Thyroid nodules

Thyroid nodules

Definition  :
Thyroid nodules are solid or fluid-filled lumps that form within your thyroid, a small gland located at the base of your neck, just above your breastbone.

The great majority of thyroid nodules aren't serious and don't cause symptoms. Thyroid cancer accounts for a small percentage of thyroid nodules.

You often won't know you have a thyroid nodule until your doctor discovers it during a routine medical exam. Some thyroid nodules, however, may become large enough to press on your windpipe, making it uncomfortable or difficult to swallow.

Treatment options depend on the type of thyroid nodule that you have.

Symptoms:
Most thyroid nodules don't cause signs or symptoms. Occasionally, however, some nodules become so large that they can:

• Be felt
• Be seen, often as a swelling at the base of your neck
• Press on your windpipe or esophagus, causing shortness of breath or difficulty swallowing

In some cases, thyroid nodules produce additional thyroxine, a hormone secreted by your thyroid gland. The extra thyroxine can cause problems such as:

• Sudden, unexplained weight loss
• Nervousness
• Rapid or irregular heartbeat

A few thyroid nodules are cancerous (malignant) but it's difficult to tell which nodules are malignant by symptoms alone. Although size isn't a predictor of whether a nodule is malignant or not, cancerous thyroid tumors are more likely to be large fixed masses that grow quickly.

When to see a doctor
Although most thyroid nodules are noncancerous (benign) and don't cause problems, ask your doctor to evaluate any unusual swelling in your neck, especially if you have trouble breathing or swallowing. It's important to eliminate the possibility of cancer.
Also seek medical care if you develop signs and symptoms of hyperthyroidism, such as:

• Sudden weight loss even though your appetite is normal or has increased
• A pounding heart
• Trouble sleeping
• Muscle weakness
• Nervousness or irritability

Causes:
Several conditions can cause one or more nodules to develop in your thyroid gland:

• Iodine deficiency. Lack of iodine in your diet can sometimes cause your thyroid gland to produce thyroid nodules. But iodine deficiency is uncommon in the United States, where iodine is routinely added to table salt and other foods.
• Overgrowth of normal thyroid tissue. Why this occurs isn't clear but such growth — which is sometimes referred to as a thyroid adenoma — is generally noncancerous (benign) and isn't considered serious unless it's bothersome or causes complications. Some thyroid adenomas (autonomous or hyperfunctioning thyroid nodules) produce thyroid hormones outside of your pituitary gland's normal regulatory influence, leading to an overproduction of thyroid hormones (hyperthyroidism).
• Thyroid cyst. Fluid-filled cavities (cysts) in the thyroid most commonly result from degenerating thyroid adenomas. Often, solid components are mixed with fluid in thyroid cysts. Cysts are usually benign, but they occasionally contain malignant solid components.
• Chronic inflammation of the thyroid (thyroiditis). Hashimoto's disease, a thyroid disorder, can cause thyroid inflammation and enlargement, and reduce thyroid gland activity (hypothyroidism).
• Multinodular goiter. "Goiter" is a term used to describe any enlargement of the thyroid gland, which can be caused by iodine deficiency or a thyroid disorder. A multinodular goiter contains multiple distinct nodules within the goiter but its cause is less clear.
• Thyroid cancer. Although the chances that a nodule is malignant are small, you're at higher risk if you have a family history of thyroid or other endocrine cancers, are younger than 30 or older than 60, are a man, or have a history of radiation exposure, particularly to the head and neck. A nodule that is large and hard or causes pain or discomfort is more worrisome in terms of malignancy.

Complications:
Complications associated with thyroid nodules include:

• Problems swallowing or breathing. Large nodules or a multinodular goiter — an enlargement of the thyroid gland containing several distinct nodules — can interfere with swallowing or breathing.
• Hyperthryoidism. Problems can occur when a nodule or goiter produces thyroid hormone, leading to hyperthyroidism. Hyperthyroidism in turn can result in unintended weight loss, muscle weakness, heat intolerance, and anxiousness or irritability. Potential complications of hyperthyroidism include heart-related complications; weak bones (osteoporosis); and thyrotoxic crisis, a sudden and potentially life-threatening intensification of your signs and symptoms that requires immediate medical care.
• Problems associated with thyroid cancer. If a thyroid nodule is cancerous, surgery is usually required. Generally, most or all of your thyroid gland is removed, after which you'll need to take thyroid hormone replacement therapy for the rest of your life. Most thyroid cancers are found early, though, and have a good prognosis.

