Category: Pediatric

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Ailmemts & Remedies Pediatric

Torticollis

Alternative Names : Wry neck; Loxia

DEFINITION:
Torticollis is a twisted neck in which the head is tipped to one side, while the chin is turned to the other.It is a stiff neck associated with muscle spasm, classically causing lateral flexion contracture of the cervical spine musculature. The muscles affected are principally those supplied by the spinal accessory nerve.

CLICK  &  SEE THE PICTURES

Symptoms:
•Limited range of motion of the head
•Headache
•Head tremor
•Neck pain
•Shoulder is higher on one side of the body
•Stiffness of neck muscles
•Swelling of the neck muscles (possibly present at birth)

Types of Torticollis:

Temporary Torticollis: This type of wry neck usually disappears after one or two days. It can be caused by:

*swollen lymph nodes
*an ear infection
*a cold
*an injury to the head and neck that causes swelling

Fixed Torticollis:  Fixed torticollis is also called acute torticollis or permanent torticollis. It is usually due to a problem with muscle or bone structure.

Muscular Torticollis:
This is the most common type of fixed torticollis. It is caused by scarring or tight muscles on one side of the neck

Klippel-Feil Syndrome:
This is a congenital form of wry neck. It occurs when the bones in an infant’s neck have formed incorrectly. Children born with this condition may have difficulty with hearing and vision.

Cervical Dystonia:
This rare disorder is sometimes referred to as spasmodic torticollis. It causes neck muscles to contract in spasms. If you have cervical dystonia, your head twists or turns painfully to one side. It may also tilt forward or backward. Cervical dystonia sometimes goes away without treatment. However, there is a risk of recurrence.

This type of wry neck  or Torticollis can happen to anyone. However, it is most commonly diagnosed in middle age. It affects more women than men.

CAUSES:
Torticollis  can be inherited. It can also develop in the womb. This may happen if the fetus’ head is in the wrong position. It can also be caused by damage to the muscles or blood supply to the neck.

Anyone can develop wry neck after a muscle or nervous system injury. However, most of the time, the cause of wry neck is not known. This is called idiopathic torticollis.

DIAGNOSIS:
Evaluation of a child with torticollis begins with history taking to determine circumstances surrounding birth and any possibility of trauma or associated symptoms. Physical examination reveals decreased rotation and bending to the side opposite from the affected muscle. Some say that congenital cases more often involve the right side, but there is not complete agreement about this in published studies. Evaluation should include a thorough neurologic examination, and the possibility of associated conditions such as developmental dysplasia of the hip and clubfoot should be examined. Radiographs of the cervical spine should be obtained to rule out obvious bony abnormality, and MRI should be considered if there is concern about structural problems or other conditions.

Evaluation by an ophthalmologist should be considered in children to ensure that the torticollis is not caused by vision problems (IV cranial nerve palsy, nystagmus-associated “null position,” etc.). Most cases in infants respond well to physical therapy. Other causes should be treated as noted above.

TREATMENT:
Common treatments  might involve a multi-phase process:

1.Low-impact exercise to increase strong form neck stability
2.Manipulation of the neck by a chiropractor, physical therapist, or D.O.†
3.Extended heat application.
4.Repetitive shiatsu massage.

†An Osteopathic Physician (D.O.) may choose to use Cranial techniques to properly position the occipital condyles – thereby relieving compression of cranial nerve XI in children with Torticollis. This is an example of Osteopathic Manipulative Treatment.

Acquired torticollis:
Acquired torticollis occurs because of another problem and usually presents in previously normal children and adults…..

*A self-limiting spontaneously occurring form of torticollis with one or more painful neck muscles is by far the most common (‘stiff neck’) and will pass spontaneously in 1–4 weeks. Usually the sternocleidomastoid muscle or the trapezius muscle is involved. Sometimes draughts, colds or unusual postures are implicated; however in many cases no clear cause is found. These episodes are rarely seen by doctors other than a family physician.

*Trauma to the neck can cause atlantoaxial rotatory subluxation, in which the two vertebrae closest to the skull slide with respect to each other, tearing stabilizing ligaments; this condition is treated with traction to reduce the subluxation, followed by bracing or casting until the ligamentous injury heals.

*Tumors of the skull base (posterior fossa tumors) can compress the nerve supply to the neck and cause torticollis, and these problems must be treated surgically.

*Infections in the posterior pharynx can irritate the nerves supplying the neck muscles and cause torticollis, and these infections may be treated with antibiotics if they are not too severe, but could require surgical debridement in intractable cases.

*Ear infections and surgical removal of the adenoids can cause an entity known as Grisel’s syndrome, a subluxation of the upper cervical joints, mostly the atlantoaxial joint, due to inflammatory laxity of the ligaments caused by an infection. This bridge must either be broken through manipulation of the neck, or surgically resected.

*The use of certain drugs, such as antipsychotics, can cause torticollis.

*Antiemetics – Neuroleptic Class – Phenothiazines

There are many other rare causes of torticollis.

Spasmodic torticollis:
Torticollis with recurrent but transient contraction of the muscles of the neck and esp. of the sternocleidomastoid. “intermittent torticollis . “cervical dystonia”

TREATMENT: Botulinum toxin has been used to inhibit the spastic contractions of the affected muscles.

