Thoracic outlet syndrome

Thoracic outlet syndrome

Definition:
Thoracic outlet syndrome is a group of disorders that occur when the blood vessels or nerves in the thoracic outlet — the space between your collarbone and your first rib — become compressed. This can cause pain in your shoulders and neck and numbness in your fingers.

Common causes of thoracic outlet syndrome include physical trauma from a car accident, repetitive injuries from job- or sports-related activities, certain anatomical defects, such as having an extra rib, and pregnancy. Even a long-ago injury can lead to thoracic outlet syndrome in the present. Sometimes doctors can't determine the cause of thoracic outlet syndrome.

Treatment for thoracic outlet syndrome usually involves physical therapy and pain relief measures. Most people improve with these conservative approaches. In some cases, however, your doctor may recommend surgery.

Symptoms:
Generally, there are three types of thoracic outlet syndrome.

• Neurogenic (neurological) thoracic outlet syndrome. This form of thoracic outlet syndrome is characterized by compression of the brachial plexus. The brachial plexus is a network of nerves that come from your spinal cord and control muscle movements and sensation in your shoulder, arm and hand. In the majority of thoracic outlet syndrome cases, the symptoms are neurogenic.
• Vascular thoracic outlet syndrome. This type of thoracic outlet syndrome occurs when one or more of the arteries and veins under the collarbone (clavicle) are compressed.
• Nonspecific-type thoracic outlet syndrome. This is also called disputed thoracic outlet syndrome or common thoracic outlet syndrome. Some doctors don't believe it exists, while others say it's a common disorder. People with nonspecific-type thoracic outlet syndrome have chronic pain in the area of the thoracic outlet that worsens with activity, but the specific cause of the pain can't be determined.

Thoracic outlet syndrome symptoms can vary, depending on which structures are compressed. When nerves are compressed, signs and symptoms of neurological thoracic outlet syndrome often include:

• Wasting in the fleshy base of your thumb (Gilliatt-Sumner hand)
• Numbness or tingling in your fingers
• Pain in your shoulder and neck
• Ache in your arm or hand
• Weakening grip

Signs and symptoms of vascular thoracic outlet syndrome — compression of one or more of your veins and arteries — can include:

• Discoloration of your hand (bluish color)
• Blood clot under your collarbone (subclavian vein thrombosis)
• Arm pain and swelling, possibly due to blood clots
• Throbbing lump near your collarbone
• Lack of color (pallor) in one or more of your fingers or your entire hand
• Weak or no pulse in the affected arm
• Tiny, usually black spots (infarcts) on your fingers

When to see a doctor
See your doctor if you consistently experience any of the signs and symptoms of thoracic outlet syndrome.


Causes:
In general, the cause of thoracic outlet syndrome is compression of the nerves and blood vessels in the thoracic outlet, just under your collarbone (clavicle). The cause of the compression varies and can include:

• Anatomical defects. Inherited defects that are present at birth (congenital) may include a cervical rib — an extra rib located above the first rib — or an abnormally tight fibrous band connecting your spine to your rib.
• Poor posture. Drooping your shoulders or holding your head in a forward position can cause compression in the thoracic outlet area.
• Trauma. A traumatic event, such as a car accident, can cause internal changes that then compress the nerves in the thoracic outlet. The onset of symptoms related to a traumatic accident often is delayed.
• Repetitive activity. Doing the same thing over and over can, over time, wear on your body's tissue. You may notice symptoms of thoracic outlet syndrome if your job requires you to repeat a movement continuously, such as typing on a computer for extended periods, working on an assembly line or repeatedly lifting things above your head, as you would if you were stocking shelves. Athletes, such as baseball pitchers and swimmers, also can develop thoracic outlet syndrome from years of repetitive movements. If you repeatedly carry heavy loads low on your body (rather than against your chest), you may also notice signs and symptoms of thoracic outlet syndrome.
• Pressure on your joints. Obesity can put an undue amount of stress on your joints, as can carrying around an oversized bag or backpack.
• Pregnancy. Because joints loosen during pregnancy, signs of thoracic outlet syndrome may first appear while you're pregnant.

Complications:
Thoracic outlet syndrome left untreated can cause permanent nerve damage; however, surgery to treat thoracic outlet syndrome is considered risky. This is because the procedure involves dividing a muscle in the neck and removing a portion of the first rib or repairing the brachial plexus nerves. For this reason, most doctors initially recommend a conservative treatment approach



Treatments and drugs:
In most cases, a conservative approach to treatment is effective, especially when the condition is diagnosed early. Treatment may include:

• Physical therapy. You'll learn how to do exercises that strengthen your shoulder muscles to open the thoracic outlet, improve your range of motion and improve your posture. These exercises, done over time, will take the pressure off your blood vessels and nerves in the thoracic outlet.
• Relaxation. Techniques that help you relax, such as deep breathing, can keep you from tensing your shoulders and remind you to maintain good posture.
• Medications. Your doctor may prescribe pain medications, muscle relaxants and anti-inflammatory drugs — aspirin or ibuprofen (Advil, Motrin, others) — to decrease inflammation and encourage muscle relaxation.

If conservative treatments don't improve your symptoms or if you're experiencing signs of significant nerve damage, worsening muscle weakness or incapacitating pain, your doctor may recommend surgery. Your doctor also may recommend surgery if you've been diagnosed with true neurogenic thoracic outlet syndrome, for which surgery is often the only treatment option, and for certain blood vessel complications, such as obstructed blood flow (occlusion) or ballooning of a portion of an artery (aneurysm) due to weakness in the wall of the blood vessel.

Surgical options
Surgery is usually effective in relieving pain associated with thoracic outlet syndrome. It may not be as successful in treating muscle weakness, especially if the condition has gone untreated for an extended period.

A specialist in thoracic surgery or vascular surgery will perform the procedure. All surgical options to treat thoracic outlet syndrome pose a significant risk of injury to the brachial plexus. The most common surgical approaches for thoracic outlet syndrome treatment are:

• Anterior supraclavicular approach. This approach repairs compressed blood vessels. Your surgeon makes an incision just under your neck to expose your brachial plexus region. He or she then is able to look for signs of trauma or may discover fibrous bands contributing to compression near your first (uppermost) rib and can repair any compressed blood vessels.
• Transaxillary approach. In this surgery, your surgeon makes an incision in your chest to access the first rib, then removes a portion of the first rib to relieve compression. The advantage of this type of surgery is that it gives the surgeon easy access to the first rib without disturbing the nerves or blood vessels. But it also means the surgeon has limited access to the area's nerves and vessels, and most fibrous bands and cervical ribs that may be contributing to compression are hidden behind these nerves and blood vessels.

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Thoracic aortic aneurysm

Thoracic aortic aneurysm

Definition:
A thoracic aortic aneurysm is a weakened and bulging area in the upper part of the aorta, the major blood vessel that feeds blood to the body. The aorta, about the thickness of a garden hose, runs from your heart through the center of your chest and abdomen. Because the aorta is the body's main supplier of blood, a ruptured thoracic aortic aneurysm can cause life-threatening bleeding. Although you may never have symptoms, finding out you have a thoracic aortic aneurysm can be frightening.

Most small and slow-growing thoracic aortic aneurysms don't rupture, but large, fast-growing aneurysms may. Depending on the size and rate at which the thoracic aortic aneurysm is growing, treatment may vary from watchful waiting to emergency surgery. Once a thoracic aortic aneurysm is found, doctors will closely monitor it so that surgery can be planned if it's necessary. Emergency surgery for a ruptured thoracic aortic aneurysm can be risky.

Symptoms:
Aortic aneurysms often grow slowly and usually without symptoms, making them difficult to detect. Some aneurysms will never rupture. Many start small and stay small, although many expand over time. Some aortic aneurysms enlarge slowly, increasing less than half an inch (1.2 centimeters) a year. Others expand at a faster rate, which increases the risk of rupture. How quickly an aortic aneurysm may grow is difficult to predict.
As an aortic aneurysm grows, some people may notice:

• Tenderness or pain in the abdomen or chest
• Back pain

Aneurysms can develop anywhere along the aorta, which runs from your heart through your abdomen. When they occur in the upper part of the aorta, they are called thoracic aortic aneurysms. More commonly, aneurysms form in the lower part of your aorta and are called abdominal aortic aneurysms. Rarely, an aneurysm can occur in between the upper and lower parts of your aorta. This type of aneurysm is called a thoracoabdominal aneurysm.

When to see a doctor
You should see your doctor if you have symptoms of a thoracic aortic aneurysm.
If you have a family history of aortic aneurysm, Marfan syndrome or other connective tissue disease, or bicuspid aortic valve, your doctor may recommend regular ultrasound exams to screen for aortic aneurysm.


