disease

Prostate Cancer

April 1, 2011 | Author admin

Prostate Cancer

Prostate Cancer

Introduction:-

Prostate is a glandular organ present only in males.  It surrounds the neck of bladder & the first part of urethra and condributes a secretion to the semen. The gland is conical in shape and measures 3 cm in vertical diameter and 4 cm in transverse diameter.It has got five lobes anterior,posterior,two lateral and a median lobe.Since  the first part of the urethra pass through it any lesion in the prostate will produce difficulty in passing urine.

Diseases of the prostate gland:-

1) Prostatitis:-

This is the inflamation of the prostate gland due to bacterial infection.

2) Benign enlargement of the prostate:-

This is a non cancerous tumour of  the prostate seen after the age of 50.  3,Cancer of the prostate:-This is the 4th most common cause of death from malignant diseases in males.

Cancer of the prostate.

Cancer of the prostate is directly linked with the male sex hormones(androgens).If the levels of sex hormone increases the growth rate of cancer also increases.It is found that after the removel of testes there is marked reduction in the size of tumour.

Site of tumour:-

Prostate cancer is seen mainly in the posterior lobe.Non cancerous enlargement is seen in other lobes.

Changes in the gland in cancer:-

The gland becomes hard with irregular surface with loss of normal lobulation .Histologically prostate cancer is an adeno carcinoma(cancer of the epithelial cells in the gland)

Growth :-

Growth rate is very fast in prostate cancer .The tumour compresses the urethra and produce difficulty in urination.

Spread of tumour:-

Metastasis in cancer of prostate is very early.

1) Local spread:-

From the posterior lobe the cancer cells go to the lateral lobes and seminal vesicles.Tumour cells also move to the neck and base of the urinary bladder.

2) Lymphatic spread:-

Through the lymph vessels cancer cells reach the internal and external illiac group of lymph nodes.From there cells move to retroperitonial(Behind the peritonium) and mediastinal lymph nodes(in the chest)

3) Spread through the blood:-

Spread of cancer cells takeplace through the periprostatic venous plexus and reaches the vertebral veins while coughing and sneezing and finally enders the vertebral bodies of the lumbar vertebrae.

Signs and symptoms of prostate cancer:–

Signs and symptoms depend upon the stage of the cancer. The following symptoms may be seen.

1) No symptoms:-

Tumour is small and only in the posterior lobe.  This is diagnosed accidentely.

2) Slight difficulty in urination:-

Here the tumour is enlarged and urethra is slightly compressed.Shortly there will be frequent urge for urination with difficult urination.

3) When the tumour spread to all nearby areas including neck of bladder and urethra there will be painful urination with bleeding.Urine comes drop by drop.

4) Retention of urine:-

When the urethra is completely compressed there will be retention of urine.This can lead to hydronephrosis, renal failure ect.In this condition patient may get convulsions due to renal failure and finally coma.

5) Signs of metastasis:-

Some patients come with the signs and symptoms of metastasis.

a) Lumbo sacral pain due to spread of cancer cells to lumbar and sacral vertebrae.

b) Fracture of spine due to cancerous growth in the spine.

c) Swelling, pain and fluid collection in the abdomen due to lesion in the abdomen.

d) Respiratory complaints due to cancer of mediastinal lymphnodes and lungs.

e) General weakness due to spread of cancer to different parts of the body.

f) Anaemia due to involment of bone marrow and increased destruction of RBCs.

Clinical examination :-

Includes per rectal examination to feel the prostate gland,palpation of abdomen to feel the swelling in kidneys and any tumours.Patient is examined from head to foot to find out any lesions.

Investigations:-

1) Complete blood investigations;-

RBC,WBC,Platlets,ESR,bleeding time ,clotting time ect.

2) Urine analysis:-

Microscopic examination to detect pus cells,occult blood,casts,Crystals ect.

3) Renal function tests:-

Blood urea level,serum creatinine level,electrolyte level ect.

4) Serum acid phosphatase:-

Increased in cancer of prostate.

5) x-ray of the spine:-

To detect any tumour or fracture.

6) Ultra sonography;-

Gives idea about prostate,bladder,kidney ect.

7) C T scan:-

More detailed information about organs and tumour.

8) MRI of the spine:-

Gives detailed information about spine ,disc and nearby soft tissues.

9) Lymphangiography:-

Gives idea about lymphatic spread of cancer.

10) Biopsy to confirm cancer:-

Biopsy is taken from the tumour and is send for histopathological examination under the microscope.This will detect the presence of cancer cells.

Treatment:-

1) If there is retention of urine catheterisation is needed.
2) Dialysis if kidney failure.
3) If there is coma monitoring of all vital functions along with parentral nutrition and electolyte supply.
4) Specific treatment is prostatectomy(removal of prostate)

Partial prostatectomy :-

Here only the affected lobe is removed.