In animals:….CLICK & SEE
The condition can also occur in animals, usually as a result of an inner ear infection but sometimes as a result of an injury. It is seen largely in domestic rodents and rabbits, but may also appear in dogs and other different animals.

Possible ComplicationsComplications may include:

•Muscle swelling due to constant tension
•Neurological symptoms due to compressed nerve roots

Prognosis:
The condition may be easier to correct in infants and children. If the condition becomes chronic, numbness and tingling may develop as nerve roots become compressed in the neck.

The muscle itself may become large (hypertrophic) due to constant stimulation and exercise.

Botulinum toxin injections often provide substantial relief.

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/Torticollis
http://www.nlm.nih.gov/medlineplus/ency/article/000749.htm
http://www.umm.edu/imagepages/19090.htm

http://commons.wikimedia.org/wiki/File:Sternocleidomastoideus.png

http://www.healthline.com/health/torticollis#Causes2

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Hydrocephalus

Definition:
Hydrocephalus (pronounced hi-dro-SEF-a-lus) is a potentially harmful build up of cerebrospinal fluid (CSF) in parts of the brain.
CLICK & SEE THE PICTURES…………

Images from a patient with normal pressure hyd...
Images from a patient with normal pressure hydrocephalus (NPH) showing pulsations of CSF with heartbeat. (Photo credit: Wikipedia)

Cerebrospinal fluid (CSF)A clear fluid produced in the brain’s ventricular system – the four cavities in the brain. It travels throughout the brain and in the area outside the brain and spinal cord. It bathes and protects or cushions the brain and spinal cord.

Hydrocephalus literally means water (hydro) in the head (cephalus). It is sometimes called water on the brain. The “water” is actually cerebrospinal fluid. Cerebrospinal fluid is normally present in areas both inside and outside the brain.

Children with hydrocephalus have too much cerebrospinal fluid in the areas of the brain called ventricles.

Ventricles are four small cavities in the brain that produce cerebrospinal fluid (CSF). This fluid flows through the ventricles to the area around the brain and spinal cord.
.

The ventricles store and circulate cerebrospinal fluid. Children with hydrocephalus may also have extra fluid in spaces between the brain and the skull called the  subarachnoid spaces

Subarachnoid spaces  are the spaces lie between the three membranes protecting the brain. Cerebrospinal fluid moves through these spaces. Delicate connective tissue extends across them.

When a child’s cerebrospinal fluid cannot flow or be reabsorbed properly, it builds up. This makes the ventricles bigger and puts pressure on the tissues of the brain

Hydrocephalus is sometimes present at birth, although it may develop later. About 1 out of 500 children is born with the disorder. The outlook if  some one has hydrocephalus depends on how quickly the condition is diagnosed and whether any underlying disorders are present.

Symptoms:
The signs and symptoms of hydrocephalus vary by age group and disease progression.

In infants, common signs and symptoms of hydrocephalus include:

*An unusually large head
*A rapid increase in the size of the head
*A bulging “soft spot” on the top of the head
*Vomiting
*Sleepiness
*Irritability
*Seizures
*Eyes fixed downward (sunsetting of the eyes)
*Developmental delay

In older children and adults, common signs and symptoms of hydrocephalus include:

*Headache followed by vomiting
*Nausea
*Blurred or double vision
*Eyes fixed downward (sunsetting of the eyes)
*Problems with balance, coordination or gait
*Sluggishness or lack of energy
*Slowing or regression of development
*Memory loss
*Confusion
*Urinary incontinence
*Irritability
*Changes in personality
*Impaired performance in school or work

Hydrocephalus produces different combinations of these signs and symptoms, depending on its cause, which also varies by age. For example, a condition known as normal pressure hydrocephalus, which mainly affects older people, typically starts with difficulty walking. Urinary incontinence often develops, along with a type of dementia marked by slowness of thinking and information processing.
Causes:
The cause of hydrocephalus is excess fluid buildup in the brain.

Our brain is the consistency of gelatin, and it floats in a bath of cerebrospinal fluid. This fluid also fills large open structures, called ventricles, which lie deep inside the brain. The fluid-filled ventricles help keep the brain buoyant and cushioned.

Cerebrospinal fluid flows through the ventricles by way of interconnecting channels. The fluid eventually flows into spaces around the brain, where it’s absorbed into your bloodstream.

Keeping the production, flow and absorption of cerebrospinal fluid in balance is important to maintaining normal pressure inside your skull. Hydrocephalus results when the flow of cerebrospinal fluid is disrupted — for example, when a channel between ventricles becomes narrowed — or when your body doesn’t properly absorb this fluid.

Defective absorption of cerebrospinal fluid causes normal pressure hydrocephalus, seen most often in older people. In normal pressure hydrocephalus, excess fluid enlarges the ventricles but does not increase pressure on the brain. Normal pressure hydrocephalus may be the result of injury or illness, but in many cases the cause is unknown.

Risk Factors:
Premature infants have an increased risk of severe bleeding within the ventricles of the brain (intraventricular hemorrhage), which can lead to hydrocephalus.

