Categories
Ailmemts & Remedies

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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Categories
Ailmemts & Remedies Pediatric

Plagiocephaly

Definition:
The skull isn’t perfectly smooth – it’s covered with lumps, dips and some flatter areas. But sometimes a large area of flattening distorts the skull, making it look parallelogram-shaped. This is known as plagiocephaly.

The most common form is positional plagiocephaly. It occurs when a baby’s head develops a flat spot due to pressure on that area. Babies are vulnerable because their skull is soft and pliable when they’re born.

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Positional plagiocephaly typically develops after birth when babies spend time in a position that puts pressure on one part of the skull. Because babies spend so much time lying on their back, for example, they may develop a flat spot where their head presses against the mattress.

Starting in the early 1990s, parents were told to put their babies to sleep on their back to reduce the risk of SIDS. While this advice has saved thousands of babies’ lives, experts have noticed a fivefold increase in misshapen heads since then.

More rarely, babies develop positional plagiocephaly when movement in the uterus is constricted for some reason – because their mother is carrying more than one baby, for example. It can also happen to breech babies who get wedged under their mother’s ribs.

Another type of plagiocephaly is craniosynostosis, a birth defect in which the joints between the bones of the skull close early. Babies born with craniosynostosis need surgery to allow their brain to grow properly.

Symptoms
Plagiocephaly may become apparent at different ages, depending on the cause. Some babies are born with a flat head (this may be a temporary deformity due to the baby’s passage down the birth canal), while others develop it later as the bones of the skull fuse. The abnormal shape can best be seen if you look down on the baby’s head from above.

Signs of plagiocephaly include:
CLICK & SEE THE PICTURES
•Parallelogram-shaped skull when viewed from above
•Flattening on one side at the back of the head, with a compensatory protrusion or bulge in the forehead on the same side
•Eyes appearing to have unequal positioning
•A bald spot on flattened side (may be asymmetrical)

To learn more you may click to see :Plagiocephaly, Brachycephaly, Brachycephaly with Plagiocephaly and Scaphocephaly

Causes & Risk Factors:
A baby’s skull is very soft and can be forced to grow in different directions fairly easily. When the skull is kept in one particular position for long periods – because the baby is sleeping in a set position (such as on his back) or because muscles attached to the skull go into spasm (known as torticollis) – areas of the skull may be squashed or pulled flat. This is known as positional or deformation plagiocephaly. It generally gets better by itself over time.

Other factors that increase the risk of plagiocephaly include a multiple birth pregnancy (as the babies ‘squash together’ in the womb), prematurity, poor muscle tone and a condition known as oligohydramnios, where there’s insufficient fluid in the womb to cushion the baby.

In the US at least, plagiocephaly has become more common in recent years. Statistics show that while one in 300 healthy infants was affected in 1992, by 1999 one in 60 had the condition.

This increase is thought to be due to the Back to Sleep campaign, designed to reduce the number of sudden infant deaths (cot deaths).

It’s possible to prevent positional plagiocephaly by changing your baby’s resting position frequently. Your baby still needs to be laid on their back to sleep, but try to alternate the position of the head and encourage them to spend time on their tummy while they’re awake and supervised.

Switch between putting them in a sloping chair, car seat or sling, or on a flat surface, so there’s no constant pressure on one area of the skull.Prolonge keeping the baby in the carseat is  very dengerous for the babies.

Plagiocephaly may also be caused by the bones of the skull joining together abnormally early. These bones normally grow together slowly so the skull expands in all directions. But if some fuse too soon (craniosynostosis), that part of the skull can’t grow in the way it should, pulling the head out of shape. This may occur in isolation, or as part of a genetic syndrome such as Apert syndrome or Crouzon syndrome.

Many vaginally delivered babies are born with an oddly shaped head caused by the pressure of passing through the birth canal. This usually corrects itself within about six weeks. But if your baby’s head hasn’t rounded out by age 6 weeks – or if you first notice that your baby has a flat spot on her skull after 6 weeks of age – it’s probably a case of positional plagiocephaly.

Plagiocephaly shows up most often in babies who are reported to be “good sleepers,” babies with unusually large heads, and babies who are born prematurely and have weak muscle tone.

