Categories
Ailmemts & Remedies

Ruptured spleen

Definition:
The spleen is a soft plum-coloured organ, packed with blood-filled tissues and covered by a smooth membrane. It’s located in the abdomen just beneath the left side of the diaphragm, under the ribs, and is shaped like a loosely clenched fist.
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The spleen’s vulnerable location and softness means it’s at risk of injury. A severe blow to the stomach area can squash the spleen, splitting or tearing its covering membrane and the tissue inside and allowing blood to rapidly leak out – rather like a squashed tomato.

A ruptured spleen is a serious condition that can occur when your spleen experiences a trauma. With enough force, a blow to your abdomen — during a sporting mishap, a fistfight or a car crash, for example — might lead to a ruptured spleen. Without emergency treatment, a ruptured spleen can cause life-threatening internal bleeding.

Though some ruptured spleens require emergency surgery, others with ruptured spleens can be treated with several days of hospital care.

You may click to seedifferent pictures of  Ruptured spleen

Symptoms
The abdomen usually feels tender and painful when the spleen ruptures. Blood leaks into the abdomen, causing irritation with subsequent tenderness and pain. Classically, a patient with a ruptured spleen describes feeling left shoulder-tip pain (this pain comes from irritation of the diaphragm by the spilt blood).

If the leak of blood is gradual, symptoms may not occur until the blood supply to the body is diminished. This will result in low blood pressure and light-headedness, blurred vision, confusion and loss of consciousness, as the oxygen supply to the heart and brain is affected. If blood loss is rapid, the person may suddenly collapse.

Causes:
A ruptured spleen is the most common serious complication of an abdominal injury and may occur as a consequence of road traffic accidents, sports injuries and violent, physical attacks.

*Injury to the left side of the body. A ruptured spleen is typically caused by a blow to the left upper abdomen or the left lower chest, such as might happen during sporting mishaps, fistfights and car crashes.

*An injured spleen may rupture soon after the abdominal trauma or, in some cases, days or even weeks after the injury.An enlarged spleen. Your spleen can become enlarged when blood cells accumulate in the spleen. An enlarged spleen can be caused by various underlying problems, such as mononucleosis and other infections, liver disease and blood cancers.

Complications: A ruptured spleen can cause life-threatening bleeding into your abdominal cavity.

Diagnosis:
Normal procedures  to diagnose a ruptured spleen include:

*A physical exam. During a physical exam  doctor will use his or her hands to place pressure on your abdomen to determine the size of your spleen and whether you’re experiencing any abdominal tenderness.

*Drawing fluid from  abdomen.  The Doctor may use a needle to draw a sample of fluid from the abdomen. If the sample reveals blood in the abdomen,  the patient may be referred for emergency treatment.

*Imaging tests of  the abdomen. If your diagnosis isn’t clear, the doctor may recommend an abdominal computerized tomography (CT) scan or another imaging test to identify or rule out other possible causes as per symptoms.

Treatment :
Untreated, a ruptured spleen can be rapidly fatal, so it requires urgent medical and surgical treatment.

Fluids must quickly be given through an intravenous drip in order to maintain the circulation to the organs of the body (including a blood transfusion) and emergency surgery is performed to stop the leak of blood.

Sometimes, if the rupture is only small, it’s possible for the surgeon to repair the spleen. However, usually the entire spleen needs to be removed in an operation called a splenectomy.

The spleen plays an important part in protecting the body against infection. In particular it clears a type of bacteria known as pneumococcus from the body. So it’s important that those who’ve had their spleen removed take extra precautions to protect themselves against infection. In particular, they should be vaccinated against pneumococcal infection.

Prognosis:
Splenic rupture permits large amounts of blood to leak into the abdominal cavity, possibly resulting in shock and death. Patients typically require emergency surgery, although it is becoming more common to simply monitor the patient to make sure the bleeding stops by itself and to allow the spleen to heal itself. Rupture of a normal spleen can be caused by trauma, for example, in an accident. If an individual’s spleen is enlarged, as is frequent in mononucleosis, most physicians will not allow activities (such as contact sports) where injury to the abdomen could be catastrophic.

Prevention
The spleen is a useful organ and it is essential to life. It is sometimes removed (splenectomy) in those who have blood disorders, such as thalassemia or hemolytic anemia. If the spleen is removed, a person must receive certain immunizations to help prevent infections that the spleen normally fights.