Certain problems during pregnancy may increase an infant’s risk of developing hydrocephalus, including:

*An infection within the uterus
*Problems in fetal development, such as incomplete closure of the spinal column

Congenital or developmental defects not apparent at birth also can increase older children’s risk of hydrocephalus.

Other factors that increase your risk of hydrocephalus include:

*Lesions or tumors of the brain or spinal cord
*Central nervous system infections
*Bleeding in the brain
*Severe head injury

Complications:
The severity of hydrocephalus depends on the age at which the condition develops and the course it follows. If the condition is well advanced at birth, major brain damage and physical disabilities are likely. In less severe cases, with proper treatment, it’s possible to have a nearly normal life span and intelligence

Diagnosis:
Doctors will examine the child, looking for signs of hydrocephalus. They may also use techniques to monitor pressure inside your baby’s head. Doctors also use imaging tests to see signs of hydrocephalus. These tests include:

*CT scan (computerized tomography) of the head
*MRI (magnetic resonance imaging)

If the child has hydrocephalus, doctors may use ultrasound images of the brain to monitor the condition.
Treatment:
To treat hydrocephalus, doctors try to improve the flow of cerebrospinal fluid. Most often, they use surgery to do this.
Surgery:
Neurosurgeons most often perform three types of operations for hydrocephalus.

1.Shunts
The most common surgery for hydrocephalus is putting in a shunt.

A shunt is a small tube (catheter) that drains extra cerebrospinal fluid from a ventricle in your child’s brain to another area in the body. There, the fluid is either reabsorbed by your child’s body or passed out through the kidneys.

Neurosurgeons place one end of the small tube in the ventricle where extra fluid is causing problems. A valve in the tube controls the amount of fluid that runs through it. This controls the pressure in your child’s head. It also makes sure that the fluid flows in only one direction, away from the brain.
CLICK & SEE

The three areas a VP shunt can be placed in the head
The tube is placed under the skin and drains the fluid to another area of the body. The end of the tube most often is placed in the belly (abdomen). This is called a ventricular to peritoneal shunt. If the abdomen is not suitable for the tube, it may be placed in the heart (ventricular to atrial shunt), chest, or other areas. No matter where the tube ends, the fluid from the brain is reabsorbed by the body.

Placement of a VP shunt from the head to the belly.
Our neurosurgeons choose from many different types of shunts and valves, depending on your child’s needs. In some cases, they use a valve that can be adjusted from the outside by a small magnet. If your child has an MRI, these types of valves must always be reset immediately by one of our neurosurgery nurse practitioners.

2.Endoscopy:
An endoscope is a thin, flexible tube that carries a light and a camera. Surgeons can use it to see inside the body and perform some operations. Endoscopy requires smaller cuts (incisions) than other types of surgery (open surgery). It is a minimally invasive technique. Neurosurgeons use it to treat some types of hydrocephalus.

The approach made by an endoscope to make a hole in the ventricle so that the patient can avoid needing a shunt.
Some children have a complex type of the condition called multiloculated hydrocephalus. This happens when bleeding or infection causes scars within the ventricles of the brain. The scaring causes many small compartments of spinal fluid that do not connect with each other to develop.

In the past, doctors treated this condition by placing a separate shunt in each area with fluid and draining it. But by using an endoscope, they can make small holes in each of the areas. This connects them so they need only one shunt to drain the entire system.

3.Endoscopic third ventriculostomy (ETV)
Depending on your child’s brain structures and age, the neurosurgeon may talk with you about using an ETV instead of putting in a shunt.

During an ETV, the neurosurgeon makes a small hole in your child’s skull. Then the neurosurgeon uses an endoscope to reach the third ventricle in brain. Using the endoscope, the neurosurgeon makes a hole in the ventricle. This lets the extra fluid drain out and be reabsorbed.

An ETV lets neurosurgeons avoid putting in any permanent hardware, such as a shunt. Such a treatment may avoid the complications of using shunt hardware. But the treatment may fail and a shunt may be needed.

This video, developed by Anthony M. Avellino, MD, shows an example of an endoscopic third ventriculostomy procedure for treatment of obstructed hydrocephalus.

Prevention:

To reduce the risk of hydrocephalus:

*If you’re pregnant, get regular prenatal care. Following your doctor’s recommended schedule for checkups during pregnancy can reduce your risk of premature labor, which places your baby at risk of hydrocephalus and other complications.

*Protect against infectious illness. Follow the recommended vaccination and screening schedules for your age and sex. Preventing and promptly treating the infections and other illnesses associated with hydrocephalus may reduce your risk.

To prevent head injury:

*Use appropriate safety equipment. For babies and children, use a properly installed, age- and size-appropriate child safety seat on all car trips. Make sure all your baby equipment — crib, stroller, swing, highchair — meets all safety standards and is properly adjusted for your baby’s size and development. Older children and adults should wear a helmet while riding a bicycle, skateboard, motorcycle, snowmobile or all-terrain vehicle.

*Always wear a seat belt in a motor vehicle. Small children should be secured in child safety seats or booster seats. Depending on their size, older children may be adequately restrained with seat belts.

