Takayasu's arteritis

Takayasu's arteritis

Definition:

Takayasu's arteritis (tah-kah-YAH-sooz ahr-tuh-RIE-tis) is a rare type of vasculitis, a group of disorders that cause blood vessel inflammation. In Takayasu's arteritis, the inflammation damages the aorta — the large artery that carries blood from your heart to the rest of your body — and the aorta's main branches. The disease can lead to blockages or narrowed arteries, called stenoses, or abnormally dilated arteries, called aneurysms. Takayasu's arteritis can also lead to arm or chest pain, high blood pressure, and eventually to heart failure or stroke.

Takayasu's arteritis mainly affects young girls and women under 40. The exact cause of the disease is not known.

The goal of treatment is to relieve inflammation in the arteries and prevent potential complications. Even with early detection and treatment, however, Takayasu's arteritis can be challenging to manage.

Symptoms:

First-stage symptoms
Symptoms of Takayasu's arteritis often occur in two stages. In the first stage, you're likely to feel unwell, with:

• Fatigue
• Rapid, unintended weight loss
• Muscle or joint pain
• Low-grade fever

Not everyone has these initial symptoms, however, and it's possible for inflammation to damage arteries for years before problems appear.

Second-stage symptoms
Second-stage symptoms begin to develop when inflammation has caused arteries to narrow, reducing the amount of blood, oxygen and nutrients reaching certain organs and tissues. These signs and symptoms may include:

• Arm or leg weakness or pain with use (claudication)
• Lightheadedness, dizziness, fainting, headaches
• Difficulty thinking and remembering
• Visual disturbances
• High blood pressure
• Difference in blood pressure between your two arms
• Diminished or absent pulse in the wrists — Takayasu's arteritis is sometimes called pulseless disease because narrowed arteries can make normal pulses difficult or impossible to detect
• Anemia, which may make you feel tired or weak
• Chest pain
• In some people, high blood pressure in the arteries in the lungs (pulmonary hypertension) leading to shortness of breath and fatigue

When to see a doctor
If you have symptoms that might suggest Takayasu's arteritis, see your doctor. Many signs and symptoms of Takayasu's arteritis are similar to those of other conditions, which can make diagnosis challenging. Still, early detection of the disease is important for getting the most benefit from treatment and preventing complications.

If you've already been diagnosed with Takayasu's arteritis, keep in mind that the symptoms of a disease flare (recurrence) are often similar to those that occurred when the disease first began. Also pay attention to any new signs or symptoms. These may indicate either a disease flare or a complication of treatment.

Causes:

In Takayasu's arteritis the aorta and other major arteries, including those leading to your head and kidneys, become inflamed. Over time, the inflammation causes changes in these arteries, including thickening, narrowing and scarring. The result is reduced blood flow to vital tissues and organs, which can lead to serious complications and even death. Sometimes arteries become abnormally dilated, leading to aneurysms that may rupture.

Just what causes the initial inflammation in Takayasu's arteritis isn't known. It's likely that Takayasu's arteritis is an autoimmune disease, in which your immune system malfunctions and attacks your own arteries as if they were foreign substances.


Complications:

The severity of Takayasu's arteritis may vary. In some people, the condition remains mild and doesn't produce complications. But in others, extended or recurring cycles of inflammation and healing in the arteries can lead to one or more of the following:

• Hardening and narrowing of blood vessels, which can cause reduced blood flow to organs and tissues
• High blood pressure, usually as a result of decreased blood flow to your kidneys
• Inflammation of the heart — either of the heart muscle itself (myocarditis), of the sac that surrounds the heart (pericarditis) or of the heart valves (valvulitis)
• Heart failure, due to high blood pressure, myocarditis or aortic regurgitation — a condition in which a faulty aortic valve allows blood to leak back into your heart — or a combination of these
• Ischemic stroke, a type of stroke that occurs as a result of reduced or blocked blood flow in arteries leading to your brain
• Transient ischemic attack, a temporary stroke that has all the symptoms of an ischemic stroke without causing lasting damage
• Aneurysm in the aorta, which occurs when the walls of the blood vessel weaken and stretch out, forming a bulge that has the potential to rupture
• Heart attack — although not common, it may occur as a result of reduced blood flow to the heart
• Lung involvement, when the arteries to the lungs (pulmonary arteries) become diseased

Pregnancy
In studies of pregnant women with Takayasu's arteritis, most women delivered a healthy baby. However, the disease may pose risks for you and your baby, and drugs to treat it may also cause problems. If you have Takayasu's arteritis and are planning on becoming pregnant, it's important to work with your doctor to develop a comprehensive plan to limit complications of pregnancy before you conceive. In addition, you'll be closely monitored throughout your pregnancy.


Treatments and drugs:

The goal of treatment is to control inflammation and prevent further damage to your blood vessels, with the fewest long-term side effects. Takayasu's arteritis can sometimes be difficult to treat because even if you appear to be in remission, disease activity may still continue "silently." In addition, by the time some people are diagnosed, it's possible that irreversible damage may already have occurred.
On the other hand, if your condition is relatively stable and uncomplicated, you may not need treatment at all.

Treatment usually consists of medications and, in some cases, surgery.

Medications
Many of these medications have serious, long-term side effects, so your doctor will try to balance their benefits against their potential risks by controlling dosing of medications and the length of time you take them.