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/rupturedspleen1.shtml
http://en.wikipedia.org/wiki/Ruptured_spleen
http://www.mayoclinic.com/health/ruptured-spleen/DS00872

how-to-treat-torn-ruptured-spleen-photo

Categories
Ailmemts & Remedies

Pilonidal sinus

Alternative Names:pilonidal cyst, pilonidal abscess or sacrococcygeal fistula

Definition:
A pilonidal sinus is a dimple in the skin in the crease of your child’s buttocks.

This may be noted at birth as a depression or hairy dimple and be present for many years without any symptoms.
Pilonidal sinus affect men more often and most commonly occur in young adults.


You may click to see picture

Two pilonidal cysts in the natal cleft
A pilonidal sinus may also occur due to a blockage in the hair follicles, often associated with an ingrown hair.
In both situations, hair acts as a foreign body, which may produce an infection. The infection may spread into the tissues of your child’s buttocks and produce an abscess (collection of pus under the skin) at a site several inches away from the sinus.

Pilonidal means “nest of hair”, and is derived from the Latin words for hair (“pilus”) and nest (“nidus”).The term was used by Herbert Mayo as early as 1830. R.M. Hodges was the first to use the phrase “pilonidal cyst” to describe the condition in 1880.

Symptoms:
A pilonidal sinus may cause no noticeable symptoms (asymptomatic). The only sign of its presence may be a small pit on the surface of the skin.

When it’s infected, a pilonidal sinus becomes a swollen mass (abscess). Signs and symptoms of an infected pilonidal cyst include:

*Pain
*Localized swelling
*Reddening of the skin
*Drainage of pus or blood from an opening in the skin (pilonidal sinus)
*Foul smell from draining pus

Hair protruding from a passage (tract) below the surface of the skin that connects the infected pilonidal cyst to the opening on the skin’s surface (a pilonidal sinus) — more than one sinus tract may form
Fever (uncommon)

Causes:
Quite why it happens isn’t entirely clear. When they occur in the cleft between the buttocks, one popular explanation is that there’s a developmental defect in the direction that the hair grows – that is, the hair grows inwards rather than outwards.

One proposed cause of pilonidal cysts is ingrown hair. Excessive sitting is thought to predispose people to the condition because they increase pressure on the coccyx region. Trauma is not believed to cause a pilonidal cyst; however, such an event may result in inflammation of an existing cyst. However there are cases where this can occur months after a localized injury to the area. Some researchers have proposed that pilonidal cysts may be the result of a congenital pilonidal dimple. Excessive sweating can also contribute to the cause of a pilonidal cyst.

The condition was widespread in the United States Army during World War II. More than eighty thousand soldiers having the condition required hospitalization.  It was termed “jeep seat or “Jeep riders’ disease”, because a large portion of people who were being hospitalized for it rode in jeeps, and prolonged rides in the bumpy vehicles were believed to have caused the condition due to irritation and pressure on the coccyx.

Risk Factors:
Certain factors can make you more susceptible to developing pilonidal cysts. These include:

*Obesity
*Inactive lifestyle
*Occupation or sports requiring prolonged sitting
*Excess body hair
*Stiff or coarse hair
*Poor hygiene
*Excess sweating

Complications:
If a chronically infected pilonidal cyst isn’t treated properly, there may be an increased risk of developing a type of skin cancer called squamous cell carcinoma.

Differential diagnosis
A pilonidal sinus can resemble a dermoid cyst, a kind of teratoma (germ cell tumor). In particular, a pilonidal cyst in the gluteal cleft can resemble a sacrococcygeal teratoma. Correct diagnosis is important because all teratomas require complete surgical excision, if possible without any spillage, and consultation with an oncologist.

Treatment :
Treatment may include antibiotic therapy, hot compresses and application of depilatory creams.

In more severe cases, the cyst may need to be lanced or surgically excised (along with pilonidal sinus tracts). Post-surgical wound packing may be necessary, and packing typically must be replaced twice daily for 4 to 8 weeks. In some cases, one year may be required for complete granulation to occur. Sometimes the cyst is resolved via surgical marsupialization.

Surgeons can also excise the sinus and repair with a reconstructive flap technique, which is done under general anesthetic. This approach is mainly used for complicated or recurring pilonidal disease, leaves little scar tissue and flattens the region between the buttocks, reducing the risk of recurrence.

Picture of Pilonidal cyst two days after surgery.