Should you be vaccinated against meningitis?

Ask your doctor if you or your child should receive a vaccine against meningitis, once a common cause of hydrocephalus. A meningitis vaccine is now recommended for people ages 2 and older who are at increased risk of this disease due to:

*Traveling to countries where meningitis is common

*Having an immune system disorder called terminal complement deficiency

*Having a damaged spleen or having had your spleen removed

*Living in a dormitory as a college freshman

*Joining the military

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:

Click to access What-is-ETV.pdf

http://en.wikipedia.org/wiki/Hydrocephalus
http://trialx.com/curebyte/2011/06/01/hydrocephalus-photos/
http://www.mayoclinic.com/health/hydrocephalus/DS00393

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Pediatric

Helping children swallow medicine

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Most parents know the battle of getting a child to swallow medicine when necessary. It’s strange how children can savour the most disgusting sweets but refuse medicine that tastes far more pleasant. It’s all part of the art of being two: recognising when your parents are really worried about something and then refusing to play the game.

But it’s important for children to get the doses of medicine they’ve been prescribed and that they finish any course of antibiotics they’re given, so you need to be patient and keep trying.

Some of the following might help:

*Make sure younger children get liquid rather than tablet forms of medicine where possible.

*Ask your doctor or pharmacist if the medicine can be prescribed in a flavour your child likes. This isn’t always possible, but there are lots of different makes of antibiotics, so it’s worth a try.

*Try mixing the medicine with something very sweet, such as honey or fruit syrup. This is particularly useful if the medicine is in tablet form. These can often be crushed into the syrup (but check with your pharmacist first, as some come in a gel form that doesn’t dissolve easily) or mixed with other more solid foods.

*Use a syringe (from the pharmacy) to give medicine, especially to younger children. This is much easier to hold than a spoon and far less likely to spill, especially when you’re holding the child tight and they’re trying to push you and the medicine away. When you put the syringe in your child’s mouth, point it towards their cheek as you press the plunger to avoid squirting it straight down their throat and choking them.

*Toddlers may be more willing when they’re given medicine in an animal-shaped medicine tube and allowed to sip it at their own pace.

*Try reverse psychology – tell your child it’s special medicine and she’s not allowed to have it. It’s amazing how often this one works.

*Bribery and corruption involving large amounts of sweets is often a good bet, too (but don’t tell your dentist).

*Stay calm and never force your child to take medicine. If they persistently refuse, try again after about half an hour.

*Say you’ll take them back to the doctor to be given the medicine (this showdown is too much for most toddlers, who’ll back down at this point).

Many children find it hard to swallow pills and capsules. Most have never had to, since almost all medications for children are available in liquid form. However, pills have their advantages: parents know the child gets the entire dose, pills hide the flavor of medicines that taste bad, pills are easier to take when traveling, and pills do not have to be refrigerated like many liquids.

What is the best way to teach a child to take a pill? There are many techniques parents can try, but everyone agrees that it is a good idea for parents to teach their kids the technique of pill swallowing before they really need it. A sick or cranky child is not a cooperative student!

Here are some suggestions that might help:

*Keep a calm and positive attitude

*Be patient. Some normal children can’t accomplish pill-swallowing until their late teens!

*Show the child how to swallow pills calmly and quickly. Demonstrate by placing a tablet or capsule back in the center of their tongue. Have them quickly drink water, Kool-Aid, or their favorite drink through a straw. When the child concentrates on using the straw and swallowing the liquid, the pill usually follows quickly along.

*Train in small steps with success at every stage. For example, have your child practice with a piece of small cake decoration. When the smallest size is swallowed without a problem, a slightly larger size may be tried. Then work up to the size of an M & M. Use substances that will melt if they get stuck or coat them first with butter. It is best to work in short sessions (5-10 minutes) several times a day over a couple of days.

*Eliminate distractions during medicine taking time. Close the door, turn the TV off, etc. allowing the child can concentrate on the job at hand
If the child gags or vomits, be calm and clean up the mess in a matter-of-fact way. Let the child settle down and try again in 10 or 15 minutes.

*Some kids like to play “Beat the Clock.” Use a one or two minute time limit!

*Give plenty of praise, such as “Oh good! You swallowed it right down.” Avoid negative comments like “Only babies take liquid medicine.” These comments rarely motivate children to try harder.

*Some pills are easier to swallow if they are broken into halves. Check with the pharmacist first, however, to make sure a divided pill does not lose its potency.

*Have the child drink a little water before taking the pill. Tables and capsules are harder to swallow when the youngster’s mouth is dry (which often happens when they are sick).

*As long as the pill does not have to be taken on “an empty stomach,” have your child place a little piece of food on their tongue, next to the pill. Next have them drink some water to swallow the food and the pill usually goes down at the same time. Don’t have your child tilt their head back too far when swallowing as this can sometimes make it more difficult for the pill to go down.