Babies with torticollis can also develop a flat spot on their skull because they often sleep with their head turned to one side. Torticollis occurs when a tight or shortened muscle on one side of the neck causes the chin to tilt to the other side. Premature babies are especially prone to torticollis

Diagnosis:
Most often, your child’s doctor can make the diagnosis of positional plagiocephaly simply by examining your child’s head, without having to order lab tests or X-rays. The doctor will also note whether regular repositioning of your child’s head during sleep successfully reshapes the child’s growing skull over time, whereas craniosynostosis, on the other hand, typically worsens over time.

If there’s still some doubt, X-rays or a CT scan of the head will show your child’s doctor if the skull bones are normally separated or if they fused together too soon. If the bones aren’t fused, the doctor will probably rule out craniosynostosis and confirm that the child has positional plagiocephaly.

It’s important the type and cause of plagiocephaly are determined, as each requires different treatment. X-rays, CT scans and other tests may be needed to confirm diagnosis.

Treatment:
The condition will sometimes improve as the baby grows, but in many cases, treatment can significantly improve the shape of a baby’s head. Initially, treatment usually takes the form of reducing the pressure on the affected area through repositioning of the baby onto his or her tummy for extended periods of time throughout the day. Other treatments include repositioning the child’s head throughout the day so that the rounded side of the head is placed dependent against the mattress, repositioning cribs and other areas that infants spend time in so that they will have to look in a different direction to see their parents, or others in the room, repositioning mobiles and other toys for similar reasons, and avoiding extended time sleeping in car-seats (when not in a vehicle), bouncy seats, or other supine seating which is thought to exacerbate the problem. If the child appears to have discomfort or cries when they are repositioned, they may have a problem with the neck.  If this is unsuccessful, treatment using a cranial remoulding orthosis (baby helmet) can help to correct abnormal head shapes. These helmets are used to treat deformational plagiocephaly, brachycephaly, scaphocephaly and other head shape deformities in infants 3-18 months of age. For years, infants have been successfully treated with cranial remolding orthoses. A cranial remolding orthoses (helmet) provides painless total contact over the prominent areas of the skull and leaves voids over the flattened areas to provide a pathway for more symmetrical skull growth. Treatment generally takes 3-4 months, but varies depending on the infant’s age and severity of the cranial asymmetry.

Prognosis:
There are some beginning studies that indicate that babies with plagiocephaly tend to have learning difficulties later on in school, however these studies are still early, and do not yet represent a scientific consensus. Other more complete studies suggest that there is no evidence to suggest that plagiocephaly is harmful to brain development, vision, or hearing

Prevention:

To successfully prevent Plagiocephaly, prenatal education on skull deformation   is crucial.
Being aware of preventative measures can help reduce the chance your child will develop positional plagiocephaly. Different repositioning techniques and adequate Tummy Time are keys to prevention and also help your baby meet developmental milestones.

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/plagiocephaly2.shtml
http://en.wikipedia.org/wiki/Plagiocephaly
http://www.babycenter.com/0_plagiocephaly-flat-head-syndrome_1187981.bc
http://www.cranialtech.com/index.php?option=com_content&view=article&id=73&Itemid=76

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http://www.monroeoandp.com/diagnosis_of_plagiocephaly.html

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Categories
Ailmemts & Remedies

Lipomas

Definition:
A lipoma is a slow-growing, fatty lump that’s most often situated between your skin and the underlying muscle layer. Often a lipoma is easy to identify because it moves readily with slight finger pressure. It’s doughy to touch and usually not tender

You may click to see the picture

A lipoma is a benign tumor composed of adipose tissue. It is the most common form of soft tissue tumor. Lipomas are soft to the touch, usually movable, and are generally painless. Many lipomas are small (under one centimeter diameter) but can enlarge to sizes greater than six centimeters. Lipomas are commonly found in adults from 40 to 60 years of age, but can also be found in children. Some sources claim that malignant transformation can occur, while others say that this has yet to be convincingly documented
:
Symptoms & Types:
There are several subtypes of lipoma:

*Angiolipoleiomyoma is an acquired, solitary, asymptomatic acral nodule, characterized histologically by well-circumscribed subcutaneous tumors composed of smooth muscle cells, blood vessels, connective tissue, and fat.