A novel and less destructive treatment is scraping the tract out and filling it with fibrin glue. This has the advantage of causing much less pain than traditional surgical treatments and allowing return to normal activities after 1–2 days in most cases.

Pilonidal cysts recur and do so more frequently if the surgical wound is sutured in the midline, as opposed to away from the midline, which obliterates the natal cleft and removes the focus of shearing stress.

Prevention:
To prevent future pilonidal sinus from developing:

*Clean the area daily with glycerin soap, which tends to be less irritating. Rinse the area thoroughly to remove any soapy residue. Washing briskly with a washcloth helps keep the area free of hair accumulation.

*Keep the area clean and dry. Powders may help, but avoid using oils or herbal remedies.
Avoid sitting for long periods of time.

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/Pilonidal_sinus
http://www.mayoclinic.com/health/pilonidal-cyst/DS00747
http://www.bbc.co.uk/health/physical_health/conditions/pilonidalsinus.shtml
http://www.childrenshospital.org/az/Site923/mainpageS923P0.html

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Categories
Ailmemts & Remedies

Pelvic prolapse

Definition:
Prolapse literally means “to fall out of place”, from the Latin prolabi meaning “to fall out”. In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place.

As the muscles, ligaments and supporting tissues in the pelvis become weaker, they are less able to hold in the organs of the pelvis such as the womb (uterus) or bladder.

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Gravity pulls these organs down and, in the more severe cases, may appear through the entrance to the vagina.

A variety of problems can occur, depending on where the weakness lies and which organs are able to descend, but in every case there is some degree of prolapse of the vaginal wall, which begins to invert (rather like a sock turning inside out).

•Prolapse of the womb or uterus is the most common prolapse, affecting as many as one in eight older women to some degree
•Prolapse of the bladder, known as a cystocele, is less common.
•Prolapse of the urethra (the tube that carries urine out of the bladder) is known as a urethrocele.
•Prolapse of the intestines is quite rare, and known as an enterocele or rectocele.

Some experts say up to 50 per cent of women who have had more than one child will eventually develop a prolapse .

Symptoms:
Symptoms depend on which tissues descend, and how severe the prolapse is.

They may include:
•A sense of heaviness or pressure in the pelvis.
•The appearance of a bulge of tissue in the genital area, which can be quite alarming, and is often red and sore.
•Urinary problems, such as having to urinate more frequently, feeling the need urgently, being incontinent (losing control of the bladder) or, conversely, being unable to pass urine when you need to.
•Pain in the pelvis or lower back.
•Sexual problems, including pain and decreased libido.
•Constipation.
•Vaginal discharge or bleeding.

Causes:

Several factors make a prolapse more likely. They include:

•Age: prolapse is rare in young women. As a woman passes the menopause and levels of the female hormone oestrogen decline, the supporting tissues of the pelvis can lose their elasticity and strength very quickly.

•Pregnancy and childbirth: this is one of the most important risk factors for prolapse. Pregnancy stretches and strains the tissues of the abdomen and pelvis. Then during labour and delivery of the baby, the pelvic floor is stretched as the baby passes through. Trauma, tears or lacerations during delivery compound the problem.

•Genetics: research has shown that younger women who develop a prolapse have up to 30 per cent lower levels of collagen (the fibres that form the internal scaffolding of the tissues). This suggests there may be a genetic predisposition, and it certainly seems to run in some families. It is also more common in certain inherited conditions such as Marfan’s syndrome and Ehlers-Danlos syndrome, where there’s abnormal collagen production.

•Muscular defects: uterine prolapse can occur very occasionally in tiny babies who have a weakness of the pelvic muscles or problems with the nerve supply to the area.

•Wide pelvic inlet: this is the round gap in the base of the pelvic bones, through which the baby passes during birth and women with this are more at risk because the tissues bridging the gap have to work even harder to hold the organs above in.

•Chronically increased pressure inside the abdomen: due to obesity or lung disease, for example, helps push the organs down and out.

Risk Factors:
Some of the risk factors for pelvic prolapse include, multiple vaginal births, especially large babies, prolonged labor, chronic conditions such as diabetes, COPD (chronic obstructive pulmonary disease), obesity, and finally genetic factors.

Treatment:
Pelvic prolapse in women is a very common condition that is sometimes avoided by patients and their caretakers. This is a general terms that describes the weakening of the tissues, and ligaments that give support to the uterus, vagina, bladder, and rectum.