*Another way to get a child to swallow a pill is to stick it in a cube of Jell-O TM. The pill will usually slide down easily with Jell-O.
One pharmacist recommended the “Tic Tac” strategy: Put a “Tic Tac” on the tip of the child’s tongue. Place a glass of water filled to the brim on the table. Have the child suck in water from the brim without picking up the class. About one half mouthful will do. Remove the lips from the glass and quickly tip head back. The “tic tac pill” will be washed to the throat and swallowed with the gulp of water without the tongue being involved. The pharmacist claims this method works with kids as young as three years old.

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.kidsgrowth.com/resources/articledetail.cfm?id=428
http://www.bbc.co.uk/health/physical_health/conditions/medicinechildrenswallow.shtml
http://www.ehow.com/how_6607984_child-swallow-pill.html

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Mastitis

Definition
Mastitis is an infection of the breast tissue that results in breast pain, swelling, warmth and redness of the breast. If you have mastitis, you might also experience fever and chills. Mastitis most commonly affects women who are breast-feeding (lactation mastitis), although in rare circumstances this condition can occur outside of lactation.

click to see the pictures

The term mastitis is from the Greek word mastos, for breast, and itis, for inflammation of. The response to injury to the udder of sheep is called inflammation. Mastitis is the reaction of milk -secreting tissue to injury produced by physical force, chemicals introduced into the gland or most commonly from bacteria and their toxins.

Click to see the picture   :Udder of a of a Roux du Valais sheep after a healed mastitis, one teat was lost due to the disease.

In most cases, lactation mastitis occurs within the first three months after giving birth (postpartum), but it can happen later during breast-feeding. The condition can leave you feeling exhausted and rundown, making it difficult to care for your baby.

Sometimes mastitis leads a mother mistakenly to wean her baby before she intends to. But you can continue breast-feeding while you have mastitis.

Types:
It is called puerperal mastitis when it occurs in lactating mothers and non-puerperal otherwise. Mastitis can occur in men, albeit rarely. Inflammatory breast cancer has symptoms very similar to mastitis and must be ruled out.

The popular misconception that mastitis in humans is an infection is highly misleading and in many cases incorrect. Infections play only a minor role in the pathogenesis of both puerperal and nonpuerperal mastitis in humans and many cases of mastitis are completely aseptic under normal hygienic conditions. Infection as primary cause of mastitis is presumed to be more prevalent in veterinary mastitis and poor hygienic conditions.

The symptoms are similar for puerperal and nonpuerperal mastitis but predisposing factors and treatment can be very different.

Click to see the picture    Serous exudate from bovine udder in E. coli mastitis at left. Normal milk at right.

Puerperal:
Puerperal mastitis is the inflammation of breast in connection with pregnancy, breastfeeding or weaning. Since one of the most prominent symptoms is tension and engourgement of the breast, it is thought to be caused by blocked milk ducts or milk excess. It is relatively common, estimates range depending on methodology between 5-33%. However only about 0.4-0.5% of breastfeeding mothers develop an abscess.

Nonpuerperal:
The term nonpuerperal mastitis describes inflammatory lesions of the breast occurring unrelated to pregnancy and breastfeeding. This article includes description of mastitis as well as various kinds of mammary abscesses. Skin related conditions like dermatitis and foliculitis are a separate entity.

Names for non-puerperal mastitis are not used very consistently and include Mastitis, Subareolar Abscess, Duct Ectasia, Periductal Inflammation, Zuska’s Disease and others.

Symptoms:
Lactation mastitis usually affects only one breast and the symptoms can develop quickly.[3] The signs and symptoms usually appear suddenly and they include:

Click to see the pictures..……….
*Breast tenderness or warmth to the touch
*General malaise or feeling ill
*Swelling of the breast
*Pain or a burning sensation continuously or while breast-feeding
*Skin redness, often in a wedge-shaped pattern
*Fever of 101 F (38.3 C) or greater [4]
*The affected breast can then start to appear lumpy and red.

Click to see the picture

Some women may also experience flu-like symptoms such as:

*Aches
*Shivering and chills
*Feeling anxious or stressed
*Fatigue
*Breast engorgement

Contact should be made with a health care provider with special breastfeeding competence as soon as the patient recognizes the combination of signs and symptoms. Most of the women first experience the flu-like symptoms and just after they may notice a sore red area on the breast. Also, women should seek medical care if they notice any abnormal discharge from the nipples, if breast pain is making it difficult to function each day or they have prolonged, unexplained breast pain.

Causes:
Since the 1980s mastitis has often been divided into non-infectious and infectious sub-groups. However, recent research [6] suggests that it may not be feasible to make divisions in this way. It has been shown that types and amounts of potentially pathogenic bacteria in breast milk are not correlated to the severity of symptoms. Moreover, although only 15% of women with mastitis in Kvist et al.’s study were given antibiotics, all recovered and few had recurring symptoms. Many healthy breastfeeding women wishing to donate breast milk have potentially pathogenic bacteria in their milk but have no symptoms of mastitis.

Mastitis typically develops when the milk is not properly removed from the breast. Milk stasis can lead to the milk ducts in the breasts becoming blocked, as the breast milk not being properly and regularly expressed.  It has also been suggested that blocked milk ducts can occur as a result of pressure on the breast, such as tight-fitting clothing or an over-restrictive bra, although there is sparse evidence for this supposition . Mastitis may occur when the baby is not appropriately attached to the breast while feeding, when the baby has infrequent feeds or has problems suckling the milk out of the breast.