Causes:
The exact causes of thoracic aortic aneurysms are unknown, but factors that can contribute to an aneurysm's development include:

• Marfan syndrome. People who are born with Marfan syndrome, a genetic condition that affects the connective tissue in the body, are particularly at risk of a thoracic aortic aneurysm. Those with Marfan syndrome may have a weakness in the aortic wall that makes them more susceptible to aneurysm. People with Marfan syndrome often have distinct physical traits, including tall stature, very long arms, a deformed breastbone and eye problems.
• Other connective tissue diseases. Besides Marfan syndrome, other connective tissue diseases, such as Ehlers-Danlos syndrome, can contribute to a thoracic aortic aneurysm. Ehlers-Danlos syndrome causes your skin, joints and connective tissue to be fragile and makes your skin stretch easily.
• Problems with your heart's valves. Sometimes, people who have problems with their aortic valve, the valve that blood flows through as it leaves your heart, have an increased risk of thoracic aortic aneurysm. This is especially true for people who have a bicuspid aortic valve, meaning their aortic valve has only two leaflets instead of three.
• Previous injury to the aorta. You're more likely to have a thoracic aortic aneurysm if you've had previous problems with your aorta, such as a tear in the wall of the aorta (aortic dissection).
• Traumatic injury. Some people who are injured in falls or motor vehicle crashes develop thoracic aortic aneurysms.

An aortic aneurysm is different from a condition called aortic dissection. Aortic dissection often occurs in the same place many aneurysms occur. In aortic dissection, a tear occurs in the wall of the aorta. This causes bleeding into and along the aortic wall and, in some cases, completely outside the aorta (rupture). Aortic dissection is a life-threatening emergency.

Complications:
Tears in the wall of the aorta (dissection) and rupture of the aorta are the main complications of thoracic aortic aneurysm. A ruptured aortic aneurysm can lead to life-threatening internal bleeding. In general, the larger the aneurysm, the greater the risk of rupture.
Signs and symptoms that your aortic aneurysm has burst include:

• Sudden, intense and persistent abdominal, chest or back pain
• Pain that radiates to your back or legs
• Sweatiness
• Clamminess
• Dizziness
• Low blood pressure
• Fast pulse
• Loss of consciousness
• Shortness of breath
• Weakness or paralysis of one side of the body, difficulty speaking or other signs of stroke

Blood clot risk
Another complication of aortic aneurysms is the risk of blood clots. Small blood clots can develop in the area of the aortic aneurysm. If a blood clot breaks loose from the inside wall of an aneurysm and blocks a blood vessel elsewhere in your body, it can cause pain or block the blood flow to the brain, legs, toes or abdominal organs.


Treatments and drugs:
The goal of treatment is to prevent your aneurysm from rupturing. Generally, your treatment options are medical monitoring or surgery. Your decision depends on the size of the aortic aneurysm and how fast it's growing.

Medical monitoring
If your thoracic aortic aneurysm is small, your doctor may recommend medical monitoring, which includes regular appointments to make sure your aneurysm isn't growing, and management of other medical conditions that could worsen your aneurysm.

It's likely your doctor will order regular imaging tests to check on the size of your aneurysm. Expect to have an echocardiogram at least six months after your aneurysm is diagnosed and regular exams and imaging tests after that.

If you have high blood pressure or blockages in your arteries, it's likely that your doctor will prescribe medications to lower your blood pressure and reduce your risk of complications from your aneurysm. These medications could include:

• Beta blockers. Beta blockers lower your blood pressure by slowing your heart rate. Examples of beta blockers include metoprolol (Lopressor, Toprol-XL), atenolol (Tenormin) and bisoprolol (Zebeta).
• Angiotensin II receptor blockers. Your doctor may also prescribe these medications if beta blockers aren't enough to control your blood pressure. These medications are recommended for people who have Marfan syndrome, even if they don't have high blood pressure. Examples of angiotensin II receptor blockers include losartan (Cozaar), valsartan (Diovan) and olmesartan (Benicar).
• Statins. These medications can help lower your cholesterol, which can help reduce blockages in your arteries and reduce your risk of aneurysm complications. Examples of statins include atorvastatin (Lipitor), lovastatin (Mevacor), simvastatin (Zocor) and others.

If you smoke or chew tobacco, it's important that you quit. Using tobacco can worsen your aneurysm.

Surgery to prevent rupture
If you have a thoracic aortic aneurysm, surgery is generally recommended if your aneurysm is 2.2 inches (5.6cm) and larger. If you have Marfan syndrome, another connective tissue disease or a family history of aortic dissection, your doctor may recommend surgery for smaller aneurysms as well.
Depending on your condition and the location of your thoracic aortic aneurysm, your doctor may recommend:

• Open-chest surgery. Open-chest surgery to repair a thoracic aortic aneurysm involves removing the damaged section of the aorta and replacing it with a synthetic tube (graft), which is sewn into place. This procedure requires open-abdominal or open-chest surgery, and it will take you several months to fully recover.
• Endovascular surgery. Doctors attach a synthetic graft to the end of a thin tube (catheter) that's inserted through an artery in your leg and threaded up into your aorta. The graft — a woven tube covered by a metal mesh support — is placed at the site of the aneurysm and fastened in place with small hooks or pins. The graft reinforces the weakened section of the aorta to prevent rupture of the aneurysm.
• Other heart surgeries. If another condition is contributing to your aneurysm's development, such as a problem with your heart's valves, your doctor may recommend additional surgeries to repair or replace the damaged valves to stop your aneurysm from worsening.

Emergency surgery
Although it's possible to repair a ruptured aortic aneurysm with emergency surgery, the risk is much higher and there is less chance of survival. Many people who have a ruptured aortic aneurysm die before they reach the hospital.

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Transient global amnesia

Transient global amnesia

Definition:
Transient global amnesia is a sudden, temporary episode of memory loss that can't be attributed to a more common neurological condition, such as epilepsy or stroke.

During an episode of transient global amnesia, your recall of recent events simply vanishes, so you can't remember where you are or how you got there. You may also draw a blank when asked to remember things that happened a day, a month or even a year ago. With transient global amnesia, you do remember who you are, and recognize the people you know well, but that doesn't make your memory loss less disturbing.

Fortunately, transient global amnesia is rare, seemingly harmless and unlikely to happen again. Episodes are usually short-lived, and afterward your memory is fine.


Symptoms:
Transient global amnesia is identified by its main symptom, which is the inability to form new memories and to recall the recent past. Once that symptom is confirmed, ruling out other possible causes of amnesia is important.
Necessary symptoms for diagnosis
Doctors base a diagnosis of transient global amnesia on the following signs and symptoms:

• Sudden onset of memory loss, verified by a witness
• Retention of personal identity despite memory loss
• Normal cognition, such as the ability to recognize and name familiar objects and follow simple directions
• Absence of signs indicating damage to a particular area of the brain, such as limb paralysis, involuntary movement or impaired word recognition
• Duration of no more than 24 hours
• Gradual return of memory
• No evidence of seizures during the period of amnesia
• No history of active epilepsy or recent head injury

Along with these signs and symptoms, a common feature of transient global amnesia includes repetitive questioning, usually of the same question — for example, "What am I doing here?" or "How did we get here?"

When to see a doctor
Seek immediate medical attention for anyone who quickly goes from normal awareness of present reality to confusion about what just happened. If the person experiencing memory loss is too disoriented to call an ambulance, call one yourself.

Although transient global amnesia isn't harmful, there's no easy way to distinguish the condition from the life-threatening illnesses that can also cause sudden memory loss. In fact, sudden amnesia is much more likely to be caused by a stroke or a seizure than by transient global amnesia. A medical evaluation is the only way to determine the cause of sudden memory loss.


Causes:
The underlying cause of transient global amnesia is unknown. There appears to be a link between transient global amnesia and a history of migraines, though the underlying factors that contribute to both conditions aren't fully understood.

Some commonly reported events that may trigger transient global amnesia include:

• Sudden immersion in cold or hot water
• Strenuous physical activity
• Sexual intercourse
• Medical procedures, such as angiography or endoscopy
• Mild head trauma
• Acute emotional distress, as might be provoked by bad news, conflict or overwork

Complications:
Transient global amnesia has no direct complications, but it can cause emotional distress. If you have an episode, the gap in your memory can be unsettling, and you're likely to worry about a recurrence. Also, a symptom as dramatic as memory loss often heralds a serious underlying disease. Transient global amnesia is an exception, but it can be hard to let go of the fear that you have a tumor or had a stroke.

If you need reassurance, ask your doctor to go over the results of your neurological exam and diagnostic tests with you. A counselor or psychotherapist can help you deal with persistent anxiety. Importantly, transient global amnesia is not a risk factor for stroke.

