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Reye’s syndrome

Definition:
Reye’s syndrome is a potentially fatal disease that causes numerous detrimental effects to many organs, especially the brain and liver, as well as causing a lower than usual level of blood sugar (hypoglycemia).. Reye’s syndrome most often affects children and teenagers recovering from a viral infection and who may also have a metabolic disorder. The exact cause is unknown, and while it has been associated with aspirin consumption by children with viral illness, it also occurs in the absence of aspirin use.
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The disease causes fatty liver with minimal inflammation and severe encephalopathy (with swelling of the brain). The liver may become slightly enlarged and firm, and there is a change in the appearance of the kidneys. Jaundice is not usually present.

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Early diagnosis is vital; while most children recover with supportive therapy, severe brain injury or death are potential complications.

Boys and girls can both be affected, but the condition is very rare – there were only three reported cases in the UK and Ireland in 2000.

The syndrome is named after Dr. R. Douglas Reye, who, along with fellow physicians Dr. Graeme Morgan and Dr. Jim Baral, published the first study of the syndrome in 1963 in The Lancet. In retrospect, the occurrence of the syndrome may have first been reported in 1929.

Symptoms :
Reye’s syndrome progresses through five stages, explained below:

*Stage I
…#Rash on palms of hands and feet
…#Persistent, heavy vomiting that is not relieved by not eating
…#Generalized lethargy
…#Confusion
…#Nightmares
…#High fever
…#Headaches

*Stage II
…#Stupor caused by encephalitis
…#Hyperventilation
…#Fatty liver (found by biopsy)
…#Hyperactive reflexes

*Stage III
…#Continuation of Stage I and II symptoms
…#Possible coma
…#Possible cerebral oedema
…#Rarely, respiratory arrest

*Stage IV
…#Deepening coma
…#Dilated pupils with minimal response to light
…#Minimal but still present hepatic dysfunction

*Stage V
…#Very rapid onset following stage IV
…#Deep coma
…#Seizures
…#Multiple organ failure
…#Flaccidity
…#Hyperammonemia (above 300 mg/dL of blood)
…#Death

Causes:
The cause of Reye’s syndrome isn’t fully understood. Reye’s syndrome seems to be triggered by using aspirin to treat a viral illness or infection — particularly flu (influenza) and chickenpox — in children and teenagers who have an underlying fatty acid oxidation disorder. Fatty acid oxidation disorders are a group of inherited metabolic disorders in which the body is unable to breakdown fatty acids because an enzyme is missing or not working properly. A screening test is needed to determine if your child has a fatty acid oxidation disorder.

In some cases, Reye’s syndrome may be an underlying metabolic condition that’s unmasked by a viral illness. Exposure to certain toxins — such as insecticides, herbicides and paint thinner — also may contribute to Reye’s syndrome.

Risk Factors:
The following factors — usually when they occur together — may increase your child’s risk of developing Reye’s syndrome:

Using aspirin to treat a viral infection, such as flu, chickenpox or an upper respiratory infection
Having an underlying fatty acid oxidation disorder

Complications:
Most children and teenagers who have Reye’s syndrome survive, although varying degrees of permanent brain damage are possible. Without proper diagnosis and treatment, Reye’s syndrome can be fatal within a few days.

Diagnosis:
Exams and TestsThe following tests may be used to diagnose Reye syndrome:

•Blood chemistry tests
•Head CT or head MRI scan
•Liver biopsy
•Liver function tests
•Serum ammonia test
•Spinal tap

Treatment:
Immediate emergency treatment is needed for Reye’s syndrome, usually in an intensive care unit.

There is no specific treatment for this condition. The health care provider will monitor the pressure in the brain, blood gases, and blood acid-base balance (pH).

Treatments may include:

•Breathing support (a breathing machine may be needed during a deep coma)
•Fluids by IV to provide electrolytes and glucose
•Steroids to reduce swelling in the brain

Prognosis :
Documented cases of Reye’s syndrome in adults are rare. The recovery of adults with the syndrome is generally complete, with liver and brain function returning to normal within two weeks of the illness. In children, however, mild to severe permanent brain damage is possible, especially in infants. Over thirty percent of the cases reported in the United States from 1981 through 1997 resulted in fatality.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/reyes1.shtml
http://en.wikipedia.org/wiki/Reye’s_syndrome
http://www.mayoclinic.com/health/reyes-syndrome/DS00142
http://www.nlm.nih.gov/medlineplus/ency/article/001565.htm
http://bryanking.net/wp-content/uploads/2009/05/reyes_syndrome.jpg

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Calcaneal spur

Definition:
A calcaneal spur is a small bony projection from the back or underside of the heel bone. The calcaneus, also known as the back or underside of the heel bone, develops bony spurs when the Achilles tendon becomes inflamed and overloaded. The localized tendons are forced to take on the weight that was previously held by the Achilles tendon, causing tenderness in the back of the heel. The tendons are constantly being agitated as the patient rests, then gets up again.

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A calcaneal spur (or heel spur) is a radiological (X-ray) finding, and when it is located on the inferior aspect of the calcaneus, is often associated with plantar fasciitis and ankylosing spondylitis. A posterior calcaneal spur may also develop on the back of the heel at the insertion of the Achilles tendon.