Experts are still unsure why breast milk can cause the breast tissue to become inflamed. One theory is that it may be due to the presence of cytokines in breast milk. Cytokines are special proteins that are used by the immune system and are passed on to the baby in order to help them resist infection. It may be the case that the woman’s immune system mistakes these cytokines for a bacterial or viral infection and responds by inflaming the breast tissue in an attempt to stop the spread of what the body perceives as an infection.

Some women (approximately 15% in Kvist et al. study) will require antibiotic treatment for infection which is usually caused by bacteria from the skin or the baby’s mouth that entering the milk ducts through skin lesions of the nipple or through the opening of the nipple.[8] Infection is usually caused by staphylococcus aureus.

Mastitis is quite common among breastfeeding women. The WHO estimates that although incidences vary between 2.6% and 33%, the prevalence globally is approximately 10% of breastfeeding women. Most mothers who develop mastitis usually do so within the first few weeks after delivery. Most breast infections occur within the first or second month after delivery or at the time of weaning.  However, in rare cases it affects women who are not breastfeeding.

Mastitis can also develop after nipple piercing. In some rare cases, however, Mastitis can occur in men.

Risk Factors:
Women who are breastfeeding are at risk for developing mastitis especially if they have sore or cracked nipples or have had mastitis before while breastfeeding another baby. Also, the chances of getting mastitis increases if women use only one position to breastfeed or wear a tight-fitting bra, which may restrict milk flow

Women with diabetes, chronic illness, AIDS, or an impaired immune system may be more susceptible to the development of mastitis.

Complications:
Complications that may arise from mastitis include recurrence, milk stasis and abscess. The abscess is the most severe complication that women can get from this condition. Also, women who have had mastitis once are likely to develop it again with a future child or with the same infant. Recurrence appears especially in cases of delayed or inadequate treatment.

Milk stasis is another complication that may arise from mastitis and it occurs when the milk is not completely drained from the breast. This causes increased pressure on the ducts and leakage of milk into surrounding breast tissue, which can lead to pain and inflammation.

Delayed treatment or inadequate treatment, especially in mastitis related to milk stasis, may lead to the formation of an abscess within the breast tissue. An abscess is a collection of pus that develops into the breast which ultimately requires surgical drainage.

Diagnosis:
The diagnosis of mastitis and breast abscess can usually be made based on a physical examination. The doctor will also take into account the signs and symptoms of the condition.

However, if the doctor is not sure whether the mass is an abscess or a tumor, an ultrasound may be performed. The ultrasound provides a clear image of the breast tissue and may be helpful in distinguishing between simple mastitis and abscess or in diagnosing an abscess deep in the breast. The test consists of placing an ultrasound probe over the breast.

In cases of infectious mastitis, cultures may be needed in order to determine what type of organism is causing the infection. Cultures are helpful in deciding the specific type of antibiotics that will be used in curing the disease. These cultures may be taken either from the breast milk or of the material aspirated from an abscess.

Mammograms or breast biopsies are normally performed on women who do not respond to treatment or on non-breastfeeding women. This type of tests is sometimes ordered to exclude the possibility of a rare type of breast cancer which causes symptoms similar to those of mastitis.

Treatment:
If you develop a painful, red or swollen breast, and especially if you have generalized symptoms such as a fever, it’s important to see your doctor because there may be infection that needs treatment with antibiotics.

You should try to continue breastfeeding. Although mastitis may interfere with breastfeeding – because the breasts become distorted in shape, for example – it is often the best treatment because it empties the breast.

In fact it’s important to persevere, because otherwise engorged breasts rapidly lead to a fall in milk production, as the body sees it as a signal that more milk is being produced than is needed.

With engorgement, if the affected area is not drained there’s a risk of infection developing. Try to give frequent feeds varying the position of the baby (many recommend a position where the baby’s chin points towards the affected area). Offer the affected breast first for the best chance of good drainage.

You can also try massaging the affected area of the breast as you feed, and applying warmth to the area.

There’s no risk to the baby from infection being passed on in the milk, so this is not a reason to stop feeding.

You can try to relieve the symptoms with cooling treatments – everything from cabbage leaves to cold flannels to gel-filled cool packs. Gentle breast massage can also help. If there is no infection, medicines are often not very effective in resolving the mastitis but may help with symptoms.

Paracetamol or ibuprofen may ease pain and reduce fever for example. These are usually safe although ibuprofen can get through into breast milk in small amounts – this doesn’t usually do any harm but you should check with your GP if your baby was born prematurely, had a low birth weight or any other medical problems. Paracetamol can also pass through into breast milk in tiny amounts but is thought to be even less likely to do harm.

Lifestyle and home remedies :
If you have mastitis, it’s safe to continue breast-feeding. Continuing breast-feeding offers the added benefit of helping clear the infection in your breast.