Treatment will depend on the type of pelvic organ prolapse you have. Your doctor may recommend first treating some types without surgery. However, in most people, surgery is eventually necessary.

*Medications. Menopause results in lower estrogen levels, which weakens the muscles of the vagina. Estrogen replacement therapy (ERT) may strengthen these muscles. However, some people shouldn’t use ERT. If you develop symptoms of one type of prolapse, you’re more likely to develop other types.

*Physical therapy. Physical therapy can include electrical stimulation and biofeedback.

*Electrical stimulation. During electrical stimulation, the doctor applies small electrical currents to certain muscles in your vagina or pelvic floor. The current causes your muscles to contract, which strengthens them.

*Biofeedback. As you perform pelvic floor exercises, a sensor monitors muscular contractions to determine if the exercises affect certain muscles.

*Surgery.  Doctors may use robot-assisted surgery to treat some types of pelvic organ prolapse. Robotic surgery allows your surgeon to make smaller incisions and can shorten your hospital stay. There are different strategies for various types of prolapse.

*Rectal prolapse (rectocele). Your surgeon will secure the tissue between your vagina and rectum to keep the organ in its proper position. Your surgeon also removes excess tissue.

*Bladder prolapse (cystocele). Your surgeon will push your bladder up and secure the connective tissue between your bladder and vagina to keep the organ in its proper position and remove excess tissue. If you have urinary incontinence, your doctor will use a bladder neck suspension or sling to support your urethra.

*Uterine prolapse. If you’re postmenopausal or don’t want more children, your surgeon may perform a hysterectomy to correct uterine prolapse.

*Vaginal vault prolapse and herniated small bowel (enterocele). These often occur high in the vagina, so your surgeon may perform the surgery through the vagina or abdomen (for severe vaginal vault prolapse). Your surgeon will attach the vagina to the tailbone at the base of the spine (vaginal vault suspension).

Kegel exercise or pelvic floor exercise:-   This exercise consists of repeatedly contracting and relaxing the muscles that form part of the pelvic floor, now sometimes colloquially referred to as the “Kegel muscles”. The exercise needs to be performed multiple times each day, for several minutes at a time, for one to three months, to begin to have an effect.

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Non-surgical pelvic prolapse treatment can be 60 to 70% successful if the prolapse is identified early. These non-invasive pelvic prolapse repair modalities include Kegel exercises, biofeedback, and the use of pessaries.
Prevention:
Women need to be aware of the risks of prolapse and the steps they can take to avoid it, including maintaining a healthy weight, eating plenty of fruit and vegetables to avoid constipation, and learning correct lifting techniques.

There are also specific exercises to keep the pelvic floor muscles strong, sometimes known as Kegel exercises. For example:

•Empty your bladder fully and then, while still sitting on the toilet, practice squeezing your pelvic muscles as if you were trying to stop the flow of urine (don’t do this while actually urinating as it can cause a potentially harmful backflow within the urinary system).

•Practise holding specially designed weighted cones within the vagina.

•Once you have some awareness of the ‘feel’ of the pelvic floor muscles, repeatedly contract them (but not the gluteal or buttock muscles) 50 to 200 times a day for a few seconds at a time.

•Some women find it hard to become aware of, and so exercise, their pelvic floor muscles. There are a number of devices that can help. These are put in the vagina where they either mechanically or electrically trigger the muscles to contract automatically. They are fairly simple to use, very discreet and have been shown to improve continence.

You can get expert advice on pelvic floor exercises from a physiotherapist, who’ll be able to teach you the techniques involved. Your GP may be able to refer you to one, or to a local incontinence clinic where the nurses are also trained on this issue.

It’s also important to aim to minimise trauma to the pelvic tissues during childbirth. Some physiotherapists and also some midwives specialise in teaching women how to strengthen their pelvic floor muscles before giving birth, and retrain them after the stretching of the tissues that occurs during delivery of the baby.

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.mayoclinic.org/pelvic-organ-prolapse/treatment.html

http://my.clevelandclinic.org/ob_gyn/womens_health/urogynecology_pelvic_floor_disorders/pelvic_organ_prolapse.aspx

http://www.bbc.co.uk/health/physical_health/conditions/pelvic_prolapse.shtml

http://en.wikipedia.org/wiki/Prolapse

Categories
Ailmemts & Remedies

Kidney transplant

Introduction:
A kidney transplant is an operation that places a healthy kidney in your body. The transplanted kidney takes over the work of the two kidneys that failed, and you no longer need dialysis.