An inferior calcaneal spur consists of a calcification of bone, which lies superior to the plantar fascia at the insertion of the plantar fascia . Posterior heel spurs are often large and palpable through the skin and may need to be removed as part of the treatment of insertional Achilles tendonitis

There is stress at the plantar(bottom of the foot) aspect of the calcaneus(heel bone) at the attachment of the plantar aponeurosis. This stress is caused by excessive running, standing, or walking, especially when the individual is unaccustomed to the activity.

Symptoms:
A sharp, stabbing pain under or on the inside of the heel. The pain is typically relieved during rest, but is worse after getting up again.As a rule of thumb, it is most painful first thing in the morning.The pain is made worse by walking on a hard surface or carrying something heavy, such as a suitcase. The pain can become so severe that it becomes difficult to continue your daily work

Special risk groups
*Most sufferers are people who are overweight and middle-aged. This is due to the shock-absorbing fat pillow under the foot shrinking over the years and becoming less effective.

*Weekend athletes.

*People who have feet that are pronated and not corrected. Pronated means that the foot tends to roll inwards when a person walks or runs.

Causes:
A bone spur forms as the body tries to repair itself by building extra bone. It generally forms in response to pressure, rubbing, or stress that continues over a long period of time.

Some bone spurs form as part of the aging process. As we age, the slippery tissue called cartilage that covers the ends of the bones within joints breaks down and eventually wears away (osteoarthritis). Also, the discs that provide cushioning between the bones of the spine may break down with age. Over time, this leads to pain and swelling and, in some cases, bone spurs forming along the edges of the joint. Bone spurs due to aging are especially common in the joints of the spine and feet.

Bone spurs also form in the feet in response to tight ligaments, to activities such as dancing and running that put stress on the feet, and to pressure from being overweight or from poorly fitting shoes. For example, the long ligament on the bottom of the foot (plantar fascia) can become stressed or tight and pull on the heel, causing the ligament to become inflamed (plantar fasciitis). As the bone tries to mend itself, a bone spur can form on the bottom of the heel (known as a “heel spur”). Pressure at the back of the heel from frequently wearing shoes that are too tight can cause a bone spur on the back of the heel. This is sometimes called a “pump bump,” because it is often seen in women who wear high heels.

Another common site for bone spurs is the shoulder. Your shoulder joint is able to move in a number of directions due to its complex structure. Over time, the bones, muscles, tendons, and ligaments that make up your shoulder can wear against one another. The muscles that allow you to lift and rotate your arm (called the rotator cuff) start at your shoulder blade and are attached to your upper arm with tendons. As these tendons move through the narrow space between the top of your shoulder and your upper arm, they can rub on the bones. Bone spurs can form in this narrow area that, in turn, pinch the rotator cuff tendons, resulting in irritation, inflammation, stiffness, weakness, pain, and sometimes tearing of the tendon. This condition, rotator cuff disorder commonly occurs with age and/or repetitive use of the shoulder. It is also common in athletes, especially baseball players, and in people such as painters who frequently work with their arms above their heads.

Diagnosis:
A bone spur is usually visible on an X-ray. But since most bone spurs do not cause problems, it would be unusual to take an X-ray just to see whether you have a bone spur. If you had an X-ray to evaluate one of the problems associated with bone spurs, such as arthritis, bone spurs would be visible on that X-ray.

Treatment:
Bone spurs do not require treatment unless they are causing pain or damaging other tissues. When needed, treatment may be directed at the causes, the symptoms, or the bone spurs themselves.

Treatment directed at the cause of bone spurs may include weight loss to take some pressure off the joints (especially when osteoarthritis or plantar fasciitis is the cause) and stretching the affected area, such as the heel cord and bottom of the foot. Seeing a physical therapist for ultrasound or deep tissue massage may be helpful for plantar fasciitis or shoulder pain.

Treatment directed at symptoms could include rest, ice, stretching, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Education in how to protect your joints is helpful if you have osteoarthritis. If a bone spur is in your foot, changing footwear or adding padding or a shoe insert such as a heel cup or orthotic may help. If the bone spur is causing corns or calluses, padding the area or wearing different shoes can help. A podiatrist (foot doctor) may be consulted if corns and calluses become a bigger problem. If the bone spur continues to cause symptoms, your doctor may suggest a corticosteroid injection at the painful area to decrease pain and inflammation of the soft tissues next to the bone spur.

Sometimes the bone spurs themselves are treated. Bone spurs can be surgically removed or treated as part of a surgery to repair or replace a joint when osteoarthritis has caused considerable damage and deformity. Examples might include repair of a bunion or heel spur in the foot or removal of small spurs underneath the point of the shoulder.

Foot care advice:
*Take time to warm up and stretch before taking part in sport or exercise and cool down afterwards.
If you run or jog, it is better to run a short distance several times a week than one long run once a week.
Do not overestimate your abilities. If necessary, seek advice about creating a suitable running schedule that will give your body time to adapt.

*If you experience pain in the heel, you may be overloading your tendons.

*To help the healing process, follow the RICE principle, which stands for Rest, Ice, Compression and Elevation.

*Rest the foot and do not run until it is completely healed. Apply an ice pack, such as a packet of frozen peas that has first been wrapped in a towel or cloth. An elasticated support bandage will compress and support the foot. It should be firm, but not so tight that it affects the circulation of blood. Elevate the foot by resting it on a chair or a pillow.

