases, requires duly treatment. For this reason leave all businesses on then and engage for the beginning in the health. Visiting of the gastroenterologist will help you to get rid from colitis and to feel far more confidently and better.

Read More......

Noma

Definition

Noma is a type of gangrene that destroys mucous membranes of the mouth and other tissues. It occurs in malnourished children in areas of poor cleanliness.

Alternative Names

Cancrum oris; Gangrenous stomatitis

Causes

The exact cause is unknown, but may be due to bacteria called fusospirochetal organisms.

This disorder most often occurs in young, severely malnourished children between the ages of 2 and 5. Often they have had an illness such as measles, scarlet fever, tuberculosis, cancer, or immunodeficiency.

Risk factors include Kwashiorkor and other forms of severe protein malnutrition, poor sanitation and poor cleanliness, disorders such as measles or leukemia, and living in an underdeveloped country.

Symptoms

Noma causes sudden, rapidly worsening tissue destruction. The gums and lining of the cheeks become inflamed and develop ulcers. The ulcers develop a foul-smelling drainage, causing breath odor and an odor to the skin.

The infection spreads to the skin, and the tissues in the lips and cheeks die. The process can eventually destroy the soft tissue and bone. Eventual destruction of the bones around the mouth cause deformity and loss of teeth

Noma can also affect the genitals, spreading to the genital skin (this is sometimes called noma pudendi).

Exams and Tests

Physical examination shows inflamed areas of the mucous membranes, mouth ulcers, and skin ulcers. These ulcers have a foul-smelling drainage. There may be other signs of malnutrition.

Treatment

Antibiotics and proper nutrition helps stop the disease from getting worse. Plastic surgery may be necessary to remove destroyed tissues and reconstruct facial bones. This will improve facial appearance and the function of the mouth and jaw.

Outlook (Prognosis)

In some cases, this condition can be deadly if left untreated. Other times, the condition may heal over time even without treatment. However, it can cause severe scarring and deformity.

Possible Complications

• Disfigurement
• Discomfort

When to Contact a Medical Professional

Medical care is needed ifmouth sores and inflammation occur and persist or worsen.

Prevention

Measures to improve nutrition, cleanliness, and sanitation may be helpful.

Read More......

Nevus pigmentary, dysplastic, blue, boundary, removal of nevus

Pigmentary nevus - a good-quality congestion of pigmentary cells on a skin. Pigmentary nevus it is seldom possible to meet at babies; they start to be shown in the childhood, and especially much they appear in youthes, and with the years number of pigmentary nevuses one step at a time decreases. The type of pigmentary nevuses can be various - they can be flat or acting above a surface of a leather, the smooth or covered hair. It is necessarily necessary for adult people to pay attention to variation of their form, color or appearance as it can be one of initial symptoms developing malignant melanoma.

Dysplastic nevuses is pigment spots of the complex form and with not sharp borders, slightly rise above a level of a skin, painting varies them from red-brown up to dark-brown on a pink background.

Dysplastic nevuses for the first time have drawn to itself attention the unusual type and the raised frequency in some families (are transferred by right of succession). As a rule, dysplastic nevuses is larger than ordinary birthmarks, reaching 5–12 mm in diameter.

Boundary pigmentary nevus. Develops in the field of dermo-epidermal joints and it is characterized raised melanocyte by activity. Clinically it looks like flat is dark-brown or black papule in diameter up to 1 sm, with a smooth dry surface is more often. The important differential-diagnostic sign boundary pigmentary nevus is the total absence on it of hair. Boundary nevus can sometimes look a spot roundish or wrong outlines with equal wavy edges. Favourite localization at boundary nevus is not present. It can settle down on a leather of the person, a neck, a trunk. According to the literature, pigmentary nevuses on a skin of a palm, soles, genitals almost always are boundary. Boundary nevus is congenital is more often, however can appear in the first years of a life or even after puberty.

Blue (dark blue) nevus represents sharply limited from a surrounding skin papule is dark-dark blue or bluish color, roundish outlines, densely-elastic consistence with a smooth hairless surface. It is characterized by massive congestions of melanin in deep layers of derma, that causes its blue color. The size of papule no more than 0,5 sm though in the literature individual supervision huge blue nevus are described, reaching several centimeters in diameter. Settles down blue nevus more often on the person, finitenesses, buttocks. Localization in an oral cavity is possible. Blue nevus meets at representatives of Asian people is more often. Congenital it never happens and appears mainly after puberty. Progress of melanoma on seat blue nevus is observed seldom, but such cases are described, as has induced it to carry to danger of melanoma.

Huge pigmentary nevus - always congenital. It increases in sizes in process of growth of the child, reaching the big size (from a palm and it is more) and borrows sometimes the most part of a trunk, a neck and other areas. Usually on a significant extent a surface of nevus is torous, warty, with deep cracks on a skin. Often there are sites trichauxis (hair nevus). Color variate from grayish up to black, often non-uniform on various sites of nevus. Malignization of huge pigmentary nevus according to various authors occurs in 1,8 % up to 10 % of cases.

Papillomatous nevus is characterized rough, torous by a surface. It is often localized on hair parts of a head, but happens and on any other site of an integument. The sizes more often greater, up to several centimeters, outlines are wrong, color variates from color of a normal skin up to brownish, less often - is dark-brown or even black. Similar fibroepithelial papilloma quite often happens it is penetrated by hair.

Removal of nevuses

Any pigmentary new growths of a skin require attention and vigilance.

Their treatment consists in radical (within the limits of not changed leather) removal by a method surgical ablation (stages are presented on illustrations in the bottom of page). Use modern noninvasive sutural and rules of aesthetic surgery allows to achieve materials undistinguished postoperative cicatrical tissue.

Read More......

Epilepsy. Guidance for patients.