Treatments and drugs:
No treatment is needed for transient global amnesia. It resolves on its own and has no confirmed aftereffects. 

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Thalassemia

Thalassemia

Definition:
Thalassemia (thal-uh-SEE-me-uh) is an inherited blood disorder characterized by less hemoglobin and fewer red blood cells in your body than normal. Several types of thalassemia exist, including alpha-thalassemia, beta-thalassemia, Cooley's anemia and Mediterranean anemia.

Hemoglobin is the substance in your red blood cells that allows them to carry oxygen. The low hemoglobin and fewer red blood cells of thalassemia may cause anemia, leaving you fatigued.
If you have mild thalassemia, you may not need treatment. But, if you have a more severe form of thalassemia, you may need regular blood transfusions. You can also take steps on your own to cope with fatigue, such as choosing a healthy diet and exercising regularly.

Symptoms:
Signs and symptoms of thalassemia include:

• Fatigue
• Weakness
• Shortness of breath
• Pale appearance
• Irritability
• Yellow discoloration of skin (jaundice)
• Facial bone deformities
• Slow growth
• Abdominal swelling
• Dark urine

The signs and symptoms you experience depend on the type and severity of thalassemia you have. Some babies show signs and symptoms of thalassemia at birth, while others may develop signs or symptoms during the first two years of life. Some people who have only one affected hemoglobin gene don't experience any thalassemia symptoms.

When to see a doctor
Make an appointment with your child's doctor for an evaluation if he or she has any signs or symptoms that worry you.


Causes:
Thalassemia is caused by mutations in the DNA of cells that make hemoglobin — the substance in your red blood cells that carries oxygen throughout your body. The mutations associated with thalassemia are passed from parents to children.
The mutations that cause thalassemia disrupt the normal production of hemoglobin and cause low hemoglobin levels and a high rate of red blood cell destruction, causing anemia. When you're anemic, your blood doesn't have enough red blood cells to carry oxygen to your tissues — leaving you fatigued.

Types of thalassemia
The type of thalassemia you have depends on the number of gene mutations you inherit from your parents and which part of the hemoglobin molecule is affected by the mutations. The more mutated genes, the more severe your thalassemia. Hemoglobin molecules are made of alpha and beta parts that can be affected by mutations.

Alpha-thalassemia
Four genes are involved in making the alpha hemoglobin chain. You get two from each of your parents. If you inherit:

• One mutated gene, you'll have no signs or symptoms of thalassemia. But, you're a carrier of the disease and can pass it on to your children.
• Two mutated genes, your thalassemia signs and symptoms will be mild. This condition may be called alpha-thalassemia minor, or you may be told you have an alpha-thalassemia trait.
• Three mutated genes, your signs and symptoms will be moderate to severe. This condition is also called hemoglobin H disease.
• Four mutated genes, the condition is called alpha-thalassemia major or hydrops fetalis. It usually causes a fetus to die before delivery or a newborn to die shortly after birth.

Beta-thalassemia
Two genes are involved in making the beta hemoglobin chain. You get one from each of your parents. If you inherit:

• One mutated gene, you'll have mild signs and symptoms. This condition is called beta-thalassemia minor or referred to as a beta-thalassemia trait.
• Two mutated genes, your signs and symptoms will be moderate to severe. This condition is called beta-thalassemia major or Cooley's anemia. Babies born with two defective beta hemoglobin genes usually are healthy at birth, but develop signs and symptoms within the first two years of life.

Complications:
Possible complications of thalassemia include:

• Iron overload. People with thalassemia can get too much iron in their bodies, either from the disease itself or from frequent blood transfusions. Too much iron can result in damage to your heart, liver and endocrine system, which includes glands that produce hormones that regulate processes throughout your body.
• Infection. People with thalassemia have an increased risk of infection. This is especially true if you've had your spleen removed.

In cases of severe thalassemia, the following complications can occur:

• Bone deformities. Thalassemia can make your bone marrow expand, which causes your bones to widen. This can result in abnormal bone structure, especially in your face and skull. Bone marrow expansion also makes bones thin and brittle, increasing the chance of broken bones.
• Enlarged spleen (splenomegaly). The spleen helps your body fight infection and filter unwanted material, such as old or damaged blood cells. Thalassemia is often accompanied by the destruction of a large number of red blood cells, making your spleen work harder than normal, causing it to enlarge. Splenomegaly can make anemia worse, and it can reduce the life of transfused red blood cells. If your spleen grows too big, it may need to be removed.
• Slowed growth rates. Anemia can cause a child's growth to slow. Puberty also may be delayed in children with thalassemia.
• Heart problems. Heart problems, such as congestive heart failure and abnormal heart rhythms (arrhythmias), may be associated with severe thalassemia.

Treatments and drugs:

Treatment for thalassemia depends on which type you have and how severe it is.

Treatments for mild thalassemia
Signs and symptoms are usually mild with thalassemia minor and little, if any, treatment is needed. Occasionally, you may need a blood transfusion, particularly after surgery, after having a baby or to help manage thalassemia complications.

Treatment for moderate to severe thalassemia
Treatments for moderate to severe thalassemia may include:

• Frequent blood transfusions. More-severe forms of thalassemia often require frequent blood transfusions, possibly every few weeks. Over time, blood transfusions cause a buildup of iron in your blood, which can damage your heart, liver and other organs. To help your body get rid of the extra iron, you may need to take medications that rid your body of extra iron.
• Stem cell transplant. Also called a bone marrow transplant, a stem cell transplant may be used to treat severe thalassemia in select cases. Prior to a stem cell transplant, you receive very high doses of drugs or radiation to destroy your diseased bone marrow. Then you receive infusions of stem cells from a compatible donor. However, because these procedures have serious risks, including death, they're generally reserved for people with the most severe disease who have a well-matched donor available — usually a sibling.

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Tetralogy of Fallot

Tetralogy of Fallot

Definition:
Tetralogy of Fallot (teh-tral-uh-je ov fuh-LOE) is a rare condition caused by a combination of four heart defects that are present at birth. These defects, which affect the structure of the heart, cause oxygen-poor blood to flow out of the heart and into the rest of the body. Infants and children with tetralogy of Fallot usually have blue-tinged skin because their blood doesn't carry enough oxygen.

Tetralogy of Fallot is often diagnosed during infancy or soon after. However, tetralogy of Fallot may not be detected until later in life, depending on the severity of the defects and symptoms. With early diagnosis followed by appropriate treatment, most children with tetralogy of Fallot live relatively normal lives, though they'll need regular medical care and may have restrictions on exercise.


Symptoms:
Tetralogy of Fallot symptoms vary, depending on the extent of obstruction of blood flow out of the right ventricle and into the lungs. Signs and symptoms may include:

• A bluish coloration of the skin caused by blood low in oxygen (cyanosis)
• Shortness of breath and rapid breathing, especially during feeding
• Loss of consciousness (fainting)
• Clubbing of fingers and toes — an abnormal, rounded shape of the nail bed
• Poor weight gain
• Tiring easily during play
• Irritability
• Prolonged crying
• A heart murmur

Tet spells
Sometimes, babies with tetralogy of Fallot will suddenly develop deep blue skin, nails and lips after crying, feeding, having a bowel movement, or kicking his or her legs upon awakening. These episodes are called Tet spells and are caused by a rapid drop in the amount of oxygen in the blood. Toddlers or older children may instinctively squat when they are short of breath. Squatting increases blood flow to the lungs. Tet spells are more common in young infants, around 2 to 4 months old.

When to see a doctor
Seek medical help if you notice that your baby has the following symptoms:

• Difficulty breathing
• Bluish discoloration of the skin
• Passing out or seizures
• Weakness
• Unusual irritability

If your baby becomes blue (cyanotic), immediately place your child on his or her side and pull the knees up to the chest. This helps increase blood flow to the lungs. Call 911 or your local emergency number immediately.


Causes:
Tetralogy of Fallot occurs during fetal growth, when the baby's heart is developing. While factors such as poor maternal nutrition, viral illness or genetic disorders may increase the risk of this condition, in most cases the cause of tetralogy of Fallot is unknown.
The four abnormalities that make up the tetralogy of Fallot include:

• Pulmonary valve stenosis. This is a narrowing of the pulmonary valve, the flap that separates the right ventricle of the heart from the pulmonary artery, the main blood vessel leading to the lungs. Constriction of the pulmonary valve reduces blood flow to the lungs. The narrowing may also affect the muscle beneath the pulmonary valve.