*Invest in suitable shoes.

*The heel can be supported with a small cushioned insole inside the shoe.

*Arch supports that fit inside shoes will prevent feet from pronating.

*If you are overweight, losing weight can help prevent foot problems.

Click to see :Heel Spur: Calcaneal Spur Treatment

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.webmd.com/a-to-z-guides/bone-spur-topic-overview?page=2
http://en.wikipedia.org/wiki/Calcaneal_spur
http://www.netdoctor.co.uk/diseases/facts/heelpain.htm
http://www.painreliever.com/calcaneal-spurs.html

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Pleurisy

Alternative Name :Pleuritis

Definition:
Pleurisy  is an inflammation of the pleura,  the lining of the pleural cavity surrounding the lungs. Among other things, infections are the most common cause of pleurisy.

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The inflamed pleural layers rub against each other every time the lungs expand to breathe in air. This can cause severe sharp pain with inhalation (also called pleuritic chest pain).

Symptoms:
The main symptom of pleurisy is a sharp or stabbing pain in the chest that gets worse with deep breathing, coughing, sneezing or laughing. The pain may stay in one place, or it may spread to the shoulder or back. Sometimes it becomes a fairly constant dull ache.

Depending on its cause, pleurisy may be accompanied by other symptoms:

*Chest pain when you inhale and exhale (between breaths, you feel almost no pain)
*Shortness of breath
*Dry cough
*Fever and chills
*Rapid, shallow breathing
*Unexplained weight loss
*Sore throat followed by pain and swelling in the joints
*Diarrhea
*Ventricular tachycardia
*Erectile dysfunction
*Vomiting blood
*Vaginal discharge
*Loss of appetite

The sharp, fleeting pain in your chest that pleurisy causes is made worse by coughing, sneezing, moving and breathing, especially deep breathing. In some cases, pain may extend from your chest to your shoulder. You may find relief from pain when you hold your breath or when you apply pressure over the painful area.

When an accumulation of fluids (pleural effusion) is associated with pleurisy, the pain usually disappears because the fluid serves as a lubricant. However, if enough fluid accumulates, it puts pressure on your lungs, compressing and interfering with their normal function, causing shortness of breath. If the fluid becomes infected, the signs and symptoms of dry cough, fever and chills may appear. An infected pleural effusion is called an empyema.

Causes:
Viral infection is the most common cause of pleurisy. However, many different conditions can cause pleurisy:

*Pneumothorax
*Bacterial infections like pneumonia and tuberculosis
*Autoimmune disorders like systemic lupus erythematosus (or drug-induced lupus erythematosus) and rheumatoid arthritis
*Lung cancer and lymphoma
*Other lung diseases like Cystic Fibrosis, sarcoidosis, asbestosis, lymphangioleiomyomatosis, and mesothelioma
*Pulmonary embolism, a blood clot in the blood vessels that go into the lungs
*Inflammatory bowel disease
*Familial Mediterranean fever, an inherited condition that often causes fever and swelling in the abdomen or lung
*Infection from a fungus or parasite
*Heart surgery, especially coronary artery bypass grafting
*High blood pressure
*Chest injuries
*Aortic dissection
*Can occur with no illness or infection
*Some cases of pleurisy are idiopathic, meaning the cause cannot be determined.

Complications:
*Breathing difficulty
*Collapsed lung due to thoracentesis
*Complications from the original illness

Diagnosis:
Tests to diagnose the underlying cause of  symptoms may include:

*Medical history and physical exam. Doctor will ask detailed questions about your medical history, including other health problems, medications and your recent signs and symptoms. Your doctor may want to examine your chest with a stethoscope. If he or she hears a “snow crunching” sound over the area of your pain, that may be enough to diagnose pleurisy. You may even be able to feel the crunching with your hand. This sign isn’t always present with pleurisy, however.

*Blood tests. A blood test may tell your doctor if you have an infection and, if so, what type of infection you have. Other blood tests also may detect an autoimmune disorder, such as rheumatoid arthritis or lupus, in which the initial sign is pleurisy.

Doctor may also order imaging tests or diagnostic procedures.

Imaging tests
Imaging tests to diagnose the underlying cause of pleurisy may include:

*Chest X-ray. A chest X-ray may show an area of inflammation in your lungs that indicates pneumonia. Sometimes doctors want a special type of chest X-ray in which you lie on your side where the pleurisy is to see if there’s any fluid that doesn’t appear on a standard chest X-ray. This type of X-ray is called a decubitus chest X-ray.

*Computerized tomography (CT) scan. Your doctor will want to investigate any unexplained abnormality seen on chest X-rays with additional imaging, usually beginning with a computerized tomography (CT) scan. In a CT scan, a computer translates information from X-rays into images of thin sections (slices) of your chest, producing more-detailed images.

*Ultrasound. This imaging method uses high-frequency sound waves to produce precise images of structures within your body. Your doctor may use ultrasound to determine whether you have a pleural effusion.

*Magnetic resonance imaging (MRI) . Magnetic resonance imaging (MRI), also called nuclear magnetic resonance (NMR) scanning, uses powerful magnets to show pleural effusions and tumors.

*Arterial blood gas :In arterial blood gas sampling, a small amount of blood is taken from an artery, usually in the wrist. The blood is then checked for oxygen and carbon dioxide levels. This test shows how well the lungs are taking in oxygen.