Treatments and drugs:
Treatment depends on the type of thyroid nodule you have.
Treating benign nodules
If a thyroid nodule isn't cancerous, there are several treatment options:

• Watchful waiting. If a biopsy shows that you have a benign thyroid nodule, your doctor may suggest simply watching your condition, which usually means having a physical exam and thyroid function tests at regular intervals. You're also likely to have another biopsy if the nodule grows larger. If a benign thyroid nodule remains unchanged, you may never need treatment beyond careful monitoring.
• Thyroid hormone suppression therapy. This involves treating a benign nodule with levothyroxine (Levoxyl, Synthroid, others), a synthetic form of thyroxine that you take in pill form. The idea is that supplying additional thyroid hormone will signal the pituitary to produce less TSH, the hormone that stimulates the growth of thyroid tissue. Although this sounds good in theory, levothyroxine therapy is a matter of some debate. There's no clear evidence that the treatment consistently shrinks nodules or even that shrinking small, benign nodules is necessary.
• Surgery. Occasionally, a nodule that's clearly benign may require surgery, especially if it's so large that it makes it hard to breathe or swallow. Surgery is also considered the best option for people with large multinodular goiters, particularly when the goiters constrict airways, the esophagus or blood vessels. Nodules diagnosed as indeterminate or suspicious by a biopsy also need surgical removal, so they can be examined more thoroughly for signs of cancer.

Treating nodules that cause hyperthyroidism
If a thyroid nodule is producing thyroid hormones, overloading your thyroid gland's normal hormone production levels, your doctor may recommend treating you for hyperthyroidism. This may include:

• Radioactive iodine. Doctors often use radioactive iodine to treat hyperfunctioning adenomas or multinodular goiters. Taken as a capsule or in liquid form, radioactive iodine is absorbed by your thyroid gland, causing the nodules to shrink and signs and symptoms of hyperthyroidism to subside, usually within two to three months.
• Anti-thyroid medications. In some cases, your doctor may recommend an anti-thyroid medication such as methimazole (Tapazole) to reduce symptoms of hyperthyroidism. Treatment is generally long-term and can have serious side effects on your liver, so it's important to discuss the treatment's risks and benefits with your doctor.
• Surgery. If treatment with radioactive iodine or anti-thyroid medications isn't an option, you may be a candidate for surgery to remove your thyroid gland. Surgery also carries certain risks that should be thoroughly discussed beforehand.

Treating cancerous nodules
Treatment for a nodule that's cancerous usually involves surgery.

• Surgery. The usual treatment for malignant nodules is surgical removal, often along with the majority of thyroid tissue — a procedure called near-total thyroidectomy. Risks of thyroid surgery include damage to the nerve that controls your vocal cords and damage to your parathyroid glands — four tiny glands located on the back of your thyroid gland that help control the level of calcium in your blood. After thyroidectomy, you'll need lifelong treatment with levothyroxine to supply your body with normal amounts of thyroid hormone.

Read more...

Thyroid cancer

Thyroid cancer

Definition  :
Thyroid cancer occurs in the cells of the thyroid — a butterfly-shaped gland located at the base of your neck, just below your Adam's apple. Your thyroid produces hormones that regulate your heart rate, blood pressure, body temperature and weight.

Although thyroid cancer isn't common in the United States, rates seem to be increasing. Doctors think this is because new technology is allowing them to find small thyroid cancers that may not have been found in the past.

Most cases of thyroid cancer can be cured with treatment.