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*Angiolipoma is a painful subcutaneous nodule, having all other features of a typical lipoma.
Chondroid lipomas are deep-seated, firm, yellow tumors that characteristically occur on the legs of women.

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*Corpus callosum lipoma is a rare congenital condition which may or may not present with symptoms. Lipomas are usually relatively small with diameters of about 1–3 cm, but in rare cases they can grow over several years into “giant lipomas” that are 10–20 cm across and weigh up to 4–5 kg.

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*Hibernoma is a lipoma of brown fat.

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*Intradermal spindle cell lipoma is distinct in that it most commonly affects women, and has a wide distribution, occurring with relatively equal frequency on the head and neck, trunk, and upper and lower extremities….click & see

*Neural fibrolipoma is an overgrowth of fibro-fatty tissue along a nerve trunk that often leads to nerve compression.click & see

*Pleomorphic lipomas, like spindle-cell lipomas, occur for the most part on the backs and necks of elderly men, and are characterized by floret giant cells with overlapping nuclei...click & see

*Spindle-cell lipoma is an asymptomatic, slow-growing subcutaneous tumor that has a predilection for the posterior back, neck, and shoulders of older men…..click & see

*Superficial subcutaneous lipoma, the most common type of lipoma, lies just below the surface of the skin. Most occur on the trunk, thighs and the forearms, although they may be found anywhere in the body where fat is located….click & see
Causes:
The exact cause of lipomas is unknown. Lipomas tend to run in families, so genetic factors likely play a role in their development.But the tendency to develop a lipoma is not necessarily hereditary although hereditary conditions, such as familial multiple lipomatosis, may include lipoma development. Genetic studies in mice from the laboratory of Santa J. Ono have shown a correlation between the HMG I-C gene (previously identified as a gene related to obesity) and lipoma development. These studies support prior epidemiologic data in humans showing a correlation between HMG I-C and mesenchymal tumors.

Cases have been reported where minor injuries are alleged to have triggered the growth of a lipoma, called “post-traumatic lipomas.” However, the link between trauma and the development of lipomas is controversial.
Diagnosis:
The diagnosis for lipoma is a simple physical examination by a health care provider. Because lipoma resembles another tumor which is cancerous, liposarcoma, a doctor may perform a biopsy of the tumor.(A tissue sample removal (biopsy) for lab examination).

An ultrasound or other imaging test, such as an MRI or CT scan,may be required  if the lipoma is large, has unusual features or appears to be deeper than the fatty tissue.

Liposarcomas — cancerous tumors in fatty tissues — grow rapidly, don’t move under the skin and are usually painful. A biopsy, MRI or CT scan is typically done if your doctor suspects liposarcoma.

Treatment:
Usually, treatment of a lipoma is not necessary, unless the tumor becomes painful or restricts movement. They are usually removed for cosmetic reasons, if they grow very large, or for histopathology to check that they are not a more dangerous type of tumor such as a liposarcoma.

Lipomas are normally removed by simple excision. The removal can often be done under local anaesthetic, and take less than 30 minutes. This cures the majority of cases, with about 1-2% of lipomas recurring after excision. Liposuction is another option if the lipoma is soft and has a small connective tissue component. Liposuction typically results in less scarring; however, with large lipomas it may fail to remove the entire tumor, which can lead to re-growth.

There are new methods being developed that are supposed to remove the lipomas without scarring. One of them is removal by the use of injection of compounds that trigger lipolysis, such as steroids or phosphatidylcholine.