Diagnostic procedures :-
In some cases,  doctor may remove fluid and tissue from the pleural space for testing. Procedures may include:

*Thoracentesis. To remove fluid for laboratory analysis, your doctor may suggest a procedure called thoracentesis. In this procedure, your doctor first injects a local anesthetic between your ribs to the area where fluid was seen on your imaging studies. Next your doctor then inserts a needle through your chest wall between your ribs to remove fluid for laboratory analysis. If only a small amount of fluid is present, your doctor may insert the needle with the help of ultrasound guidance over the site of the fluid.

*Pleural biopsy. If tuberculosis or lung cancer is a suspected cause of your condition,  doctor may perform thoracentesis with pleural biopsy — removal of a sample of tissue to be examined in a pathology laboratory. The biopsy needle has a small hook on the end that lifts away a small piece of tissue. Your doctor may use ultrasound guidance for this procedure as well.

*Thoracoscopy. This procedure, performed while you’re under a general anesthetic, allows a surgeon to see inside your chest and obtain a sample of pleural tissue. First, the surgeon makes one or more small incisions between your ribs. A tube with a tiny video camera is then inserted into your chest cavity – a procedure sometimes called video-assisted thoracoscopic surgery (VATS). Tools designed for this type of surgery allow your surgeon to cut away tissue for testing.
Treatment:
Treatment has several goals:

*Remove the fluid, air, or blood from the pleural space
*Relieve symptoms
*Treat the underlying condition

Procedures:
If large amounts of fluid, air, or blood are not removed from the pleural space, they may put pressure on the lung and cause it to collapse.

The surgical procedures used to drain fluid, air, or blood from the pleural space are as follows:

*During thoracentesis, a needle or a thin, hollow, plastic tube is inserted through the ribs in the back of the chest into the chest wall. A syringe is attached to draw fluid out of the chest. This procedure can remove more than 6 cups (1.5 litres) of fluid at a time.

*When larger amounts of fluid must be removed, a chest tube may be inserted through the chest wall. The doctor injects a local painkiller into the area of the chest wall outside where the fluid is. A plastic tube is then inserted into the chest between two ribs. The tube is connected to a box that suctions the fluid out. A chest x-ray is taken to check the tube’s position.

*A chest tube also is used to drain blood and air from the pleural space. This can take several days. The tube is left in place, and the patient usually stays in the hospital during this time.

*Sometimes the fluid contains thick pus or blood clots, or it may have formed a hard skin or peel. This makes it harder to drain the fluid. To help break up the pus or blood clots, the doctor may use the chest tube to put certain medicines into the pleural space. These medicines are called fibrinolytics. If the pus or blood clots still do not drain out, surgery may be necessary.

Medications:
A couple of medications are used to relieve pleurisy symptoms:

*Paracetamol (acetaminophen) or anti-inflammatory agents to control pain and decrease inflammation. Only indomethacin (brand name Indocin) has been studied with respect to relief of pleurisy.

*Codeine-based cough syrups to control a cough

There may be a role for the use of corticosteroids (for tuberculous pleurisy), tacrolimus (Prograf) and methotrexate (Trexall, Rheumatrex) in the treatment of pleurisy. Further studies are needed.

Alternative Treatmewnt:
A number of alternative or complementary medicines are being investigated for their anti-inflammatory properties, and their use in pleurisy. At this time, clinical trials of these compounds have not been performed.

Extracts from the Brazilian folk remedy Wilbrandia ebracteata (“Taiuia”) have been shown to reduce inflammation in the pleural cavity of mice.  The extract is thought to inhibit the same enzyme, cyclooxygenase-2 (COX-2), as the non-steroidal anti-inflammatory drugs. Similarly, an extract from the roots of the Brazilian Petiveria alliacea plant reduced inflammation in a rat model of pleurisy.  The extract also reduced pain sensations in the rats. An aqueous extract from Solidago chilensis has been shown to reduce inflammation in a mouse model of pleurisy

Lifestyle changes:
The following may be helpful in the management of pleurisy:

*Lie on your painful side. This may actually lessen your pain.

*Take OTC medicines such as ibuprofen (Advil, Motrin, others) as needed to relieve pain and inflammation.

*Breathing deeply and coughing to clear mucus as the pain eases. Otherwise, pneumonia may develop.

*Get plenty of rest. Even when you start to feel better, be careful not to overdo it.

Prognosis:
Pleurisy and other disorders of the pleura can be serious, depending on what caused the inflammation in the pleura.

If the condition that caused the pleurisy or other pleural disorders isn’t too serious and is diagnosed and treated early, one usually can expect a full recovery.

Prevention:
Early treatment of bacterial respiratory infections can prevent pleurisy.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Pleurisy
http://www.mayoclinic.com/health/pleurisy/DS00244
http://www.nlm.nih.gov/medlineplus/ency/article/001371.htm
http://www.bbc.co.uk/health/physical_health/conditions/pleurisy.shtml

http://www.webmd.com/lung/understanding-pleurisy-basics

http://www.nhlbi.nih.gov/health/dci/Diseases/pleurisy/pleurisy_whatare.html

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Perthes’ disease

Alternative Names: Legg-Calve-Perthes’ disease, ischemic necrosis of the hip, coxa plana, osteochondritis and avascular necrosis of the femoral head, Legg–Perthes Disease or Legg–Calve-Perthes Disease (LCPD).