• Ventricular septal defect. This is a hole in the wall that separates the two lower chambers (ventricles) of the heart. The hole allows deoxygenated blood in the right ventricle — blood that has circulated through the body and is en route to the lungs to replenish its oxygen supply — to flow into the left ventricle and mix with oxygenated blood fresh from the lungs. Blood from the left ventricle also flows back to the right ventricle in an inefficient manner. This ability for blood to flow through the ventricular septal defect dilutes the supply of oxygenated blood to the body and eventually can weaken the heart.
• Overriding aorta. Normally the aorta, the main artery leading out to the body, branches off the left ventricle. In tetralogy of Fallot, the aorta is shifted slightly to the right and lies directly above the ventricular septal defect. In this position the aorta receives blood from both the right and left ventricles, mixing the oxygen-poor blood from the right ventricle with the oxygen-rich blood from the left ventricle.
• Right ventricular hypertrophy. When the heart's pumping action is overworked, it causes the muscular wall of the right ventricle to enlarge and thicken. Over time this may cause the heart to stiffen, become weak and eventually fail.

Rarely, some babies who have tetralogy of Fallot will have a hole between their heart's upper chambers (atrial septal defect), as well. When this occurs, the condition is known as pentalogy of Fallot.


Complications:

All babies with tetralogy of Fallot need corrective surgery. Without treatment, your baby may not grow and develop properly. He or she is also at increased risk of serious complications, such as infective endocarditis, an inflammation of the inner lining of the heart caused by a bacterial infection.
Untreated cases of tetralogy of Fallot usually develop severe complications over time, which may result in death or disability by early adulthood.

Treatments and drugs:

Surgery is the only effective treatment for tetralogy of Fallot. There are two types of surgery that may be performed, including intracardiac repair or a temporary procedure that uses a shunt. Most babies and children will have intracardiac repair.

Intracardiac repair
Tetralogy of Fallot treatment for most babies involves a type of open-heart surgery called intracardiac repair. This surgery is typically performed during the first year of life. During this procedure, the surgeon places a patch over the ventricular septal defect to close the hole between the ventricles. He or she also repairs the narrowed pulmonary valve and widens the pulmonary arteries to increase blood flow to the lungs. After intracardiac repair, the oxygen level in the blood increases and your baby's
symptoms will lessen.

Temporary surgery
Occasionally babies need to undergo a temporary surgery before having intracardiac repair. If your baby was born prematurely or has pulmonary arteries that are underdeveloped (hypoplastic), doctors will create a bypass (shunt) between the aorta and pulmonary artery. This bypass increases blood flow to the lungs. When your baby is ready for intracardiac repair, the shunt is removed.

After the surgery
While most babies do well after intracardiac repair, complications are possible. Possible complications are chronic pulmonary regurgitation, in which blood leaks through the pulmonary valve, and an irregular heartbeat (arrhythmia). Sometimes blood flow to the lungs is still restricted after intracardiac repair. Infants and children with these complications may require another surgery, and in some cases, their pulmonary valves may be replaced by artificial valves. Pulmonary valve replacement sometimes isn't necessary until decades after the original surgery. In addition, as with any surgery, there's a risk of infection, unexpected bleeding or blood clots. Arrhythmias are usually treated with medication, but some people may need a pacemaker or implantable defibrillator later in life. Complications can continue throughout childhood, adolescence and adulthood. Your child will need lifelong medical follow-up to monitor for and treat any complications.

Ongoing care
After surgery your baby will require continuing care. Your doctor will schedule routine checkups with your child to make sure that the procedure was successful and to monitor for any new problems.
Your doctor may also recommend that your child limit physical activity. However, if surgery was completely successful and there's no pulmonary valve leakage or obstruction, your child may not have any activity restrictions.

Sometimes, doctors recommend that your child take antibiotics during dental procedures to prevent infections that may cause endocarditis, an inflammation of the lining of the heart. Although, in cases where the heart was completely repaired, your child may not need preventive antibiotics. Preventive antibiotics are, however, recommended specifically for those who have artificial valves or who've had repair with prosthetic material. Ask your cardiologist what's right for your child.

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Tetanus

Tetanus

Definition:
Tetanus is a serious bacterial disease that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles. Tetanus can interfere with your ability to breathe and, ultimately, threaten your life. Tetanus is commonly known as "lockjaw."

Thanks to the tetanus vaccine, cases of tetanus are rare in the United States and the developed world. The incidence of tetanus is much higher in less-developed countries. Around a million cases occur worldwide each year.

Tetanus can be treated, but not always effectively. Fatality is highest in individuals who haven't been immunized and in older adults with inadequate immunization — wherever they may live. In countries with low vaccine rates, infants also are at high risk of severe illness and death.

Symptoms:
Signs and symptoms of tetanus may appear anytime from a few days to several weeks after tetanus bacteria enter your body through a wound. The average incubation period is seven to eight days.
Common signs and symptoms of tetanus, in order of appearance, are:

• Spasms and stiffness in your jaw muscles
• Stiffness of your neck muscles
• Difficulty swallowing
• Stiffness of your abdominal muscles
• Painful body spasms, lasting for several minutes, typically triggered by minor occurrences, such as a draft, loud noise, physical touch or light

Other signs and symptoms may include:

• Fever
• Sweating
• Elevated blood pressure
• Rapid heart rate

When to see a doctor
See your doctor to obtain a tetanus booster shot if you have a deep or dirty wound and you haven't had a booster shot within the past five years or aren't sure of your vaccination status. Or see your doctor about a tetanus booster for any wound — especially if it may have been contaminated with dirt, animal feces or manure — if you haven't had a booster shot within the past 10 years or aren't sure of your vaccination status.

Causes:
The bacteria that cause tetanus, Clostridium tetani, are found in soil, dust and animal feces. When they enter a deep flesh wound, spores of the bacteria may produce a powerful toxin, tetanospasmin, which actively impairs your motor neurons, nerves that control your muscles. The effect of the toxin on your nerves can cause muscle stiffness and spasms — the major signs of tetanus.

Complications:
Once tetanus toxin has bonded to your nerve endings it is impossible to remove. Complete recovery from a tetanus infection requires the growth of new nerve endings and can take up to several months.
Complications of tetanus infection may include:

• Disability. Treatment for tetanus typically involves the use of powerful sedatives to control muscle spasms. Prolonged immobility due to the use of these drugs can lead to permanent disability. In infants, tetanus infections may cause lasting brain damage, ranging from minor mental deficits to cerebral palsy.
• Death. Severe tetanus-induced (tetanic) muscle spasms can interfere with your breathing, causing periods in which you can't breathe at all. Respiratory failure is the most common cause of death. Lack of oxygen may also induce cardiac arrest and death. Pneumonia is another cause of death. 

Treatments and drugs:
Since there's no cure for tetanus, treatment consists of wound care, medications to ease symptoms and supportive care.

Wound care
Cleaning the wound is essential to preventing growth of tetanus spores. This involves removing dirt, foreign objects and dead tissue from the wound.

Medications

• Antitoxin. Your doctor may give you a tetanus antitoxin, such as tetanus immune globulin. However, the antitoxin can neutralize only toxin that hasn't yet bonded to nerve tissue.
• Antibiotics. Your doctor may also give you antibiotics, either orally or by injection, to fight tetanus bacteria.
• Vaccine. Having tetanus once doesn't make you immune to the bacteria afterward. So you'll need to receive a tetanus vaccine in order to prevent future tetanus infection.
• Sedatives. Doctors generally use powerful sedatives to control muscle spasms.
• Other drugs. Other medications, such as magnesium sulfate and certain beta blockers, may be used to help regulate involuntary muscle activity, such as your heartbeat and breathing. Morphine may be used for this purpose as well as sedation.

Supportive therapies
Tetanus infection often requires a long period of treatment in an intensive care setting. Since sedatives may result in shallow breathing, you may need to be supported temporarily by a ventilator.

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Testicular torsion

Testicular torsion

Definition:
Testicular torsion occurs when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum. The reduced blood flow causes sudden and often severe pain and swelling. Testicular torsion is most common between ages 12 and 16, but it can occur at any age, even before birth.

Testicular torsion usually requires emergency surgery. If treated within a few hours, the testicle can usually be saved. But waiting longer can cause permanent damage and may affect the ability to father children. When blood flow has been cut off for too long, a testicle may become so badly damaged it has to be removed.

Symptoms:
Signs and symptoms of testicular torsion include:

• Sudden or severe pain in the scrotum — the loose bag of skin under your penis that contains the testicles
• Swelling of the scrotum
• Abdominal pain
• Nausea and vomiting
• A testicle that's positioned higher than normal or at an unusual angle

When to see a doctor
Seek emergency care for sudden or severe testicle pain. Prompt treatment can prevent severe damage or loss of your testicle if the cause of the pain is testicular torsion.

You also need to seek prompt medical help if you've had sudden testicle pain that goes away without treatment. This can occur when a testicle twists and then untwists on its own (intermittent torsion and detorsion). Even though the testicle untwisted on its own, you still need to see a doctor because surgery is frequently needed to prevent the problem from happening again.


