Hepatoma

10:38 AM by ARAS Medical Services

A hepatoma is a cancer that starts in the liver. It is the most common type of cancer originating in the liver.

Symptoms

The first signs of the disease may include:

  • Abdominal pain
  • Weight loss
  • Large mass that can be felt in the upper right section of the abdomen

People who have had cirrhosis for a long time may also experience:

  • Sudden feeling of illness
  • Fever
  • Sudden abdominal pain and shock (very low blood pressure) caused by a rupture or bleeding of the tumor

Causes and Risk Factors

Risk factors for hepatoma include:

  • Long-standing cases of cirrhosis (severe scarring of the liver)
  • Chronic infection with hepatitis B
  • Chronic infection with hepatitis C
  • Certain food fungi

Diagnosis

At first, symptoms may not offer clues that the disease is present. When the person has had cirrhosis for a long time and a tumor can be felt in the abdomen, the doctor will suspect hepatoma.

Other ways to detect the disease include:

  • Ultrasound
  • CT scan
  • MRI scan
  • Liver biopsy. For this, a small sample of tissue is taken for examination under a microscope.

Treatment

The survival rate for people with hepatoma is poor. This is because the tumor is usually discovered at a later stage.

Treatment options include:

  • Surgery, if the tumor is small
  • Chemotherapy. This can slow the growth of the tumor but not cure the cancer.
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Juvenile Nasopharyngeal Angiofibroma

2:07 PM by ARAS Medical Services

Introduction

Juvenile angiofibroma (JNA) is a benign tumor that tends to bleed and occurs in the nasopharynx of prepubertal and adolescent males.

History of the Procedure

Hippocrates described the tumor in the 5th century BC, but Friedberg first used the term angiofibroma in 1940. Other titles (eg, nasopharyngeal fibroma, bleeding fibroma of adolescence, fibroangioma) have also been used.

The image below depicts a coronal CT scan.

Coronal CT scan of the lesion filling the left na...

Coronal CT scan of the lesion filling the left nasal cavity and ethmoid sinuses, blocking the maxillary sinus and deviating the nasal septum to the right side.

Coronal CT scan of the lesion filling the left na...

Coronal CT scan of the lesion filling the left nasal cavity and ethmoid sinuses, blocking the maxillary sinus and deviating the nasal septum to the right side.


Frequency

Juvenile nasopharyngeal angiofibroma (JNA) accounts for 0.05% of all head and neck tumors. A frequency of 1:5,000-1:60,000 in otolaryngology patients has been reported.

Sex

Juvenile nasopharyngeal angiofibroma (JNA) occurs exclusively in males. Females with juvenile nasopharyngeal angiofibroma (JNA) should undergo genetic testing.

Age

Onset is most commonly in the second decade; the range is 7-19 years. Juvenile nasopharyngeal angiofibroma (JNA) is rare in patients older than 25 years.

Etiology

The lesion originates in close proximity to the posterior attachment of the middle turbinate, near the superior border of the sphenopalatine foramen.

A hormonal theory has been suggested because of the lesion's occurrence in adolescent males.

Other theories include a desmoplastic response of the nasopharyngeal periosteum or the embryonic fibrocartilage between the basiocciput and the basisphenoid.

Etiology from nonchromaffin paraganglionic cells of the terminal branches of the maxillary artery has also been suggested. Comparative genomic hybridization analysis of these tumors revealed deletions of chromosome 17, including regions for the tumor suppressor gene p53 as well as the Her-2/neu oncogene.

Pathophysiology

The tumor starts adjacent to the sphenopalatine foramen. Large tumors are frequently bilobed or dumbbell-shaped, with one portion of the tumor filling the nasopharynx and the other portion extending to the pterygopalatine fossa.

Anterior growth occurs under the nasopharyngeal mucous membrane, displacing it anteriorly and inferiorly toward the postnasal space. Eventually, the nasal cavity is filled on one side, and the septum deviates to the other side. Superior growth is directed toward the sphenoid sinus, which may also be eroded. The cavernous sinus may become invaded if the tumor advances further.