Prognosis:
Lipomas are rarely life-threatening and the common subcutaneous lipomas are not a serious condition. Lipomas growing in internal organs can be more dangerous, for example lipomas in the gastrointestinal tract can cause bleeding, ulceration and painful obstructions. Malignant transformation of lipomas into liposarcomas is very rare and most liposarcomas are not produced from pre-existing benign lesions, although a few cases of malignant transformation have been described for bone and kidney lipomas. It is possible these few reported cases were well-differentiated liposarcomas in which the subtle malignant characteristics were missed when the tumour was first examined. Deep lipomas have a greater tendency to recur than superficial lipomas, because complete surgical removal of deep lipomas is not always possible

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/Lipoma
http://www.mayoclinic.com/health/lipoma/DS00634
http://www.nlm.nih.gov/medlineplus/ency/imagepages/1209.htm
http://www.helium.com/items/1297816-lipoma-diagnosis-and-treatment
http://www.mdguidelines.com/lipoma
http://www.kmle.co.kr/search.php?Search=angiolipoleiomyoma
http://www.cholinergicurticaria.net/2008/10/13/could-angiolipomas-or-tumors-cause-cholinergic-urticaria/
http://www.med.uc.edu/neurorad/webpage/eua.html
http://www.lookfordiagnosis.com/mesh_info.php?term=Lipoma&lang=1
http://radiographics.rsna.org/content/19/5/1253.full
http://www.medscape.com/content/2001/00/40/56/405672/art-nf1001.01.fig1.jpg

Categories
Ailmemts & Remedies

Kidney Cancer

Definition:
Kidney cancer is usually defined as a cancer that originates in the kidney.

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The two most common types of kidney cancer, reflecting their location within the kidney, are renal cell carcinoma (RCC) and urothelial cell carcinoma (UCC) of the renal pelvis.
The distinction between these two types (RCC and UCC) is important because their prognosis, staging, and management, i.e. treatment (e.g. surgery, chemotherapy etc.), are different.

Renal cell carcinoma (RCC) is the most common type in adults, responsible for approximately 80 per cent of cases.

Types:
In addition to renal cell carcinoma and renal pelvis carcinoma, other, less common types of kidney cancer include:

*Squamous cell carcinoma
*Juxtaglomerular cell tumor (reninoma)
*Angiomyolipoma
*Renal oncocytoma
*Bellini duct carcinoma
*Clear-cell sarcoma of the kidney
*Mesoblastic nephroma
*Wilms’ tumor, usually is reported in children under the age of 5.
*Mixed epithelial stromal tumor

Rarely, some other types of cancer and potentially cancerous tumors that more usually originate elsewhere can originate in the kidneys. These include:

*Clear cell adenocarcinoma
*Transitional cell carcinoma
*Inverted papilloma
*Renal lymphoma
*Teratoma
*Carcinosarcoma
*Carcinoid tumor of the renal pelvis

Cancer in the kidney may also be secondary, the result of metastasis from a primary cancer elsewhere in the body.

Around 208,500 new cases of kidney cancer are diagnosed in the world each year, accounting for just under 2% of all cancers. The highest rates are recorded in Northern America and the lowest rates in Asian and African regions.

In the United States in 2008, these two types together are estimated to cause 54,390 new cases and 13,010 deaths.

2005. The most recent estimates of incidence of kidney cancer suggest that there are 63,300 new cases annually in the EU25. In Europe, kidney cancer accounts for nearly 3% of all cancer cases.

In the UK kidney cancer is the eighth most common cancer in men, with 4,622 new cases diagnosed in 2005. This compares to 2,758 new cases of kidney cancer in women, giving a male:female ratio of 1.5:1. In women it is the fourteenth most common cancer. Male kidney cancer incidence rates increased by more than 85% from 7.1 per 100,000 in 1975 to 13.4 per 100,000 in 2005. In women the rates have more than doubled over the same period from 3.2 to 6.6 per 100,000. Most of the increase has occurred in older men and women, with rates more than doubling between 1975 and 2005 for men in their 70s and early 80 and women aged 65 and over. The incidence of the disease in Britain has an aspect ratio of 50.6% of the final exitus( quote by Welsh Cancer Intelligence, 2005 ).

The incidence of kidney cancer is increasing also in the United States, and this increase is thought to be real, at least in part, not due only to changes in diagnostic practices.

Some types of kidney cancer have a known hereditary or familial risk, and to date five hereditary syndromes have been associated with renal cell carcinoma

Symptoms:
Many people with kidney cancer have no symptoms at first, especially when the cancer is small. The affected kidney will become larger and in time, the tumour may grow through the wall of the kidney and invade nearby tissues and organs, such as the muscles around the spine, liver and nearby large blood vessels.