Causes:
Testicular torsion occurs when the testicle rotates on the spermatic cord, which brings blood to the testicle from the abdomen. If the testicle rotates several times, blood flow to it can be entirely blocked, causing damage more quickly.

Most males who get testicular torsion have an inherited trait that allows the testicle to rotate freely inside the scrotum. This inherited condition often affects both testicles. But not every male with the trait will have testicular torsion.

What causes testicular torsion is unknown. Signs and symptoms of testicular torsion may follow:

• Physical activity
• An injury to the scrotum
• Cold temperatures
• Rapid growth of the testis during puberty
• Sleep

Complications:
Testicular torsion can cause the following complications:

• Damage to or death of the testicle. When testicular torsion is not treated for several hours, blocked blood flow can cause permanent damage or death of the testicle. If the testicle is badly damaged, it has to be surgically removed.
• Inability to father children. In some cases, damage or loss of a testicle affects a man's ability to father children.

Treatments and drugs:
Surgery is required to correct testicular torsion. In some cases, the doctor may be able to untwist the testicle by pushing on the scrotum (manual detorsion), but you'll still need surgery to prevent torsion from occurring again.

Surgery for testicular torsion is usually done under general anesthesia, which means you won't be conscious. The surgery generally doesn't require a stay in the hospital. During surgery, your doctor will:

• Make a small cut in your scrotum
• Untwist your spermatic cord, if necessary
• Stitch one or usually both testicles to the inside of the scrotum to prevent rotation

The sooner the testicle is untwisted, the greater the chance it can be saved. The success rate is about 95 percent when treatment occurs within six hours, but declines steadily to about 20 percent after 24 hours.

Testicular torsion in newborns and infants
Testicular torsion may occur in newborns and infants, though it's rare. The infant's testicle may be hard, swollen or a darker color. Ultrasound may not detect reduced blood flow to the infant's scrotum, so surgery may be needed to confirm testicular torsion.

Treatment for testicular torsion in infants is controversial. If a boy is born with signs and symptoms of testicular torsion, it may be too late for emergency surgery to help. In some cases, the doctor may recommend a later, nonemergency surgery. But emergency surgery can sometimes save all or part of the testicle and can prevent torsion in the infant's other testicle. Treating testicular torsion in infants may prevent future problems with male hormone production and with fathering children.

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Testicular cancer

Testicular cancer

Definition  :
Testicular cancer occurs in the testicles (testes), which are located inside the scrotum, a loose bag of skin underneath the penis. The testicles produce male sex hormones and sperm for reproduction.
Compared with other types of cancer, testicular cancer is rare. But testicular cancer is the most common cancer in American males between the ages of 15 and 34.

Testicular cancer is highly treatable, even when cancer has spread beyond the testicle. Depending on the type and stage of testicular cancer, you may receive one of several treatments, or a combination. Regular testicular self-examinations can help identify growths early, when the chance for successful treatment of testicular cancer is highest.

Symptoms:
Signs and symptoms of testicular cancer include:

• A lump or enlargement in either testicle
• A feeling of heaviness in the scrotum
• A dull ache in the abdomen or groin
• A sudden collection of fluid in the scrotum
• Pain or discomfort in a testicle or the scrotum
• Enlargement or tenderness of the breasts

Cancer usually affects only one testicle.

When to see a doctor
See your doctor if you detect any pain, swelling or lumps in your testicles or groin area, especially if these signs and symptoms last longer than two weeks.

Causes:

It's not clear what causes testicular cancer in most cases. Doctors know that testicular cancer occurs when healthy cells in a testicle become altered. Healthy cells grow and divide in an orderly way to keep your body functioning normally. But sometimes some cells develop abnormalities, causing this growth to get out of control — these cancer cells continue dividing even when new cells aren't needed. The accumulating cells form a mass in the testicle.

Nearly all testicular cancers begin in the germ cells — the cells in the testicles that produce immature sperm. What causes germ cells to become abnormal and develop into cancer isn't known.

Treatments and drugs:
The options for treating your testicular cancer depend on several factors, including the type and stage of cancer, your overall health, and your own preferences. Treatment options may include:

Surgery
Surgery to remove your testicle (radical inguinal orchiectomy) is the primary treatment for nearly all stages and types of testicular cancer. To remove your testicle, your surgeon makes an incision in your groin and extracts the entire testicle through the opening. A prosthetic, saline-filled testicle can be inserted if you choose. You'll receive anesthetics during surgery. All surgical procedures carry a risk of pain, bleeding and infection.

You may also have surgery to remove the lymph nodes in your groin (retroperitoneal lymph node dissection). Sometimes this is done at the same time as surgery to remove your testicle. In other cases it can be done later. The lymph nodes are removed through a large incision in your abdomen. Your surgeon takes care to avoid severing nerves surrounding the lymph nodes, but in some cases severing the nerves may be unavoidable. Severed nerves can cause difficulty with ejaculation, but won't prevent you from having an erection.

In cases of early-stage testicular cancer, surgery may be the only treatment needed. Your doctor will give you a recommended schedule for follow-up appointments. At these appointments — typically every few months for the first few years and then less frequently after that — you'll undergo blood tests, CT scans and other procedures to check for signs that your cancer has returned. If you have a more advanced testicular cancer or if you're unable to adhere closely to the recommended follow-up schedule, your doctor may recommend other treatments after surgery.

Radiation therapy
Radiation therapy is a treatment option that's frequently used in people who have the seminoma type of testicular cancer. Radiation therapy is also used in certain situations in people who have the nonseminoma type of testicular cancer. Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. During radiation therapy, you're positioned on a table and a large machine moves around you, aiming the energy beams at precise points on your body. Side effects may include fatigue, as well as skin redness and irritation in your abdominal and groin areas.

Chemotherapy
Chemotherapy treatment uses drugs to kill cancer cells. Chemotherapy drugs travel throughout your body to kill cancer cells that may have migrated from the original tumor. Your doctor might recommend chemotherapy after surgery. Chemotherapy may be used before or after lymph node removal. Side effects of chemotherapy depend on the drugs being used. Ask your doctor what to expect. Common side effects include fatigue, nausea, hair loss, infertility and an increased risk of infection. There are medications and treatments available that reduce some of the side effects of chemotherapy.

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Retractile testicle

Retractile testicle

Definition  :

A retractile testicle is a testicle that may move back and forth between the scrotum and the groin. When the retractile testicle is residing in the groin, it may be easily guided by hand into its proper position in the scrotum — the bag of skin hanging behind the penis — during a physical examination.
For most boys, the problem of a retractile testicle goes away sometime before or during puberty, the time when an out-of-place testicle moves to its correct location in the scrotum and stays there permanently.

About a quarter of the time, the retractile testicle stays up in the groin and is no longer movable. When this happens, the condition is called an ascending testicle.

Symptoms:
Testicles form in the abdomen during fetal development. During the final months of development, the testicles gradually descend into the scrotum. If your son has a retractile testicle, the testicle originally descended as it should, but then it didn't remain in place.
Signs and symptoms of a retractile testicle include the following:

• The testicle may be moved by hand from the groin into the scrotum and won't immediately retreat to the groin.
• It may spontaneously appear in the scrotum and remain there for a time.
• It may spontaneously disappear again for a time.

The movement of the testicle almost always occurs without pain or discomfort. Therefore, a retractile testicle is noticed only when it is no longer seen or felt in the scrotum.

The position of one testicle is usually independent of the position of the other one. For example, a boy may have one normal testicle and one retractile testicle.

Retractile testicle is different from undescended testicle (cryptorchidism). The undescended testicle is one that never entered the scrotum. If a doctor attempted to guide an undescended testicle, it would
cause discomfort or pain.

When to see a doctor
During regular well-baby checkups and annual childhood checkups, your son's doctor examines your son's testicles to determine if they're descended and appropriately developed. If you believe that your son has a retractile or ascending testicle — or have other concerns about the development of his testicles — see his doctor. He or she will tell you how often to schedule checkups to monitor changes in the condition.

If your son experiences pain in the groin or testicles, see your son's doctor immediately.

Causes:

An overactive muscle causes a testicle to become a retractile testicle. The cremaster muscle is a thin pouch-like muscle in which a testicle rests. When the cremaster muscle contracts, it pulls the testicle up toward the body.

The main purpose of the cremaster muscle is to control the temperature of the testicle. In order for a testicle to develop and function properly, it needs to be slightly cooler than normal body temperature. When the environment is warm, the cremaster muscle is relaxed; when the environment is cold, the muscle contracts and draws the testicle toward the warmth of the body. The cremaster reflex can also be stimulated by rubbing the genitofemoral nerve on the inner thigh and by extreme emotion, such as anxiety.