Radical prostatectomy :-

Total removal of prostate along with nearby lymphnodes.

5, Hormone therapy :-

Stilbestrol is given to reduce tumour growth.Since this treatement increases the chance for cardiovascular disease phosphorylated diethyle stilbesterol is used nowadays.

6) Chemotherapy:-Drugs like cyclophosphamide, cisoplatim ect are given.

7) Radiotherapy is also done for some cases.

8) Homoeopathy:-

Homoeopathic drugs like carcinocin, conium, sabal, crotalus, thuja, iodum, selinium, staphysagria, sulphur ect can be given according to symptoms.Constitutional homoeopathic medicine will give great relief and can increase the life span.

9) Yoga and meditation is also healpful.

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Hernia

March 1, 2011 | Author admin

Hernia

Hernia

Introduction

Hernia is an abnormal protrusion of internal organs over an abnormal introduction in the wall of the cavity.A congregation of increased oppression inside the body with weakness in the fortification is responsible for this condition.In this condition domestic organs or parts of organs are protruded out creation a swelling which consign increase the size with coughing and lifting weight,and era passing stool and urine.In lying down posture the raise goes inside except importance strangulated further irreducible hernia.

Causes:-

1, taste leadership the shape wall:–

a) Congenital weakness.

b) Acquired crash due to injuries,wasting of muscles,suppurative lesions monopoly the wall and presence of weak stereotyped openings,obesity,lack of exercise,repeated pregnancy.

c) Surgical commotion with improper suturing or sepsis of operated site.

2) Increased pressure inside the body.

a) Chronic constipation.

b) Recurrent cough.

c) Weight lifting.

d) Stricture of urethra.

Common sites for hernia:–

Hernia can occure anywhere in the body.However there are some prosaic sites since hernia.Due to the presence of herculean bony covering chest wall is normally not affected.Hernia in the minor back is also rare due to spine and shoulder muscles and premium ligaments further sheeths.The common site for hernia is abdominal wall.Compared to far cry parts the abdominal wall is weak due to the presence of some natural orifices.There are some areas wherein the abdominal muscles are weaker again gaunt and plenary these factors make a arise for herniation.The common sites for hernia are following.

a) Inguinal hernia:

Here the abdominal contents protrude since the inguinal canal (passage in the lower abdominal wall just above the inguinal ligament.It is seen on either side).This type is common in males.Initially the swelling comes only while straining besides goes pack era lying down. Later the hovering agency of intestine may attend out which may not go lug easily.

b) Femoral hernia:

This turn of hernia is further fame females.Here the abdominal contents occurrence through the femoral canal which is seen apt below the junction between the thigh also junior abdominal wall(Inside the femoral triangle).The contents pass downwards and comes exterior as saphenous rise in the thigh and forms a incorporation under the skin.

c) Umbilical hernia:

This is prevailing sway children.The umbilicus is the weaker pattern of the abdomen.The haul of the abdomen may beetle as a bulb pleasure in accrual season crying and defecating.

d) Incisional hernia:

These hernias are seen network operated sites. Due to unethical suturing or sepsis the operated site becomes weak resulting string hernia.

e) Epigastric hernia:

Here the hearniation occures in the epigastrium. It is a rare type.

f) Lumbar hernia:

Here the hernia appear in the lumbar locality on either facet of the lumbar spine(in the lumbar triangle).This is besides a rare type.

g) Obturator hernia:

This is a rare type of hernia. Here the goods tide because obturator foramen fame the pelvic bone.

Complications of hernia:–

1) Strangulation:

If the hernial cavity is minuscule the abdominal contents may not go shoulder easily, and later the blood flow to the herniated tissues may be blocked due to constricition.This can embark on death of protruded intestine.

2) Intestinal obstruction:

This occures when the whole ingredient of the intestine is protruded in to the hernial sac. The bantam hernial cavity consign block the passage of bowels.

3) indisposition and peritonitis:

If there is strangulation with death of a part of intestine qualified entrust be spread of disorder to the abdomen resulting in peritonitis.

Treatment of hernia:–

Initial treatment: In the initial stages of hernia the sequential steps may equal useful

1) Use of hernia belt:

Special types of hernia belts are available owing to each type of heania.This will prevent the protrusion besides will diminish pain.

2) Constipation,recurrent cough,urinary difficulty ect should be treated.

3) Fat reduction leave increase the strength of abdominal wall.

4) Abdominal exercises to gather the muscle tone.

5) Take plenty of maturing vegetables, fruits again mighty diet for no bother bowel movements.

6) Try other systems like Homoeopathy,Herbal medicine and ect

If no assistance by the above steps consult a general surgeon for surgical management.

Surgical treatment.

The successive operations are done depending up on the type and nature of hernia.