To relieve your discomfort:

*Maintain your breast-feeding routine.
*Get as much rest as possible.
*Avoid prolonged engorgement before breast-feeding.
*Use varied positions to breast-feed.
*Drink plenty of fluids.
*If you have trouble emptying a portion of your breast, apply warm compresses to the breast or take a warm shower before breast-feeding or pumping milk.
*Wear a supportive bra.
*While waiting for the antibiotics to take effect, take a mild pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others).

If breast-feeding on the infected breast is too painful or your infant refuses to nurse on that breast, try pumping or hand-expressing milk.

Prevention :
To get your breast-feeding relationship with your infant off to its best possible start — and to avoid complications such as mastitis — consider making an appointment with a lactation consultant. A lactation consultant can give you tips and provide invaluable advice for proper breast-feeding technique.

Minimize your chances of getting mastitis by fully draining the milk from your breasts while breast-feeding. Allow your baby to completely empty one breast before switching to the other breast during feeding. If your baby nurses for only a few minutes on the second breast — or not at all — start breast-feeding on that breast the next time you feed your baby.

Alternate the breast you offer first at each breast-feeding, and change the position you use to breast-feed from one feeding to the next. Make sure your baby latches on properly during feedings. Finally, don’t let your baby use your breast as a pacifier. Babies enjoy sucking and often find comfort in suckling at the breast even when they’re not hungry

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/mastitis1.shtml
http://www.riversideonline.com/health_reference/Womens-Health/DS00678.cfm
http://en.wikipedia.org/wiki/Mastitis
http://www.breastfeedingbasics.com/html/breast_infections.shtml
http://glamomamas.com/2011/05/breastfeeding-it%E2%80%99s-choice/

http://melancoholismo.blogspot.com/2009/12/humor-patologico-5-muestra-del-extrano.html

http://www.righthealth.com/topic/mastitis/overview/adam_images?img=4

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Ailmemts & Remedies Pediatric

Labyrinthitis

Definition:
The labyrinth is a group of interconnected canals chambers located in the inner ear. It is made up of the cochlea and the semicircular canals. The cochlea is involved in transmitting sounds to the brain. The semicircular canals send information to the brain about the head’s position and how it is moving. The brain uses this information to maintain balance. Labyrinthitis is caused by the inflammation of the labyrinth. Its most frequent symptom is vertigo ( dizziness ), because the information that the semicircular canals send to the brain about the position of the head is affected.
click & see the pictures
The labyrinth is a system of narrow fluid-filled channels in the inner ear, which is involved in the detection of body movement, helping to control balance and posture.

Labyrinthitis can cause balance disorders.

In addition to balance control problems, a labyrinthitis patient may encounter hearing loss and tinnitus. Labyrinthitis is usually caused by a virus, but it can also arise from bacterial infection, head injury, extreme stress, an allergy or as a reaction to a particular medication. Both bacterial and viral labyrinthitis can cause permanent hearing loss, although this is rare.

Labyrinthitis often follows an upper respiratory tract infection (URI).

Labyrinthitis is rare and is more likely to occur after middle ear infections, meningitis , or upper respiratory infection. It may also occur after trauma, because of a tumor, or after the ingesting of toxic substances. It is thought to be more common in females than in males.

Symptoms:
•The most common symptoms

*Vertigo

*Nausea

*Vomiting

*Loss of balance

Other possible symptoms are:

*A mild headache

*Tinnitus (a ringing or rushing noise)

*Hearing loss

•These symptoms often are provoked or made worse by moving your head, sitting up, rolling over, or looking upward.

•Symptoms may last for days or even weeks depending on the cause and severity.

*Symptoms may come back, so be careful about driving, working at heights, or operating heavy machinery for at least 1 week from the time the symptoms end.

*Rarely, the condition may last all your life, as with Meniere’s disease. This condition usually involves tinnitus and hearing loss with the vertigo. In rare cases it can be debilitating.

Causes:
Many times, you cannot determine the cause of labyrinthitis. Often, the condition follows a viral illness such as a cold or the flu. Viruses, or your body’s immune response to them, may cause inflammation that results in labyrinthitis.

Other potential causes are these:

•Trauma or injury to your head or ear

•Bacterial infections: If found in nearby structures such as your middle ear, such infections may cause the following:

*Fluid to collect in the labyrinth (serous labyrinthitis)

*Fluid to directly invade the labyrinth, causing pus-producing (suppurative) labyrinthitis

•Allergies

•Alcohol abuse

•A benign tumor of the middle ear

•Certain medications taken in high doses

*Furosemide (Lasix)

*Aspirin

*Some IV antibiotics

*Phenytoin (Dilantin) at toxic levels

•Benign paroxysmal positional vertigo: With this condition, small stones, or calcified particles, break off within the vestibule and bounce around. The particles trigger nerve impulses that the brain interprets as movement.

•More serious causes of vertigo can mimic labyrinthitis, but these occur rarely.

*Tumors at the base of the brain

*Strokes or insufficient blood supply to the brainstem or the nerves surrounding the labyrinth

Diagnosis
Diagnosis of labyrinthitis is based on a combination of the individual’s symptoms and history, especially a history of a recent upper respiratory infection. The doctor will test the child’s hearing and order a laboratory culture to identify the organism if the patient has a discharge.

