Sunday, July 10, 2011

What is Trachoma?

Trachoma (Ancient Greek: "rough eye"), also called "Egyptian ophthalmia" in older times, is an infectious eye disease, and remains the leading cause of infectious blindness in the world. Globally, 41 million people suffer from active infection and nearly 8 million people are visually impaired as a result of this disease. Globally this disease results in considerable disability.


Trachoma is caused by Chlamydia trachomatis and it is spread by direct contact with eye, nose, and throat secretions from affected individuals, or contact with fomites (inanimate objects), such as towels and/or washcloths, that have had similar contact with these secretions. Flies can also be a route of mechanical transmission. Untreated, repeated trachoma infections result in entropion—a painful form of permanent blindness when the eyelids turn inward, causing the eyelashes to scratch the cornea. Children are the most susceptible to infection due to their tendency to easily get dirty, but the blinding effects or more severe symptoms are often not felt until adulthood.

Blinding endemic trachoma occurs in areas with poor personal and family hygiene. Many factors are indirectly linked to the presence of trachoma including lack of water, absence of latrines or toilets, poverty in general, flies, close proximity to cattle, crowding and so forth. However, the final common pathway seems to be the presence of dirty faces in children that facilitates the frequent exchange of infected ocular discharge from one child’s face to another. Most transmission of trachoma occurs within the family.

Signs and symptoms

The bacterium has an incubation period of 5 to 12 days, after which the affected individual experiences symptoms of conjunctivitis, or irritation similar to "pink eye." Blinding endemic trachoma results from multiple episodes of reinfection that maintains the intense inflammation in the conjunctiva. Without reinfection, the inflammation will gradually subside.

The conjunctival inflammation is called “active trachoma” and usually is seen in children, especially pre-school children. It is characterized by white lumps in the undersurface of the upper eyelid (conjunctival follicles or lymphoid germinal centres) and by non-specific inflammation and thickening often associated with papillae. Follicles may also appear at the junction of the cornea and the sclera (limbal follicles). Active trachoma will often be irritating and have a watery discharge. Bacterial secondary infection may occur and cause a purulent discharge.

The later structural changes of trachoma are referred to as “cicatricial trachoma”. These include scarring in the eyelid (tarsal conjunctiva) that leads to distortion of the eyelid with buckling of the lid (tarsus) so the lashes rub on the eye (trichiasis). These lashes will lead to corneal opacities and scarring and then to blindness. Linear scar present in the Sulcus subtarsalis is called Arlt's line(named after Carl Ferdinand von Arlt). In addition, blood vessels and scar tissue can invade the upper cornea (pannus). Resolved limbal follicles may leave small gaps in pannus (Herbert’s Pits).
Most commonly children with active trachoma will not present with any symptoms as the low grade irritation and ocular discharge is just accepted as normal.

However, further symptoms may include:

  • Eye discharge
  • Swollen eyelids
  • Trichiasis (turned-in eyelashes)
  • Swelling of lymph nodes in front of the ears
  • Seeing bright lights
  • Increased heart rate
  • Further ear, nose and throat complications.

The major complication or the most important one is corneal ulcer occurring due to rubbing by concentrations, or trichiasis with superimposed bacterial infection.
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Alternative therapy for Psoriasis

Some studies suggest psoriasis symptoms can be relieved by changes in diet and lifestyle. Fasting periods, low energy diets and vegetarian diets have improved psoriasis symptoms in some studies, and diets supplemented with fish oil (in this study cod liver oil) have also shown beneficial effects. Fish oils are rich in the two omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and contain Vitamin E, furthermore cod liver oil contains Vitamin A and Vitamin D.

The severity of psoriasis symptoms may also be influenced by lifestyle habits related to alcohol, smoking, weight, sleep, stress and exercise.

Another treatment is ichthyotherapy, which is practised at some spas in Turkey, Croatia, Ireland, Hungary and Serbia. Doctor fish living in outdoor thermal pools are encouraged to feed on the psoriatic skin, only consuming the affected areas. The outdoor location of the spa may also have a beneficial effect. This treatment can provide temporary relief of symptoms. A revisit to the spas every few months is often required. This treatment has been examined in two small clinical trials, with positive results.

Hypnotherapy may be effective for psoriasis.