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During a transplant, the surgeon places the new kidney in your lower abdomen and connects the artery and vein of the new kidney to your artery and vein. Often, the new kidney will start making urine as soon as your blood starts flowing through it. But sometimes it takes a few weeks to start working.

If you have advanced and permanent kidney failure, kidney transplantation may be the treatment option that allows you to live much like you lived before your kidneys failed. Since the 1950s, when the first kidney transplants were performed, much has been learned about how to prevent rejection and minimize the side effects of medicines.

But transplantation is not a cure; it’s an ongoing treatment that requires you to take medicines for the rest of your life. And the wait for a donated kidney can be years long.

Many transplanted kidneys come from donors who have died. Some come from a living family member. The wait for a new kidney can be long. People who have transplants must take drugs to keep their body from rejecting the new kidney for the rest of their lives.

A successful transplant takes a coordinated effort from your whole health care team, including your nephrologist, transplant surgeon, transplant coordinator, pharmacist, dietitian, and social worker. But the most important members of your health care team are you and your family. By learning about your treatment, you can work with your health care team to give yourself the best possible results, and you can lead a full, active life.

Around 40 per cent of patients with end-stage renal failure (ESRF) need a transplant which frees people from the need for dialysis treatments.

A successful kidney transplant has ten times the function of dialysis (for example ten times the ability to remove toxins and extra water from the blood). It means that transplant patients have a better quality of life, with more energy than they did on dialysis.

How transplants work:-
An assessment is necessary to determine whether your body will accept an available kidney. This may require several visits over four to six months, and all potential recipients must be healthy enough for surgery.

Although there is no age limit, few units will transplant patients over 70 years – unless very fit.

If a family member, partner or friend wants to donate a kidney, they will need to be evaluated for general health too.

If there is no potential living donor, you will need to register with hospital and be put on a national waiting list to receive a kidney from a deceased donor. but this varies considerably around the country. Kidneys can also be donated by strangers.

If there is a suitable living donor, the operation can be scheduled in advance, when it suits both sides. If you’re on a waiting list for a deceased donor kidney, as soon as it becomes available, you must go to the hospital quickly – where a test is carried out to check the kidney won’t be rejected. If it’s suitable, the transplant can proceed. The operation usually takes three to four hours.

A surgeon places the new kidney inside your lower abdomen and connects the artery and vein of the new kidney to your artery and vein. Your blood flows through the new kidney, which makes urine, just like your own kidneys did when they were healthy. Unless they are causing infection or high blood pressure, your own kidneys are left in place.

During the operation, the transplant kidney is inserted into the lower abdomen and connected to an artery and vein (to the leg). The blood flows through the new kidney, which makes urine, just like the old kidneys did when they were healthy. The old kidneys are usually left in place.

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Often the new kidney will start making urine as soon as blood starts flowing through it, but about one third of patients will require dialysis for around a week. Most patients leave hospital two weeks after the operation.

To prevent the immune system from seeing the new kidney as foreign and rejecting it, you’ll have to take drugs that turn off (or suppress) your immune response (immunosupressants). It’s important to understand the instructions for taking these medicines before leaving hospital, as missing the tablets for just 24 hours can cause rejection and the loss of the kidney.

Recovery From Surgery:-
As after any major surgery, you’ll probably feel sore and groggy when you wake up. However, many transplant recipients report feeling much better immediately after surgery. Even if you wake up feeling great, you’ll need to stay in the hospital for about a week to recover from surgery, and longer if you have any complications.

Posttransplant Care:-
Your body’s immune system is designed to keep you healthy by sensing “foreign invaders,” such as bacteria, and rejecting them. But your immune system will also sense that your new kidney is foreign. To keep your body from rejecting it, you’ll have to take drugs that turn off, or suppress, your immune response. You may have to take two or more of these immunosuppressant medicines, as well as medications to treat other health problems. Your health care team will help you learn what each pill is for and when to take it. Be sure that you understand the instructions for taking your medicines before you leave the hospital.

If you’ve been on hemodialysis, you’ll find that your posttransplant diet is much less restrictive. You can drink more fluids and eat many of the fruits and vegetables you were previously told to avoid. You may even need to gain a little weight, but be careful not to gain weight too quickly and avoid salty foods that can lead to high blood pressure

Rejection:-
You can help prevent rejection by taking your medicines and following your diet, but watching for signs of rejection—like fever or soreness in the area of the new kidney or a change in the amount of urine you make—is important. Report any such changes to your health care team.