Definition:
Perthes’ disease  is a degenerative disease of the hip joint, where growth/loss of bone mass leads to some degree of collapse of the hip joint and to deformity of the ball of the femur and the surface of the hip socket. The disease is characterized by idiopathic avascular osteonecrosis of the capital femoral epiphysis of the femoral head leading to an interruption of the blood supply of the head of the femur close to the hip joint. The disease is typically found in young children, and it can lead to osteoarthritis in adults. The effects of the disease can sometimes continue into adulthood.

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Perthes’ disease  affects the top of the femur (thigh bone) where it meets the hip bone. The blood supply to the growth plate of the bone (epiphysis) becomes inadequate. As a result, the bone softens and breaks down – a process called necrosis.

This happens gradually over several weeks. Then, as the blood supply recovers, the bone reforms and hardens. This takes 18 to 36 months and may lead to a deformed shape, with flattening of the ball-shaped head of the femur that normally fits into the round socket of the hip joint.

Recent research has suggested Perthes’ may be linked to a subtle problem with blood clotting.

Perthes’ most commonly affects children between the ages of four and eight, but younger children and teenagers can also develop the condition.

It affects around one in 20,000 children and is up to five times more common in boys. It’s also more common among Caucasians.

In ten to 20 per cent of cases, both hips are affected.

It is named for Arthur Legg, Jacques Calvé and Georg Perthes  and was first described by Karel Maydl.

:
Symptoms:
The first symptom is often limping, which is usually painless. Sometimes there may be mild pain that comes and goes.

Other symptoms may include:

•Hip stiffness that restricts movement in the hip
•Knee pain
•Limited range of motion
•Persistent thigh or groin pain
•Shortening of the leg, or legs of unequal length
•Wasting of muscles in the upper thigh

Causes:
Legg believed trauma to be the cause, Calve ricketts, and Perthes infection. Presently, a number of factors have been implicated including heredity, trauma, endocrine, inflammatory, nutritional, and altered circulatory hemodynamics.

Although no-one has identified the cause of Perthes disease it is known that there is a reduction in blood flow to the joint. It is thought that the artery of the ligamentum teres femoris closes too early, not allowing time for the medial circumflex femoral artery to take over.  For example, a child may be 6 years old chronologically but may have grown to 4 years old in terms of bone maturity. The child may then engage in activity appropriate for a child of 6 but may not yet have the bone strength of an older child, leading to flattening or fracture of the hip joint. Genetics do not appear to be a determining factor, but it has been suggested that a deficiency of some blood factors used to disperse blood clots may lead to blockages in the vessels supplying the joint, but these have not been proven. There is also a deficiency of proteins C and S which act as blood anticoaglants and their deficiency may cause clot formation in ligamentum teres femoris artery and hinder blood supply to the femoral head

Risk factors:
Perthes disease can affect children of nearly any age, but it’s most common among boys ages 2 to 12. In fact, it’s up to five times more common in boys. When girls develop Legg-Calve-Perthes disease, it tends to be more severe.

In addition, Perthes disease is most common in Asians, Eskimos and whites. The disease may be more likely in physically active children who are small for their age and in those who are exposed to secondhand smoke.

Complications:
*Permanent hip deformity. Perthes disease may cause a permanently deformed hip joint — especially if the condition develops after ages 6 to 8.

*Osteoarthritis may develop later in life. Early recognition and proper treatment of  Perthes disease may minimize this complication.

Diagnosis:
X-Rays of the hip confirm the diagnosis. X-rays usually demonstrate a flattened, and later fragmented, femoral head. A bone scan or MRI may be useful in making the diagnosis in those cases where x-rays are inconclusive. Neither bone scan nor MRI offer any additional useful information beyond that of x-rays in an established case. If MRI or bone scans are necessary, a positive diagnosis relies upon patchy areas of vascularity to the capital femoral epiphysis (the developing femoral head).

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Treatment :
The goal of treatment is to keep the ball of the thighbone inside the socket and  to avoid severe degenerative arthritis. Your health care provider may call this “containment.”

Physical therapy and anti-inflammatory medicine (such as ibuprofen) can relieve stiffness in the hip joint. When the hip is painful, or the limp gets worse, restricting activities such as running may help reduce the inflammation. Nighttime traction may also help.

Health care providers no longer recommend several months of bedrest.

Orthopedic assessment is crucial. Younger children have a better prognosis than older children.

Treatment has traditionally centered on removing pressure from the joint until the disease has run its course. Options include traction (to separate the femur from the pelvis and reduce wear) braces (often for several months, with an average of 18 months) to restore range of motion, physiotherapy, and surgical intervention when necessary because of permanent joint damage. To maintain activities of daily living, custom orthotics may be used. These devices internally rotate the femoral head and abduct the leg(s) at 45 degrees. Orthoses can start as proximal as the lumbar spine (LSO), and extend the length of the limbs to the floor. Most functional bracing is achieved using a waist belt and thigh cuffs derived from the Scottish-Rite Orthosis. These devices are typically prescribed by a physician and implemented by a certified orthotist. For older children, the distraction method has been found to be a successful treatment, using an external fixator which relieves the hip from carrying the body’s weight. This allows room for the top of the femur to regrow. Many children need no intervention at all and are simply asked to refrain from contact sports or games which impact the hip. The Perthes Association has a “library” of equipment which can be borrowed to assist with keeping life as normal as possible, newsletters, a helpline, and events for the families to help children and parents to feel less isolated.