If the cremaster reflex is strong enough, it can result in a retractile testicle, pulling the testicle out of the scrotum and up into the groin.

Causes of an ascending testicle
A small percentage of retractile testicles can become ascending testicles. This means the once-movable testicle becomes stuck in the "up position." Contributing factors may be:

• Short spermatic cord. Each testicle is attached to the end of the spermatic cord, which extends down from the groin and into the scrotum. The cord houses blood vessels, nerves and the tube that carries semen from the testicle to the penis. If growth of the spermatic cord doesn't keep pace with other body growth, the "tight" cord may pull the testicle up.
• A problem with the normal path of a descending testicle. The testicles develop in the abdomen during pregnancy, then drop down into the scrotum. Sometimes part of the fetal structure fails to detach from the abdomen, resulting in an upward pull on the testicle.
• Scar tissue from hernia surgery. An inguinal hernia is caused by a small gap in the abdominal lining through which a portion of the intestines can protrude into the groin. Scar tissue following surgery to repair the hernia may limit the growth or elasticity of the spermatic

Complications:
Retractile testicles are not associated with any ill effects, aside from a greater risk of the testicle becoming an ascending testicle.

Treatments and drugs :

A retractile testicle is likely to descend on its own before or during puberty. If your son has a retractile testicle, your son's doctor will monitor any changes in the testicle's position in annual evaluations to determine if it stays in the scrotum, remains retractile or becomes an ascending testicle.

If the testicle has ascended — no longer movable by hand — or if it's still retractile by age 14, your son's doctor may recommend treatment to move the testicle permanently into the scrotum. Treatments include:

• Surgery. In a surgical procedure (orchiopexy), the surgeon guides the testicle to its proper position in the scrotum and stitches it into place. Follow-up exams are usually recommended. Ask your child's doctor how often he needs to be seen.
• Hormone therapy. Because descent of the testicle is partially regulated by hormones, descent can sometimes be induced with hormone therapy using human chorionic gonadotropin (HCG) injections.

Adolescent boys and men who have had treatments to correct an ascending or retractile testicle should regularly monitor the position of the testicle to ensure it doesn't ascend at a later time.

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De Quervain's tenosynovitis

De Quervain's tenosynovitis

Definition:
De Quervain's tenosynovitis (dih-kwer-VAINS ten-oh-sine-oh-VIE-tis) is a painful condition affecting the tendons on the thumb side of your wrist. If you have de Quervain's tenosynovitis, it will probably hurt every time you turn your wrist, grasp anything or make a fist.

Although the exact cause of de Quervain's tenosynovitis isn't known, any activity that relies on repetitive hand or wrist movement — such as working in the garden, playing golf or racket sports or lifting your baby — can make it worse.

Symptoms:
Symptoms of de Quervain's tenosynovitis include:

• Pain near the base of your thumb
• Swelling near the base of your thumb
• Difficulty moving your thumb and wrist when you're doing activities that involve grasping or pinching
• A "sticking" or "stop-and-go" sensation in your thumb when trying to move it

If the condition goes too long without treatment, the pain may spread farther into your thumb, back into your forearm or both. Pinching, grasping and other movements of your thumb and wrist aggravate the pain.

When to see a doctor
Consult your doctor if you're still having problems with pain or function and you've already tried:

• Avoiding moving your thumb in the same way over and over again whenever possible
• Avoiding pinching with your thumb when moving your wrist from side to side
• Applying cold to the affected area
• Using nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve)

If the pain continues to interfere with your daily life or activities, seek medical advice.

Causes:
Chronic overuse of your wrist is commonly associated with de Quervain's tenosynovitis.
When you grip, grasp, clench, pinch or wring anything in your hand, you use two major tendons in your wrist and lower thumb. These tendons normally glide unhampered through the small tunnel that connects them to the base of the thumb. If you repeat a particular motion day after day, it may irritate the sheath around the two tendons, causing thickening that restricts the movement of the tendons.
Other causes of de Quervain's tenosynovitis include:

• Direct injury to your wrist or tendon; scar tissue can restrict movement of the tendons
• Inflammatory arthritis, such as rheumatoid arthritis

Complications:
If de Quervain's tenosynovitis is left untreated, it may be hard to use your hand and wrist properly. If the affected tendons are no longer able to slide within their tunnel, you may develop a limited range of motion.

Treatments and drugs  :
Treatment for de Quervain's tenosynovitis may include medications, physical or occupational therapy, or surgery. Treatment is generally successful if begun early on, though the pain may recur if you can't discontinue the repetitive motions that aggravate your condition. If you start treatment early on, your symptoms of de Quervain's tenosynovitis should generally improve within four to six weeks. When de Quervain's tenosynovitis starts during pregnancy, symptoms usually get better around the end of pregnancy or when breast-feeding stops.

Medications
To reduce pain and swelling, your doctor may recommend using NSAIDs, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve).
Your doctor may also recommend injections of corticosteroid medications into the tendon sheath to reduce swelling. If treatment begins within the first six months of symptoms, most people recover completely after receiving corticosteroid injections, often after just one injection.

Therapy
Initial treatment of de Quervain's tenosynovitis may include:

• Immobilizing your thumb and wrist, keeping them straight with a splint or brace to help rest your tendons
• Avoiding repetitive thumb movements whenever possible
• Avoiding pinching with your thumb when moving your wrist from side to side
• Applying ice to the affected area

You may also see a physical or occupational therapist. These therapists may review your habits and give suggestions on how to make necessary adjustments to relieve stress on your wrists. Your therapist can also teach you exercises focused on your wrist, hand and arm to strengthen your muscles, reduce pain, and limit the irritation of the tendons. The therapist may also make a splint to keep your wrist and thumb from moving if off-the-shelf versions don't fit you well.

Surgery
If your case is more serious, your doctor may recommend outpatient surgery. Surgery involves a procedure in which your doctor inspects the sheath surrounding the involved tendon or tendons, and then opens the sheath to release the pressure and restore free tendon gliding.
Your doctor will talk to you about how to rest, strengthen and rehabilitate your body after surgery. A physical or occupational therapist may meet with you after surgery to teach you new strengthening exercises and help you adjust your daily routine to prevent future problems.

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Patellar tendinitis

Patellar tendinitis

Definition:
Patellar tendinitis is an injury that affects the tendon connecting your kneecap (patella) to your shinbone. The patellar tendon plays a pivotal role in the way you use your leg muscles. It helps your muscles extend your knee so that you can kick a ball, run uphill and jump up in the air.

Patellar tendinitis is most common in athletes whose sports involve frequent jumping — such as basketball and volleyball. For this reason, patellar tendinitis is commonly known as jumper's knee. However, even people who don't participate in jumping sports can experience patellar tendinitis.
For most people, treatment of patellar tendinitis begins with physical therapy to stretch and strengthen the muscles around the knee.

Symptoms:
Pain is the first symptom of patellar tendinitis. The pain usually is located in the section of your patellar tendon between your kneecap (patella) and the area where the tendon attaches to your shinbone (tibia).
The pain in your knee may:

• Initially be present only as you begin physical activity or just after an intense workout
• Progress to the point that it interferes with your sports performance
• Eventually interfere with daily tasks such as climbing stairs or getting up from a chair

When to see a doctor
If you experience knee pain, try self-care measures first, such as icing the affected area and temporarily reducing or avoiding activities that trigger your symptoms.
Call your doctor if your pain:

• Continues or worsens
• Interferes with your ability to perform routine daily activities
• Is associated with swelling or redness about the joint

Causes:
Patellar tendinitis is a common overuse injury. It occurs when you place repeated stress on your patellar tendon. The stress results in tiny tears in the tendon, which your body attempts to repair. But as the tears in the tendon become more numerous, they cause pain from inflammation and a weakening of the tendon structure. When this tendon damage persists over more than a few weeks, it is called tendinopathy.

Complications:
 If you try to work through your pain, ignoring the warning signs your body is sending you, you could cause larger and larger tears in the patellar tendon. Knee pain and reduced function can persist if the factors contributing to patellar tendinitis are not addressed, and you may progress to the more chronic state of patellar tendinopathy.

Treatments and drugs:

Doctors typically begin with less invasive treatments before considering other options, such as surgery.

Medications
Pain relievers such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others) may provide short-term relief from pain associated with patellar tendinitis.

Therapy
A variety of physical therapy techniques can help reduce the symptoms associated with patellar tendinitis, including:

• Stretching exercises. Regular, steady stretching exercises can reduce muscle spasm and help lengthen the muscle-tendon unit. Don't bounce during your stretch.
• Strengthening exercises. Weak thigh muscles contribute to the strain on your patellar tendon. Eccentric exercises, which involve lowering your leg very slowly after you extend your knee, are particularly helpful.
• Patellar tendon strap. A strap that applies pressure to your patellar tendon can help to distribute force away from the tendon itself and direct it through the strap instead. This may help relieve pain.
• Iontophoresis. This therapy involves spreading a corticosteroid medicine on your skin and then using a device that delivers a low electrical charge to push the medication through your skin.