A psychological symptom management programme has been reported as being a helpful adjunct to traditional therapies in the management of psoriasis. In the UK, The Psoriasis and Psoriatic Arthritis Alliance (PAPAA, a not-for-profit charity) has funded research, carried out by the University of Manchester, to develop a symptom management programme called Electronic Targeted Intervention for Psoriasis (eTIPs) using a modified Cognitive Behaviour Therapy model. This research follows research by Fortune, et al. on psychological stress, distress and disability in patients with psoriasis.

It has been suggested that cannabis might treat psoriasis, due to the anti-inflammatory properties of its cannabinoids, and the regulatory effects of THC on the immune system. The adverse effects of cannabis might be overcome by use of more specific cannabinoid receptor medications, to inhibit keratinocyte proliferation.

On 17 November 2008, researchers led by Yin-Ku Lin of Chang Gung Memorial Hospital and Chang Gung University in Taoyuan, Taiwan, told Reuters by telephone that Indigo naturalis (qing dai, 青黛), a dark blue plant used in traditional Chinese medicine, appears to be effective in treating psoriasis. In the latest issue of Archives of Dermatology, they wrote, "The Indigo naturalis ointment-treated lesions showed an 81 percent improvement, the (nonmedicated) ointment-treated lesions showed a 26 percent improvement."
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What is Psoriasis?

Psoriasis ( /səˈraɪ.əsɨs/) is a chronic immune-mediated disease that appears on the skin. It occurs when the immune system sends out faulty signals that speed up the growth cycle of skin cells. Psoriasis is not contagious. There are five types of psoriasis: plaque, guttate, inverse, pustular and erythrodermic. The most common form, plaque psoriasis, is commonly seen as red and white hues of scaly patches appearing on the top first layer of the epidermis (skin). Some patients, though, have no dermatological symptoms.

In plaque psoriasis, skin rapidly accumulates at these sites, which gives it a silvery-white appearance. Plaques frequently occur on the skin of the elbows and knees, but can affect any area, including the scalp, palms of hands and soles of feet, and genitals. In contrast to eczema, psoriasis is more likely to be found on the outer side of the joint.

The disorder is a chronic recurring condition that varies in severity from minor localized patches to complete body coverage. Fingernails and toenails are frequently affected (psoriatic nail dystrophy) and can be seen as an isolated symptom. Psoriasis can also cause inflammation of the joints, which is known as psoriatic arthritis. Between 10% and 40% of all people with psoriasis have psoriatic arthritis.

The cause of psoriasis is not fully understood, but it is believed to have a genetic component and local psoriatic changes can be triggered by an injury to the skin known as the Koebner phenomenon,see Koebnerisin. Various environmental factors have been suggested as aggravating to psoriasis, including stress, withdrawal of systemic corticosteroid, as well as other environmental factors, but few have shown statistical significance.

There are many treatments available, but because of its chronic recurrent nature, psoriasis is a challenge to treat.
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Hairy elbow syndrome

Hypertrichosis cubiti (HC) or hairy elbow syndrome consists of a localised form of long vellus hair on the extensor surfaces of the distal third of the upper arm and the proximal third of the forearm bilaterally, or occasionally on other parts of the body.

In the 28 cases reported in the literature so far the elbow hair abnormality was either isolated or associated with short stature or other physical abnormalities. Most of these cases were sporadic, but autosomal dominant as well as autosomal recessive inheritance patterns have been postulated.

We report on three unrelated girls (aged 7 to 11 years) of whom one presented with excess hair in the elbows alone and the other two had associated abnormalities including short stature, dysmorphic facial features and mental retardation. The literature on this subject has been reviewed and the authors focus on cases of HC with associated anomalies.

A pathogenic explanation by somatic mosaicism is proposed.
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What is Liver transplantation?

Liver transplantation or hepatic transplantation is the replacement of a diseased liver with a healthy liver allograft. The most commonly used technique is orthotopic transplantation, in which the native liver is removed and replaced by the donor organ in the same anatomic location as the original liver. Liver transplantation nowadays is a well accepted treatment option for end-stage liver disease and acute liver failure. It is also one of the most expensive treatments in modern medicine.

Typically 3 surgeons and 1 anesthesiologist are involved, with up to 4 supporting nurses. The surgical procedure is very demanding and ranges from 4 up to 18 hours depending on outcome. Numerous anastomoses and sutures, and many disconnections and reconnections of abdominal and hepatic tissue, must be made for the transplant to succeed, requiring an eligible recipient and a well-calibrated live or cadaveric donor match. By any standard, hepatic transplantation is a major surgical procedure with an appreciable degree of risk.