• Corticosteroids. The first line of treatment is usually with a corticosteroid such as prednisone or methylprednisolone (Medrol). About half the people treated with corticosteroids respond well. You often start feeling better in just a few days, but you usually need to continue taking medication for an extended period of time. After the first month, your doctor may gradually begin to lower the dose until you reach the lowest dose you need to control inflammation. Some of your symptoms may return during this tapering period. Long-term side effects of corticosteroids include cataracts, high blood sugar, increased risk of infections, loss of calcium from bones, menstrual irregularities, suppressed adrenal gland hormone production, thin skin, obesity, easy bruising and slower wound healing.
  
• Cytotoxic drugs. If your condition doesn't respond well to corticosteroids or you have trouble tapering off the medication, you may need treatment with cytotoxic drugs, such as methotrexate (Trexall, Rheumatrex) or azathioprine (Imuran, Azasan). These drugs suppress the inflammation in your blood vessels, but they have risks. They can increase your susceptibility to infection, as well as your risk of developing lymph node tumors (lymphoma) and skin cancer.
  
• Transplant medications. Some people respond well to medications that were developed for people receiving organ transplants. These drugs, including mycophenolate (Cellcept), work by suppressing the immune system, and they have effectively reduced blood vessel inflammation in people with Takayasu's arteritis. Side effects include abdominal pain, fever, constipation, headache and swelling. These drugs may not be taken during pregnancy.

Surgery
If your arteries become severely narrowed or blocked, surgery may be necessary to open or bypass these arteries to allow an uninterrupted flow of blood. Often, this helps to improve symptoms such as high blood pressure and chest pain. In some cases, though, narrowing or blockage may recur, requiring a second procedure. Also, if you develop large aneurysms, surgery may be needed to prevent them from rupturing. These procedures, best performed when inflammation of the arteries is sufficiently suppressed, include:

• Bypass surgery. In this procedure, an artery or a vein is removed from a different part of your body and attached to the blocked artery, providing a bypass for blood to flow through.
  
• Percutaneous angioplasty. During this procedure, a tiny balloon is threaded through a blood vessel and into the affected artery. Once in place the balloon is expanded to widen the blocked area.
  
• Stenting. Tiny wire mesh coils called stents may be inserted into the area widened by angioplasty. The stents help to prop open the artery to prevent the blood vessel from narrowing again.

Read more...

Tachycardia

Tachycardia

Definition:

Tachycardia is a faster than normal heart rate. A healthy adult heart normally beats 60 to 100 times a minute when a person is at rest. If you have tachycardia (tak-ih-KAHR-de-uh), the rate in the upper chambers or lower chambers of the heart, or both, are increased significantly.

Heart rate is controlled by electrical signals sent across heart tissues. Tachycardia occurs when an abnormality in the heart produces rapid electrical signals.

In some cases, tachycardias may cause no symptoms or complications. However, tachycardias can seriously disrupt normal heart function, increase the risk of stroke, or cause sudden cardiac arrest or death.

Treatments may help control a rapid heartbeat or manage diseases contributing to tachycardia.

Symptoms:

When your heart's rate is too rapid, it may not effectively pump blood to the rest of your body, depriving your organs and tissues of oxygen. This can cause these tachycardia symptoms:

• Dizziness
• Shortness of breath
• Lightheadedness
• Rapid pulse rate
• Heart palpitations — a racing, uncomfortable or irregular heartbeat or a sensation of "flopping" in the chest
• Chest pain
• Fainting (syncope)

Some people with tachycardia have no symptoms, and the condition is only discovered during a physical examination or with a heart-monitoring test called an electrocardiogram.

When to see a doctor
A number of conditions can cause a rapid heart rate and tachycardia symptoms. It's important to get a prompt, accurate diagnosis and appropriate care. See your doctor if you or your child experiences any tachycardia symptoms.

If you faint, have difficulty breathing or have chest pain lasting more than a few minutes, get emergency care, or call 911 or your local emergency number. Seek emergency care for anyone experiencing these symptoms.

Causes:

Tachycardia is caused by something that disrupts the normal electrical impulses that control the rhythm of your heart's pumping action. Many things can cause or contribute to problems with the heart's electrical system. These factors include:

• Damage to heart tissues from heart disease
• Abnormal electrical pathways in the heart present at birth (congenital)
• Disease or congenital abnormality of the heart
• High blood pressure
• Smoking
• Fever
• Drinking too much alcohol
• Drinking too many caffeinated beverages
• A side effect of medications
• Abuse of recreational drugs, such as cocaine
• Imbalance of electrolytes, mineral-related substances necessary for conducting electrical impulses
• Overactive thyroid (hyperthyroidism)

In some cases, the exact cause of tachycardia can't be determined.

Electrical circuitry of the heart
Your heart is made up of four chambers — two upper chambers (atria) and two lower chambers (ventricles). The rhythm of your heart is normally controlled by a natural pacemaker — the sinus node — located in the right atrium. The sinus node produces electrical impulses that normally start each heartbeat.

From the sinus node, electrical impulses travel across the atria, causing the atria muscles to contract and pump blood into the ventricles. The electrical impulses then arrive at a cluster of cells called the atrioventricular node (AV node) — usually the only pathway for signals to travel from the atria to the ventricles.

The AV node slows down the electrical signal before sending it to the ventricles. This slight delay allows the ventricles to fill with blood. When electrical impulses reach the muscles of the ventricles, they contract, causing them to pump blood either to the lungs or to the rest of the body.