Modern treatment focuses on removing pressure from the joint to increase blood flow, in concert with physiotherapy. Pressure is minimized on the hip through use of crutches or a cane, and the avoidance of running-based sports. Swimming is highly recommended, as it allows exercise of the hip muscles with full range of motion while reducing the stress to a minimum. Cycling is another good option as it also keeps stress to a minimum. Physiotherapy generally involves a series of daily exercises, with weekly meetings with a physiotherapist to monitor progress. These exercises focus on improving and maintaining a full range of motion of the femur within the hip socket. Performing these exercises during the healing process is essential to ensure that the femur and hip socket have a perfectly smooth interface. This will minimize the long term effects of the disease. Use of zoledronic acid has also been investigated.

Perthes disease is self limiting, but if the head of femur is left deformed there can be a long-term problem. Treatment is aimed at minimizing damage while the disease runs its course, not at ‘curing’ the disease. It is recommended not to use steroids or alcohol as these reduce oxygen in the blood which is needed in the joint. As sufferers age, problems in the knee and back can arise secondary to abnormal posture and stride adopted to protect the affected joint. The condition is also linked to arthritis of the hip, though this appears not to be an inevitable consequence. Hip replacements are relatively common as the already damaged hip suffers routine wear; this varies by individual, but generally is required any time after age 50.

Prognosis:
The Prognosis depends on the child’s age and the severity of the disease. In general, the younger the child is when the disease starts, the better the outcome.

Children younger than 6 have the best prognosis since they have time for the dead bone to revascularize and remodel, with a good chance that the femoral head will recover and remain spherical after resolution of the disease.  Children who have been diagnosed with Perthes’ Disease after the age of 10 are at a very high risk of developing osteoarthritis and Coxa Magna.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose
Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/001264.htm
http://en.wikipedia.org/wiki/Legg%E2%80%93Calv%C3%A9%E2%80%93Perthes_syndrome
http://www.mayoclinic.com/health/legg-calve-perthes-disease/DS00654
http://www.bbc.co.uk/health/physical_health/conditions/perthes2.shtml
http://orthoinfo.aaos.org/topic.cfm?topic=A00070

http://www.concordortho.com/patient-education/topic-detail-popup.aspx?topicID=8de6c8d126950dbbae6601bda872854b

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Ailmemts & Remedies

Meningioma (mostly benign brain tumour)

Definition:
A meningioma is a tumor that arises from the meninges — the membranes that surround your brain and spinal cord. Most meningiomas are noncancerous (benign), though, rarely, a meningioma may be cancerous (malignant). Some meningiomas are classified as atypical, meaning they’re neither benign nor malignant, but rather something in between.

Symptoms typically appear gradually and vary depending on the location and brain area affected. Because these are slow growing tumors, not all meningiomas need to be treated immediately.A meningioma that causes no significant signs and symptoms may be monitored over time. Treatment options focus on removing the tumor and relieving the compression on the brain

Three layers of membranes, called meninges, lying just under the skull, protect the brain and spinal cord. From the outermost layer inward they are: the dura mater, arachnoid mater, and pia mater. A meningioma grows from the arachnoid cells that form the middle layer, and are firmly attached to the dura. Some meningiomas contain cysts or calcified mineral deposits, and others contain hundreds of tiny blood vessels. Because meningiomas tend to grow inward, they commonly cause pressure on the brain or spinal cord. They can also grow outward causing the skull to thicken (hyperostosis).

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Pic-1.Meningiomas grow from the dura covering of the brain. As the tumor grows, it compresses and displaces normal brain tissue. Increasing size, pressure and swelling cause neurologic symptoms.

The World Health Organization (WHO) developed a classification system for all known tumor types, including meningiomas. Tumors are classified by their cell type and grade by viewing the cells taken during a biopsy under a microscope. Treatment varies depending on the grade of your meningioma.

•WHO, Grade I meningiomas are the slowest growing. If the tumor is not causing symptoms, it may be best to observe its growth over time with periodic MRI scans. If there is a chance the tumor will grow enough in your lifetime to cause symptoms, then surgical removal may be recommended. Most Grade I meningiomas are treated with surgery and continued observation.

•WHO, Grade II meningiomas are called atypical. They are slightly more aggressive in growth than Grade I and have a slightly higher risk of recurrence. Surgery is the first line treatment for these types of meningiomas. Some Grade II meningiomas require radiation after surgery.

•WHO, Grade III meningiomas are the most aggressive and are called malignant or anaplastic. Malignant meningiomas account for less than 1% of all meningiomas. Surgery is the first line treatment for Grade III meningiomas followed by radiation. If the tumor recurs, chemotherapy is used.

Meningiomas represent about 20% of all primary brain tumors and 12% of all spinal cord tumors. They can occur in children, but most often occur in adults between the ages of 40 and 60 years. Most meningiomas are benign (not cancerous), as less than 10% of meningiomas are malignant. While malignant meningiomas occur in both women and men, benign meningiomas occur most often in women.