Before transplantation, liver support therapy might be indicated (bridging-to-transplantation). Artificial liver support like liver dialysis or bioartificial liver support concepts are currently under preclinical and clinical evaluation. Virtually all liver transplants are done in an orthotopic fashion, that is, the native liver is removed and the new liver is placed in the same anatomic location. The transplant operation can be conceptualized as consisting of the hepatectomy (liver removal) phase, the anhepatic (no liver) phase, and the postimplantation phase. The operation is done through a large incision in the upper abdomen. The hepatectomy involves division of all ligamentous attachments to the liver, as well as the common bile duct, hepatic artery, hepatic vein and portal vein. Usually, the retrohepatic portion of the inferior vena cava is removed along with the liver, although an alternative technique preserves the recipient's vena cava ("piggyback" technique).

The donor's blood in the liver will be replaced by an ice-cold organ storage solution, such as UW (Viaspan) or HTK until the allograft liver is implanted. Implantation involves anastomoses (connections) of the inferior vena cava, portal vein, and hepatic artery. After blood flow is restored to the new liver, the biliary (bile duct) anastomosis is constructed, either to the recipient's own bile duct or to the small intestine. The surgery usually takes between five and six hours, but may be longer or shorter due to the difficulty of the operation and the experience of the surgeon.

The large majority of liver transplants use the entire liver from a non-living donor for the transplant, particularly for adult recipients. A major advance in pediatric liver transplantation was the development of reduced size liver transplantation, in which a portion of an adult liver is used for an infant or small child. Further developments in this area included split liver transplantation, in which one liver is used for transplants for two recipients, and living donor liver transplantation, in which a portion of a healthy person's liver is removed and used as the allograft. Living donor liver transplantation for pediatric recipients involves removal of approximately 20% of the liver (Couinaud segments 2 and 3).

Further advance in liver transplant involves only resection of the lobe of the liver involved in tumors and the tumor-free lobe remains within the recipient. This speeds up the recovery and the patient stay in the hospital quickly shortens to within 5–7 days.

Many major medical centers are now using radiofrequency ablation of the liver tumor as a bridge while awaiting for liver transplantation. This technique has not been used universally and further investigation is warranted.
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Management of Liver Cirrhosis.

Generally, liver damage from cirrhosis cannot be reversed, but treatment could stop or delay further progression and reduce complications. A healthy diet is encouraged, as cirrhosis may be an energy-consuming process. Close follow-up is often necessary. Antibiotics will be prescribed for infections, and various medications can help with itching. Laxatives, such as lactulose, decrease risk of constipation; their role in preventing encephalopathy is limited.

Treating underlying causes

Alcoholic cirrhosis caused by alcohol abuse is treated by abstaining from alcohol. Treatment for hepatitis-related cirrhosis involves medications used to treat the different types of hepatitis, such as interferon for viral hepatitis and corticosteroids for autoimmune hepatitis. Cirrhosis caused by Wilson's disease, in which copper builds up in organs, is treated with chelation therapy (e.g., penicillamine) to remove the copper.

Preventing further liver damage

Regardless of underlying cause of cirrhosis, alcohol and paracetamol, as well as other potentially damaging substances, are discouraged. Vaccination of susceptible patients should be considered for Hepatitis A and Hepatitis B.

Preventing complications

Salt restriction is often necessary, as cirrhosis leads to accumulation of salt (sodium retention). Diuretics may be necessary to suppress ascites.

Esophageal variceal bleeding
For portal hypertension, propranolol is a commonly used agent to lower blood pressure over the portal system. In severe complications from portal hypertension, transjugular intrahepatic portosystemic shunting is occasionally indicated to relieve pressure on the portal vein. As this can worsen encephalopathy, it is reserved for those at low risk of encephalopathy, and is generally regarded only as a bridge to liver transplantation or as a palliative measure.

Hepatic encephalopathy
High-protein food increases the nitrogen balance, and would theoretically increase encephalopathy; in the past, this was therefore eliminated as much as possible from the diet. Recent studies show that this assumption was incorrect, and high-protein foods are even encouraged to maintain adequate nutrition.