Symptoms:
Thyroid cancer typically doesn't cause any signs or symptoms early in the disease. As thyroid cancer grows, it may cause:

• A lump that can be felt through the skin on your neck
• Changes to your voice, including increasing hoarseness
• Difficulty swallowing
• Pain in your neck and throat
• Swollen lymph nodes in your neck

When to see a doctor
If you experience any these signs or symptoms, make an appointment with your doctor. Thyroid cancer isn't common, so your doctor may investigate other causes of your signs and symptoms first.

Causes:
It's not clear what causes thyroid cancer. Thyroid cancer occurs when cells in your thyroid undergo genetic changes (mutations). The mutations allow the cells to grow and multiply rapidly. The cells also lose the ability to die, as normal cells would. The accumulating abnormal thyroid cells form a tumor. The abnormal cells can invade nearby tissue and can spread throughout the body.
Types of thyroid cancer
The type of thyroid cancer determines treatment and prognosis. Types of thyroid cancer include:

• Papillary thyroid cancer. The papillary type of thyroid cancer is the most common, making up about 80 percent of all thyroid cancer diagnoses.
• Follicular thyroid cancer. Follicular thyroid cancer also includes Hurthle cell cancer.
• Medullary thyroid cancer. Medullary thyroid cancer may be associated with inherited genetic syndromes that include tumors in other glands. However, most medullary thyroid cancers are sporadic, meaning they aren't associated with inherited genetic syndromes.
• Anaplastic thyroid cancer. The anaplastic type of thyroid cancer is very rare, aggressive and very difficult to treat.
• Thyroid lymphoma. Thyroid lymphoma begins in the immune system cells in the thyroid. Thyroid lymphoma is very rare.

Complications:
Thyroid cancer that comes back
Despite treatment, thyroid cancer can return, even if you've had your thyroid removed. This could happen if microscopic cancer cells spread beyond the thyroid before it's removed. Thyroid cancer recurrence can occur decades after thyroid cancer treatment.
Thyroid cancer may recur in:

• Lymph nodes in the neck
• Small pieces of thyroid tissue left behind during surgery
• Other areas of the body — most often the lungs or the bones

Thyroid cancer that recurs can be treated. Your doctor may recommend periodic blood tests or thyroid scans to check for signs of a thyroid cancer recurrence.

Treatments and drugs:
Your thyroid cancer treatment options depend on the type and stage of your thyroid cancer, your overall health and your preferences.
Most cases of thyroid cancer can be cured with treatment.

Surgery
Most people with thyroid cancer undergo surgery to remove all or most of the thyroid. Operations used to treat thyroid cancer include:

• Removing all or most of the thyroid (thyroidectomy). Surgery to remove the entire thyroid is the most common treatment for thyroid cancer. In most cases, the surgeon leaves small rims of thyroid tissue around the parathyroid glands to reduce the risk of parathyroid damage. Sometimes surgeons refer to this as a near-total thyroidectomy.
• Removing lymph nodes in the neck. When removing your thyroid, the surgeon may also remove enlarged lymph nodes from your neck and test them for cancer cells.

Thyroid surgery is performed by making an incision in the skin at the base of your neck. Thyroid surgery carries a risk of bleeding and infection. Damage can also occur to your parathyroid glands during surgery, later leading to low calcium levels in your body. There's also a risk of accidental damage to the nerves connected to your vocal cords, which can cause vocal cord paralysis, hoarseness, soft voice or difficulty breathing.

Thyroid hormone therapy
After thyroid cancer surgery, you'll take the thyroid hormone medication levothyroxine (Levothroid, Synthroid, others) for life. This pill has two benefits: It supplies the missing hormone your thyroid would normally produce, and it suppresses the production of thyroid-stimulating hormone (TSH) from your pituitary gland. High TSH levels could conceivably stimulate any remaining cancer cells to grow.
You'll likely have blood tests to check your thyroid hormone levels every few months until your doctor finds the proper dosage for you.