Surgical and other procedures
If conservative treatments haven't helped, your doctor may suggest other therapies such as:

• Corticosteroid injection. An ultrasound-guided corticosteroid injection into the sheath around the patellar tendon may help relieve pain. But these types of drugs can also weaken tendons and make them more likely to rupture.
• Platelet-rich plasma injection. An injection of platelet-rich plasma has been tried in some people with chronic patellar tendon problems. Studies are ongoing. It is hoped the injections might promote new tissue formation and help heal tendon damage.
• Surgery. If conservative approaches aren't helping after many months of treatment, in rare cases your doctor might suggest surgical intervention for the patellar tendon. Some of these procedures can be accomplished through small incisions around your knee.

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Teen depression

Teen depression

Definition:

Teen depression is a serious medical problem that causes a persistent feeling of sadness and loss of interest in activities. It affects how your teen thinks, feels and behaves, and it can cause emotional, functional and physical problems. Although mood disorders, such as depression, can occur at any time in life, symptoms may be different between teens and adults.

Issues such as peer pressure, academic expectations and changing bodies can bring a lot of ups and downs for teens. But for some teens, the lows are more than just temporary feelings — they're a symptom of depression.

Teen depression isn't a weakness or something that can be overcome with willpower — it can have serious consequences and requires long-term treatment. For most teens, depression symptoms ease with treatment such as medication and psychological counseling.

Causes:

It's not known exactly what causes depression. A variety of factors may be involved. These include:

• Biological chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. When these chemicals are out of balance, it may lead to depression symptoms.
  
• Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression.
  
• Inherited traits. Depression is more common in people whose biological (blood) relatives also have the condition.
  
• Early childhood trauma. Traumatic events during childhood, such as physical or emotional abuse, or loss of a parent, may cause changes in the brain that make a person more susceptible to depression.
  
• Learned patterns of negative thinking. Teen depression may be linked to learning to feel helpless — rather than learning to feel capable of finding solutions for life's challenges.

Complications:

Untreated depression can result in emotional, behavioral and health problems that affect every area of your teen's life. Complications related to teen depression can include:

• Low self-esteem
• Alcohol and drug abuse
• Academic problems
• Family conflicts and relationship difficulties
• Social isolation
• Involvement with the juvenile justice system
• Suicide

Treatments and drugs:

Many types of treatment are available. In some cases, a primary care doctor can prescribe medications that relieve depression symptoms. However, many teens need to see a psychiatrist or psychologist or other mental health counselor. A combination of medications and psychological counseling (psychotherapy) is very effective for most teens with depression.

If your teen has severe depression or is in danger of self-harm, he or she may need a hospital stay or may need to participate in an outpatient treatment program until symptoms improve.
Here's a closer look at depression treatment options.

Medications
Because studies on the effects of antidepressants in teens are limited, doctors rely mainly on adult research when prescribing medications. The Food and Drug Administration (FDA) has approved two medications for teen depression — fluoxetine (Prozac) and escitalopram (Lexapro). However, as with adults, other medications may be prescribed at the doctor's discretion (off label), depending on your teen's needs.

Talk with your teen's doctor and pharmacist about possible side effects, weighing the benefits and risks. In some cases, side effects may go away as the body adjusts to the medication. 

Antidepressants and increased suicide risk
Although antidepressants are generally safe when taken as directed, the FDA requires that all antidepressants carry "black box" warnings, the strictest warnings for prescriptions. In some cases, children, adolescents and young adults under the age of 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. So, people in these age groups must be closely monitored by loved ones, caregivers and health care providers.

If your teen has suicidal thoughts while taking an antidepressant, immediately contact your doctor or get emergency help.

For most teens, the benefits of taking an antidepressant generally outweigh any possible risks. In the long run, antidepressants are likely to reduce suicidal thinking or behavior. 

Managing medications
Carefully monitor your teen's use of medications. To work properly, antidepressants need to be taken consistently at the prescribed dose. Because overdose can be a risk for teens with depression, your teen's doctor may prescribe only small supplies of pills at a time, or recommend that you dole out medication so that your teen does not have a large amount of pills available at once.

Finding the right medication
Everyone's different, so finding the right medication or dose for your teen may take some trial and error. This requires patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as the body adjusts.

If your teen has bothersome side effects, he or she shouldn't stop taking an antidepressant without talking to the doctor first. Some antidepressants can cause withdrawal symptoms unless the dose is slowly tapered off — quitting suddenly may cause a sudden worsening of depression. Encourage your teen not to give up.

If antidepressant treatment doesn't seem to be working, your teen's doctor may recommend a blood test called cytochrome P450 (CYP450) to check for specific genes that affect how the body processes antidepressants. This may help identify which antidepressant might be a good choice. However, these genetic tests have limitations and may not be widely available.

Antidepressants and pregnancy
If your teen is pregnant or breast-feeding, some antidepressants may pose an increased health risk to her unborn or nursing child. If your teen becomes pregnant or plans to become pregnant, make certain she talks to her doctor about antidepressant medications and managing depression during pregnancy.

Psychotherapy
Psychotherapy, also called psychological counseling or talk therapy, is a general term for treating depression by talking about depression and related issues with a mental health provider. Psychotherapy may be done one-on-one, with family members or in a group.

Through these regular sessions, your teen can learn about the causes of depression, how to identify and make changes in unhealthy behaviors or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals. Psychotherapy can help your teen regain a sense of happiness and control and help ease depression symptoms such as hopelessness and anger. It may also help your teen adjust to a crisis or other current difficulty.

Hospitalization and other treatment programs
In some teens, depression is so severe that a hospital stay is needed, especially if your teen is in danger of self-harm or hurting someone else. Getting psychiatric treatment at a hospital can help keep your teen calm and safe until symptoms are better managed. Day treatment programs also may help. These programs provide the support and counseling needed while your teen gets depression symptoms under control.

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Tuberculosis

Tuberculosis

Definition:

Tuberculosis (TB) is a potentially serious infectious disease that primarily affects your lungs. The bacteria that cause tuberculosis are spread from person to person through tiny droplets released into the air via coughs and sneezes.

Tuberculosis was once rare in developed countries, but the number of TB cases began increasing in 1985. Part of the increase was caused by the emergence of HIV, the virus that causes AIDS. HIV weakens a person's immune system so it can't fight the TB germs.

Many strains of tuberculosis can resist the effects of the drugs most commonly used to treat the disease. People who have active tuberculosis must take several different types of medications together for many months to eradicate the infection and prevent development of antibiotic resistance.

Symptoms:

Although your body may harbor the bacteria that cause tuberculosis, your immune system usually can prevent you from becoming sick. For this reason, doctors make a distinction between:

• Latent TB. In this condition, you have a TB infection, but the bacteria remain in your body in an inactive state and cause no symptoms. Latent TB, also called inactive TB or TB infection, isn't contagious.
  
• Active TB. This condition makes you sick and can spread to others. It can occur in the first few weeks after infection with the TB bacteria, or it might occur years later. Most people infected with TB germs never develop active TB.

Signs and symptoms of active TB include:

• Cough
• Unexplained weight loss
• Fatigue
• Fever
• Night sweats
• Chills
• Loss of appetite

What organs are affected?
Tuberculosis usually attacks your lungs. Signs and symptoms of TB of the lungs include:

• Coughing that lasts three or more weeks
• Coughing up blood
• Chest pain, or pain with breathing or coughing

But tuberculosis can also affect other parts of your body, including your kidneys, spine or brain. When TB occurs outside your lungs, symptoms vary according to the organs involved. For example, tuberculosis of the spine may give you back pain, and tuberculosis in your kidneys might cause blood in your urine.

When to see a doctor
See your doctor if you have a fever, unexplained weight loss, drenching night sweats or a persistent cough. These are often signs of TB, but they can also result from other medical problems. Your doctor can perform tests to help determine the cause.

Causes:

Tuberculosis is caused by bacteria that spread from person to person through microscopic droplets released into the air. This can happen when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings.

Although tuberculosis is contagious, it's not especially easy to catch. You're much more likely to get tuberculosis from someone you live with or work with than from a stranger. Most people with active TB who've had appropriate drug treatment for at least two weeks are no longer contagious.

HIV and TB
Since the 1980s, the number of cases of tuberculosis has increased dramatically because of the spread of HIV, the virus that causes AIDS. Tuberculosis and HIV have a deadly relationship — each drives the progress of the other.

Infection with HIV suppresses the immune system, making it difficult for the body to control TB bacteria. As a result, people with HIV are many times more likely to get TB and to progress from latent to active disease than are people who aren't HIV-positive.

