Juvenile angiofibroma

Definition

Juvenile angiofibroma is a noncancerous growth of the back of the nose or upper throat.

Alternative Names

Nasal tumor; Angiofibroma - juvenile; Benign nasal tumor

Causes

Juvenile angiofibroma is not very common. It is usually found in adolescent boys. The tumor contains many blood vessels, spreads within the area in which it started (locally invasive), and can cause bone damage.

Symptoms

• Difficulty breathing through the nose
• Easy bruising
• Frequent or repeated nosebleeds
• Hearing loss
• Nasal discharge, usually bloody
• Prolonged bleeding
• Stuffy nose

Exams and Tests

The doctor may see the angiofibroma when examining the upper throat.

Tests that may be done include:

• CT scan of the head
• Nasal mucosal biopsy (this can be very dangerous, and should only be done after using CT scan or arteriogram to see the blood supply to the growth)
• X-ray

Treatment

Treatment is required if the angiofibroma is growing larger, blocking the airways, or causing repeated nosebleeds. In some cases, no treatment is necessary.

Surgery may be needed to remove the tumor. Removal is often difficult because the tumor is not enclosed and may have spread deeply to other areas.

A procedure called embolization may be done to prevent the tumor from bleeding. The procedure may correct the nosebleeds by itself, or it may be followed by surgery to remove the tumor.

Outlook (Prognosis)

Although not cancerous, angiofibromas may continue to grow. Some may disappear on their own.

It is common for the tumor to return after surgery.

Possible Complications

• Anemia
• Pressure on the brain (rare)
• Spread of the tumor to the nose, sinuses, and other structures

When to Contact a Medical Professional

Call your health care provider if you often have nosebleeds.

Prevention

There is no known way to prevent this condition.

References

Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 4th ed. St Louis, Mo: Mosby; 2005.

Grainger RC, Allison D, Adam, Dixon AK. Diagnostic Radiology: A Textbook of Medical Imaging. 4th ed. Orlando, Fl: Churchill Livingstone; 2001.

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Anencephaly

Definition

Anencephaly is the absence of a large part of the brain and the skull.

Alternative Names

Aprosencephaly with open cranium

Causes

Anencephaly is one of the most common neural tube defects. Neural tube defects are birth defects that affect the tissue that grows into the spinal cord and brain. Anencephaly occurs early in the development of an unborn baby. It results when the upper part of the neural tube fails to close. Why this happens is not known. Possible causes include environmental toxins and low intake of folic acid during pregnancy.

Anencephaly occurs in about 4 out of 10,000 births. The exact number is unknown, because many of these pregnancies result in miscarriage. Having one infant with this condition increases the risk of having another child with neural tube defects.

Symptoms

• Absence of the skull
• Absence of the brain (cerebral hemispheres and cerebellum)
• Facial feature abnormalities
• Heart defects

Exams and Tests

A pregnancy ultrasound is done to confirm the diagnosis. The ultrasound may reveal too much fluid is in the uterus. This condition is called polyhydramnios.

Other tests that may be done on the pregnant mother:

• Amniocentesis (to look for increased levels of alpha-fetoprotein)
• Alpha-fetoprotein level (increased levels suggest a neural tube defect)
• Urine estriol level

A pre-pregnancy serum folic acid test may also be done.

Treatment

There is no current therapy. Talk to your doctor about care decisions.

Outlook (Prognosis)

This condition usually causes death within a few days.

When to Contact a Medical Professional

A health care provider usually detects this condition during routine prenatal testing and ultrasound. Otherwise, it is recognized at birth.

If anencephaly is detected before birth, further counseling will be needed.

Prevention

It is important for women who may become pregnant to get enough folic acid.

There is good evidence that folic acid can help reduce the risk of certain birth defects, including anencephaly. Women who are pregnant or planning to become pregnant should take a multivitamin with folic acid every day. Many foods are now fortified with folic acid to help prevent these kinds of birth defects.

Getting enough folic acid can reduce the chance of neural tube defects by 50 percent.

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Pancreatitis

Pancreatitis is more common in men

Pancreatitis is a serious, potentially life threatening disease in which inflammation causes the pancreatic enzymes to digest itself. Because of its location inflammation can spread easily and quickly to the surrounding area and its organs.
There are two stages of the disease in which an acute stage pancreatitis can sometimes goes on to become a chronic illness.

Function of the pancreas
The pancreas is a gland that lies behind the stomach. Its role is to produce hormones that control the body’s use of sugar, insulin and glucagons, and to secrete digestive juices, enzymes and sodium bicarbonate, into the small intestine. It is the functions that are affected by the inflammation.

Causes of pancreatitis
The causes of pancreatitis are not fully understood but it is usually caused by gall stones or alcohol abuse. Gallstones can block the drainage of enzymes from the pancreas causing a build up resulting in inflammation and damage. Alcohol affects the pancreas in a number of negative ways, (it causes protein plugs to block outflow, increases duct permeability and the accumulation of digestive enzymes), all of which damage this vital organ.

Other less common causes include:

Some medications such as methyldopa, NSAIDs, tetracyclines and corticosteroids

Peptic ulcer disease

Cancer of the pancreas

Trauma to the abdomen or back

Viral infections such as mumps, hepatitis, rubella.

Scorpion or snake bites

People more prone to pancreatitis
Pancreatitis affects over 80000 Americans a year. African Americans aged between 35-64 years are 10 times more at risk than any other group. More men than women have chronic pancreatitis.