Even if you do everything you’re supposed to do, your body may still reject the new kidney and you may need to go back on dialysis. Unless your health care team determines that you’re no longer a good candidate for transplantation, you can go back on the waiting list for another kidney.

Side Effects of Immunosuppressants:
Immunosuppressants can weaken your immune system, which can lead to infections. Some drugs may also change your appearance. Your face may get fuller; you may gain weight or develop acne or facial hair. Not all patients have these problems, though, and diet and makeup can help.

Immunosuppressants work by diminishing the ability of immune cells to function. In some patients, over long periods of time, this diminished immunity can increase the risk of developing cancer. Some immunosuppressants cause cataracts, diabetes, extra stomach acid, high blood pressure, and bone disease. When used over time, these drugs may also cause liver or kidney damage in a few patients.

Hope through Research:-
The NIDDK, through its Division of Kidney, Urologic, and Hematologic Diseases, supports several programs and studies devoted to improving treatment for patients with progressive kidney disease and permanent kidney failure, including patients who receive a transplanted kidney.

•The End-Stage Renal Disease Program promotes research to reduce medical problems from bone, blood, nervous system, metabolic, gastrointestinal, cardiovascular, and endocrine abnormalities in kidney failure and to improve the effectiveness of dialysis and transplantation. The program seeks to increase kidney graft and patient survival and to maximize quality of life.

•The NIH Organ/Tissue Transplant Center, located at the NIH Clinical Center in Bethesda, MD, is a collaborative project of NIH, the Walter Reed Army Medical Center, the Naval Medical Research Center, and the Diabetes Research Institute at the University of Miami. The site includes a state-of-the-art clinical transplant ward, operating facility, and outpatient clinic designed for the study of new drugs or techniques that may improve the success of organ and tissue transplants.

•The U.S. Renal Data System (USRDS) collects, analyzes, and distributes information about the use of dialysis and transplantation to treat kidney failure in the United States. The USRDS is funded directly by NIDDK in conjunction with the Centers for Medicare & Medicaid Services. The USRDS publishes an Annual Data Report, which characterizes the total population of people being treated for kidney failure; reports on incidence, prevalence, mortality rates, and trends over time; and develops data on the effects of various treatment modalities. The report also helps identify problems and opportunities for more focused special studies of renal research issues.

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.topnews.in/health/kidney-transplant-patients-low-physical-activity-likely-die-early-211177
http://www.nlm.nih.gov/medlineplus/kidneytransplantation.html
http://www.kidney.niddk.nih.gov/kudiseases/pubs/transplant/
http://www.bbc.co.uk/health/physical_health/conditions/in_depth/kidneys/kidneys_transplant.shtml

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Categories
Ailmemts & Remedies Pediatric

Hypospadias

Definition:
Hypospadias is a birth defect found in boys in which the penile meatus is not at the tip of the penis. The meatus is the term for the opening of the penis through which urine normally exits the bladder. The incidence is reported to be 1 in 300 live male births. There is some family risk of hypospadias, as familial tendencies have been noted. Up to 14% of male siblings are affected.

Hypospadias is usually classified according to the location of the opening. As the defect increases in severity, the opening to the penis will be found further back on the penis. The most severe types can have openings at the region of the scrotum and even in the perineum (the region between the anus and scrotum).

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In some men with hypospadias, there’s another abnormality called chordee, in which the penis curves downwards and the foreskin only covers the front of it.In the most severe forms of hypospadias, the urethral opening is so far back it’s almost in the scrotum. The scrotum itself may be small and the testes may not have descended (that is, they’re still deep in the abdomen). When babies are born like this, it can be difficult to work out which sex they are without further tests.

click tom see the picture

Both hypospadias and chordee must be repaired so that a child can have normal urinary and reproductive health.

Symptoms:
Hypospadias is a structural abnormality that doesn’t progress or put the man at risk of any other serious illness. However, as with any abnormalities of the urinary system, there may be an increased risk of urinary infection in more severe cases.

Hypospadias may cause emotional turmoil when a boy realises he’s different from his friends. It can also cause practical problems with passing urine (those with the condition usually have to sit down to pee) and later with sexual intercourse, which may be embarrassing or difficult to cope with. Hypospadias may cause general worries about sexuality and fertility.

