HEALTH Conspiracy

Saturday, March 10, 2012

How Anxiety And Depression Are Connected

By Deden Sura Agung Depression is a disorder that does not get nearly enough attention. Depressed people are often told to "cheer up...

Wednesday, October 19, 2011

HEMANGIOMA

<div class="MsoNormal" style="text-align: justify; text-indent: 36pt;">By Deden Sura Agung</div><div class="MsoNormal" style="text-align: justify; text-indent: 36pt;"> </div><div class="MsoNormal" style="text-align: justify; text-indent: 36pt;">Hemangioma is a lesion that growth can be predicted, these lesions can be evoluted, and also aimed at vascular lesions found in adults who do not experience regression and sometimes experienced progression. The origins of the terminology on the basis of the appearance of abnormalities and maternal impressions, such as strawberry hemangiomas, cherry angiomas, port-wine stains and salmon patches. Virchow then make a histopathological classification of the first, divided into three: angioma simplex, angioma cavernosum, and angioma racemosim, and ambiguous terminology is still survive in the modern medical books until now. Diagnosis for these lesions is really not easy to do because naming of the description of ambiguous and not appropriate proficiency level, therefore, clinical correlation is needed to make a final diagnosis.</div><div class="MsoNormal" style="text-align: justify; text-indent: 36pt;"> 
</div><div class="MsoNormal" style="text-align: justify; text-indent: 36pt;"></div><div class="MsoNormal" style="margin-bottom: 0cm; text-align: justify;">CLASSIFICATION<a class="cssButton" href="javascript:void(0)" id="publishButton" target=""></a> 
<div class="cssButtonOuter"><div class="cssButtonMiddle"><div class="cssButtonInner"><a class="cssButton" href="javascript:void(0)" id="publishButton" target=""></a></div></div></div></div><div class="MsoNormal" style="text-align: justify;"><div style="text-align: left;"></div>Mulliken and Glowacki in 1982 proposed a classification system for vascular birthmarks that connects the history of the emergence of these birthmarks and physical examination with the cellular picture. They divided the vascular lesions of infancy and the kids into two major types: hemangiomas, with endothelial hyperplasia, and malformations, with normal endothelial changes. The key of the terminology is the word "oma" is derived from the Greek language, which was originally meaning "a lump or tumor". When this suffix is used for a term that describes lesions that grow from the cell proliferation. Most of hemangioma during infancy did not appear at birth but appear postnatally. Grew rapidly during the first year (proliferative phase), slowed, then regresses spontaneously in childhood (involuting phase), and then stabilized (involuted phase). 
 Histologically, proliferative phase has the character of an increase in mitotic activity, whereas in apoptotic phase of involution occurs, fibrosis occurs slowly and infiiltrasi fat. While the vascular malformation is a wrong morphogenesis that appear at 40-10 weeks in intrauterine life. Most of the vascular malformations appear at birth, or not appear at birth but appear a year later. If it has appeared it will continue to grow in proportion with the growth of the patient, however, rapid growth can grow due to trauma, hormonal changes, thrombosis, infection, or surgical intervention. In histology, vascular malformations have kareakteristik canal dilated, with an abnormal vascular wall, and endothelial quiet. There are classifies hemangiomas as follows: Superficial, Deep, Mixed, based on the location of the skin and subcutaneous tissue. It would be more appropriate terminology for these two disorders based on the use classification of vascular anomalies.</div><div class="MsoNormal" style="text-align: justify;"> 
</div><div class="MsoNormal" style="text-align: justify;">FREQUENCY 
Eighty percent growth as a single tumor, 20% multiple. Hemangiomas appear more in women than in men, with a ratio of 3-5:1. Incidence is more on baby as much as 10-12% were white, and about 22% found in premature infants weighing less than 1000 grams.</div><div class="MsoNormal" style="text-align: justify;"> 
</div><div class="MsoNormal" style="text-align: justify;">PATHOPHYSIOLOGY 
Hemangioma is a vascular network consisting of endothelial cells to proliferate. Proliferation is not regular at first, but over time become a regular form blood vessels in the form of lobules with lumen containing blood cells. Growth properties of endothelial cells is benign and has a thin basal membrane. </div><div class="MsoNormal" style="text-align: justify;">Proliferation is slowed and eventually stopped. The hypothesis of Takahashi stated that in the last trimester of pregnancy, the fetus is formed in the immature endothelial cells with pericyte is also immature, have the ability to perform limited proliferation began at age 8 months to 18 months of the first period of life after being born so there was hemangioma. During the proliferative activity of the endothelium occurs influx of a number of mast cells (as a proliferative stimulus endothelium) and tissue inhibitors of metalloproteinase (TIMP or tissue growth inhibitors). Endothelium proliferation returned to normal after stopping the proliferation phase (involution).</div><div class="MsoNormal" style="text-align: justify;"> 
</div><div class="MsoNormal" style="margin-bottom: 0cm; text-align: justify;">RESULT AND PROGNOSIS</div><div class="MsoNormal" style="text-align: justify;">Most hemangiomas occur during the early months of life, proliferates and peaked at age 1 year, and after it undergoes involution slowly. 50% experienced a complete involution by age 5 years. Seventy percent at age 7 years, and continued improvement until the age of 10-12 years. The exception of congenital hemangioma, which appear at birth usually regresses by age 1 year. Unlike vascular malformations, hemangiomas rarely cause distortion of the bones and excess growth except for a large facial hemangioma.</div>