Hepatorenal syndrome
The hepatorenal syndrome is defined as a urine sodium less than 10 mmol/L and a serum creatinine > 1.5 mg/dl (or 24 hour creatinine clearance less than 40 ml/min) after a trial of volume expansion without diuretics.

Spontaneous bacterial peritonitis
Cirrhotic patients with ascites are at risk of spontaneous bacterial peritonitis.


If complications cannot be controlled or when the liver ceases functioning, liver transplantation is necessary. Survival from liver transplantation has been improving over the 1990s, and the five-year survival rate is now around 80%, depending largely on the severity of disease and other medical problems in the recipient.[20] In the United States, the MELD score is used to prioritize patients for transplantation. Transplantation necessitates the use of immune suppressants (cyclosporine or tacrolimus).

Decompensated cirrhosis
In patients with previously stable cirrhosis, decompensation may occur due to various causes, such as constipation, infection (of any source), increased alcohol intake, medication, bleeding from esophageal varices or dehydration. It may take the form of any of the complications of cirrhosis listed above.

Patients with decompensated cirrhosis generally require admission to hospital, with close monitoring of the fluid balance, mental status, and emphasis on adequate nutrition and medical treatment - often with diuretics, antibiotics, laxatives and/or enemas, thiamine and occasionally steroids, acetylcysteine and pentoxifylline. Administration of saline is generally avoided as it would add to the already high total body sodium content that typically occurs in cirrhosis.
read more "Management of Liver Cirrhosis."

Cirrhosis of Liver - Signs and symptoms

Cirrhosis (pronounced /sɪˈroʊsɪs/) is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrosis, scar tissue and regenerative nodules (lumps that occur as a result of a process in which damaged tissue is regenerated), leading to loss of liver function. Cirrhosis is most commonly caused by alcoholism, hepatitis B and C, and fatty liver disease, but has many other possible causes. Some cases are idiopathic, i.e., of unknown cause.

Ascites (fluid retention in the abdominal cavity) is the most common complication of cirrhosis, and is associated with a poor quality of life, increased risk of infection, and a poor long-term outcome. Other potentially life-threatening complications are hepatic encephalopathy (confusion and coma) and bleeding from esophageal varices. Cirrhosis is generally irreversible, and treatment usually focuses on preventing progression and complications. In advanced stages of cirrhosis the only option is a liver transplant.

The word "cirrhosis" derives from Greek κιρρός [kirrhós] meaning yellowish, tawny (the orange-yellow colour of the diseased liver) + Eng. med. suff. -osis. While the clinical entity was known before, it was René Laennec who gave it the name "cirrhosis" in his 1819 work in which he also describes the stethoscope.

Signs and symptoms

Some of the following signs and symptoms may occur in the presence of cirrhosis or as a result of the complications of cirrhosis. Many are nonspecific and may occur in other diseases and do not necessarily point to cirrhosis. Likewise, the absence of any does not rule out the possibility of cirrhosis.

Spider angiomata or spider nevi. Vascular lesions consisting of a central arteriole surrounded by many smaller vessels because of an increase in estradiol. These occur in about 1/3 of cases.

Palmar erythema. Exaggerations of normal speckled mottling of the palm, because of altered sex hormone metabolism.

Nail changes.
Muehrcke's lines - paired horizontal bands separated by normal color resulting from hypoalbuminemia (inadequate production of albumin).
Terry's nails - proximal two-thirds of the nail plate appears white with distal one-third red, also due to hypoalbuminemia
Clubbing - angle between the nail plate and proximal nail fold > 180 degrees
Hypertrophic osteoarthropathy. Chronic proliferative periostitis of the long bones that can cause considerable pain.
Dupuytren's contracture. Thickening and shortening of palmar fascia that leads to flexion deformities of the fingers. Thought to be caused by fibroblastic proliferation and disorderly collagen deposition. It is relatively common (33% of patients).

Gynecomastia. Benign proliferation of glandular tissue of male breasts presenting with a rubbery or firm mass extending concentrically from the nipples. This is caused by increased estradiol and can occur in up to 66% of patients.
Hypogonadism. Manifested as impotence, infertility, loss of sexual drive, and testicular atrophy because of primary gonadal injury or suppression of hypothalamic or pituitary function.

Liver size. Can be enlarged, normal, or shrunken.

Splenomegaly (increase in size of the spleen). Caused by congestion of the red pulp as a result of portal hypertension.
Ascites. Accumulation of fluid in the peritoneal cavity giving rise to flank dullness (needs about 1500 mL to detect flank dullness).