If there is no history of a recent infection, the doctor will order tests such as a commuted topography (CT) scan or a magnetic resonance imaging (MRI) scan to help rule out other possible causes of vertigo, such as tumors. If it is believed a bacterium is causing the labyrinthitis, blood tests may be done, or any fluid draining from the ear may be analyzed to help determine what type of bacteria is present.

Labyrinthitis, or inner ear infection, causes the labyrinth area of the ear to become inflamed.
(Illustration by GGS Information Services.)
Recovery:
Recovery from acute labyrinthine inflammation generally takes from one to six weeks; however, it is not uncommon for residual symptoms (dysequilibrium and/or dizziness) to last for many months or even years[5] if permanent damage occurs.

Recovery from a permanently damaged inner ear typically follows three phases:

1.An acute period, which may include severe vertigo and vomiting
2.approximately two weeks of sub-acute symptoms and rapid recovery
3.finally a period of chronic compensation[clarification needed] which may last for months or years.

Labyrinthitis and anxiety:
Chronic anxiety is a common side effect of labyrinthitis which can produce tremors, heart palpitations, panic attacks, derealization and depression. Often a panic attack is one of the first symptoms to occur as labyrinthitis begins. While dizziness can occur from extreme anxiety, labyrinthitis itself can precipitate a panic disorder. Three models have been proposed to explain the relationship between vestibular dysfunction and panic disorder:

*Psychosomatic model: vestibular dysfunction which occurs as a result of anxiety.

*Somatopsychic model: panic disorder triggered by misinterpreted internal stimuli (e.g., stimuli from vestibular dysfunction), that are interpreted as signifying imminent physical danger. Heightened sensitivity to vestibular sensations leads to increased anxiety and, through conditioning, drives the development of panic disorder.

*Network alarm theory: panic which involves noradrenergic, serotonergic, and other connected neuronal systems. According to this theory, panic can be triggered by stimuli that set off a false alarm via afferents to the locus ceruleus, which then triggers the neuronal network. This network is thought to mediate anxiety and includes limbic, midbrain and prefrontal areas. Vestibular dysfunction in the setting of increased locus ceruleus sensitivity may be a potential trigger.
Treatment:
Vestibular rehabilitation therapy (VRT) is a highly effective way to substantially reduce or eliminate residual dizziness from labyrinthitis. VRT works by causing the brain to use already existing neural mechanisms for adaptation, plasticity, and compensation.

Rehabilitation strategies most commonly used are:
*Gaze stability exercises – moving the head from side to side while fixated on a stationary object (aimed to restore the Vestibulo-ocular reflex) An advanced progression of this exercise would be walking in a straight line while looking side to side by turning the head.

*Habituation exercises – movements designed to provoke symptoms and subsequently reduce the negative vestibular response upon repetition. Examples of these include Brandt-Daroff exercises.

*Functional retraining – including postural control, relaxation, and balance training.
These exercises function by challenging the vestibular system. Progression occurs by increasing the amplitude of the head or focal point movements, increasing the speed of movement, and combining movements such as walking and head turning.

One study found that patients who believed their illness was out of their control showed the slowest progression to full recovery, long after the initial vestibular injury had healed.  The study revealed that the patient who compensated well was one who, at the psychological level, was not afraid of the symptoms and had some positive control over them. Notably, a reduction in negative beliefs over time was greater in those patients treated with rehabilitation than in those untreated. “Of utmost importance, baseline beliefs were the only significant predictor of change in handicap at 6 months followup.”

Prochlorperazine is commonly prescribed to help alleviate the symptoms of vertigo and nausea.

Because anxiety interferes with the balance compensation process, it is important to treat an anxiety disorder and/or depression as soon as possible to allow the brain to compensate for any vestibular damage. Acute anxiety can be treated in the short term with benzodiazepines such as diazepam (Valium); however, long-term use is not recommended because of the addictive nature of benzodiazepines and the interference they may cause with vestibular compensation and adaptive plasticity.  Benzodiazepines and any other form of mind or mood altering addictive drug should not be used on patients with addictive history.

Prognosis :
Most people who have labyrinthitis recover completely, although it often takes five to six weeks for the vertigo to disappear entirely and the individual’s hearing to return to normal. In a few cases, the hearing loss may be permanent. Permanent hearing loss is more common in cases of labyrinthitis that are caused by bacteria. For some individuals, episodes of dizziness may still occur months after the main episode is over.

Prevention :
The most effective preventive strategy includes prompt treatment of middle ear infections, as well as monitoring of patients with mumps, measles, influenza, or colds for signs of dizziness or hearing problems.

Parental concerns:
Labyrinthitis generally resolves by itself; however, in some cases permanent hearing loss can result. Labyrinthitis may cause repeated episodes of vertigo even after the main symptoms have gone away. If the episodes occur when the head is moved suddenly, this can make it difficult for a child to engage in some physical activities or sports .

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/labyrinthitis.shtml
http://www.healthofchildren.com/L/Labyrinthitis.html
http://www.dizziness-and-balance.com/disorders/unilat/vneurit.html
http://en.wikipedia.org/wiki/Labyrinthitis

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