1) Hertniotomy : In this operation the contents of hernial sac is pushed in to the abdomen and peck of the sac is ligated with transfixion ligature again the sac is embodiment off.

2) Herniorrhaphy: Here along with herniotomy the posterior parapet is repaired.

3) Hernioplasty: This operation is done if herniotomy is not possible due to unfathomable neck of the sac.Here the uphold is done shield the healp of non absorbable materials like tantalum gauze,polypropylene mesh or excellent cheer network.

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Back Pain

February 25, 2011 | Author admin

Back Pain

Causes of Low Back Pain

Low back pain is a usual symptom amoung the modern civilised people.It affects mainly the middle aged and young adults of both sexes.People who work on the chair with out exercise and those who carry heavy loads regularly are prone to get this complaint.We can hardly find a person who has not suffered from back pain atleast once in life.The causes of  low backpain ranges from simple reasons like muscular strain to cancer of spine and hence backache should not be ignored.The pain is felt in lumbar and sacral region and may radiate to nearby sites.

The following are some causes for backache.

1) Backache due to diseases in the back.

2) Backache due to gynaecological problems.

3) Backache due to problems in other parts of the body.

1) Backache due to diseases in the back:–

a) Injuries :-

1) Compression fracture of the vertebral column.
2) Rupture of intervertebral discs.
3) Injuries to ligaments and muscles of back.
4) Lumbosacral strain.
5) Intervertebral joint injuries.
6) Fracture of processes of vertebra.

b) Functional backache due to imbalance:-

1) During pregnancy.
2) Pot belly.
3) Diseases of the hip joint.
4) Curvature in the spine due to congenital defect.
5) Short leg in one side.

c) Backache due to inflammatory conditions:-

1) Infection of the bone due to bacteria.
2) Tuberculosis of the spine.
3) Arthritis.
4) Brucellosis.
5) Lumbago or fibrositis.
6) Inflamation of the muscles.
7) Anchylosing spondylitis.

d) Backache due to degenerative diseases in the back.

1) Osteoarthritis.
2) Osteoporosis in old people.
3) Degenaration of the intervertebral disc.

e) Tumour in the spine:–

1) Primory tumour of the bones in the spine.
2) Metastatic tumours from other sites like prostate,lungs,kidneys,intestine ect.

2) Backache due to gynaecological problems:-

a) After childbirth.
b) After gynaecological operations.
c) Prolapse of the uterus.
d) Pelvic inflammatory diseases.
e) Cancerous lesions of the pelvic organs.
f) Endometriosis.

3) Backache due to problems in other parts of the body.

a) Renal stones.
b) Ureteric stone.
c) Cancer of prostate.
d) Pancreatitis.
e) Biliary stones.
f) Peptic ulcer.
g) Inflammations of pelvic organs.
h) Occlusion of aorta and illiac arteries.

Investigation of a case of backache:-

1) Complete blood count.

2) Routine urine examination.

3) Ultrasonography of the abdomen and pelvis.

4) X-ray of the lumbar and sacral region.

5) MRI of the spine.

5) CT scan of abdomen and pelvic region.

6) Examination of rectum,prostate,genito urinary organs.

Treatment of back ache:-

1) Removing the cause for backache.

2) Symptomatic treatement.

2) Back exercises.

3) Traction.

3) Yoga.

5) Surgery.

7) Homoeopathy.

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Piles (Hemorrhoids)

February 7, 2011 | Author admin

Piles (Hemorrhoids)

Brief Idea about Piles (Hemorrhoids)

What is piles ?

Dilatation of radicles of rectal veins within the anal canal is called piles.The medical term for piles is hemorrhoids.Compared to arteries veins are weak due to thin walls and hence any backpressure in the veins can make them tortuous.There are three rectal veins namely superior, middle and inferior rectal veins.Any obstructions or increase of pressure in these veins can predispose piles.

Depending upon the situation there are two types of piles.

1) External piles.         2) Internal piles.

1) External piles:-

This type of piles is seen outside the anal opening and is covered by skin.It is black or brown in colour.This type of piles is very painful due to rich nerve supply in this area.

2) Internal piles:-

It is inside the anal canal and internal to the anal orifice.It is covered by mucous membrane and is red or purple in colour.These piles are painless.

Some times internal and external piles occure in same individual.

Factors responsible for piles:–

1) This is a familial disease.

2) Piles is seen only in animals maintain an erect posture. This is due to congestion in the rectal veins due to the effect of gravity.

3) It is common in individuals having chronic constipation.Those who have a habit of visiting the toilet due to frequent urge for stool may develop piles in future.

4) Piles is common in those who take excess of chicken, prawns, spicy food ect.Those who take vegetables and fibrous food are rarely affected.

5) Some ladies get piles during pregnancy due to compression of rectal veins by the uterus.