Lateral spread is directed toward the pterygopalatine fossa, bowing the posterior wall of the maxillary sinus. Later, the infratemporal fossa is invaded. Occasionally, the greater wing of the sphenoid may be eroded, exposing the middle fossa dura. Proptosis and optic nerve atrophy result if orbital fissures are encroached upon by the tumor. Extranasopharyngeal angiofibroma is extremely rare and tends to occur in older patients, predominately in females, but the tumor is less vascular and less aggressive than juvenile nasopharyngeal angiofibroma (JNA).

Presentation

Symptoms

  • Nasal obstruction (80-90%) - Most frequent symptom, especially in initial stages
  • Epistaxis (45-60%) - Mostly unilateral and recurrent; usually severe epistaxis that necessitates medical attention; diagnosis of angiofibroma in adolescent males to be ruled out
  • Headache (25%) - Especially if paranasal sinuses are blocked
  • Facial swelling (10-18%)
  • Other symptoms - Unilateral rhinorrhea, anosmia, hyposmia, rhinolalia, deafness, otalgia, swelling of the palate, deformity of the cheek

Signs

  • Nasal mass (80%)
  • Orbital mass (15%)
  • Proptosis (10-15%)
  • Other signs include serous otitis due to eustachian tube blockage, zygomatic swelling, and trismus that denote spread of the tumor to the infratemporal fossa, decreasing vision due to optic nerve tenting (rare)
Differentials
  • Other causes of nasal obstruction, (eg nasal polyp, antrochoanal polyp, teratoma, encephalocele, dermoids, inverting papilloma, rhabdomyosarcoma, squamous cell carcinoma)
  • Other causes of epistaxis, systemic or local
  • Other causes of proptosis or orbital swellings
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ROBOTIC HEART VALVE SURGERY

2:25 PM by ARAS Medical Services

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Stroke

11:08 AM by ARAS Medical Services

What is Stroke?

A stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. Brain cells die when they no longer receive oxygen and nutrients from the blood or there is sudden bleeding into or around the brain. The symptoms of a stroke include sudden numbness or weakness, especially on one side of the body; sudden confusion or trouble speaking or understanding speech; sudden trouble seeing in one or both eyes; sudden trouble with walking, dizziness, or loss of balance or coordination; or sudden severe headache with no known cause. There are two forms of stroke: ischemic - blockage of a blood vessel supplying the brain, and hemorrhagic - bleeding into or around the brain.

Is there any treatment?

Generally there are three treatment stages for stroke: prevention, therapy immediately after the stroke, and post-stroke rehabilitation. Therapies to prevent a first or recurrent stroke are based on treating an individual's underlying risk factors for stroke, such as hypertension, atrial fibrillation, and diabetes. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischemic stroke or by stopping the bleeding of a hemorrhagic stroke. Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage. Medication or drug therapy is the most common treatment for stroke. The most popular classes of drugs used to prevent or treat stroke are antithrombotics (antiplatelet agents and anticoagulants) and thrombolytics.

What is the prognosis?

Although stroke is a disease of the brain, it can affect the entire body. A common disability that results from stroke is complete paralysis on one side of the body, called hemiplegia. A related disability that is not as debilitating as paralysis is one-sided weakness or hemiparesis. Stroke may cause problems with thinking, awareness, attention, learning, judgment, and memory. Stroke survivors often have problems understanding or forming speech. A stroke can lead to emotional problems. Stroke patients may have difficulty controlling their emotions or may express inappropriate emotions. Many stroke patients experience depression. Stroke survivors may also have numbness or strange sensations. The pain is often worse in the hands and feet and is made worse by movement and temperature changes, especially cold temperatures.

Recurrent stroke is frequent; about 25 percent of people who recover from their first stroke will have another stroke within 5 years.