Symptoms of pancreatitis

Pain in the stomach area that radiates to the back

Nausea and/or vomiting

Fever

Breathing difficulties

Shock

Weight loss

Symptoms of sugar diabetes

Treatment for pancreatitis
Treatment will obviously depend on the symptoms and the severity of the pancreatitis. Admission to hospital is often required to support and monitor the patient during the initial stages. When the condition is life threatening intensive care will be needed. Fluid balance, a period with no nutrition by mouth, antibiotics, strong analgesics, oxygen even surgery are treatment options for the person with pancreatitis.

Prognosis for pancreatitis
As pancreatitis can recur education to manage and maximise well being will be very important. If the cause of the pancreatitis is alcohol then all drinking must stop. If gallstones led to pancreatitis then removal of the gallbladder is the best way to avoid future recurrences. If the gall bladder is not removed then fatty foods should be avoided.

Article Sources Include: NHS Direct, University of Pittsberg Medical Center, BBC Health, Womenshealth About.com

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Successful Cancer Detection From a Single Drop of Blood

Technological advancements in the field of cancer detection may soon end the need for use of surgical biopsies to remove lumps of tissue for lab analysis and pave the way for the use of a simple prick of the finger instead. New technology has now made it possible for cancer proteins to be analyzed from just a tiny drop of blood or minute tissue sample that is equivalent to four nanograms, which is smaller in size than the dot of the punctuation mark commonly called a period.

The use of the same procedure may also enhance cancer therapy by allowing for fast and easy monitoring of patient response to treatment. Although current research has analyzed only blood cancers with the use of the new methodology, scientists are optimistic that they will also be able to apply the technique to solid tumors and have already begun testing it on head and neck tumors.

Researchers from Stanford University in California have developed a machine capable of separating cancer-associated proteins by means of their electric charge. This varies according to modifications on the protein's surface. Since immune system agents known as antibodies bind to specific molecules, they can be used to identify comparative amounts and positions of various proteins. This technique allowed researchers to detect varying levels of activity of common cancer genes in human lymphoma samples as well as to distinguish between different types of lymphoma. The team found that the procedure worked on lymphoma samples drawn from laboratory mice as well as on cultured tumor cells. The system is called nanofluidic proteomic immunoassay (NIA).

According to researcher, Dr Dean Feisher, “This technology allows us to analyze cancer-associated proteins on a very small scale. Not only can we detect picogram levels—one trillionth of a gram—of protein, but we can also see very subtle changes in the ways the protein is modified.”

The research team was also able to confirm the anti-cancer effect of a cholesterol-lowering statin drug on one lymphoma patient. Regarding this accomplishment, Feisher noted, “This is the first time we have been able to see that this compound affects the biology of cancer cells in patients.” He also acknowledged, “Now we have a tool that will really help us look at what's happening in cells over time.” The findings of the analysis were published in the online version of the journal Nature Medicine.

Alice Fan, a clinical instructor in the division of oncology at Stanford’s medical school, believes the technique offers hope of a major advancement in tracking tumor cells during treatment. She said, “The standard way we measure if a treatment is working is to wait several weeks to see if the tumor mass shrinks. It would really be a leap forward if we could detect what is happening at a cellular level.” However, the researchers cautioned that more research would be necessary before the methodology will be clinically available.

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Heart Problems + Depression = Increased Heart Failure Risks

Patients who have heart problems and become depressed have increased odds of heart failure, according to new data. Previous research has shown risks of depression increases nearly three times following an initial heart attack and also increases the risk of a second heart attack. This makes heart disease combined with depression an increased concern, especially since the new research has discovered antidepressants didn’t seem to curb increased risks of heart failure with depression and heart problems.

The recently released findings by Dr. Heidi May, an epidemiologist at the Intermountain Medical Center in Murray, Utah, where she investigated patient’s heart problems combined with depression, shows the combination increases the odds of heart failure. Dr. May’s study evaluated nearly 14,000 patients who were recruited from the cardiac catheterization registry from the center where Dr. May is employed. One of the leading heart hospitals in the U.S. When the patients were diagnosed with heart problems they did not have signs of heart failure or depression, but they were tracked until they developed heart failure or died. Dr. May and researchers found that patients who were diagnosed with depression following a diagnosis of coronary heart disease had a two fold increase in their odds of heart failure, a condition where the heart losses its ability to pump blood efficiently. According to the study, heart failure in non-depressed patients following a diagnosis of coronary artery disease was 3.6 per 100, but for those patients with post-heart disease depression diagnosis, their odds increased to 16.4 per 100.

Heart disease, depression and stress disorders are two conditions which can significantly limit a patients daily life and activities, as well as contribute to mounting medical expenses. During Dr. May’s study, she determined that patients who had developed depression after a heart disease diagnosis odds of developing heart failure didn’t decrease with antidepressant medication. Dr. May said, "Patients need to be carefully screened for depression so that interventions that alter some of the risk associated with depression can be used and the related risk of heart failure and other cardiovascular events can be diminished."

Based on previous studies, patients suffering from depression are less likely to take their medication and follow their doctors' advice, which according to May could be a contributing factor to heart failure among patients with heart disease and depression. "I think that doctors can maybe pay closer attention to the patients that have depression and really follow them to make sure they're taking their medications, that they're following the right diet, they're exercising and do the things that they're asking them to do," according to May .

With the new research, that will be published in the April 21 issue of the Journal of American College of Cardiology we can see the increased risk of heart failure among heart disease patients who later develop depression. Dr. May and researchers hope their study can help uncover reasons that may contribute to heart failure and relieve some of the burdens that it puts on the health care system, as well as learn better ways to treat depression. With the 50 percent increase in risk’s for patients with heart disease developing heart failure, Dr. May believes additional studies would help to delve into the association between heart disease, depression and heart failure, along with other cardiovascular issues.

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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.

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Bronchiolitis

Ethiology

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.

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