Types of tachycardias
Tachycardia occurs when a problem in electrical signals produces a heartbeat that is faster than normal. Common types of tachycardia include the following:

• Atrial fibrillation is a rapid heart rate caused by chaotic electrical impulses in the atria. These signals result in rapid, uncoordinated, weak contractions of the atria. The chaotic electrical signals bombard the AV node, usually resulting in an irregular, rapid rhythm of the ventricles. Atrial fibrillation may be temporary, but some episodes won't end unless treated.
• 
  Most people with atrial fibrillation have some structural abnormalities of the heart related to such conditions as heart disease or high blood pressure. Other factors that may contribute to atrial fibrillation include a heart valve disorder, hyperthyroidism or heavy alcohol use.
  
  
• Atrial flutter is a very fast, but regular rate of the atria caused by irregular circuitry within the atria. The fast rate results in weak contractions of the atria. The rapid signals entering the AV node cause a rapid and sometimes irregular ventricular rate. Episodes of atrial flutter may get better on their own, or the condition may persist unless treated.
  
  People who experience atrial flutter often experience atrial fibrillation at other times.
  
  
• Supraventricular tachycardias (SVTs), which originate somewhere above the ventricles, are caused by abnormal circuitry in the heart, usually present at birth, that creates a loop of overlapping signals.
• 
  In one form of SVT, an abnormality in the AV node may "split" an electrical signal into two, sending one signal to the ventricles and another back to the atria. Another common abnormality is the presence of an extra electrical pathway from the atria to the ventricles that bypasses the AV node. This may result in a signal going down one pathway and up the other. Wolff-Parkinson-White syndrome is one disorder featuring an extra pathway.
  
  
• Ventricular tachycardia is a rapid rate that originates with abnormal electrical signals in the ventricles. The rapid beat doesn't allow the ventricles to fill and contract efficiently to pump enough blood to the body. Ventricular tachycardia is often a life-threatening medical emergency.
  
• Ventricular fibrillation occurs when rapid, chaotic electrical impulses cause the ventricles to quiver ineffectively instead of pumping necessary blood to the body. This serious problem is fatal if the heart isn't restored to a normal rhythm within minutes.
  Most people who experience ventricular fibrillation have an underlying heart disease or have experienced serious trauma, such as being struck by lightning.
   

Complications:

Complications of tachycardias vary in severity depending on such factors as the type of tachycardia, the rate and duration of a rapid heart rate, and the existence of other heart conditions. Possible complications include:

• Blood clots that can cause a stroke or heart attack
• Inability of the heart to pump enough blood (heart failure)
• Frequent fainting spells
• Sudden death, usually only associated with ventricular tachycardia or ventricular fibrillation

Treatments and drugs:

The treatment goals for tachycardias are to slow a fast heart rate when it occurs, prevent future episodes and minimize complications.

Stopping a fast heart rate
A fast heartbeat may correct itself, and you may be able to slow your heart rate using simple physical movements. However, you may need medication or other medical treatment to slow down your heartbeat. Ways to slow your heartbeat include:

• Vagal maneuvers. Your doctor may ask you to perform an action, called a vagal maneuver, during an episode of a fast heartbeat. Vagal maneuvers affect the vagus nerve, which helps regulate your heartbeat. The maneuvers include coughing, bearing down as if you're having a bowel movement, and putting an icepack on your face.
  
• Medications. If vagal maneuvers don't stop the fast heartbeat, you may need an injection of an anti-arrhythmic medication to restore a normal heart rate. An injection of this drug is administered at a hospital. Your doctor may also prescribe a pill version of an anti-arrhythmic drug, such as flecainide (Tambocor) or propafenone (Rythmol), to take if you have an episode of a fast heartbeat that doesn't respond to vagal maneuvers.
  
• Cardioversion. In this procedure, a shock is delivered to your heart through paddles or patches on your chest. The current affects the electrical impulses in your heart and restores a normal rhythm. It's typically used when emergency care is needed or when maneuvers and medications aren't effective.

Preventing episodes of a fast heart rate
With the following treatments, it may be possible to prevent or manage episodes of tachycardia.

• Catheter ablation. This procedure is used most often when an extra electrical pathway is responsible for an increased heart rate. In this procedure, catheters are threaded through the blood vessels to your heart. Electrodes at the catheter tips can use heat, extreme cold, or radiofrequency energy to damage (ablate) the extra electrical pathway and prevent it from sending electrical signals. This procedure is highly effective, especially for supraventricular tachycardia. Catheter ablation can also be used to treat atrial fibrillation and atrial flutter.
  
• Medications. Anti-arrhythmic medications may prevent a fast heart rate when taken regularly. Other medications that may be prescribed — either as an alternative or in combination with anti-arrhythmic medications — are calcium channel blockers, such as diltiazem (Cardizem) and verapamil (Calan) or beta blockers, such as metoprolol (Lopressor, Toprol) and esmolol (Brevibloc).
  
• Pacemaker. A pacemaker is a small device that's surgically implanted under your skin. When the device senses an abnormal heartbeat, it emits an electrical pulse that helps the heart resume a normal beat.
  
• Implantable cardioverter-defibrillator. If you're at risk of having a life-threatening tachycardia episode, your doctor may recommend an implantable cardioverter-defibrillator (ICD). The device, about the size of a cell phone, is surgically implanted in your chest. The ICD continuously monitors your heartbeat, detects an increase in heart rate and delivers precisely calibrated electrical shocks to restore a normal heart rhythm.
  