Radioactive iodine
Radioactive iodine treatment uses large doses of a form of iodine that's radioactive. Radioactive iodine treatment is often used after thyroidectomy to destroy any remaining healthy thyroid tissue, as well as microscopic areas of thyroid cancer that weren't removed during surgery. Radioactive iodine treatment may also be used to treat thyroid cancer that recurs after treatment or that spreads to other areas of the body.

Radioactive iodine treatment comes as a capsule or liquid that you swallow. The radioactive iodine is taken up primarily by thyroid cells and thyroid cancer cells, so there's a low risk of harming other cells in your body.
Side effects may include:

• Nausea
• Dry mouth
• Dry eyes
• Altered sense of taste or smell
• Pain where thyroid cancer cells have spread, such as the neck or chest

Most of the radioactive iodine leaves your body in your urine in the first few days after treatment. During that time you'll be given instructions for precautions you need to take to protect other people from the radiation. For instance, you may be asked to temporarily avoid close contact with other people, especially children and pregnant women.

External radiation therapy
Radiation therapy can also be given externally using a machine that aims high-energy beams at precise points on your body. Called external beam radiation therapy, this treatment is typically administered a few minutes at a time, five days a week, for about six weeks. During treatment, you lie still on a table while a machine moves around you. External radiation therapy is generally used to treat thyroid cancer that has spread to the bones.

Chemotherapy
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy is typically given as an infusion through a vein. The chemicals travel throughout your body, killing quickly growing cells, including cancer cells.
Chemotherapy is not commonly used in the treatment of thyroid cancer, but it may benefit some people who don't respond to other, more standard therapies.

Clinical trials
Clinical trials are studies of new cancer treatments or new ways of using existing treatments. Enrolling in a clinical trial gives you the chance to try out the latest in cancer treatment options, but clinical trials can't guarantee a cure. Ask your doctor whether you might be eligible to enroll in a clinical trial. Together you can discuss the benefits and risks of a trial and decide whether participating in a clinical trial is right for you.

Read more...

Thunderclap headaches

Thunderclap headaches

Definition:
Thunderclap headaches live up to their name, grabbing your attention like a clap of thunder. The pain of these sudden, severe headaches peaks within 60 seconds and can start fading after an hour. Some of these headaches, however, can last for more than a week.

Thunderclap headaches are uncommon, but they can be a warning sign of potentially life-threatening conditions — usually having to do with bleeding in and around the brain. That's why it's so important to seek emergency medical attention if you experience a thunderclap headache.

Symptoms:
Thunderclap headaches are dramatic. Symptoms include pain that:

• Strikes suddenly and severely — sometimes described as the worst headache ever experienced
• Peaks within 60 seconds
• Lasts for anywhere between an hour to 10 days
• Can occur anywhere in the head or neck
• Can be accompanied by nausea or vomiting

When to see a doctor
Seek immediate medical attention for any headache that comes on suddenly and severely.

Causes:
Some thunderclap headaches appear as a result of:

• No obvious physical reason

In other cases, potentially life-threatening conditions may be responsible, including:

• Bleeding between the brain and membranes covering the brain
• A rupture of a blood vessel in the brain
• A tear in the lining of an artery (for example, carotid or vertebral artery) that supplies blood to the brain
• Leaking of cerebrospinal fluid which when present is usually due to a tear of the covering around a nerve root in the spine
• A tumor in the third ventricle of the brain that blocks the flow of cerebrospinal fluid
• Death of tissue or bleeding in the pituitary gland
• A blood clot in the brain
• Severe elevation in blood pressure
• Infection such as meningitis or encephalitis

Treatments and drugs:
There's no single treatment for thunderclap headaches because so many potential causes exist. Treatment is aimed at the underlying cause of the headaches — if one is found.

Read more...

Thumb arthritis

Thumb arthritis

Definition:
Thumb arthritis is the most common form of osteoarthritis affecting the hand. Also called basal joint arthritis, thumb arthritis occurs when the cushioning cartilage wears away from the adjoining ends of the bones that form your thumb joint (carpometacarpal joint).

Thumb arthritis can cause severe hand pain, swelling, and decreased strength and range of motion, making it difficult to do simple household tasks, such as turning doorknobs and opening jars.
Treatment for thumb arthritis may include self-care measures, splints, medication or corticosteroid injections. If you have severe thumb arthritis, you may need surgery.