Epilepsy - one of the most widespread diseases of nervous system which cause of the prominent features represents a serious medical and social problem. Among the children's population frequency of epilepsy makes 0,75-1 %, from them of 65 % can live practically without attacks provided that they pass appropriating medical examination and receive appropriate treatment. Epilepsy - disease of the brain, described attacks of infringements of impellent, sensitive, vegetative or cogitative functions. Thus during between attacks the patient can be absolutely normal, nothing differing from other people. It is important to note, that the individual attack yet is not an epilepsy. Only repeated attacks - the basis for an establishment of the diagnosis of epilepsy. At epilepsy attacks also should be spontaneous, i.e. nothing to be provoked; they appear always unexpectedly. The attacks arising at temperature (pyretic spasmes), a fright, at a capture of blood, as a rule, have no attitude to epilepsy.

The reasons of occurrence of an epilepsy depend on age. At children of younger age the most frequent causal factor got epilepsy is oxygen starvation during pregnancy (hypoxia), as well as congenital developmental anomalies of a brain, intra-uterine infections (a toxoplasmosis, a cytomegaly, a roetheln, a herpes, etc.); less often - a patrimonial trauma. There are also forms of epilepsy with hereditary predisposition (for example, youthful myoclonic epilepsy). At these forms the risk of a birth of the sick child if one of parents is sick of epilepsy, is low and makes no more than 8 %. Extremely seldom there are progressing hereditary forms of epilepsy, mainly, in families with close relatives marriage or in the certain ethnic groups (for example, among a Finno-Ugrian population). In these families the risk of a birth of the sick child can be very high and reach 50 %.

Thus, allocate a "symptomatic" epilepsy (when it is possible to find out structural defect of a brain), an autopathic epilepsy (when there is a hereditary predisposition and structural changes in a brain are absent) and a cryptogenic epilepsy (when the reason of disease to reveal it is not possible).

Allocate nidal (franctional, focal, local) attacks, at which spasmes or original sensations (for example, numbness) in the certain parts of a body can be observed; most often - on behalf of or finitenesses, especially in hands. Nidal attacks can be shown also by short attacks of visual, acoustical, olfactory or flavouring hallucinations; short-term sensation of a pain or discomfort in a stomach; inflow of ideas with impossibility to concentrate; sensation «already seen» or «never seen»; attacks of unmotivated fear. The consciousness at these attacks is usually kept (simple fractional attacks), and the patient in details describes the sensations.
Deenergizing consciousness without falling and spasmes (complex fractional attacks) is possible. Thus the patient continues automated to carry out the interrupted action. During this moment can meet automatisms: chewing, stroking bodies, rub palms and so forth thus is made impression, that the person is simply absorbed by the activity. Duration of franctional attacks usually no more than 30 sec. After complex of fractional attacks short-term confusion of consciousness, drowsiness are possible.

Generalized attacks happen convulsive and non-convulsive (absenses). Generalized convulsive tonic-clonic attacks - the most serious, shocking, frightening parents and attacks surrounding type, nearby not the heaviest. Sometimes in some hours or even days up to an attack patients test some phenomena named by harbingers: the general discomfort, alarm, aggression, irritability, a sleeplessness, sweaty, the feeling of heat or a cold, etc. If directly ahead of an attack of the patient feels aura (discomfort in a stomach, visual sensations, unreality surrounding and so forth), and then loses consciousness and falls in spasmes such attack refers to again-generalized.
During aura some patients have time to secure themselves, having called to the aid associates or having reached up to a bed. At primarily-generalized convulsive attacks of the patient does not feel aura; these attacks are especially dangerous the suddenness. Favourite time of their occurrence - the period soon after awakening patients. In the beginning of an attack (a tonic phase) there is a pressure of muscles and shrill shout is often observed. During this phase probably biting language. Short-term respiratory standstill with the subsequent occurrence of cyanosis develops. The clonic phase of an attack further develops: there are rhythmical twitchings muscles, is usual with involving all finitenesses. In the end of clonic phases it is often observed incontience of urine. Spasmes usually stop spontaneously in some minutes (2-5 mins). Then the post attack period comes, described drowsiness, confusion of consciousness, a headache and approach of a dream.

Non-convulsive generalized attacks called by absense. They arise almost exclusively at children's age and an early youth. The child suddenly fades (deenergizing of consciousness) and steadfastly looks in one point; the sight seems absent. Attacks proceed all some 5-20 seconds and often remain not noticed. These attacks are very sensitive to hyperventilation - are provoked by the deep forced breath during 2-3 minutes

Allocate also myoclonic attacks: involuntary reduction of muscles of all body or its parts, for example, hands or a head, thus the patient can reject aside subject matters being hands. These attacks quite often arise in the morning, especially if the patient has not slept. The consciousness at them is kept. Atopic attacks are characterized by sudden full loss of a muscular tone owing to what the patient sharply falls. Convulsive reductions are absent. Children of the first year of a life have a special type of heavy attacks - infantile spasms. The given attacks proceed serially in the form of nods, folding of a trunk, bending of hands and legs. Children with this type of attacks usually lag behind in impellent and mental progress.

Exist about 40 various forms of epilepsy and different types of attacks. The doctor should lead indispensable inspection and precisely diagnose the form of epilepsy and character of attacks. Thus for each form there is certain an antiepileptic preparation and the programme of treatment.

Read More......

Illnesses of the spinal cord

Illnesses of a spinal cord often lead to irreversible neurologic infringements and to proof and expressed invalidization. Insignificant on the sizes the pathological centers cause occurrence of pamplegia, paraplegia and infringements of sensitivity from top to bottom from the center as through the small area of cross-section section of a spinal cord pass practically all axifugal impellent and eisodic sensitive spending ways. Many illnesses, especially accompanied a compression of a spinal cord from the outside, carry inversive character in this connection sharp defeats of a spinal cord should be carried to the most critical urgent conditions in neurology.

The spinal cord has a segmentary structure and innervate finitenesses and a trunk. 31 pairs spinal nerves that does anatomic diagnostics concerning simple depart from it. To define localization of pathological process in a spinal cord allow border of frustration of sensitivity, paraplegia and other typical syndromes. Therefore at diseases of a spinal cord careful inspection of the patient with application of additional laboratory tests, including a nuclear magnetic resonance, computer tomography, myelography and research somatosensory the caused potentials is required. Owing to ease in carrying out and the best resolution computer tomography and the nuclear magnetic resonance supersede standard myelography. Especially valuable information on internal structure of a spinal cord gives a nuclear magnetic resonance.