• Surgery. Open-heart surgery may be needed in some cases to destroy an extra electrical pathway. In another type of surgery, called the maze procedure, a surgeon makes small incisions in heart tissue to create a pattern or maze of scar tissue. Because scar tissue doesn't conduct electricity, it interferes with stray electrical impulses that cause some types of tachycardia. Surgery is usually used only when other treatment options don't work or when surgery is needed to treat another heart disorder.

Preventing blood clots
Some people with tachycardias have an increased risk of developing a blood clot that could cause a stroke or heart attack. Your doctor may prescribe a drug-thinning medication, such as dabigatran (Pradaxa) and warfarin (Coumadin) to help lower your risk.

Treating an underlying disease
If another medical condition is contributing to tachycardia — for example, some form of heart disease or hyperthyroidism — treating the underlying problem may prevent or minimize tachycardia episodes.

Read more...

Uveitis

Uveitis

Definition:

Uveitis (u-ve-I-tis) is inflammation of the uvea, the middle layer of the eye. The uvea consists of the iris, choroid and ciliary body. The choroid is sandwiched between the retina and the white of the eye (sclera), and it provides blood flow to the deep layers of the retina. The most common type of uveitis is an inflammation of the iris called iritis (anterior uveitis).

Infections, injury and autoimmune disorders may be associated with the development of uveitis, though the exact cause is often unknown.

Uveitis can be serious, leading to permanent vision loss. Early diagnosis and treatment are important to prevent the complications of uveitis.

Symptoms:

The signs, symptoms and characteristics of uveitis include:

• Eye redness
• Eye pain
• Light sensitivity
• Blurred vision
• Dark, floating spots in your field of vision (floaters)
• Decreased vision
• Whitish area (hypopyon) inside the eye in front of the lower part of the colored area of the eye (iris)

The site of uveitis varies and is described by where in the eye it occurs.

• Anterior uveitis affects the front of your eye (also called iritis).
• Posterior uveitis affects the back of your eye (also called choroiditis).
• Intermediary uveitis affects the ciliary body (also called cyclitis).
• Panuveitis occurs when all layers of the uvea are inflamed.

In any of these conditions, the jelly-like material in the center of your eye (vitreous) can also become inflamed and infiltrated with inflammatory cells.
Symptoms may occur suddenly and get worse quickly, though in some cases, symptoms develop gradually. Symptoms may be noticeable in one or both eyes.

When to see a doctor
Contact your doctor if you think you may have symptoms of uveitis. Your doctor may refer you to an eye specialist (ophthalmologist). If you're having significant eye pain and new vision problems, seek prompt medical attention.


Causes:

Sometimes, the specific cause of uveitis isn't clear. However, in some people, uveitis is associated with:

• Autoimmune disorders, such as Behcet's disease, sarcoidosis or ankylosing spondylitis
• Inflammatory disorders, such as Crohn's disease or ulcerative colitis
• Infections such as cat-scratch disease, herpes, syphilis, toxoplasmosis, tuberculosis or West Nile virus
• Eye injury
• Certain cancers, such as lymphoma, that can directly or indirectly affect the eye

Complications:

Left untreated, uveitis can cause the following complications:

• Abnormally high pressure inside the eye (glaucoma)
• Damage to the optic nerve
• Clouding of the lens (cataract) or cornea
• Retinal problems, such as fluid within the retina or retinal detachment
• Vision loss

Treatments and drugs:

If uveitis is caused by an underlying condition, treatment will focus on that specific condition. The goal of treatment is to reduce the inflammation in your eye.
Treatment of uveitis may include:

• Anti-inflammatory medication. Your doctor may prescribe anti-inflammatory medication, such as a corticosteroid, to treat your uveitis. This medication may be given as eyedrops. Or, you may be given corticosteroid pills or an injection into the eye. For people with difficult-to-treat posterior uveitis, a device that's implanted in your eye may be an option. This device slowly releases corticosteroid medication into your eye for about 2 1/2 years.
  
• Antibiotic or antiviral medication. If uveitis is caused by an infection, antibiotics, antiviral medications or other medicines may be given with or without corticosteroids to bring the infection under control.
  
• Immunosuppressive or cell-destroying (cytotoxic) medication. Immunosuppressive or cytotoxic agents may be necessary if your uveitis doesn't respond well to corticosteroids or becomes severe enough to threaten your vision.
  
• Surgery. Vitrectomy — surgery to remove some of the jelly-like material in your eye (vitreous) — may be necessary both for diagnosis and management of your uveitis. A small sample of the vitreous can help identify a specific cause of eye inflammation, such as a virus, bacterium or lymphoma. The procedure may also be used to remove developing scar tissue in the vitreous.

The part of your eye affected by uveitis — either the front (anterior) or back (posterior) of the uvea — may determine how quickly your eye heals. Uveitis affecting the back of your eye tends to heal more slowly than uveitis in the front of the eye. Severe inflammation takes longer to clear up than mild inflammation does.

Uveitis can come back. Make an appointment with your doctor if any of your symptoms reappear after successful treatment.

Read more...

Uterine prolapse

Uterine prolapse

Definition:

Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then slips down into or protrudes out of the vagina.