Drug-resistant TB
Another reason tuberculosis remains a major killer is the increase in drug-resistant strains of the bacterium. Ever since the first antibiotics were used to fight tuberculosis 60 years ago, the germ has developed the ability to survive attack, and that ability gets passed on to its descendants. Drug-resistant strains of tuberculosis emerge when an antibiotic fails to kill all of the bacteria it targets. The surviving bacteria become resistant to that particular drug and frequently other antibiotics as well.


Complications:

Without treatment, tuberculosis can be fatal. Untreated active disease typically affects your lungs, but it can spread to other parts of the body through your bloodstream. Examples include:

• Bones. Spinal pain and joint destruction may result from TB that infects your bones. In many cases, the ribs are affected.
  
• Brain. Tuberculosis in your brain can cause meningitis, a sometimes fatal swelling of the membranes that cover your brain and spinal cord.
  
• Liver or kidneys. Your liver and kidneys help filter waste and impurities from your bloodstream. These functions become impaired if the liver or kidneys are affected by tuberculosis.
  
• Heart. Tuberculosis can infect the tissues that surround your heart, causing inflammation and fluid collections that may interfere with your heart's ability to pump effectively. This condition, called cardiac tamponade, can be fatal.

Treatments and drugs:

Medications are the cornerstone of tuberculosis treatment. But treating TB takes much longer than treating other types of bacterial infections. With tuberculosis, you must take antibiotics for at least six to nine months. The exact drugs and length of treatment depend on your age, overall health, possible drug resistance, the form of TB (latent or active) and its location in the body.

Most common TB drugs
If you have latent tuberculosis, you may need to take just one type of TB drug. Active tuberculosis, particularly if it's a drug-resistant strain, will require several drugs at once. The most common medications used to treat tuberculosis include:

• Isoniazid
• Rifampin (Rifadin, Rimactane)
• Ethambutol (Myambutol)
• Pyrazinamide

Medication side effects
Side effects of TB drugs aren't common but can be serious when they do occur. All tuberculosis medications can be highly toxic to your liver. When taking these medications, call your doctor immediately if you experience any of the following:

• Nausea or vomiting
• Loss of appetite
• A yellow color to your skin (jaundice)
• Dark urine
• A fever that lasts three or more days and has no obvious cause

Completing treatment is essential
After a few weeks, you won't be contagious and you may start to feel better. It might be tempting to stop taking your TB drugs. But it is crucial that you finish the full course of therapy and take the medications exactly as prescribed by your doctor. Stopping treatment too soon or skipping doses can allow the bacteria that are still alive to become resistant to those drugs, leading to TB that is much more dangerous and difficult to treat.

To help people stick with their treatment, a program called directly observed therapy (DOT) is sometimes recommended. In this approach, a health care worker administers your medication so that you don't have to remember to take it on your own.

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Tapeworm infection

Tapeworm infection

Definition:

Tapeworm infection is caused by ingesting food or water contaminated with tapeworm eggs or larvae. If you ingest certain tapeworm eggs, they can migrate outside your intestines and form larval cysts in body tissues and organs (invasive infection). If you ingest tapeworm larvae, however, they develop into adult tapeworms in your intestines (intestinal infection).

An adult tapeworm consists of a head, neck and chain of segments called proglottids. When you have an intestinal tapeworm infection, the tapeworm head adheres to the intestine wall, and the proglottids grow and produce eggs. Adult tapeworms can live for up to 20 years in a host. Intestinal tapeworm infections are usually mild, but invasive larval infections can cause serious complications.


Tapeworm infection:

Many people with intestinal tapeworm infection have no symptoms. If you do feel the effects, your symptoms will depend on the type of tapeworm you have and its location. Invasive tapeworm infection symptoms vary depending on where the larvae have migrated.

Intestinal infection
Signs and symptoms of intestinal infection include:

• Nausea
• Weakness
• Loss of appetite
• Abdominal pain
• Diarrhea
• Weight loss and inadequate absorption of nutrients from food

Invasive infection
If tapeworm larvae have migrated out of your intestines and formed cysts in other tissues, they can eventually cause organ and tissue damage, resulting in:

• Fever
• Cystic masses or lumps
• Allergic reactions to the larvae
• Bacterial infections
• Neurological symptoms, including seizures

When to see a doctor
If you experience any of the signs or symptoms of tapeworm infection, seek medical attention.


Causes:

A tapeworm infection starts after ingestion of tapeworm eggs or larvae.

• Ingestion of eggs. If you eat food or drink water contaminated with feces from a person or animal with tapeworm, you ingest microscopic tapeworm eggs. For example, a pig infected with tapeworm will pass tapeworm eggs in its feces, which gets into the soil. If this same soil comes in contact with a food or water source, it becomes contaminated. You can then be infected when you eat or drink something from the contaminated source. Once inside your intestines, the eggs develop into larvae. At this stage, the larvae become mobile. If they migrate out of your intestines, they form cysts in other tissues, such as your lungs, central nervous system or liver.
  
• Ingestion of larvae cysts in meat or muscle tissue. When an animal has a tapeworm infection, it has tapeworm larvae in its muscle tissue. If you eat raw or undercooked meat from an infected animal, you ingest the larvae, which then develop into adult tapeworms in your intestines. Adult tapeworms can measure up to 50 feet (15.2 meters) long and can survive as long as 20 years in a host. Some tapeworms attach themselves to the walls of the intestines, where they cause irritation or mild inflammation, while others may pass through to your stool and exit your body. 

Complications:

Intestinal tapeworm infections usually aren't complicated. The complications that do sometimes develop include:

• Digestive blockage. If tapeworms grow large enough, they can block your appendix, leading to infection (appendicits); your bile ducts, which carry bile from your liver and gallbladder to your intestine; or your pancreatic duct, which carries digestive fluids from your pancreas to your intestine.
  
• Brain and central nervous system impairment. Called neurocysticercosis (noor-o-sis-tih-sur-KOE-sis), this especially dangerous complication of invasive pork tapeworm infection can result in headaches and visual impairment, as well as seizures, meningitis, hydrocephalus or dementia. Death can occur in severe cases of infection.
  
• Organ function disruption. When larvae migrate to the liver, lungs or other organs, they become cysts. Over time, these cysts grow, sometimes large enough to crowd the functioning parts of the organ or reduce its blood supply. Tapeworm cysts sometimes rupture, releasing more larvae, which can move to other organs and form additional cysts. A ruptured or leaking cyst can cause an allergy-like reaction, with itching, hives, swelling and difficulty breathing. Surgery or organ transplantation may be needed in severe cases. 

Treatments and drugs:

Some people with tapeworm infections never need treatment, for the tapeworm exits the body on its own. Others don't realize they have it because they have no symptoms. However, if you're diagnosed with intestinal tapeworm infection, medication will likely be prescribed to get rid of it.

Treatments for intestinal infections
The most common treatment for tapeworm infection involves oral medications that are toxic to the adult tapeworm, including:

• Praziquantel (Biltricide)
• Albendazole (Albenza)
• Nitazoxanide (Alinia)

Which medication your doctor prescribes depends on the species of tapeworm involved and the site of the infection. These drugs target the adult tapeworm, not the eggs, so it's important to avoid reinfecting yourself. Always wash your hands after using the toilet and before eating.

To be certain that your tapeworm infection has cleared, your doctor will probably have your stool samples checked at certain intervals after you've finished taking your medication. Successful treatment — meaning that your stool is free of tapeworm eggs, larvae or proglottids — is most likely if you receive appropriate treatment for the type of tapeworm causing your infection.

Treatments for invasive infections
Treating an invasive infection depends on the location and effects of the infection.

• Anthelmintic drugs. Albendazole (Albenza) can shrink some tapeworm cysts. Your doctor may monitor the cysts periodically using imaging studies such as ultrasound or X-ray to be sure the drug is effective.
  
• Anti-inflammatory therapy. Dying tapeworm cysts can cause swelling or inflammation in tissues or organs, so your doctor may recommend prescription corticosteroid medication, such as prednisone or dexamethasone, to reduce inflammation.
  
• Anti-epileptic therapy. If the disease is causing seizures, anti-epileptic medications can stop them.
  
• Shunt placement. One type of invasive infection can cause too much fluid on the brain, called hydrocephalus. Your doctor may recommend placing a permanent shunt, or tube, in your head to drain the fluid.
  
• Surgery. Whether cysts can be removed surgically depends on their location and symptoms. Cysts that develop in the liver, lungs and eyes are typically removed, since they can eventually threaten organ function. Your doctor might recommend a drainage tube as an alternative to surgery. The tube allows aggressive rinsing (irrigation) of the area with anti-parasitic solutions.

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