Parity of an anatomic structure of a spine column and spinal cord with clinical symptoms

The universal organization of a longitudinal axis spinal cord by a somatic principle allows to identify easily reasonably the syndromes caused by defeat of a spinal cord and spinal nerves. Longitudinal localization of the pathological center establish on the uppermost border of sensitive and impellent dysfunction. In the mean time the parity between bodies of spondyles (or their superficial reference points, awned shoots) and the segments of a spinal cord located under them complicates anatomic interpretation of symptoms of diseases of a spinal cord. Syndromes of defeat of a spinal cord describe according to the involved segment, instead of a being next to spondyle.
During embryonal progresses the spinal cord grows more slowly a spine column so the spinal cord comes to an end behind of a body of the first lumbar spondyle, and its radices accept more steep descending direction to reach innervate them structures of finitenesses or internal bodies. The useful rule consists in that. That is radices (except for CVIII) leave rachial the channel through apertures above bodies of spondyles appropriating them, whereas chest and lumbar radix — under the same spondyles. The top cervical segments lay behind of bodies of spondyles with same numbers, bottom cervical — on one segment above a spondyle appropriating them, top chest — on two segments above, and bottom chest — on three. Lumbar and sacral segments of a spinal cord [(the last shape a brain cone (conusmedullaris)] are localized behind of spondyles ThIX—li. To specify propagation various extramedullary processes, especially at spondylosis, important carefully to measuresagittal diameters of the rachial channel. In norm at cervical and chest levels these parameters make 16—22 mm; at a level of spondyles li-liii-nearby 15—23 mm and below — 16—27 mm.

Clinical syndromes of diseases of a spinal cord

As the basic clinical symptoms of defeat of a spinal cord serve loss of sensitivity the border which are passing on a horizontal circle on a trunk, i.e. «A level of frustration of sensitivity», and weakness in finitenesses, innervate descending corticospinal fibres. Infringements of sensitivity, especially paresthesia, can appear in stops (or one stop) and to extend upwards, originally making impression about polyneuropathy before the constant border of frustration of sensitivity will be established. The pathological centers leading a break corticospinal and bulbospinal of ways at same level of a spinal cord, cause paraplegia or pamplegia, accompanied increase of a muscular tone and deep tendinous reflexes, and also the symptom of Babynskiy.
At detailed survey usually find out segmentary infringements, for example a strip of changes of sensitivity top level conducting touch frustration (a hyperalgesia or a hyperpathia), and also a hypotonia, an atrophy and the isolated loss deep tendinous reflexes. A level conducting frustration of sensitivity and segmentary semiology approximately specify localization cross-section affect. As an exact localizing attribute the pain felt on an average line of a back, especially at a chest level serves, the pain in interscapular areas can appear the first symptom of a compression of a spinal cord. Radicular pains points on primary localization of the spinal defeat located more lateralis. At involving the bottom department of a spinal cord — a brain cone of a pain are often marked in the bottom part of a back.

At an early stage of sharp cross-section defeat in finitenesses the hypotonia, instead of spasticity because of a so-called spinal shock can be marked. The given condition can be kept about several weeks, and it is erroneous it sometimes accept for extensive segmentary defeat, but later reflexes become high. At the sharp cross-section defeats especially caused by a heart attack, to a paralysis often precede short clonic or myoclonic movements in finitenesses. Other important symptom of cross-section defeat of the spinal cord, requiring close attention, especially at a combination with spasticity and availability of a level of sensitive frustration, vegetative dysfunction, first of all a delay serves wet.

Significant efforts are undertaken for clinical differentiation intramedullary (inside of a spinal cord) and extramedullary compression defeats, but the majority of rules are approximate and do not allow to differentiate one from others reliably. To the attributes testifying in favour of extramedullary of pathological processes, concern radicular pains; a syndrome half spinal affcets Brown-Sekar; symptoms of defeat peripheral effector neuron within the limits of one-two segments, often asymmetric; early attributes of involving of corticospinal ways; essential decrease in sensitivity in sacral segments.
On the other hand, hardly focalized the burning pains, the dissociated loss of painful sensitivity safety of sarcous-articulate sensitivity, conservation of sensitivity in the field of perineum, sacral the segments, late arising and less expressed the pyramidal semiology, normal or slightly changed structure SMZH are usually characteristic for intramedullary defeats. «Untact sacral segments» means safety of perception of painful and temperature irritations in sacral dermatome, it is usual with SIIInoSV. With rostral zones above a level of frustration of sensitivity. As a rule, it is an authentic sign the intramedullary defeats, accompanied involving of the most internal fibres spinothalamic ways, but not mentioning the most external fibres providing touch innervation sacral dermatome.

Browm-Sekar syndrome designate aggregate of symptoms half cross-section defeat of the spinal cord, shown homolateral monocles hemiplegia with loss of muscular-articulate and vibrating (deep) sensitivity a combination with contralateral loss of painful and temperature (superficial) sensitivity. The top border of frustration of painful and temperature sensitivity quite often define on 1—2 segments below a site of damage of a spinal cord as spinothalamic ways after formation synapse in a back horn pass fibres in opposite lateral funicle, rising upwards. If there are segmentary infringements in the form of radicular pains, muscular atrophies, fading tendinous reflexes they usually happen unilateral.

The pathological centers limited by the central part of a spinal cord or mentioning in basic it, mainly amaze neurocyte of grey substance and segmentary conductors, decussate at the given level. The most widespread processes such are a bruise at a spinal trauma, myelosyringosis, tumours and vascular defeats in pool of a forward spinal artery. At involving a cervical department of a spinal cord the syndrome of the central spinal defeat is accompanied by weakness of the hand significantly more expressed in comparison with weakness of a leg, and the dissociated frustration of sensitivity (analgesia, i.e loss of painful sensitivity distribution in the form of a cape on shoulders and the bottom part of a neck, without anesthesia, i.e. losses of tactile sensations, and at safety of vibrating sensitivity).