Uterine prolapse can happen to women of any age, but it often affects postmenopausal women who've had one or more vaginal deliveries. Damage to supportive tissues during pregnancy and childbirth, effects of gravity, loss of estrogen, and repeated straining over the years all can weaken your pelvic floor and lead to uterine prolapse.

If you have mild uterine prolapse, treatment usually isn't needed. But if uterine prolapse makes you uncomfortable or disrupts your normal life, you might benefit from treatment.


Symptoms:

Uterine prolapse varies in severity. You may have mild uterine prolapse and experience no signs or symptoms. If you have moderate to severe uterine prolapse, you may experience:

• Sensation of heaviness or pulling in your pelvis
• Tissue protruding from your vagina
• Urinary problems, such as urine leakage or urine retention
• Trouble having a bowel movement
• Low back pain
• Feeling as if you're sitting on a small ball or as if something is falling out of your vagina
• Sexual concerns, such as sensing looseness in the tone of your vaginal tissue
• Symptoms that are less bothersome in the morning and worsen as the day goes on

When to see a doctor
Uterine prolapse doesn't require treatment unless it's severe. If your signs and symptoms become bothersome and disrupt your normal activities, make an appointment with your doctor to discuss your options.


Causes:
 Pregnancy and trauma incurred during childbirth, particularly with large babies or after a difficult labor and delivery, are the main causes of muscle weakness and stretching of supporting tissues leading to uterine prolapse. Loss of muscle tone associated with aging and reduced amounts of circulating estrogen after menopause also may contribute to uterine prolapse. In rare circumstances, uterine prolapse may be caused by a tumor in the pelvic cavity.


Complications:

Possible complications of uterine prolapse include:

• Ulcers. In severe cases of uterine prolapse, part of the vaginal lining may be displaced by the fallen uterus and protrude outside your body, rubbing on underwear. The friction may lead to vaginal sores (ulcers). In rare cases, the sores could become infected.
  
• Prolapse of other pelvic organs. If you experience uterine prolapse, you might also have prolapse of other pelvic organs, including your bladder and rectum. A prolapsed bladder (cystocele) bulges into the front part of your vagina, which can lead to difficulty in urinating and increased risk of urinary tract infections. Weakness of connective tissue overlying the rectum may result in a prolapsed rectum (rectocele), which may lead to difficulty having bowel movements.

Treatments and drugs:

If you have mild uterine prolapse, either without symptoms or with symptoms that don't bother you, you probably don't need treatment. However, your pelvic floor may continue to lose tone, making uterine prolapse more severe as time goes on. Check back with your doctor to monitor the extent of your prolapse and review your symptoms.

Simple self-care measures, such as performing exercises called Kegels to strengthen your pelvic muscles, may provide symptom relief. Maintaining a healthy weight and avoiding heavy lifting may help reduce pressure on supportive pelvic structures.

For more-severe cases of uterine prolapse, treatment options include:

• Vaginal pessary. This device fits inside your vagina and holds your uterus in place. Used as temporary or permanent treatment, vaginal pessaries come in many shapes and sizes, so your doctor will measure and fit you for the proper device. You'll also learn how to insert, remove and clean the pessary. You may be able to take the pessary out overnight and reinsert it each day.
  
  But a vaginal pessary may be of little use if you have severe uterine prolapse. Also, a vaginal pessary can irritate vaginal tissues, possibly to the point of causing sores (ulcers) on vaginal tissues, and it may interfere with sexual intercourse.
  
  
• Surgery. To repair damaged or weakened pelvic floor tissues, doctors often use a vaginal approach to surgery, although sometimes doctors recommend an abdominal surgery. A hysterectomy, which removes your uterus, also may be needed.
  
  As an alternative to vaginal and abdominal surgery, your doctor may recommend minimally invasive (laparoscopic) surgery. This procedure involves smaller abdominal incisions, special surgical instruments and a lighted camera-type device (laparoscope) to guide the surgeon.
  
  In some cases, surgical repair may be possible through a graft of your own tissue, donor tissue or some synthetic material onto weakened pelvic floor structures to support your pelvic organs.
  Which surgery and surgical approach your doctor recommends depends on your individual needs and circumstances. Each surgery has pros and cons that you'll need to discuss with your surgeon.
  

If you plan to have more children, you might not be a good candidate for surgery to repair uterine prolapse. Pregnancy and delivery of a baby put strain on the supportive tissues of the uterus and can undo the benefits of surgical repair. Also, for women with major medical problems, the risks of surgery might outweigh the benefits. In these instances, pessary use may be your best treatment choice for bothersome symptoms.

Talk with your doctor to learn your options, including the benefits and risks.

Read more...

Uterine polyps

Uterine polyps

Definition:

Uterine polyps are growths attached to the inner wall of the uterus that extend into the uterine cavity. Overgrowth of cells in the lining of the uterus (endometrium) leads to the formation of uterine polyps, also known as endometrial polyps. These polyps are usually noncancerous (benign), although some can be cancerous or can eventually turn into cancer (precancerous polyps).

The sizes of uterine polyps range from a few millimeters — no larger than a sesame seed — to several centimeters — golf ball sized or larger. They attach to the uterine wall by a large base or a thin stalk.

You can have one or many uterine polyps. They usually stay contained within your uterus, but occasionally, they may slip down through the opening of the uterus (cervix) into your vagina. Uterine polyps most commonly occur in women who are going through or have completed menopause (peri- and postmenopausal women), although younger women can get them, too.