As the cancer develops, the following may occur:

•Blood in the urine, which is usually painless and may ‘come and go’ as the tumour bleeds (the first symptom in 60 per cent of cases)
•Pain in the back or side
•Swelling in the abdomen
•High blood pressure
•Feeling generally unwell or tired
•Loss of appetite
•Polycythaemia (too much blood in body) or anaemia (too little)
•Varicocele (tangled network of veins in the scrotum)
•Hip fracture, owing to spread of the cancer to bone
•Excessive hair growth in females
•Feeling thirsty
•Night sweats
•Severe weight loss

Causes:
Kidney cancer develops most often in people over 40, but no one knows the exact causes of this disease. Doctors can seldom explain why one person develops kidney cancer and another does not. However, it is clear that kidney cancer is not contagious. No one can “catch” the disease from another person.

Research has shown that people with certain risk factors are more likely than others to develop kidney cancer. A risk factor is anything that increases a person’s chance of developing a disease.

Studies have found the following risk factors for kidney cancer:

•Smoking: Cigarette smoking is a major risk factor. Cigarette smokers are twice as likely as nonsmokers to develop kidney cancer. Cigar smoking also may increase the risk of this disease.
•Obesity: People who are obese have an increased risk of kidney cancer.
•High blood pressure: High blood pressure increases the risk of kidney cancer.
•Long-term dialysis: Dialysis is a treatment for people whose kidneys do not work well. It removes wastes from the blood. Being on dialysis for many years is a risk factor for kidney cancer.
•Von Hippel-Lindau (VHL) syndrome: VHL is a rare disease that runs in some families. It is caused by changes in the VHL gene. An abnormal VHL gene increases the risk of kidney cancer. It also can cause cysts or tumors in the eyes, brain, and other parts of the body. Family members of those with this syndrome can have a test to check for the abnormal VHL gene. For people with the abnormal VHL gene, doctors may suggest ways to improve the detection of kidney cancer and other diseases before symptoms develop.
•Occupation: Some people have a higher risk of getting kidney cancer because they come in contact with certain chemicals or substances in their workplace. Coke oven workers in the iron and steel industry are at risk. Workers exposed to asbestos or cadmium also may be at risk.

Diagnosis:-

If a patient has symptoms that suggest kidney cancer, the doctor may perform one or more of the following procedures:

•Physical exam: The doctor checks general signs of health and tests for fever and high blood pressure. The doctor also feels the abdomen and side for tumors.
•Urine tests: Urine is checked for blood and other signs of disease.
•Blood tests: The lab checks the blood to see how well the kidneys are working. The lab may check the level of several substances, such as creatinine. A high level of creatinine may mean the kidneys are not doing their job.
•Intravenous pyelogram (IVP): The doctor injects dye into a vein in the arm. The dye travels through the body and collects in the kidneys. The dye makes them show up on x-rays. A series of x-rays then tracks the dye as it moves through the kidneys to the ureters and bladder. The x-rays can show a kidney tumor or other problems.
•CT scan (CAT scan): An x-ray machine linked to a computer takes a series of detailed pictures of the kidneys. The patient may receive an injection of dye so the kidneys show up clearly in the pictures. A CT scan can show a kidney tumor.
•Ultrasound test: The ultrasound device uses sound waves that people cannot hear. The waves bounce off the kidneys, and a computer uses the echoes to create a picture called a sonogram. A solid tumor or cyst shows up on a sonogram.
•Biopsy: In some cases, the doctor may do a biopsy. A biopsy is the removal of tissue to look for cancer cells. The doctor inserts a thin needle through the skin into the kidney to remove a small amount of tissue. The doctor may use ultrasound or x-rays to guide the needle. A pathologist uses a microscope to look for cancer cells in the tissue.
•Surgery: In most cases, based on the results of the CT scan, ultrasound, and x-rays, the doctor has enough information to recommend surgery to remove part or all of the kidney. A pathologist makes the final diagnosis by examining the tissue under a microscope.