The defeats localized in the field of body C or below, squeeze the spinal nerves which are a part of a horse tail, and cause languid asymmetric paraparesis with areflexia to which dysfunction of a bladder and an intestines, as a rule, accompanies. Distribution of sensitive frustration reminds outlines of a saddle, reaches level L and corresponds to zones innervation radicular, entering in a horse tail. Achilles and knee reflexes are lowered or are absent. Pains, irradiate in perineum or a hip are often marked. At pathological processes in the field of a cone of a spinal cord of a pain are expressed more poorly, than at defeats a horse tail, and frustration of functions of an intestines and a bladder arise earlier; die away only Achilles reflexes. Compression processes can simultaneously grasp as a horse tail, and a cone and to cause the combined syndrome of defeat peripheral effector neuron with some hyperreflection and symptom of Babinskiy.

The classical syndrome of the big occipital aperture is characterized by weakness of muscles of a humeral belt and a hand after which there is a weakness homolateral legs and, finally, contralateral hands. Volumetric processes of the given localization sometimes give a suboccipital pain extending on a neck and shoulders. Other certificate of a high cervical level of defeat syndrome of Gorner which is not observed at availability of variations below segment TII serves. Some illnesses can cause sudden «insult-like» myelopathy without previous symptoms. To their number concern a epidural haemorrhage, hemorrhachis, a heart attack of a spinal cord, an incomplete dislocation of spondyles.

Read More......

Diagnostics and treatment of tinea

A tinea represents a fungoid infection which can amaze set of parts of a body of the person. Below we shall designate sites of a body on which can appear dermatosis.
The-part of a head covered by hair.
- A smooth leather of a trunk.
- Nails.
- Stops of legs.
- Inguinal area.
- A skin of the face on which the vegetation settles down.

The given infection is widely widespread. If in time to undertake elimination of illness and to observe all doctor's instructions such effective treatment will give the favorable forecast. But can be and so, that at the started illness the chronic form tinea develops.
Infection tinea occurs at direct contact to the sick person, or through the polluted subjects. Among these subjects there can be a footwear, towels or mats in bathroom. The activator of disease tinea is the fungus.

Treatment of illness individually, depends on the form of its display. At disease of tinea it is necessary to address to the doctor. In fact depending on the form of disease of defeat of a leather differ on appearance and duration of existence of illness.

From a tinea of a hair parts of a head basically suffer children, and is characterized by occurrence small, one step at a time extending папул on a head, as well as a peeling, loss of hair on the amazed sites. Also on seat of papule can be formed inflamed, furuncular-like units.
At disease of a tinea of a smooth skin, papules extend on any sites of a skin, there are flat formations, dry, covered by scaly crust or damp, covered by crusts. Depending on a degree of their increase, the centers of spots are cleared, giving a classical picture of a leather in the form of circles.

A tinea nails begins with tips of one or more nails on legs or hands. In the second case disease is shown far less often, than in the first. Illness leads to a gradual thickening of nails, variation of their color, a curvature. Under them the substance formed from of died cells accumulates. As a result, the nail can be completely destroyed.
A tinea stop causes finely lamellar peeling of a skin, occurrence of bubbles between fingers. In heavy cases the infection can lead to inflammatory process of all the stops, described a strong itch and a pain at walking.

A tinea of an inguinal areas it is characterized by occurrence red, with precise borders, spots in an inguinal areas. The designated spots can extend on buttocks, internal surfaces of a hips and external genitals.
At diagnostics of a tinea, it is carried out scrape from the amazed sites of a leather. The received material investigate by means of a microscope.
A tinea, as a rule, it is treated by preparations for external application. Local treatment proceeds within two weeks after disappearance of symptoms. Also, at treatment of a tinea use the open damp bandages.

Read More......

Basal ganglia of endbrain and movement

Basal ganglia are located in the basis of a endbrain and represent the important subcrustal connecting link between associative areas of a cerebral cortex and impellent areas of a cerebral cortex. Following structures are concern to basal ganglia: a striped kernel of basal ganglia consisting caudate nucleus of basal ganglia and shells of basal ganglia, a pale sphere of basal ganglia subdivided on internal and external departments, a black substance of basal ganglia and a subthalamic kernel of basal ganglia. In structure of basal ganglia often include also a fencing and less often - amygdala.

Infringements of movements are caused by defeat of basal kernels - the anatomically isolated group of pair subcrustal structures.

Basal kernels facilitate movements started by a bark and suppress extra accompanying movements. Striatum receives the somatotopic organized projections almost from all zones of a bark. These projections are organized in the form of parallel ways which begin from frontal areas, postcentral (somatotopic) areas, precentral (motor) areas and parietotemporal-occipital areas.

Neurocytes of striatum send fibres to the structures shaping the main axifugal way of basal kernels - to a mesh part of a black substance and a medial pale sphere.

Thus, at braking neurocytes a mesh part of a black substance and a medial pale sphere exciting influence thalamus on a bark amplifies - as promotes simplification of movement started by a bark.

On the contrary, at excitation neurocytes a mesh part of a black substance and a medial pale sphere exciting influence thalamus on a bark suppresses - that leads to braking of unnecessary movement.

On a spinal cord basal kernels have no direct output. The direct way from striatum to a mesh part of a black substance and a medial pale sphere is formed brake by fibres. Their function consists in strengthening exciting influence of kernels thalamus on those departments of a motor bark which are responsible for the necessary movement. The indirect way is organized more difficultly. Its function consists in suppression of exciting influence thalamus on other departments of a motor bark.

Thus, if activation of a direct way from striatum strengthens excitation of a motor bark activation of an indirect way - weakens.

Activity of these two ways is adjusted with the compact part of a black substance sending to striatum dopaminergic fibres. These fibres raise direct a axifugal way to striatum (through neurocytes with D1-receptors) and brake - indirect (through neurocytes with D2-receptors). Striatum sends also brake gamma-aminobutyric acid fibres to a compact part of a black substance, forming that with it a negative feedback. Finally, activity of striatum modulate it cholinergic inserted neurocytes - antagonists dopaminergic neurocytes.

Read More......