Signs and symptoms of hypospadias may include:

*Opening of the urethra at a location other than the tip of the penis
*Downward curve of the penis (chordee)
*Hooded appearance of the penis because only the top half of the penis is covered by foreskin
*Abnormal spraying during urination

Causes:
Hypospadias is present at birth (congenital). The exact reason this defect occurs is unknown. Sometimes hypospadias is inherited.

As the penis develops in a male fetus, certain hormones stimulate the formation of the urethra and foreskin. Hypospadias results when a malfunction occurs in the action of these hormones, causing the urethra to develop abnormally.

As a boy is developing in utero, the penis begins to form in the sixth week of fetal life. Two folds of tissue join each other in the middle and a hollow tube is formed in the middle of the future penis. This tube is the urethra and its opening is called the penile meatus. As the skin folds develop to form the penis, any interruption in this process leads to the meatus being located in a location further from the end of the penis. The exact etiology for this premature cessation of urethral formation is poorly understood. In addition, the etiology of the often-associated abnormal downward curvature (chordee) is also poorly understood.

Risk Factors:
This condition is more common in infants with a family history of hypospadias.

Some research suggests that there may be an increased risk of hypospadias in infant males born to women of an advanced age or those who used in vitro fertilization (IVF) to conceive. The connection to IVF may be due to the mother’s exposure to progesterone, a natural hormone, or to progestin, a synthetic form of progesterone, administered during the IVF process. Other research, however, hasn’t confirmed a link between IVF and hypospadias, but did find an association between a mother’s exposure to pesticides and hypospadias.

Diagnosis:
A physical examination can diagnose this condition. Imaging tests may be needed to look for other congenital defects.

Treatment
The treatment of hypospadias is always surgical. Initially when the child is born and hypospadias is identified, it is important to delay any thoughts of circumcision until seen by a urologist. This is because the foreskin can provide essential additional skin needed to reconstruct the urethra.

Hypospadias is often repaired  before a child is one year of age. This way, the boy is in diapers and management of dressings are made easier. However, the exact age of repair can vary according to the size of the penis and severity of the defect. It can be repaired in most of the  cases with a single operation, but on occasion, a second operation may be needed. The operation is performed under general anesthesia with the child completely asleep. Most of the boys will have a small tube exiting the tip of their new meatus. This “stent” will protect the new urethra and allow for adequate healing. Most patients leave the hospital the same day or the following day. However, more complex repairs for the more severe types of hypospadias can require longer hospital stays due to the need for bedrest and immobilization in the immediate post-operative setting.


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The exact type of operation employed varies according to the severity of the defect. For the more distal defects that have openings closer to the normal position at the end of the penis, a new tube can be created from the surrounding skin. This creation of a tube is known as a Thiersch-Duplay repair. For more severe defects, the options range. Additional hairless skin is often needed to recreate the urethral tube when longer defects are seen. Here, the subdermal skin of the foreskin can be used. For the most severe defects, we can remove mucosal skin from the inside of the cheek or use subdermal skin from other hairless parts of the body. It is important to use hairless skin as future hair growth in the neourethra can present multiple problems.

Complications:
The usual risks of surgery are present at the time of performing  hypospadias repairs. Risk of infection is controlled with use of antibiotics with the surgery and in the post-operative setting. Bleeding is well controlled by using a penile tourniquet during the operation. This limits the blood loss to a very minimal amount, while allowing for good visualization of the tissues for the surgeon.

By using good surgical techniques   the longer-term complications of the surgery are minimised. The most common problems that present are fistula and stricture. A fistula occurs if a hole develops along the pathway of the repair proximal to the tip of the penis. In other words, a hole can develop along the underside of the penis allowing for leakage of urine. Additionally, a stricture is a scar that can form causing a narrowing in the urethra. If either of these complications occur, an additional repair will be needed usually 6 months later

Prognosis:
Results after surgery are typically good. In some cases, more surgery is needed to correct fistulas or a return of the abnormal penis curve.

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/hypospadias.shtml
http://www.nlm.nih.gov/medlineplus/ency/article/001286.htm
http://www.mayoclinic.com/health/hypospadias/DS00884
http://www.cornellurology.com/pediatrics/hypospadias.shtml

http://www.medindia.net/patients/paediatrics/Hypospadias.htm

http://www.surgeryencyclopedia.com/Fi-La/Hypospadias-Repair.html

http://www.adhb.govt.nz/newborn/Guidelines/Anomalies/Hypospadias.htm

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