Symptoms:

Signs of uterine polyps include:

• Irregular menstrual bleeding — for example, having frequent, unpredictable periods of variable length and heaviness
• Bleeding between menstrual periods
• Excessively heavy menstrual periods
• Vaginal bleeding after menopause
• Infertility

Some women may experience only light bleeding or spotting or may even be symptom-free.
When to see a doctor
Seek medical care if you have:

• Vaginal bleeding after menopause
• Bleeding between menstrual periods
• Irregular menstrual bleeding

Causes:
 Although the exact cause of uterine polyps is unknown, hormonal factors appear to play a role. Uterine polyps are estrogen-sensitive, meaning that they respond to estrogen in the same way that the lining of your uterus does — growing in response to circulating estrogen.


Complications:

Uterine polyps may be associated with infertility. If you have uterine polyps and you experience infertility, removal of the polyps might allow you to become pregnant.

Uterine polyps also may present an increased risk of miscarriage in women who undergo in vitro fertilization (IVF). If you're considering IVF treatment and you have uterine polyps, your doctor may recommend polyp removal before embryo transfer.


Treatments and drugs:

For uterine polyps, your doctor might recommend:

• Watchful waiting. Small polyps without symptoms (asymptomatic) may resolve on their own. Treatment is unnecessary unless you're at risk of uterine cancer.
  
• Medication. Certain hormonal medications, including progestins and gonadotropin-releasing hormone agonists, may shrink a uterine polyp and lessen symptoms. But taking such medications is usually a short-term solution at best — symptoms typically recur once you stop taking the medicine.
  
• Curettage. Your doctor uses a long metal instrument with a loop on the end to scrape the inside walls of your uterus. This may be done to collect a specimen for lab testing or to remove a polyp. Your doctor may perform curettage with the assistance of a hysteroscope, which allows your doctor to view the inside of your uterus before and after the procedure.
  
• Surgical removal. During hysteroscopy, instruments inserted through the hysteroscope — the device your doctor uses to see inside your uterus — make it possible to remove polyps once they're identified. The removed polyp may be sent to a lab for microscopic examination.

If a uterine polyp contains cancerous cells, your doctor will talk with you about the next steps in evaluation and treatment.
Rarely, uterine polyps can recur. If they do, you might need more treatment.

Read more...

Uterine fibroids

Uterine fibroids

Definition:

Uterine fibroids are noncancerous growths of the uterus that often appear during your childbearing years. Also called fibromyomas, leiomyomas or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.

As many as 3 out of 4 women have uterine fibroids sometime during their lives, but most are unaware of them because they often cause no symptoms. Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound.

In general, uterine fibroids seldom require treatment. Medical therapy and surgical procedures can shrink or remove fibroids if you have discomfort or troublesome symptoms. Rarely, fibroids can require emergency treatment if they cause sudden, sharp pelvic pain or profuse menstrual bleeding.

Symptoms:

In women who have symptoms, the most common symptoms of uterine fibroids include:

• Heavy menstrual bleeding
• Prolonged menstrual periods — seven days or more of menstrual bleeding
• Pelvic pressure or pain
• Frequent urination
• Difficulty emptying your bladder
• Constipation
• Backache or leg pains

Rarely, a fibroid can cause acute pain when it outgrows its blood supply. Deprived of nutrients, the fibroid begins to die. Byproducts from a degenerating fibroid can seep into surrounding tissue, causing pain and fever. A fibroid that hangs by a stalk inside or outside the uterus (pedunculated fibroid) can trigger pain by twisting on its stalk and cutting off its blood supply.
Fibroid location influences your signs and symptoms:

• Submucosal fibroids. Fibroids that grow into the inner cavity of the uterus (submucosal fibroids) are thought to be primarily responsible for prolonged, heavy menstrual bleeding and are a problem for women attempting pregnancy.
  
• Subserosal fibroids. Fibroids that project to the outside of the uterus (subserosal fibroids) can sometimes press on your bladder, causing you to experience urinary symptoms. If fibroids bulge from the back of your uterus, they occasionally can press either on your rectum, causing constipation, or on your spinal nerves, causing backache.

When to see a doctor
See your doctor if you have:

• Pelvic pain that doesn't go away
• Overly heavy or painful periods
• Spotting or bleeding between periods
• Pain with intercourse
• Difficulty emptying your bladder
• Difficulty moving your bowels

Seek prompt medical care if you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.


Causes:

Uterine fibroids develop from the smooth muscular tissue of the uterus (myometrium). A single cell reproduces repeatedly, eventually creating a pale, firm, rubbery mass distinct from neighboring tissue. The growth patterns of uterine fibroids vary — some fibroids may continue to grow slowly; other fibroids may remain the same size or even shrink on their own over time.
Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. They can be single or multiple, in extreme cases expanding the uterus so much that it reaches the rib cage.
Doctors don't know the cause of uterine fibroids, but research and clinical experience point to these factors:

• Genetic alterations. Many fibroids contain alterations in genes that are different from those in normal uterine muscle cells.
• Hormones. Estrogen and progesterone, two hormones that stimulate development of the uterine lining during each menstrual cycle in preparation for pregnancy, appear to promote the growth of fibroids. Fibroids contain more estrogen and progesterone receptors than do normal uterine muscle cells.
• Other chemicals. Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.