Bronchiolitis

Etiology

Many diseases have bronchiolitis like clinical displays, vast majority from them virus ethiology. A respiratory-syncytial virus (РС) consider as the most frequent reason bronchiolitis. It is established, that from 40 up to 75 % of children acts in hospital with the diagnosis bronchiolitis, caused this virus. Other activators can be rhinovirus, a virus parainfluenza (type 3), adenovirus (type 3, 7 and 21), a virus of a flu and, occasionally, a virus of an epidemic parotitis. Though in children of advanced age Mycoplasma pneumoniae usually causes disease of the bottom respiratory ways, but at chest age it seldom causes bronchiolitis.

Epidemiology

Using widely widespread clinical term «the whistling child at a respiratory infection», Henderson and co-author. Have noted, that the highest frequency of disease was at children of the first year of a life: 11,4 cases on 100 children in a year. On the second to year of a life frequency decreased to 6 cases on 100 children in a year. In Houston frequency РС bronchiolitis, demanding hospitalization, in families with a low social level made 5 cases on 100 chest babies in a year. About 80 % of the hospitalized children 6 months Therefore authors were more younger have come to conclusion: the the child is more younger, the more hard at it disease proceeds and is more often hospitalization is required.

Babies with heavy forms bronchiolitis have a low level of the antibodies transferred from mother. From the hospitalized children with the proved Óß-infection at 18-20 % can arise apnoea to which contribute prematurity and early age of the child. Other group of high risk for occurrence of the Óß-infection is made by patients with VPS. At the general lethality 1-2 % in this group at the Óß-infection it reaches 37 %.

Epidemic of the Óß-virus develops annually in the winter while frequency contamination viruses parainfluenza decreases a little. The disease caused by the Óß-virus, is very infectious, if in collective there is a patient, as a rule, all contact children (98 %) fall ill. Transfer of the Óß-virus to family as is significant. Reasonably to be ill to one member of family that 46 % of the others were infected.

Frequency of hospital infections is high. During flash of the Óß-infection of 45 % of tentatively not infected hospitalized children were ill with this infection. The risk of disease raised with an increase of duration of hospitalization. Probably, its basic source in hospital is the medical personnel which distributed a virus, catching through the secrets allocated by infected patients. Infection occured approximately in 42 %.

Clinical aspects

Usually the baby catches from the senior children or adults with an infection of respiratory ways.

Diagnosis: bronchiolitis

Cough, cold, ptarmus are the first symptoms of disease. In the subsequent at patients on a background of irritability respiratory frustration with polypnea, participation in breath of auxiliary muscles, dry rattles progress. There can be an insignificant fever. The appreciable short wind causes difficulty of the certificate sucking. Physical survey reveals signs of sharp inflammatory disease of respiratory ways: polypnea, cyanosis, inflating of wings of a nose and impaction compliant seats of a chest wall. Lungs emphysematous, the edge of a liver can act on some fingers from under a costal arch. At lungs auscultation - dry diffuse and damp rattles, lengthening of an exhalation.

Indispensable laboratory researches at the patient with heavy bronchiolitis include: the roentgenogram of a thorax; the clinical analysis of blood; research of arterial gases of blood; virologic definition of the Óß-virus and antibodies to it; crop of blood on microflora if it is impossible to exclude a bacterial pneumonia.

Radiological inspection of the child with sharp bronchiolitis shows availability sharp emphysema lungs at the majority of patients. At half of children define peribronchial sealings. Leukocytosis usually is absent. RS the virus can be identified by reaction of linkage complement or indirect immunofluorescence antibodies in film, taken with a mucous membrane of a nose.

For diagnostics of respiratory insufficiency at bronchiolitis it is necessary to investigate arterial gases of blood. On the basis of a series from 32 patients the Hall and co-authors have established, that average saturation by oxygen of hemoglobin has made 87 %. Hypoxemia persistence, proceeding 3-7 weels, even on a background of clinical improvement of a condition.

Read More......

Arterial hypertensia and atherosclerosis

The atherosclerosis is a scourge of 20-th century. One of factors of its progress is the arterial hypertensia. At an atherosclerosis infringement of balance of lipids in blood that is shown in increase of a level of lipoproteins low density and lowering of a level of lipoproteins high density is marked. It leads to formation on walls of vessels so-called atheromatous plaque which will consist of some salts of calcium, fibres of fibrin and cholesterol. And it, in turn, conducts to narrowing a gleam of vessels, and most seriously it concerns to vessels of heart (coronary arteries) as causes an ischemic heart disease and a heart attack of a myocardium, and to vessels of a brain that is shown in the form of infringements of blood circulation of a brain and insults.

Displays of an atherosclerosis

The atherosclerosis usually externally is not shown in any way until narrowing of vessels will not reach that degree when blood circulation in bodies and fabrics is broken seriously. For example, it can be a pain behind a brest, connected with physical activity, and sometimes and in rest, a pain in finitenesses which also are connected with narrowing arteries.

Heart attack of a myocardium

The heart attack of a myocardium is a condition at which in a cardiac musle – a myocardium – there is a sharp infringement of blood circulation as a result of full corking a gleam of one of coronary arteries atheromatous plaque or a blood clot (that happens less often). At absence of blood circulation during certain time in a fabric of a myocardium comes necrosis which already happens irreversible. In the subsequent this necrosis is replaced with a cicatricial tela.