Caput medusa. In portal hypertension, the umbilical vein may open. Blood from the portal venous system may be shunted through the periumbilical veins into the umbilical vein and ultimately to the abdominal wall veins, manifesting as caput medusa.

Cruveilhier-Baumgarten murmur. Venous hum heard in epigastric region (on examination by stethoscope) because of collateral connections between portal system and the remnant of the umbilical vein in portal hypertension.
Fetor hepaticus. Musty odor in breath as a result of increased dimethyl sulfide.

Jaundice. Yellow discoloring of the skin, eye, and mucus membranes because of increased bilirubin (at least 2–3 mg/dL or 30 mmol/L). Urine may also appear dark.

Asterixis. Bilateral asynchronous flapping of outstretched, dorsiflexed hands seen in patients with hepatic encephalopathy.

Other. Weakness, fatigue, anorexia, weight loss.
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What is Hepatitis?

Hepatitis is a disease of the liver. In hepatitis, the liver is inflamed. There can be several reasons, why the liver is inflamed, for this reason there are several kinds of hepatitis. The most common forms are Hepatitis A, Hepatitis B and Hepatitis C. Most cases of Hepatitis are caused by viruses. Some forms are caused by bacteria, fungi or parasites. The bacteria that cause Tuberculosis or Syphilis can also cause hepatitis, as can the parasite responsible for Malaria.

Hepatitis can also be caused by alcohol. About one in four people who drink more than three alcoholic drinks a day, (over a period of 10-15 days) will have some form of hepatitis caused by alcohol.

Various drugs and chemicals can also cause Hepatitis, most notably Paracetamol (overdose), yellow phosphorous, and others. Hepatitis may also be caused by other diseases.

Hepatitis A

Hepatitis A can be transmitted through infected food. The patient's immune system makes antibodies against hepatitis A. This will make the patient immune against future infection. People with hepatitis A should rest, drink a lot of water and avoid alcohol. A vaccine is available. It will protect against infection from hepatitis A for life. Hepatitis A can be spread through personal contact, consumption of raw sea food or by drinking contaminated water. This occurs primarily in third world countries. Strict personal hygiene and avoiding raw and unpeeled foods can help prevent an infection. Infected people excrete the hepatitis A virus with their stool two weeks before and one week after the appearance of jaundice. The time between the infection and the start of the illness can run from 15 to 45 days, and approximately 15% of sufferers may experience relapsing symptoms from six months to a year after the first diagnosis.

Hepatitis B

Hepatitis B is not spread by food or casual contact. Instead, hepatitis B is spread by blood or body fluids from an infected person. A baby can get it from its mother during childbirth, and it can also be spread by sexual contact, use of street drugs, and unsafe medical care. Some people just have hepatitis B for a little while and then suppress the infection, but others can be infected for life usually with few or no symptoms for many years. Hepatitis B sometimes damages the liver severely, and can cause cancer. There is a vaccine that works very well to prevent hepatitis B, and there is treatment for people with serious disease cause by hepatitis B.The vaccine can be found in the clinics near you.

Hepatitis C

Hepatitis C is not spread by food or casual contact. It is spread in ways that are similar to hepatitis B. There is no vaccine, and the treatment is somewhat unpleasant. People with hepatitis C who drink alcohol greatly increase their risk for liver damage.
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Lung Cancer

Lung cancer is the malignant change and growth of lung tissue. It causes 1.3 million people to die each year, more than any other cancer. Although lung cancer was once an illness that affected males much more than it did women, the number of cases in women has been increasing in the last few decades, which has been blamed on the rising ratio of female to male smokers.

Currently, lung cancer is the leading causing of cancer death in women, killing more women than breast cancer, ovarian cancer and uterine cancers together.The large majority of people who get lung cancer have smoked for many years.

However, there are certain types of lung cancers that appear in otherwise healthy patients who have never smoked. There are 2 main types of Lung cancer, small cell lung cancer and non-small cell lung cancer. Small cell lung cancer typically responds well to chemotherapy and radiotherapy, and non-small cell lung cancer is more commonly treated with surgical removal of the lung tumor.

Bevacizumab is effective in the treatment of Non-small cell lung cancer.

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How does Erection happens?