Complications:

Although uterine fibroids usually aren't dangerous, they can cause discomfort and may lead to complications such as anemia from heavy blood loss. In rare instances, fibroid tumors can grow out of your uterus on a stalk-like projection. If the fibroid twists on this stalk, you may develop a sudden, sharp, severe pain in your lower abdomen. If so, seek medical care right away. You may need surgery.

Pregnancy and fibroids
Fibroids usually don't interfere with conception and pregnancy. However, it's possible that fibroids could distort or block your fallopian tubes, or interfere with the passage of sperm from your cervix to your fallopian tubes. Submucosal fibroids may prevent implantation and growth of an embryo, and in these cases, doctors often recommend removing these fibroids before attempting pregnancy.

In other cases, treatment for fibroids during pregnancy isn't necessary. A common complication of fibroids during pregnancy is localized pain, typically between the first and second trimesters. This is usually easily treated with pain relievers. But if you have fibroids and you've experienced repeated pregnancy losses, your doctor may recommend removing one or more fibroids to improve your chances of carrying a baby to term, especially if no other causes of miscarriage can be found and if your fibroids distort the shape of your uterine cavity.


Treatments and drugs:

There's no single best approach to uterine fibroid treatment. Many treatment options exist.

Watchful waiting
Many women with uterine fibroids experience no signs or symptoms. If that's the case for you, watchful waiting (expectant management) could be the best option. Fibroids aren't cancerous. They rarely interfere with pregnancy. They usually grow slowly — or not at all — and tend to shrink after menopause when levels of reproductive hormones drop.

Medications
Medications for uterine fibroids target hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pressure. They don't eliminate fibroids, but may shrink them. Medications include:

• Gonadotropin-releasing hormone (GnRH) agonists. Medications called GnRH agonists (Lupron, Synarel, others) treat fibroids by causing your natural estrogen and progesterone levels to decrease, putting you into a temporary postmenopausal state. As a result, menstruation stops, fibroids shrink and anemia often improves. Your doctor may prescribe a GnRH agonist to shrink the size of your fibroids before a planned surgery. Many women have significant hot flashes while using GnRH agonists.
  
• Progestin-releasing intrauterine device (IUD). A progestin-releasing IUD can relieve heavy bleeding and pain caused by fibroids. A progestin-releasing IUD provides symptom relief only and doesn't shrink fibroids or make them disappear.
  
• Androgens. Danazol, a synthetic drug similar to testosterone, may effectively stop menstruation, correct anemia and even shrink fibroid tumors and reduce uterine size. However, this drug is rarely used to treat fibroids. Unpleasant side effects, such as weight gain, dysphoria (feeling depressed, anxious or uneasy), acne, headaches, unwanted hair growth and a deeper voice, make many women reluctant to take this drug.
  
• Other medications. Oral contraceptives or progestins can help control menstrual bleeding, but they don't reduce fibroid size. Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal medications, may be effective in relieving pain related to fibroids, but they don't reduce bleeding caused by fibroids.

Hysterectomy
This operation — the removal of the uterus — remains the only proven permanent solution for uterine fibroids. But hysterectomy is major surgery. It ends your ability to bear children, and if you also elect to have your ovaries removed, it brings on menopause and the question of whether you'll take hormone replacement therapy. Most women with uterine fibroids can choose to keep their ovaries.

Myomectomy
In this surgical procedure, your surgeon removes the fibroids, leaving the uterus in place. With myomectomy, there's a risk of fibroid recurrence.
Myomectomy options include:

• Abdominal myomectomy. If you have multiple fibroids, very large fibroids or very deep fibroids, your doctor may use an open abdominal surgical procedure to remove the fibroids.
  
• Laparoscopic or robotic myomectomy. If the fibroids are small and few in number, you and your doctor may opt for a laparoscopic procedure, which uses slender instruments inserted through small incisions in your abdomen to remove the fibroids from your uterus. Your doctor views your abdominal area on a remote monitor via a small camera attached to one of the instruments. Use of a surgical robot now allows for removal of more fibroids or larger fibroids.
  
• Hysteroscopic myomectomy. This procedure may be an option if the fibroids are contained
  inside the uterus (submucosal). A long, slender instrument (hysteroscope) is passed through your vagina and cervix and into your uterus. Your doctor can see and remove the fibroids through the scope. This procedure is best performed by a doctor experienced in this technique.

Focused ultrasound surgery
MRI-guided focused ultrasound surgery (FUS) is a noninvasive treatment option for uterine fibroids that preserves your uterus.

This procedure is performed while you're inside of a specially crafted MRI scanner that allows doctors to visualize your anatomy, and then locate and destroy (ablate) fibroids inside your uterus without making an incision. Focused high-frequency, high-energy sound waves are used to target and destroy the fibroids. One or two treatment sessions are done in an on- and off-again fashion, sometimes spanning several hours.

Because it's a newer technology, researchers are learning more about the long-term safety and effectiveness of FUS. Research continues, but so far data collected show that FUS for uterine fibroids is safe and very effective.

Other minimally invasive procedures for fibroids
Certain procedures can destroy uterine fibroids without actually removing them through surgery. They include:

• Myolysis. In this laparoscopic procedure, an electric current or laser destroys the fibroids and shrinks the blood vessels that feed them. A similar procedure called cryomyolysis freezes the fibroids. The safety, effectiveness and associated risk of fibroid recurrence of myolysis and cryomyolysis have yet to be determined.
  