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Symptoms:
mall tumors (e.g., < 2.0 cm) are usually incidental findings at autopsy without having caused symptoms. Larger tumors can cause symptoms depending on the size and location.

*Focal seizures may be caused by meningiomas that overlie the cerebrum.

*Progressive spastic weakness in legs and incontinence may be caused by tumors that overlie the parasagittal frontoparietal region.

*Sylvian tumors may cause myriad motor, sensory, aphasic, and seizure symptoms, depending on the location.

*Increased intracranial pressure eventually occurs, but is less frequent than in gliomas.

Meningiomas grow slowly; it may take years before they cause symptoms. Some people with meningiomas have no symptoms. The tumor may be found incidentally on a diagnostic scan performed for another reason such as a trauma.  Larger tumors can cause symptoms depending on the size and location. They often first appear as headaches and seizures, primarily due to increased pressure of the growing tumor. Weakness in the arms or legs, or loss of sensation, may occur with spinal cord meningiomas.

Meningiomas are often named according to their location and symptoms:
•Convexity meningiomas: grow on the surface of the brain. They may not produce symptoms until they reach a large size. Symptoms include seizures, neurological deficits, or headaches.

•Falx and parasagittal meningiomas: grow from the dural fold, called the falx, which runs between the left and right sides of the brain. The falx contains two large blood vessels (superior and inferior sagittal sinuses). Because of the danger of injuring the sinuses, removing a tumor in the falx or parasagittal region can be difficult. Symptoms may include personality changes, headache, vision problems, and arm or leg weakness.

•Olfactory groove meningiomas: grow along the olfactory nerves that run between the brain and the nose. These tumors often cause a loss of smell. They can compress the frontal lobes causing personality changes that may be mistaken for depression. They can also compress the optic nerves to the eyes, causing visual problems such as loss of specific areas within your field of vision, or even blindness.

•Sphenoid meningiomas: grow along the sphenoid ridge, which lies behind the eyes. These tumors can cause visual problems, loss of sensation in the face, or facial numbness. Tumors in this location can sometimes encase the major blood vessels of the brain (e.g. cavernous sinus, or carotid arteries) as well as the cranial nerves in the area making them difficult to completely remove.

•Posterior fossa meningiomas: grow along the underside of the brain near the brainstem and cerebellum. These tumors can compress the cranial nerves causing facial symptoms or loss of hearing. Petroclival tumors can compress the trigeminal nerve, resulting in facial pain (trigeminal neuralgia) or spasms of the facial muscles. Foramen magnum meningiomas grow near the area where the spinal cord connects to the brain and can cause headaches, or other signs of brainstem compression such as difficulty walking.

•Intraventricular meningiomas: grow inside the fluid-filled ventricles deep inside the brain. They can block the flow of cerebrospinal fluid (CSF) causing hydrocephalus, which can produce headaches and dizziness.

•Intraorbital meningiomas: grow around the eye sockets of the skull and can cause pressure in the eyes to build up, giving a bulging appearance. They can also cause loss of vision.

•Spinal meningiomas: grow predominantly in the thoracic spine. They can cause back pain (typically at night) or loss of sensation and paralysis of the legs from compression of the spinal nerves.

Causes:
Scientists are not certain what causes meningioma tumors, although several theories are being investigated. Most agree that a malformed chromosome is the most common abnormality in meningiomas, but the cause of this abnormality is unknown.Most cases are sporadic while some are familial. Persons who have undergone radiation to the scalp are more at risk for developing meningiomas. People with a genetic disorder known as neurofibromatosis type 2 (NF2) are more likely to develop meningiomas. Of people with malignant meningiomas, a higher percent have mutations in NF2. Studies have also found that patients who received radiation treatment to the head for medulloblastomas, ependymomas, or other tumors are at higher risk for developing meningiomas later in life secondary to the radiation.

Diagnosis:
First, the doctor will ask about your personal and family medical history and perform a complete physical examination. In addition to checking your general health, the doctor performs a neurological exam. This includes checks for mental status and memory, cranial nerve function (sight, hearing, smell, tongue and facial movement), muscle strength, coordination, reflexes, and response to pain. If a problem is found, the doctor may order diagnostic imaging tests such as computerized tomography (CT) or magnetic resonance imaging (MRI) scans to help determine the size, location, and type of tumor, if one exists . Skull x-rays may be obtained if the tumor is believed to involve the bone. For spinal cord tumors, a myelogram may be done, and in some cases, angiograms, or x-rays of the blood vessels, are necessary. The diagnosis can be confirmed by a biopsy.

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Risk Factors:
*Radiation treatment. Radiation therapy that involves radiation to the head may increase the risk of a meningioma.

*Female hormones. Meningiomas are more common in women, leading doctors to believe that female hormones may play a role.

*An inherited nervous system disorder. The rare disorder neurofibromatosis type 2 increases the risk of meningioma and other brain tumors.
Treatment:
The treatment you receive for a meningioma depends on many factors, including the size of your meningioma, where it’s situated and how aggressive it’s believed to be. Your doctor will also take into consideration your overall health and your goals for treatment.

Wait-and-see approach
Immediate treatment isn’t necessary for everyone with a meningioma. A small, slow-growing meningioma that isn’t causing signs or symptoms may not require treatment.