The penis is shaped like a banana or sausage. It has a duct or tube called the urethra running right through it. Semen and urine pass along the urethra to get out of the body. Around the whole urethra is tissue called the corpus spongiosum penis (which is Latin for "body of the penis that is like a sponge"). It is near the lower surface of the penis. Also inside the penis near its upper surface are two cylindrical tissues called the corpora cavernosa penis (Latin for "bodies of the penis that are like caves"). (One of these tissues by itself is called a corpus cavernosum.) The corpus spongiosum penis and corpora cavernosa penis are filled with many blood vessels called arteries which carry blood.
When a man is sexually aroused or stimulated (made sexually excited) by touch – for example, if he masturbates or another person touches him in a sexual way – the touching is picked up by nerves in the arteries of the corpus spongiosum penis and corpora cavernosa penis. The nerves then cause a chemical called nitric oxide to be released into the arteries. This makes the arteries dilate (become wider), and they fill up with blood. Thus, the corpus spongiosum penis and corpora cavernosa penis all fill with blood and become larger and harder. This makes the penis grow longer, thicker and harder. The corpora cavernosa penis press against blood vessels called veins that let blood flow out of the penis. Since less blood can flow out of the penis through the veins, more of it stays in the penis, which remains hard. During an erection, a valve stops urine from entering the urethra so that only semen flows along it. This is why it is very difficult for a man to urinate when he is having an erection.
A man can also become sexually aroused without being touched, for example, if he sees a naked person or thinks about having sex with someone. In this case, his brain sends messages through his spinal cord (which is inside his vertebral column or backbone) to his penis and makes an erection happen. The brain can also stop an erection from happening, even if the man is being touched sexually.
An erection of the penis can also happen by itself when a man is asleep, often when he is dreaming. The scientific term for this is nocturnal penile tumescence (which means "swelling of the penis at night"). It is also common for a man to wake up after a night's sleep to find that he has an erection. This is often caused by his bladder being full of urine, which presses on the tissues in the penis. Such an erection is sometimes informally called a morning glory or morning wood.
After a man has had an orgasm and has ejaculated, his erection usually ends. How long this takes depends on the length and thickness of his penis. A man can also stop having an erection without having an orgasm and ejaculating, if he is no longer sexually aroused. Nerves in his body cause the arteries in the penis to constrict (become narrower). This forces blood out of the corpus spongiosum penis and corpora cavernosa penis. As they go back to their normal size, they do not press so much on the veins leading out of the penis. This lets blood flow faster out of the corpus spongiosum penis and corpora cavernosa penis. The scientific term for this process is detumescence.
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Saturday, July 9, 2011

Prvention of Esophageal varices

Ideally, patients with known varices should receive treatment to reduce their risk of bleeding.

The non-selective β-blockers (e.g., propranolol 10 mg PO TID, timolol or nadolol 20 mg PO OD) and nitrates (e.g. isosorbide mononitrate (IMN) 20 mg BD to TID) have been evaluated for secondary prophylaxis. Non-selective β-blockers (but not cardioselective β-blockers like atenolol) are preferred because they decrease both cardiac output by β1 blockade and splanchnic blood flow by blocking vasodilating β2 receptors at splanchnic vasculature. The effectiveness of this treatment has been shown by a number of different studies.

Unfortunately, non-selective β-blockers do not prevent the formation of esophageal varices.

Ultimately the treatment of portal hypertension can prevent development of esophageal varices.
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Treatment of Esophageal varices

In emergency situations, the care is directed at stopping blood loss, maintaining plasma volume, correcting disorders in coagulation induced by cirrhosis, and appropriate use of antibiotics (usually a quinolone or ceftriaxone, as infection by gram-negative strains is either concomitant, or a precipitant).

Blood volume resuscitation should be done promptly and with caution. Goal should be hemodynamic stability and hemoglobin of over 8. Resuscitation of all lost blood leads to increase in portal pressure leading to more bleeding. Volume resuscitation can also worsen ascites and increase portal pressure. (AASLD guildlines)

Therapeutic endoscopy is considered the mainstay of urgent treatment. Two main therapeutic approaches exist:

  1. Variceal ligation, or banding
  2. Sclerotherapy

In cases of refractory bleeding, balloon tamponade with Sengstaken-Blakemore tube may be necessary, usually as a bridge to further endoscopy or treatment of the underlying cause of bleeding (usually portal hypertension). Methods of treating the portal hypertension include: transjugular intrahepatic portosystemic shunt (TIPS), or a distal splenorenal shunt procedure or a liver transplantation.
Nutritional supplementation is not necessary if the patient is not eating for four days or less.
Terlipressin and octreotide (50mcg bolus IV followed by 25-50mcg/h IVF for 1 to 5 days) have also been used.