By Deden Sura Agung Hemangioma is a lesion that growth can be predicted, these lesions can be evoluted, and also aimed at vascular lesions ...

Saturday, September 24, 2011

MENSTRUAL DISORDERS - MENORRHAGIA AND DYSMENORRHOEA

<div style="text-align: justify;">By Deden Sura Agung</div><div style="text-align: justify;"> </div><div style="text-align: justify;">Abnormalities of menstruation is most reason for women to visit obstetricians and gynecology, and menorrhagia are the most frequent cause in women with iron deficiency anemia in the western world. Menstrual disorders can be found abnormalities of blood ejected from the amount or duration of bleeding that occurs each cycle. Menstrual abnormalities that can be encountered is amenorrhoea, oligomenorrhoea, menorrhagia and dysmenorrhoea.</div><div style="text-align: justify;"> 
</div><div style="color: orange; text-align: justify;">AMENORRHOEA</div><div style="text-align: justify;">A symptom of ovarian dysfunction and reproductive systems are usually associated with infertility problems. His definition is a state of menstruation are not acquired more than 6 months (not in a state of pregnancy). Amenorrhoea can be divided into:</div><ol><li>Primary amenorrhoea, if a woman never got a period until the age of 16 years.</li>
<li>Secondary amenorrhoea is the absence of menstruation for more than 6 months in women who usually have irregular menstrual cycles or up to 12 months in women who usually experience oligomenorrhoea.</li>
</ol><div style="text-align: justify;">The cause of amenorrhoea is known to date are:</div><ol><li>Physiological; prepubertal, gestation, lactation, Postmenopouse.</li>
<li>Pathological; Congenital testicular feminization, the absence of the uterus, imperforate hymen.</li>
<li>Hipotalamic; Congenital - Kallman's syndrome, Learned - weight loss, excessive exercise, craniopharyngioma.</li>
<li>Pituitary; Tumor - prolactinoma, Infarction - Sheehan's syndrome, Iatrogenic damage - surgery, radiotherapy.</li>
<li>Ovary; Congenital - gonadotropin receptor abnormalities, ovarian resistance syndrome, ovarian dysgenesis, Learned - radiation, chemotherapy, surgery, autoimmune disease.</li>
</ol><div style="text-align: justify;">As for amennorrhoea primer, because: 
Delay Puberty, familial, nutritional, Delay adrenarche, Congenital structural abnormalities, imperforate hymen, Absence of the uterus or vagina (chromosome abnormalities). 
 
The successful management of amenorrhoea depends on accurate diagnosis and assessment of patient needs. Patients should be given an explanation of fertility problem, hirsutism, delayed secondary sexual development and protection against osteoporosis. In addition to history and thorough physical examination, investigations are also needed, especially those leading to endocrine disorders. 
 
Therapy 
Women with ovarian disorders requiring sex steroid hormone therapy with estrogen and progesterone are periodic. Estrogen deficiency can adversely impact bone and blood vessels, and therefore there is a suspicion in women with Turner syndrome was not optimal bone growth and higher risk for fracture. In addition to hormone replacement therapy that can improve fertility in patients with ovarian disorders. 
In women with low concentrations of gonadotropins required ovulation induction with gonadotropin therapy. 
 