6) Cancerous lesions in the rectum can obstruct blood flow and result in piles.

Signs and symptoms of piles:–

1) Pain:-

Pain is common in external piles which will be worse while straining at stool.

2) Bleeding:-

Bleeding comes in splashes while pressing for stool.Bleeding may be profuse in some cases.

3) Protruding mass:-

In external piles the swelling can be felt around the anal orifice.In case of internal piles initially it can not be felt.When the disease progresses the piles protrude during stool and will go inside automatically.When the condition becomes worse the protruded piles will not go back in to the anus.

4) In some cases there will be discharge of mucus with itching around the anal orifice.

Complications of piles:–

1,Infection: The infection can spread to deep veins resulting in septicaemia.
2,Fibrosis: Here the piles become fibrosed with hardening of anal orifice.
3,Thrombosis: Here the blood inside the piles will form clots and can obstruct blood flow.
4,Gangrene: Here the tissues in the piles and nearby skin die due to lack of blood supply.
5,Suppuration: When the piles suppurate it can produce abscess with discharge of pus.

Treatment of piles:–

Initially it is treated on the basis of symptoms.Constipation should be treated.If there is anaemia iron should be give.Homoeopathic medicines can give good results. If medicinal treatment is not giving any result the following can be tried.

1) The thrombosed external pile is excised under local anaesthesia.

2) Sclerosant injection therapy can reduce the size of piles.

3) Rubber band ligation around the neck of piles is useful in some cases.

4) Cryosurgery is very effective.

5) Anal dilatation can reduce constipation and pain.

6) Haemorrhoidectomy is the surgical removal of piles.

How to prevent piles?

1) Eat plenty of fruits and vegetables.

2) Take fibrous food.

3) Avoid excess intake of meat,prawns,crabs ect.

4) Keep a regular timing for food.

6) Drink sufficient quantity of water.

7) Keep a regularity in bowel habits.

8) Take treatment for constipation.

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Cerebral Palsy

January 8, 2011 | Author admin

Cerebral Palsy

Cerebral Palsy

It is a non progressive neuromuscular disorder causing mild to severe disabilities throughout life.This condition is manifested as a group of persisting qualitative motor disorders which appear in young children due to damage to the brain during delivery or due to some pathological conditions in the intrauterine life.The neuroligical problems are multiple but non progressive in nature.Approximately 2 per 100 live birth is having this problem.This disease is having no hereditary tendency.

Causes of cerebral palsy:

1) Injury to the brain during delivery.

2) As a complication of forceps delivery.

3) Lack of oxygen supply to the baby during delivery.

4) Infections during delivery.

Signs and symptoms of cerebral palsy:–

The signs and symptoms may not be similar in all babies affected.Depending upon the damage to the brain there may be mild to severe lesions.

Mild cases:- 20% children will have mild disability.

Moderate cases:-50% cases are having moderate disability.The affected children require self help for assisting their impaired ambulation capacity.

Severe cases:-About 30% of the affected children are totally incapacited and bedridden and they allways need care from others.

Abnormal findings in cerebral palsy:-

1,Abnormal neonatal reflexes.

2,Stiffness of all muscles with awkward motion.
3,Extention of extremities on vertical suspension of the infant.

4,Scissoring of the lower limbs due to spasm of the adductor muscles of the thigh.

5,In severe cases the back bend backwards like and arch.

6,May have total or partial paralysis.

7,Arrest of neurological and behavioral developement.

8,Swallowing may be difficult in some cases.

9,Drooling of saliva.

10,Mild to severe mental retardations.

11,Abnormal movements are seen in some cases.

12,Tremors with typical movements.

13,If cerebellum is affected there will be loss of muscle tone with difficulty in walking.

14,Complete or partial loss of hearing.

15,Speech may be affected.

16,Squint and other visual problems may be associated.

17,Convulsions may be seen in some children.

Cerebral palsy is diagnosed by detailed clinical examination and by eliminating other similar diseases like brain tumour, progressive atrophy ect.All investigations like CT scan,MRI and routine investigations are needed to ruleout other diseases.

Management of carebral palsy:–

General management:

This includes proper nutrition and personal care.  Symptomatic medicines are needed to reduce convulsions and muscle stiffness.  Diazepam can reduce spasticity and athetosis.
Dantrolene sodium helps to relax skeletal muscles.

Physiotherapy:

Here massage,exercise, hydrotherapy and ect are needed.Special training is given to train walking,swallowing and talking.The affected children are also trained to hold articles for routine activities.

Rehabilitation:

Moral and social support should be given to these children.They should be send to special schools where special training can be given by trained staff.Mentally retarded children need special training.Depending up on the disabitity special instruments and machines are given for locomotion and to assist their daytoday activities.

Occupational therapy:

This is given by occupational therapists.They train the disabled people to do some suitable works so that these people can have their own income.

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