Symptoms:
The first and most common symptom of thumb arthritis is pain. Pain occurs at the base of your thumb when you grip, grasp or pinch an object between your thumb and forefinger or use your thumb to apply force — such as when turning a key, pulling a zipper or opening a jar. Eventually, you may even experience pain when not using your thumb.
Other signs and symptoms may include:

• Swelling, stiffness and tenderness at the base of your thumb
• Decreased strength when pinching or grasping objects
• Decreased range of motion
• Enlarged, bony or out-of-joint appearance of the joint at the base of your thumb

When to see a doctor
If you have persistent swelling, stiffness or pain at the base of your thumb, seek medical advice. If your doctor determines that you have thumb arthritis, he or she can work with you to develop a pain management and treatment plan.
Also seek medical advice if you experience side effects — such as nausea, abdominal discomfort, black or tarry stools, constipation, or drowsiness — from arthritis medications.

Causes:
Thumb arthritis usually occurs as a result of trauma or injury to the joint. Some people also develop thumb arthritis in association with osteoarthritis in larger joints.

The basal joint gives the thumb a wide range of motion, allowing you to pinch, grip and grasp objects. The bones in the thumb's basal joint are the first metacarpal bone, which runs through the heel of your hand, and the trapezium (truh-PEE-zee-um), a small bone at the base of your thumb.

In a normal basal joint, cartilage covers the ends of the bones — acting as a cushion and allowing bones to glide smoothly against each other. With thumb arthritis, the cartilage that covers the ends of the bones deteriorates and its smooth surface roughens. The bones then rub against each other, resulting in friction and joint damage.

The damage to the joint may result in growth of new bone along the sides of the existing bone (bone spurs), which can produce noticeable lumps on your thumb joint.

Treatments and drugs:
Your doctor may recommend a combination of treatments, including self-care measures, activity modification, splints, medications and physical therapy. In early stages, nonsurgical treatments are usually effective. In severe cases, surgery may be necessary.

Splints
Your doctor may recommend the use of a splint to support your joint and limit the movement of your thumb and wrist. Splints help:

• Decrease pain
• Encourage proper positioning
• Rest your joint

Depending on your needs, you may wear a splint just at night or throughout the day and night.

Medications
To relieve your pain, your doctor may recommend oral and topical medications, including:

• Acetaminophen (Tylenol, others). Acetaminophen may have fewer side effects than do other pain relievers.
• Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, which decrease inflammation and relieve pain, include over-the-counter (OTC) medications such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others).
• Prescription pain relievers. These include COX-2 inhibitors (Celebrex), meloxicam (Mobic) or tramadol (Conzip, Ultram, others).

NSAIDs have risks of side effects that increase when used at high doses for long-term treatment. Side effects may include ringing in your ears, gastric ulcers, cardiovascular problems, gastrointestinal bleeding, and liver and kidney damage.

Injections
If a combination of analgesics and splint use isn't effective, your doctor may recommend injecting a long-acting corticosteroid into your basal joint. Corticosteroid injections can offer temporary pain relief and reduce inflammation.

Surgery
If you don't respond to other treatments or if you're barely able to bend and twist your thumb, your doctor may recommend surgery.
You and your doctor can discuss surgical options and select the one best suited to you. Options include:

• Joint fusion (arthrodesis). In arthrodesis, your surgeon permanently fuses the bones in the affected joint to increase stability and reduce pain. The fused joint can then bear weight without pain, but has no flexibility.
• Osteotomy. In this procedure, sometimes called bone cutting, your surgeon repositions the bones in the affected joint to help correct deformities.
• Trapeziectomy. In this procedure, your surgeon removes the trapezium, one of the bones in your thumb joint.
• Joint replacement (arthroplasty). In this procedure, your surgeon removes part or all of the affected joint and replaces it with a graft from one of your tendons. New plastic or metal devices called prostheses also are being developed to replace the joint. Currently, however, doctors prefer to use a tendon arthroplasty.