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Slipped Disc, HNP, Bulging Disc

4:14 PM by ARAS Medical Services



Slipped Disk Overview The disks are protective shock-absorbing pads between the bones of the spine. Although they do not actually "slip," a disk may split or rupture. This can cause the disk to fail, allowing the gel to escape into the surrounding tissue. The leaking jellylike substance can place pressure on the spinal cord or on a single nerve fiber and cause pain either around the damaged disk or anywhere along the area controlled by that nerve. This condition is also known as a herniated, ruptured, prolapsed, or, more commonly, slipped disk. The most frequently affected area is the low back, but any disk can rupture, including those in the neck. Slipped Disk Causes Factors that lead to injury from a slipped disk include aging with associated degeneration and loss of elasticity of the discs and supporting structures; improper lifting, especially if accompanied by twisting or turning; and excessive strain. Sudden forceful trauma is a more rare cause. Slipped Disk Symptoms The nerves of the body exit the spine at each spinal level. A herniated disk can therefore produce symptoms anywhere along the course of that nerve, though the injury and irritation of the nerve are at the spine itself (this is known as referred pain). A slipped disk can produce varying degrees of pain in the back or neck along with numbness or weakness. * For slipped disks in the neck - Numbness, tingling, weakness, or pain in the shoulder, neck, arm, or hand * For slipped disks in the lower back o Numbness, tingling, weakness, or pain in the buttocks, back, legs, or feet o Numbness and tingling around the anus or genitals o Pain down the back of each leg from the buttocks to the knee (this is called sciatica) o Pain with movement, straining, coughing, or doing leg raises o Difficulty controlling bowel movements or bladder function Exams and Tests The doctor will take a complete medical history and perform a physical examination. * This history should include other illnesses, prior spine problems, any injuries, duration and type of symptoms, and response to treatments. The examination should include a spine examination, testing of basic nerve functions, an abdominal examination, and a general screening. * Often no diagnostic tests are needed for adequate treatment. In certain cases, imaging studies or laboratory tests of blood and urine may provide your doctor further information necessary to establish an adequate diagnosis. If needed at all, they may not be necessary immediately. Sometimes they are ordered later if basic treatments fail to improve your condition. * If imaging studies are taken, they are often one of the following: o Plain x-rays (and even CT scans) cannot depict a prolapsed disk and can only identify bony abnormalities. These x-rays are best used to evaluate back pain that is from causes other than a prolapsed disk, such as bony displacement, tumor, or broken bone. Most young or middle-aged people without a history to suggest trauma or tumor are best served without the expense and radiation associated with obtaining these x-rays. In most cases, the bones seen on x-ray are normal. o More specialized tests include an MRI or myelogram (which includes injecting dye into the spinal column) of the back. These are better for diagnosing a prolapsed disk and the way the specific nerve is affected. In the absence of signs or symptoms suggesting severe nerve damage, however, these studies are very rarely indicated or ordered early in the course of the evaluation. This is because of cost, availability of the test, and the fact that the findings rarely affect initial treatment decisions. Your doctor may obtain these tests after a course of treatment fails to provide you relief. o Bone scans can detect infection, healing fractures, or tumors. This test is essentially never ordered as part of an emergency evaluation and generally needs to be arranged by your doctor in advance. Medical Treatment The doctor often prescribes bed rest or limited activity for several days followed by gradual increase in activity over the next few weeks. Strict bed rest is generally no longer advised because people with back pain have been shown to recover more quickly with normal activity as long as lifting, bending, and strain are limited. Treat with ice or cold packs early after an injury and switch to heat later. Heat may be used early if the pain and symptoms are not caused by a sudden injury. Physical therapy, exercise, and massage can be helpful if indicated (always check with your doctor before resuming any stressful activity). Surgery If these measures are not successful within a reasonable time and the tests confirm a herniated disk as the source of symptoms, surgery may be considered. Except in extreme cases or in those that have a high potential for permanent nerve damage, surgery is no longer considered early in a case. Often, time and basic spine care resolve most cases. Several surgical options exist. Your doctor will refer you to a spine specialist to discuss which option is best for you and what the likelihood of success will be.
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Spine Surgery

3:30 PM by ARAS Medical Services
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