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Esophageal varices

In medicine (gastroenterology), esophageal varices are extremely dilated sub-mucosal veins in the lower esophagus. They are most often a consequence of portal hypertension, commonly due to cirrhosis; patients with esophageal varices have a strong tendency to develop bleeding.

Esophageal varices are diagnosed with endoscopy.

The majority of blood from the esophagus is drained via the esophageal veins, which carry deoxygenated blood from the esophagus to the azygos vein, which in turn drains directly into the superior vena cava. These veins have no part in the development of esophageal varices. The remaining blood from the esophagus is drained into the superficial veins lining the esophageal mucosa, which drain into the coronary vein (left gastric vein), which in turn drains directly into the portal vein. These superficial veins (normally only approximately 1mm in diameter) become distended up to 1–2 cm in diameter in association with portal hypertension.

Normal portal pressure is approximately 9 mmHg compared to an inferior vena cava pressure of 2-6 mmHg. This creates a normal pressure gradient of 3-7 mmHg. If the portal pressure rises above 12mmHg, this gradient rises to 7-10 mmHg.[2] A gradient greater than 5 mmHg is considered portal hypertension. At gradients greater than 10 mmHg, blood flow though the hepatic portal system is redirected from the liver into areas with lower venous pressures. This means that collateral circulation develops in the lower esophagus, abdominal wall, stomach, and rectum. The small blood vessels in these areas become distended, becoming more thin-walled, and appear as varicosities. In addition, these vessels are poorly supported by other structures, as they are not designed for high pressures.

In situations where portal pressures increase, such as with cirrhosis, there is dilation of veins in the anastomosis, leading to esophageal varices. Splenic vein thrombosis is a rare condition which causes esophageal varices without a raised portal pressure. Splenectomy can cure the variceal bleeding due to splenic vein thrombosis. The most common cause of esophageal varices is from aging changes in the vessels.

Varices can also form in other areas of the body, including the stomach (gastric varices), duodenum (duodenal varices), and rectum (rectal varices). Treatment of these types of varices may differ.
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Focal nodular hyperplasia

Focal nodular hyperplasia (FNH) is a benign tumour of the liver (hepatic tumour), which is the second most prevalent tumour of the liver (the first is hepatic hemangioma). It is usually asymptomatic, rarely grows or bleeds, and has no malignant potential. This tumour is often resected because it is difficult to distinguish from hepatic adenoma.


Focal nodular hyperplasia's most recognizable gross feature is a central stellate scar seen in 60-70% of cases. Microscopically, a lobular proliferation of bland-appearing hepatocytes with a bile ductular proliferation and malformed vessels within the fibrous scar is the most common pattern. Other patterns include telangiectatic, hyperplastic-adenomatous, and lesions with focal large-cell dysplasia.[ Rarely, these lesions may be multiple or can occur as part of a syndrome with hemangiomas, epithelioid hemangioendothelioma, hepatic adenomas, fibrolamellar hepatocellular carcinoma, vascular malformations of the brain, meningiomas, and/or astrocytomas.

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Asbestosis is a chronic inflammatory and fibrotic medical condition affecting the parenchymal tissue of the lungs caused by the inhalation and retention of asbestos fibers. It usually occurs after high intensity and/or long-term exposure to asbestos (particularly in those individuals working on the production or end-use of products containing asbestos) and is therefore regarded as an occupational lung disease. People with extensive occupational exposure to the mining, manufacturing, handling or removal of asbestos are at risk of developing asbestosis. Sufferers may experience severe dyspnea (shortness of breath) and are at an increased risk for certain malignancies, including lung cancer but especially mesothelioma. Asbestosis specifically refers to interstitial (parenchymal) fibrosis from asbestos, and not pleural fibrosis or plaquing.

Signs and symptoms

The signs and symptoms of asbestosis do not manifest until after an appreciable latency (time since first exposure), often several decades under current conditions in the US. The primary symptom of asbestosis is generally the slow onset of dyspnea, especially on exertion.Clinically advanced cases of asbestosis may lead to respiratory failure. On auscultation of the lungs, the physician may hear inspiratory rales.