MENORRHAGIA 
Are spending too much blood and is usually accompanied by blood clots during menstruation, occurs in menstruation with regular cycle. Normal amount of blood ejected each period is about 50 ml, but the upper limit of normal menstrual bleeding was 80 ml. Causes of menorrhagia can be divided into four categories:</div><ol style="text-align: justify;"><li>Coagulation Disorders, The incidence of menorrhagia is closely linked to conditions such as thrombocytopenic purpura and von Willebrand's disease. In women with thrombocytopenia, excessive menstrual blood can be attributed to the low number of platelets that is when menstruation occurs. In these circumstances, splenectomi known to lower the amount of blood loss significantly. However, excessive menstrual bleeding can also be found on the state of the normal coagulation system.</li>
<li>Dysfunctional Uterine Bleeding, Is abnormal bleeding from the uterus (long, frequency, amount) that occurs within and outside the menstrual cycle, with no organ abnormalities, hematological and pregnancy, and an abnormal process of hypothalamic - pituitary - ovarian.</li>
<li>Suspected menorrhagia associated with uterine fibroids, pelvic infections, endometrial polyps, foreign bodies such as an intrauterine device, myometrial hypertrophy and vascular abnormalities.</li>
<li>Medical Disorders, Menorrhagia associated with various endocrine disorders such as Cushing's disease hipothiroidism and although the mechanism is unknown. If thyroid disease is the cause, need to look for other symptoms such as abnormal weight gain, hair loss and constipation.</li>
</ol>DYSMENORRHOEA 
Dysmenorrhoea means painful menstruation. A symptom complex, accompanied by cramps in the lower abdomen. Pain radiating to the back and legs, and usually accompanied by gastrointestinal disorders, neurological and malaise. Pain may be felt before, during and after menstruation. Could be colic or continuously. Based on the etiology, dysmenorrhoe can be divided into 2 primary dysmenorrhoea and secondary dysmenorrhoea. 
<ol style="text-align: justify;"><li>Dysmenorrhoea primary (idiopathic). There are various theories that explain why women may experience dysmenorrhoea (uterine hyperactivity, endothelins, prostaglandins, vasopressin).</li>
<li>Secondary Dysmenorrhoea. This situation can be associated with abnormalities of the pelvis and uterus such as fibroids, IUDs, PID, adenomyosis, endometriosis or cervical stenosis. The cause of the pain itself is not so clear and the use of inhibitors of prostaglandin synthesis is not very effective to eliminate the pain. </li>
</ol><div style="text-align: justify;">To search for the etiology of menorrhagia and dysmenorhoea, required a complete diagnose. Characteristics to look for bleeding. Bleeding a lot, regular, cyclic without any spotting between cycles can lead to dysfunctional uterine bleeding. While the history of progressive pain during menstruation and is accompanied disparenia can lead to endometriosis. Similarly Asked postkoitus pelvic pain and bleeding. Risk factor for endometrial carcinoma such as the use of tamoxifen, estrogen therapy, polycystic ovary syndrome and obesity should always be sought in the diagnose. On physical examination may be obtained hipoparatiroid symptoms, anemia or blood clotting disorder. Abdominal and pelvic examination is mandatory in patients with complaints of menorrhagia. In the laboratory examination of hemoglobin should not be overlooked when the patient's complaint is menorrhagia, and iron supplementation should be given when needed. Examination of TSH and T4 are not absolutely necessary, unless there are other things that lead to a state of thyroid disorders. Besides intra-uterine examination is also necessary to assess the direction of malignancy, which is usually found in women over the age of 45 years with irregular bleeding and acquired risk factors.</div> 
MENORRHAGIA AND DYSMENORRHOEA MANAGEMENT 
Management that existed at the time is divided into three parts, namely: 
<ol style="text-align: justify;"><li>Non-hormonal (synthetic prostaglandin inhibitors, antifibrinolitik and ethamsylate). Antifibrinolitik commonly used is that tranexamic acid can reduce menstrual bleeding by 50%. These drugs are quite effective with minimal side effects that depend on the dose. NSAIDs is an inhibitor of prostaglandin synthesis which is the drug chosen for menorrhagia. The principle works is to decrease the concentration of endometrial prostaglandins. The drugs are usually used mefenamic acid, but keep in mind the side effects of gastrointestinal disorders such as dyspepsia syndrome, nausea and diarrhea. Ethamsylate believed to decrease capillary fragility of the endometrium, but not yet widely used because the results vary.</li>
<li>Hormonal (progesterone, oral contraceptives and hormone replacement therapy). Synthetic progesterone is used widely for the treatment of menorrhagia. The effect thus suppress endometrial glands are depleted and epithelium and decidual transformation that is formed thinner. There are several types of cyclic progesterone as progesterone, progesterone or progesterone intrauterine sustainable. In addition progesterone may also be given estrogen-progesterone combinations such as danazol or GnRH analogues.</li>
<li>Surgical treatment. There are several things you can do with the way surgery is hysterectomy, endometrial ablation techniques and endometrial resection transervikal by way of thermal balloon and microwave endometrial ablation.</li>
</ol>

By Deden Sura Agung Abnormalities of menstruation is most reason for women to visit obstetricians and gynecology, and menorrhagia are the m...