Diagnostics of an atherosclerosis

Usually the atherosclerosis comes to light only when the conditions caused by it are marked: a stenocardia, a heart attack of a myocardium, an insult, infringements of blood circulation in finitenesses. Diagnostics of an atherosclerosis is based on following methods of research:

* The electrocardiogram. It is a method based on registration of electric activity of heart. As we already spoke, in heart there is a spending system on which passes an electric impulse from unit where it is formed up to other muscles. These potentials reflect work of heart. At the certain pathology, on an electrocardiogram those or other attributes are marked. It especially concerns anisorhythmia, the ischemic phenomena which are characteristic for a heart attack of a myocardium.
* The bicycle ergometry. This method also is based on an electrocardiogram, but carried out under the certain load when the patient receives physical activity on a velosimulator. Owing to such load the demand of heart for blood supply amplifies, and there is visible an availability of infringements of a blood-groove in heart.
* The coronary arteriography. It is radiological methods of diagnostics at which into coronary vessels it is entered thin long catheter which usually enter through a humeral or femoral artery. After achievement by catheter coronary arteries, in them it is entered opaque medium. After that the x-ray picture which helps to reveal sites of narrowing of arteries atheromatous plaque is done.
* The echocardiography (ultrasonic of heart). This method allows to reveal structural variations from heart, for example, a thickening of ventricular walls, that speaks about their hypertrophy. It is one of signs of an arterial hypertensia.
* The computer tomography. It is a radiological method which allows to receive level-by-level cuts of fabrics of heart.
* The magnetic resonance imaging procedure. The given method also allows to receive level-by-level cuts of fabrics, and especially vessels as it is very sensitive. It not a x-ray method in which electromagnetic waves in strong by a magnet a field are applied.

Treatment of an atherosclerosis

Treatment of an atherosclerosis includes, first of all, variation of a diet, physical exercises, as well as preparations for reduction of a level of cholesterol in blood. To surgical methods concern first of all balloon angioplasty when into a gleam narrowed plaque a vessel it is entered thin long catheter with inflated cartridge on the end then the gleam of an artery extends, and stent when in a gleam of an artery it is established so-called stent, playing a part of a skeleton for a vessel. In some cases other interventions, for example, shunting are spent also.

Read More......

Sarcoma

Sarcoma of soft parts – extensive group of the malignant new growths occurring from primitive embryonic mesoderm (an average germinal leaf). Primary mesenchyma, a part of mesoderm, gives rise to various variants of the connecting fabric which are a part of sinews, bands, muscles, etc. From them and formation of a sarcoma is possible. However some sarcomas have ectodermal and epithelial origin, characteristic for a cancer.

The majority of cases of a sarcoma arises spontaneously, i.e. without the visible reasons, however to risk factors of the given disease carry chemical carcinogens, an ionizing radiation, a burden heredity.

The sarcoma of soft parts can meet at any age, but meets at people white color of a skin after 40 years (middle age ill - 50 years) more often. Other essential laws it is not revealed.

The sarcoma of soft parts meets reasonably seldom, frequency about 1 case on 1 million person in a year or about 6000 cases in a year in absolute expression among all population of the Earth. Death rate from a sarcoma rather high: about half of the patients who have ill a sarcoma, dies.

The most frequent place of development of a sarcoma – the bottom finitenesses. The above, the less often sarcoma is. If on the bottom finitenesses the sarcoma meets approximately in 40 % of cases, in the field of a head and a neck only in 5 %.

Besides usual characteristics of a tumor (the histological structure, the size, availability of the nearest and remote metastasizes) can be divided sarcomas on a degree malignity:

* the Low degree of malignity. Here carry such characteristics of a sarcoma, as a high differentiation of cells and small mitotic their activity, small quantity of actually tumoral cells and a plenty stromas in a sarcoma, small quantity of vessels and a small number of the centers necrosis.
* the High degree of malignity. Here carry opposite characteristics of a sarcoma, as a high differentiation of cells and small mitotic their activity, small quantity of actually tumoral cells and a plenty stromas in a sarcoma, small quantity of vessels and a small number of the centers necrosis.

On a degree of malignity define the forecast of disease, so also probability of success of treatment.

Examples of sarcomas of soft parts are:

* alveolar sarcoma of soft parts;
* angiosarcoma;
* malignant perithelial endothelioma;
* malignant mesenchymoma;
* malignant fibrous histiocytoma;
* malignant neurilemmoma;
* leiomyosarcoma;
* lipoblastoma;
* rhabdomyoblastoma;
* synovial sarcoma;
* fibrosarcoma;
* epithelioid sarcoma.

Usually the sarcoma is characterized by slow growth and painlessness during enough long time, therefore revealing is long an existing and causeless swelling (palpated formation on finitenesses, in a stomach and other parts of a body) should guard and force is urgent to address to the doctor for specification of the diagnosis. The most frequent metastasises of a sarcoma are observed in lungs, less often – in regional lymph nodes.

Diagnostics of a sarcoma is spent by survey by the expert, application of means of medical visualization, biopsy with the subsequent research of a fabric of a tumor and some other additional methods.

From all means of medical visualization (ultrasonic research, a x-ray computer tomography, a magnetic resonance tomography) consider as the most informative MRT though in each specific case the choice of a method of diagnostics should be spent individually.

Tumors biopsy can be excisional (through a cut), and also paracentetic. Opened (excisional) biopsy has advantage in case of the specified specification of already available plan of treatment.

Treatment of a sarcoma of soft fabrics mainly surgical. If radical operation is impossible, as additional methods the chemotherapy and-or beam therapy of a sarcoma are used. Unfortunately, their efficiency while is low, and in case of a tracking down of metastasises the probability of treatment endeavors to zero.

To the factors improving the forecast of disease, carry time of doubling of a tumor more than 20 days, an recurrence-free interval more than year, quantity of units less than 4. Radical removal of a tumor and metastasises in lungs is capable to give 5-years survival rate approximately 20 % to patients. The basic problem remains recurring diseases. The lowest risk of relapse – for tumors of the bottom finitenesses (less than 25 %), the highest – for extraperitoneal spaces (about 75 %).

To the factors improving survival rate, carry: age less than 50 years; a low degree malignity sarcomas; a pain in the field of a tumor; the small sizes of a tumor and its arrangement on finitenesses; absence of metastasises.

Read More......

Microcephaly

Definition

Microcephaly describes a head size significantly below normal for a person's age and sex, based on standardized charts. Head size is measured as the distance around the top of the head.

Considerations

Microcephaly most often occurs because of failure of the brain to grow at a normal rate. Skull growth is determined by brain expansion, which takes place during the normal growth of the brain during pregnancy and infancy.

Conditions that affect brain growth can cause microcephaly, including infections, genetic disorders, and severe malnutrition.