Each of these surgical procedures can be done on an outpatient basis. After surgery, you can expect to wear a cast or splint over your thumb and wrist for up to six weeks. Once the cast is removed, you may work with a physical therapist to help regain hand strength and movement. Although recovery is slow, you should be able to resume your normal activities within six months of surgery.

Read more...

Thrombophlebitis

Thrombophlebitis

Read more...

Thrombocytosis

Thrombocytosis

Definition:
Thrombocytosis (throm-boe-sie-TOE-sis) is a disorder in which your body produces too many platelets (thrombocytes), which play an important role in blood clotting. The disorder is called reactive thrombocytosis when it's caused by an underlying condition, such as an infection.

Thrombocytosis may also be caused by a blood and bone marrow disease. When caused by a bone marrow disorder, thrombocytosis is called autonomous, primary or essential thrombocytosis or essential thrombocythemia.

Your doctor may detect thrombocytosis in routine blood test results that show a high platelet level. If your blood test indicates thrombocytosis, it's important for your doctor to determine whether it's reactive thrombocytosis or if you have thrombocythemia, which is more likely to cause blood clots.

Symptoms:
Reactive thrombocytosis rarely causes symptoms. More often, signs and symptoms relate to the underlying condition. If symptoms of reactive thrombocytosis do occur, they may include:

• Headache
• Dizziness or lightheadedness
• Chest pain
• Weakness
• Fainting
• Temporary vision changes
• Numbness or tingling of the hands and feet

When to see a doctor
Because thrombocytosis isn't likely to cause symptoms, you probably won't know you have the condition unless a routine blood test reveals a higher than normal number of platelets. If your blood test results show a high platelet count, your doctor will try to determine the reason.


Causes:

Bone marrow — spongy tissue inside your bones — contains stem cells that can become red blood cells, white blood cells or platelets. Platelets travel through your blood vessels. They stick together to form clots that stop the bleeding when you damage a blood vessel, such as when you get a cut. A normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood.

If you have thrombocytosis caused by a bone marrow disorder (essential thrombocythemia), your bone marrow overproduces the cells that form platelets (megakaryocytes), releasing too many platelets into your blood. If your blood test results reveal a high platelet count, it's important for your doctor to determine whether you have essential thrombocythemia or reactive thrombocytosis.
Reactive thrombocytosis causes include:

• Acute bleeding and blood loss
• Allergic reactions
• Cancer
• Chronic kidney failure or another kidney disorder
• Exercise
• Heart attack
• Infections
• Iron deficiency anemia
• Removal of your spleen
• Hemolytic anemia — a type of anemia in which your body destroys red blood cells faster than it produces them, often due to certain blood diseases or autoimmune disorders
• Inflammation, such as from rheumatoid arthritis, celiac disease, connective tissue disorders or inflammatory bowel disease
• Major surgery
• Pancreatitis
• Trauma

Medications that can cause reactive thrombocytosis include:

• Epinephrine (Adrenalin Chloride, EpiPen)
• Tretinoin
• Vincristine

Complications:
If your high platelet count results from a bone marrow disease (essential thrombocythemia), rather than reactive thrombocytosis, you may be at risk of developing blood clots, some of which can be life-threatening.

Treatments and drugs:
Treatment for reactive thrombocytosis is directed at the underlying cause. If a recent surgery or an injury that caused significant blood loss is the cause, your elevated platelet count may not last long. If the cause is a chronic infection or an inflammatory disease, your platelet count may remain high until the condition is brought under control. In most cases, your platelet count will return to normal after the underlying cause is resolved.

Removal of your spleen may cause lifelong thrombocytosis. In that case, your doctor may prescribe low-dose aspirin to help prevent bleeding or blood-clotting incidents, although these occur rarely in reactive thrombocytosis.

Read more...

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.

Read more...

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.

Read more...

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. 

Read more...

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.

Read more...

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.

Read more...

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.

Read more...

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.

Read more...

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.

Read more...

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.

Read more...