The characteristic pulmonary function finding in asbestosis is a restrictive ventilatory defect. This manifests as a reduction in lung volumes, particularly the Vital Capacity (VC) and Total Lung Capacity (TLC). The TLC may be reduced through alveolar wall thickening; however this is not always the case. Large airway function, as reflected by FEV1/FVC, is generally well preserved. In the more severe cases, the drastic reduction in lung function due to the stiffening of the lungs and reduced TLC may induce right-sided heart failure (cor pulmonale).[ In addition to a restrictive defect, asbestosis may produce reduction in Diffusion Capacity and arterial hypoxemia.
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What is Mesothelioma?

Mesothelioma, more precisely malignant mesothelioma, is a rare form of cancer that develops from the protective lining that covers many of the body's internal organs, themesothelium. It is usually caused by exposure to asbestos.
Its most common site is the pleura (outer lining of the lungs and internal chest wall), but it may also occur in the peritoneum (the lining of the abdominal cavity), the pericardium (a sac that surrounds the heart), or the tunica vaginalis (a sac that surrounds the testis).

Most people who develop mesothelioma have worked on jobs where they inhaled asbestos and glass particles, or they have been exposed to asbestos dust and fiber in other ways. It has also been suggested that washing the clothes of a family member who worked with asbestos or glass can put a person at risk for developing mesothelioma.Unlike lung cancer, there is no association between mesothelioma and smoking, but smoking greatly increases the risk of other asbestos-induced cancers. Those who have been exposed to asbestos have collected damages for asbestos-related disease, including mesothelioma. Compensation via asbestos funds or lawsuits is an important issue in law practices regarding mesothelioma (see asbestos and the law).

The symptoms of mesothelioma include shortness of breath due to pleural effusion (fluid between the lung and the chest wall) or chest wall pain, and general symptoms such as weight loss. The diagnosis may be suspected with chest X-ray and CT scan, and is confirmed with abiopsy (tissue sample) and microscopic examination. A thoracoscopy (inserting a tube with a camera into the chest) can be used to take biopsies. It allows the introduction of substances such as talc to obliterate the pleural space (called pleurodesis), which prevents more fluid from accumulating and pressing on the lung. Despite treatment with chemotherapy, radiation therapy or sometimes surgery, the disease carries a poor prognosis. Research aboutscreening tests for the early detection of mesothelioma is ongoing.
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Wednesday, April 6, 2011

Prevention and treatment for Computer Vision Syndrome?

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Computer Vision Syndrome results due to the strain on eyes during long hours of computing. Common symptoms includes dry eyes and blurry vision.


CVS can be easily avoided using following ways:

  1. Use proper lighting. Low or very bright lighting will result in strain on eyes. So avoid it. The light should not reflect on screen.
  2. Choose large fonts during reading (press CTRL + for Mozilla FF or Google Chrome or increase zoom for IE).
  3. Place the Monitor or Laptop screen at a level so that it is comfortable with the eyes. (see image). Position the monitor 20 to 26 inches away from the eyes.
  4. After working for 20-30 min, take a break and look away from the computer screen. Blink your eyes to maintain the moisture.. Put your both palms on both eyes for a min. That will relax your eyes.
  5. Do not work on computer wearing contact lenses for more than 2 hours.
  6. Use the protective anti reflective screen for monitor. 
  7. Use LCD monitors over CRT ones. The LCD monitors are costly than CRT but are more energy efficient and protective for eyes.

  1. Regularly check your eyes with ophthalmologist. Ask for computer glasses. 
  2. Use eye drops after consulting your doctor.
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    Saturday, March 12, 2011

    What is Computer Vision Syndrome (CVS)?

    As per wiki Computer vision syndrome (CVS) is a temporary condition resulting from focusing the eyes on a computer display for protracted, uninterrupted periods of time. This condition occurs in the peoples who spends hours on computers. Proper ergonomic design is necessary to prevent repetitive strain injuries.

    Common symptoms of Computer Vision Syndrome (CVS)

    • Eyestrain
    • Blurry Vision
    • Dry Eyes
    • Headaches
    • Double Vision
    • Back and Neck pain
    • Difficulty refocusing the eyes
    • Polyopia
     Computer Vision Syndrome can be easily prevented. Read more about prevention and treatment of CVS here.
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