Causes

Primary Causes:

• Cornelia de Lange syndrome
• Cri du chat syndrome
• Down syndrome
• Rubinstein-Taybi syndrome
• Seckel syndrome
• Smith-Lemli-Opitz syndrome
• Trisomy 13
• Trisomy 18

Secondary Causes:

• Uncontrolled phenylketonuria (PKU) in the mother
• Methylmercury poisoning
• Congenital rubella
• Congenital toxoplasmosis
• Congenital CMV
• Use of certain drugs during pregnancy
• Malnutrition

Home Care

There are no specific home care procedures for microcephaly. Care depends on the condition that caused the microcephaly.

When to Contact a Medical Professional

Microcephaly is often diagnosed at birth or during routine well-baby examinations when the infant's height, weight, and head circumference is measured. If you suspect your infant's head size is too small or not growing normally, consult your health care provider.

What to Expect at Your Office Visit

This finding is usually discovered by the health care provider during routine examination. Head measurements are a routine procedure during a well-baby examination up to 18 months (longer in certain circumstances). They are painless and take only a few seconds while the measuring tape is placed around the infant's head.

Documenting microcephaly in detail may include:

• What is the head circumference?
• Is the head growing at a slower rate than the body?
• What other symptoms are also present?

Note: A record of the head circumference should be maintained over time.

Although the health care provider maintains records on your baby, it may be helpful to maintain your own records of the well-baby findings, and to bring your records to the health care provider's attention if you notice that the infant's head growth pattern seems to be decreasing.

If a diagnosis was made by your health care provider related to microcephaly, you may want to note that diagnosis in your child's personal medical record.

Read More......

Facial Flushing Caused by Mastocytosis

Mastocytosis Defined
Mast cells are cells of the immune system that are found around blood vessels in the skin, gastrointestinal tract, respiratory tract, and genitourinary tract. They contain granules of several substances, the most common of which is histamine. These granules are released in response to contact with certain foreign substances. In the most common form of mastocytosis, there are a greater number of mast cells in the tissues. These mast cells cause a typical skin response called urticaria pigmentosa in which a hive immediately develops after stroking the skin with a blunt object.

Symptoms of Mastocytosis
People with mastocytosis also experience symptoms throughout the body caused by the release of large amounts of histamine and other chemicals. The flushing occurs suddenly on the face and upper trunk. Many patients cannot identify a trigger that causes the flushing, but some identify exercise, heat, or emotional anxiety as a possible trigger. The red, hot face is often accompanied by palpitations, low blood pressure, dizziness, chest pain, explosive diarrhea, nausea, or fatigue. Medications such as opioid narcotics like morphine and codeine, and aspirin or other non-steroidal anti-inflammatory drugs like ibuprofen or naproxen can also start a flushing attack.

Diagnosis of Facial Flushing Caused by Mastocytosis
Mastocytosis can be difficult to diagnose. Correctly identifying the clinical symptoms aids in the diagnosis. Sometimes skin lesions and bone marrow are biopsied and the urine checked for increased levels of the chemicals contained in mast cells.

Treatment of Facial Flushing Caused by Mastocytosis
There are numerous treatment options for mastocytosis depending on the main symptoms. Antihistamines are useful in some certain types of mastocytosis. Aspirin and other non-steroidal anti-inflammatory drugs can reduce flushing symptoms, except in patients in whom these medications actually trigger flushing. Other treatment options include cromolyn sodium, ketotifen, topical steroids, and PUVA.

Read More......

Lupus - Fast Facts

Lupus Basics:

Systemic lupus erythematosus, also commonly referred to as lupus or SLE, is a chronic, inflammatory, autoimmune disease. Lupus can affect the joints, skin, kidneys, lungs, heart, nervous system and other organs of the body. It is not uncommon for symptoms associated with lupus to resemble symptoms associated with other types of arthritis and rheumatic disease, making lupus difficult to diagnose.

Several types of lupus exist:

• Systemic lupus erythematosus
• Discoid lupus
• Subacute cutaneous lupus erythematosus
• Drug-induced lupus
• Neonatal lupus

Cause of Lupus:

It is known that lupus is an autoimmune disease, meaning the immune system attacks a person's own cells and tissues. The reason for the immune system malfunction is not completely understood but as is the case with rheumatoid arthritis, scleroderma, and other autoimmune diseases, it is thought to involve genetic factors and environmental factors.

Symptoms Associated With Lupus:

Symptoms which help doctors differentiate lupus from other rheumatic diseases include:

• A butterfly-shaped rash appearing on the cheeks and over the bridge of the nose (malar rash)
• Scaly sores appearing on the face, neck, and chest (discoid rash)
• Photosensitivity (sensitivity to sunlight)
• Mouth ulcers
• Arthritis pain and joint stiffness
• Serositis - Inflammation of tissues which line the lungs, heart, abdomen, and internal organs
• Kidney problems
• Central nervous system abnormalities
• Blood abnormalities
• Antinuclear antibodies
• Immune system problems

Fatigue, fever, swollen glands, and weight loss may occur with lupus.

Diagnosis of Lupus:

There is no single test used to diagnose lupus. Diagnosis is based on a combination of factors (clinical symptoms, blood tests, and medical history) which together provide evidence of abnormalities in several organ systems. Laboratory tests and x-rays are used to confirm the diagnosis of lupus.

Besides abnormalities which may be revealed by routine blood counts, chemistry tests, and urinalysis, tests which are specifically relevant to lupus include:

• Sedimentation rate and CRP
• Antinuclear antibody test
• Specific antibodies (anti-dsDNA, anti-smith, anti-phospholipid)
• Complement test

Treatment of Lupus:

Treatment of lupus depends on the severity of symptoms and organ systems involved. NSAIDs (nonsteroidal anti-inflammatory drugs) are commonly prescribed to control inflammation. Plaquenil which is used as a DMARD (disease-modifying anti-rheumatic drug) is another commonly prescribed medication used to treat lupus, as are other immunosuppressants including Imuran, Cytoxan, cyclosporine, and CellCept.

Corticosteroids (e.g. prednisone) are also used to treat the condition.