Treatment:
Treatment options which may be considered include:

•Surgery to remove all (or part) of the affected kidney. This is the most common treatment and can be done as a keyhole operation in some cases. If the cancer is at an early stage and hasn’t spread, surgery alone may be enough. If the cancer has spread, surgery to remove the affected kidney may still be advised, often in addition to further surgery to remove a secondary kidney tumour (one which has spread to another part of the body).
•Radiotherapy may be advised to kill any cancerous cells left behind following an operation.
•Arterial embolisation may be used instead of surgery, where the artery to the kidney tumour is blocked. The blood supply to the tumour is then cut off, and the tumour dies.
•Medications such as sunitinib, temsirolimus, bevacizumab, interferon-alpha have improved the outlook for kidney cancer patients. Speak to your specialist about what may be best for you.
Chemotherapy doesn’t work as well as it does for other types of cancer. The type of treatment depends on the type and how large the cancer is, whether it has spread and general health.

If a cure is not realistic, in some cases treatment aims to control the cancer, limiting the growth or spread so it progresses less rapidly. This may limit the amount of symptoms for some time.

If the cancer is confined to the kidney without spreading, and the patient is in otherwise good general health, the outlook is good, with around 95 per cent of patients surviving five years after diagnosis (if the tumour is less than 4 cm). Surgical removal of an affected kidney in this situation gives a good chance of cure.

However, many people with kidney cancer are diagnosed when the cancer has already spread, so a cure is less likely. However, treatment can often slow down the progression of the cancer.

Follow-up care:-

Follow-up care after treatment for kidney cancer is important. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because cancer cells can remain in the body after treatment. The doctor monitors the recovery of the person treated for kidney cancer and checks for recurrence of cancer. Checkups help ensure that any changes in health are noted. The patient may have lab tests, chest x-rays, CT scans, or other tests.

Support for people with kidney cancer

Living with a serious disease such as kidney cancer is not easy. People with kidney cancer may worry about caring for their families, keeping their jobs, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.

Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. Patients may want to talk with a member of their health care team about finding a support group.

The Cancer Information Service at 1-800-4-CANCER begin_of_the_skype_highlighting 1-800-4-CANCER end_of_the_skype_highlighting can provide information to help patients and their families locate programs, services, and publications.

The promise of cancer research:

Doctors all over the country are conducting many types of clinical trials. These are research studies in which people volunteer to take part. In clinical trials, doctors are testing new ways to treat kidney cancer. Research has already led to advances, and researchers continue to search for more effective approaches.

Patients who join these studies have the first chance to benefit from treatments that have shown promise in earlier research. They also make an important contribution to medical science by helping doctors learn more about the disease. Although clinical trials may pose some risks, researchers do all they can to protect their patients.

Researchers are studying surgery, biological therapy, chemotherapy, and combinations of these types of treatment. They also are combining chemotherapy with new treatments, like stem cell transplantation. A stem cell transplant allows a patient to be treated with high doses of drugs. The high doses destroy both cancer cells and normal blood cells in the bone marrow. Later, the patient receives healthy stem cells from a donor. New blood cells develop from the transplanted stem cells.

Other approaches also are under study. For example, researchers are studying cancer vaccines that help the immune system to find and attack kidney cancer cells.

Patients who are interested in being part of a clinical trial should talk with their doctor.

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/in_depth/cancer/typescancer_kidney.shtml
http://en.wikipedia.org/wiki/Kidney_cancer
http://www.medicinenet.com/kidney_cancer/page7.htm

Kidney Cancer – Causes, Symptoms Diagnosis And Treatment

http://www-cancer.us/320/kidney-cancer-treatment/

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Categories
Ailmemts & Remedies Pediatric

Epispadias

Definition:
An epispadias is a rare type of malformation of the penis in which the urethra ends in an opening on the upper aspect (the dorsum) of the penis. It can also develop in females when the urethra develops too far anteriorly. It occurs in around 1 in 120,000 male and 1 in 500,000 female births.

An epispadia occurs when the urethra opening is abnormally placed. In a male infant with epispadias, the urethra will be generally open on the top or side of the penis.