If the plan is not to undergo treatment for your meningioma, you’ll likely have brain scans periodically to evaluate your meningioma and look for signs that it’s growing. Your doctor creates a personalized follow-up schedule for you. For instance, you might undergo brain scans every few months at first and then have scans done annually. If your doctor determines your meningioma is growing and needs to be treated, you have several treatment options.

Surgery
If your meningioma causes signs and symptoms or shows signs that it’s growing, your doctor may recommend surgery. Surgeons work to remove the meningioma completely. But because a meningioma may occur near many delicate structures in the brain or spinal cord, it isn’t always possible to remove the entire tumor. In those cases, surgeons remove as much of the meningioma as possible.

The type of treatment, if any, you need after surgery depends on several factors.

*If no visible tumor remains, then no further treatment may be necessary. However, you will have periodic follow-up scans.

*If the tumor is benign and only a small piece remained, then your doctor may recommend periodic follow-up scans only. In some cases, small, leftover tumors may be treated with a form of radiation treatment called stereotactic radiosurgery.

*If the tumor is atypical or malignant, you’ll likely need radiation.

Surgery may pose risks including infection and bleeding. The specific risks of your surgery will depend on where your meningioma is located. For instance, surgery to remove a meningioma that occurs around the optic nerve can lead to vision loss. Ask your surgeon about the specific risks of your surgery…..click & see

A craniotomy is cut in the skull to expose the tumor. After the tumor is removed, brain tissue can re-expand in the cavity……..click & see

Radiation therapy
If your meningioma can’t be completely removed, your doctor may recommend radiation therapy following surgery. The goal of radiation therapy is to destroy any remaining meningioma cells and reduce the chance that your meningioma may recur. Radiation therapy uses a large machine to aim high-powered energy beams at the tumor cells.

Advances in radiation therapy increase the dose of radiation to the meningioma while reducing radiation to healthy tissue. These include fractionated stereotactic radiotherapy (SRT) and intensity-modulated radiotherapy (IMRT).

Radiosurgery
Radiosurgery is a type of radiation treatment that aims several beams of powerful radiation at a precise point. Contrary to its name, radiosurgery doesn’t involve scalpels or incisions. Radiosurgery typically is done in an outpatient setting in a few hours. Radiosurgery may be an option for people with meningiomas that can’t be removed with conventional surgery or for meningiomas that recur despite treatment.

Fractionated radiation
For tumors too large for radiosurgery or those in an area that can’t tolerate the high intensity of radiosurgery — such as near the optic nerve — a possible option is fractionated radiation. This involves delivering the radiation in small fractions over time. For example, this approach might require one treatment a day for 30 days.

Drugs
For people with meningiomas that recur or don’t respond to surgery and radiation, doctors are trying different system treatments. Unfortunately, most chemotherapy has not proved valuable, but some drugs, such as hydroxyurea (Droxia, Hydrea), are sometimes used. Other drugs are being tested as well, such as those that inhibit the formation of blood vessels (angiogenesis inhibitors). Much more study is needed.

Complications:
A meningioma and its treatment, typically surgery and radiation therapy, can cause long-term complications, including:

*Difficulty concentrating

*Memory loss

*Personality changes

*Seizures

Your doctor can treat some complications and refer you to specialists to help you cope with other complications.

Alternative Medications:
Alternative medicine treatments can’t treat meningiomas, but some may help provide relief from treatment side effects or help you cope with the stress of having a meningioma.

Alternative medicine therapies that may be helpful include:

*Acupuncture

*Hypnosis

*Massage

*Meditation

*Music therapy

*Relaxation exercises

Discuss options with your doctor.

Coping and support
Being diagnosed with a meningioma can be overwhelming. As you come to terms with your diagnosis, your life can be turned upside down with visits to doctors and surgeons as you prepare for your treatment. To help you cope, try to:

*Learn everything you can about meningiomas. Ask your health care team where you can get more information about meningioma and your treatment options. Visit your local library and ask a librarian to help you track down reliable resources for more information, including online sources. Write down your questions so that you’ll remember to ask them at your next appointment with your doctor. The more you know about your condition, the better prepared you’ll be to make decisions about your treatment.

*Build a support network. Having friends and family supporting you can be valuable. You may find it helps to have someone to talk to about your emotions. Other people who may provide support include social workers and psychologists — ask your doctor for a referral if you feel that you need someone else to talk to. Talk with your pastor, rabbi or other spiritual leader. Other people with meningiomas can offer a unique perspective, so consider joining a support group – whether it’s in your community or online. Ask your health care team about brain tumor or meningioma support groups in your area, or contact the American Brain Tumor Association.

*Take care of yourself. Try to stay healthy during your treatment for a meningioma by taking care of yourself. Eat a diet rich in fruits and vegetables, and get moderate exercise daily if your doctor allows it. Get enough sleep so that you wake feeling rested. Reduce stress in your life by focusing on what’s important to you. These measures won’t cure your meningioma, but they may help you feel better as you recover from surgery or help you to cope during radiation therapy.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.mayfieldclinic.com/PE-MENI.htm
http://en.wikipedia.org/wiki/Meningioma
http://www.mayoclinic.com/health/meningioma/DS00901
http://www.bbc.co.uk/health/physical_health/conditions/braintumourbenign.shtml

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