Studies are currently ongoing which are testing the effectiveness of new treatments for lupus, most of which are monoclonal antibodies.

Prevalence of Lupus:

Lupus affects 10 times more women than men. Though lupus can develop at any age, disease onset usually occurs between the ages of 18 and 45 years old. African-Americans and Asians have a higher risk of developing lupus than people of other racial or ethnic backgrounds. The Lupus Foundation of America estimates that 1.5 million Americans have one of the types of lupus, but that estimate actually may be low.

Points of Interest About Lupus:

• Systemic lupus erythematosus (SLE), as its name suggests, can involve multiple organ systems and is the most serious type.
• Discoid lupus erythematosus affects only the skin and does not involve other organ systems.
• Drug-induced lupus is caused by a reaction to certain prescription medications. Symptoms resemble SLE but it does not affect the central nervous system or kidneys.
• Subacute cutaneous lupus erythematosus causes skin lesions to appear on parts of the body exposed to the sun.
• Neonatal lupus is a rare disease which affects newborn babies.
• Nearly all lupus patients are positive for antinuclear antibodies.

Read More......

Atheroembolic renal disease

Definition

Atheroembolic renal disease (AERD) is an inflammatory reaction in the small blood vessels of the kidneys.

Alternative Names

Renal disease - atheroembolic; Cholesterol embolization syndrome; Atheroemboli - renal; Atherosclerotic disease - renal

Causes

AERD is linked to atherosclerosis. Atherosclerosis is a common disorder of the arteries. It occurs when fat, cholesterol, and other substances build up in the walls of arteries and form hard substances called plaque.

In AERD, cholesterol crystals from plaque break off and move to the kidneys and into the blood stream. Once in circulation, the crystals get stuck in tiny blood vessels called arterioles. There, they cause an intense inflammatory response. The result is organ damage due to decreased blood supply. Acute kidney failure is possible if the reaction is severe.

Atherosclerosis of the aorta is the most common cause of AERD. The cholesterol crystals may also break off during cardiac catheterization or aortic surgery.

In some cases, AERD may occur without a cause.

The risk factors for AERD are the same as risk factors for atherosclerosis.

Symptoms

AERD may not cause any symptoms. Symptoms that may occur include:

• Foot pain, ulcers on the feet, or blue toes
• Pain in the abdomen, nausea, or vomiting
• Pancreatitis or hepatitis (rare)
• Strokes or blindness
• Flank pain and blood in the urine (rare)
• Uncontrolled high blood pressure

Kidney failure may result in the following:

• Nausea or vomiting
• Loss of appetite
• Weight loss
• Decreased or no urine output
• Swelling
• Decrease in sensation
• Skin pigment changes
• Dry itchy skin
• Drowsiness, confusion, lethargy

Exams and Tests

The doctor will perform a physical exam. Swelling may affect the entire body. An eye exam may show particles in the small arteries of the retina.

The doctor will listen to your lungs and heart with a stethoscope. Abnormal sounds may be heard. For example, a loud whooshing sound called a bruit may be heard over the aorta or renal artery.

Read More......

Hidradenitis Suppurativa

Hidradenitis suppurativa is a chronic, scarring disease that affects the apocrine, or sweat glands. It is a common skin condition but is frequently misdiagnosed. Hidradenitis suppurativa does not occur before puberty. Most people are between 20 to 40 years old when they develop hidradenitis suppurativa. It can be a disabling and distressing skin condition.

Cause of Hidradenitis Suppurativa
The exact cause of hidradenitis suppurativa is disputed. Because it looks similar to acne, some investigators believe that it is caused by the formation of keratin plugs in the follicles. Because hidradenitis suppurativa occurs in areas that contain apocrine, or sweat, glands, other investigators believe that it is caused by a blockage of the apocrine gland. In either case, the plugged gland or follicle becomes larger, ruptures, and becomes infected. Obesity and cigarette smoking may be triggering factors.

Appearance of Hidradenitis Suppurativa
Hidradenitis suppurativa occurs in areas of the body that contain sweat glands including the armpits, groin, buttocks, scalp, and under the female breast. When the condition is mild it may only present as a cluster of 2 or 3 blackheads that communicate under the skin. Once the disease begins, it gets progressively worse. The extensive, deep inflammation leads to painful abscesses. These heal incompletely and cause cord-like scars on the skin. The infection can progress under the skin in tracts linking the abscesses. These boils can be very painful and restrict movement of the affected area.

Diagnosing Hidradenitis Suppurativa
Hidradenitis suppurativa is diagnosed clinically based on its appearance. There are no lab tests or biopsies that establish the diagnosis. In the early stages, it can be misdiagnosed as an isolated boils. Many people are embarrassed by the multiple infections thinking they are ingrown hairs in sensitive areas. They do not go to the health care provider until the boils have become numerous or intolerable.

Treatment of Hidradenitis Suppurativa
Treating hidradenitis suppurativa is difficult. It is best treated in the early stages before extensive scarring develops. However, it must be diagnosed correctly. The following are some of the treatment options:

Antibiotics - Oral antibiotics may help suppress the inflammation especially in mild cases, but they do not cure the disease. The same antibiotics that are used for acne are used for hidradenitis suppurativa, only in higher doses. These antibiotics include erythromycin, tetracycline, minocycline, and doxycycline. Topical antibiotics do not help.

Isotretinoin (Accutane) - Isotretinoin may be helpful in mild cases, but the response is unpredictable. Sometimes isotretinoin is used to reduce the size of the affected areas prior to surgery. Isotretinoin does have significant side effects and must not be used by pregnant women.

Steroid injection - Injecting a steroid into an inflamed lesion is sometimes helpful. The injection helps reduce inflammation and may be used if an area is especially painful. Steroid injections are normally combined with other treatments.

Surgery - In moderate to severe cases, surgery is the most definitive option. Taking out only the immediately affected area only leads to recurrence of the disease. The treatment of choice is called wide local excision. In this procedure, the affected area and surrounding normal tissue are surgically excised. The excision is not stitched back together but left open to heal from the inside out. Skin grafts may be placed in the excised area to speed healing.

Read More......