• Endometrial ablation. This treatment, performed with a specialized instrument inserted into your uterus, uses heat, microwave energy, hot water or electric current to destroy the lining of your uterus, either ending menstruation or reducing your menstrual flow. Endometrial ablation is effective in stopping abnormal bleeding, but doesn't affect fibroids outside the interior lining of the uterus.
  
• Uterine artery embolization. Small particles (embolic agents) injected into the arteries supplying the uterus cut off blood flow to fibroids, causing them to shrink. This technique, performed by an interventional radiologist, is proving effective in shrinking fibroids and relieving the symptoms they can cause. Advantages over surgery include no incision and a shorter recovery time. Complications may occur if the blood supply to your ovaries or other organs is compromised.

Read more...

Indigestion

Indigestion

Definition:


Indigestion — also called dyspepsia or an upset stomach — is a general term that describes discomfort in your upper abdomen. Indigestion is not a disease, but rather a collection of symptoms you experience, including bloating, belching and nausea. Although indigestion is common, how you experience indigestion may differ from other people. Symptoms of indigestion might be felt occasionally or as often as daily.
Fortunately, you may be able to prevent or treat the symptoms of indigestion.

Symptoms:

Most people with indigestion have one or more of the following symptoms:

• Early fullness during a meal. You haven't eaten much of your meal, but you already feel full and may not be able to finish eating.
• Uncomfortable fullness after a meal. Fullness lasts longer than it should.
• Pain in the upper abdomen. You feel a mild to severe pain in the area between the bottom of your breastbone (sternum) and your navel.
• Burning in the upper abdomen. You feel an uncomfortable heat or burning sensation between the bottom of the breastbone and navel.

Less frequent symptoms that may come along with indigestion include:

• Nausea. You feel like you are about to vomit.
• Bloating. Your stomach feels swollen, tight and uncomfortable.

Sometimes people with indigestion also experience heartburn, but heartburn and indigestion are two separate conditions. Heartburn is a pain or burning feeling in the center of your chest that may radiate into your neck or back after or during eating.
When to see a doctor
Mild indigestion is usually nothing to worry about. Consult your doctor if discomfort persists for more than two weeks. Contact your doctor right away if pain is severe or accompanied by:

• Unintentional weight loss or loss of appetite
• Repeated vomiting or vomiting with blood
• Black, tarry stools
• Yellow coloring in the skin and eyes (jaundice)
• Trouble swallowing that gets progressively worse

Seek immediate medical attention if you have:

• Shortness of breath, sweating or chest pain radiating to the jaw, neck or arm
• Chest pain on exertion or with stress

Causes:

There are many possible causes of indigestion. Some are related to lifestyle and what you're eating and drinking. Indigestion can also be caused by other digestive conditions.
Common causes include:

• Overeating
• Eating too quickly
• Fatty or greasy foods
• Spicy foods
• Too much caffeine
• Too much alcohol
• Too much chocolate
• Too many carbonated beverages
• Smoking
• Nervousness
• Emotional trauma
• Medications, including antibiotics, and some pain relievers
• Pancreas inflammation (pancreatitis)
• Peptic ulcers
• Gallstones
• Stomach cancer

When a cause for indigestion can't be found after a thorough evaluation, a person may have functional dyspepsia. Functional dyspepsia is a type of indigestion that occurs because of an impairment in the stomach's ability to accept and digest food and then pass that food to the small intestine.

Complications:

Although indigestion doesn't usually have serious complications, it can affect your quality of life by making you feel uncomfortable and causing you to eat less. When indigestion is caused by an underlying condition, that condition could come with complications of its own.

Treatments and drugs:

If lifestyle changes — especially avoiding offending foods — don't help your indigestion, there also are over-the-counter and prescription medications that may help. Most are designed to reduce stomach acid or help move food from the stomach to the small intestine.
Types of indigestion medications include:

• Antacids. Alka-Seltzer, Maalox, Mylanta, Tums, and others are available over-the-counter and work by neutralizing stomach acid. Side effects include diarrhea and constipation. These are often the first medications doctors recommend.

• H-2-receptor antagonists (H2RAs). These medications don't begin working as quickly as antacids do, but they work for a longer period of time. Examples of these drugs include Axid, Tagamet, Pepcid and Zantac, which are available over-the-counter or by prescription. Possible side effects that can occur include headache, nausea, vomiting, constipation, diarrhea, and bruising or bleeding.

• Proton pump inhibitors (PPIs). Aciphex, Nexium, Prevacid, Prilosec, Protonix and Zegerid are most effective for people who also have gastroesophageal reflux disease (GERD). These medications reduce stomach acid more effectively than H2RAs. They're available by prescription, although Prilosec and Prevacid also come in over-the-counter strength. Possible side effects include back pain, aching, cough, headache, dizziness, abdominal pain, gas, nausea, vomiting, constipation and diarrhea. Long-term use has, rarely, been associated with bone fractures.

• Prokinetics. Medications, such as Reglan, can be helpful if your stomach empties slowly. People taking this prescription medication frequently experience side effects, such as fatigue, sleepiness, depression, anxiety and involuntary muscle spasms.

• Antibiotics. If the bacteria that causes peptic ulcer disease (Helicobacter pylori) is causing your indigestion, your doctor may prescribe an antibiotic.

• Antidepressants. If a thorough evaluation doesn't reveal a cause for your symptoms and the conventional treatments listed above don't work, your doctor may recommend an antidepressant medication. These prescription medications may improve the discomfort from indigestion by decreasing your sensation of pain.

Read more...