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Boys will suffer from a short, wide penis and widened pubic bone. In a female infant with epispadias, the urethra will generally be located between the clitoris and the labia or in the abdominal area. Girls will suffer from a widened pubic bone and an abnormal clitoris and labia. In both males and females, urine will flow into the kidney and urinary tract infections are common. It is also common for the child to have urinary incontinence, kidney damage and often infertility issues as an adult.

A doctor will perform a series of tests to diagnose epispadias, which may include blood tests, x-rays and ultrasounds. Treatment involves surgery to help with urine control and appearance.

It is also called bladder exstrophy

Symptoms:

In males:
*Abnormal opening from the joint between the pubic bones to the area above the tip of the penis
*Backward flow of urine into the kidney (reflux nephropathy)
*Short, widened penis with an abnormal curvature
*Urinary tract infections
*Widened pubic bone

In females:……..Picture
*Abnormal clitoris and labia
*Abnormal opening where the from the bladder neck to the area above the normal urethral opening
*Backward flow of urine into the kidney (reflux nephropathy)
*Widened pubic bone
*Urinary incontinence
*Urinary tract infections

Causes:
The causes of epispadias are unknown at this time. It may be related to improper development of the pubic bone.

In boys with epispadias, the urethra generally opens on the top or side of the penis rather than the tip. However, it is possible for the urethra to be open along the entire length of the penis.

In girls, the opening is usually between the clitoris and the labia, but may be in the belly area.

Epispadias can be associated with bladder exstrophy, an uncommon birth defect in which the bladder is inside out, and sticks through the abdominal wall. However, epispadias can also occur with other defects.

Epispadias is an uncommon and partial form of a spectrum of failures of abdominal and pelvic fusion in the first months of embryogenesis known as the exstrophy – epispadias complex. While epispadias is inherent in all cases of exstrophy it can also, much less frequently, appear in isolation as the least severe form of the complex spectrum. It occurs as a result of defective migration of the genital tubercle primordii to the cloacal membrane, and so malformation of the genital tubercle, at about the 5th week of gestation.

Presentation:
Most cases involve a small and bifid penis, which requires surgical closure soon after birth, often including a reconstruction of the urethra. Where it is part of a larger Exstrophy, not only the urethra but also the bladder (bladder exstrophy) or the entire perineum (cloacal exstrophy) are open and exposed on birth, requiring closure.

Relationship to other conditions:
Despite the similarity of name, an epispadias is not a type of hypospadias, and involves a problem with a different set of embryologic processes.

In women:
Women can also have this type of congenital malformation. Epispadias of the female may occur when the urethra develops too far anteriorly, exiting in the clitoris or even more forward. For females, this may not cause difficulty in urination but may cause problems with sexual satisfaction. Frequently, the clitoris is bifurcated at the site of urethral exit, and therefore clitoral sensation is less intense during sexual intercourse due to frequent stimulation during urination. However, with proper stimulation, using either manual or positional techniques, clitoral orgasm is definitely possible

Diagnosis:
•Blood test to check electrolyte levels
•Intravenous pyelogram (IVP), a special x-ray of the kidneys, bladder, and ureters
•MRI and CT scans, depending on the condition
•Pelvic x-ray
•Ultrasound of the urogenital system

Treatment:
The main treatment for isolated epispadias is a comprehensive surgical repair of the genito-urinary area usually during the first 7 years of life, including reconstruction of the urethra, closure of the penile shaft and mobilisation of the corpora. The most popular and successful technique is known as the modified Cantwell-Ransley approach. In recent decades however increasing success has been achieved with the complete penile disassembly technique despite its association with greater and more serious risk of damage

Prognosis:
Even with successful surgery, patients may have long-term problems with:
*incontinence, where serious usually treated with some form of continent urinary diversion such as the Mitrofanoff
*depression and psycho-social complications
*sexual dysfunction

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/001285.htm
http://en.wikipedia.org/wiki/Epispadias
http://health.stateuniversity.com/pages/794/Hypospadias-Epispadias.html
http://www.wikidoc.org/index.php/Epispadias
http://www.eclips.consult.com/eclips/article/Pediatrics/S0084-3954(07)70134-3

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