Giant cell arteritis

Giant cell arteritis

Definition:
Giant cell arteritis is an inflammation of the lining of your arteries — the blood vessels that carry oxygen-rich blood from your heart to the rest of your body. Most often, it affects the arteries in your head, especially those in your temples. For this reason, giant cell arteritis is sometimes called temporal arteritis or cranial arteritis.

Giant cell arteritis frequently causes headaches, jaw pain, and blurred or double vision. Blindness and, less often, stroke are the most serious complications of giant cell arteritis.
Prompt treatment of giant cell arteritis is critical in order to prevent permanent tissue damage and loss of vision. Corticosteroid medications usually relieve symptoms of giant cell arteritis and may prevent loss of vision. You'll likely begin to feel better within days of starting your treatment.


Symptoms:
The most common symptoms of giant cell arteritis are head pain and tenderness — often severe — that usually occurs in both temples. Some people, however, have pain in only one temple or in the front of the head.
Signs and symptoms of giant cell arteritis can vary. For some people, the onset of the condition feels like the flu — with muscle stiffness and aches (myalgia) around the shoulders and hips, fever and fatigue, as well as headaches.
Generally, signs and symptoms of giant cell arteritis include:

• Persistent, severe head pain and tenderness, usually in your temple area
• Vision loss or double vision
• Scalp tenderness — it may hurt to comb your hair or even to lay your head on a pillow, especially where the arteries are inflamed
• Jaw pain (jaw claudication) when you chew or open your mouth wide
• Sudden, permanent loss of vision in one eye
• Fever
• Unexplained weight loss

Pain and stiffness in the neck, shoulders or hips are common symptoms of a related disorder, polymyalgia rheumatica. Approximately half the people with giant cell arteritis also have polymyalgia rheumatica.

When to see a doctor
If you develop a new, persistent headache or any of the problems listed above, see your doctor without delay. If you're diagnosed with giant cell arteritis, starting treatment as soon as possible can usually help prevent blindness.

Causes:
Your arteries are pliable tubes with thick, elastic walls. Oxygenated blood leaves your heart through your body's main artery, the aorta. The aorta then subdivides into smaller arteries that deliver blood to all parts of your body, including your brain and internal organs.

With giant cell arteritis, some of these arteries become inflamed, causing them to swell and sometimes decreasing blood flow. Just what causes these arteries to become inflamed isn't known.
Although almost any large or medium-sized artery can be affected, swelling most often occurs in the temporal arteries in your head, which are located just in front of your ears and continue up into your scalp. In some cases, the swelling affects just part of an artery with sections of normal vessel in between.

Complications:
Giant cell arteritis can cause the following complications:

• Blindness. This is the most serious complication of giant cell arteritis. The swelling that occurs with giant cell arteritis narrows your blood vessels, reducing the amount of blood — and, therefore, oxygen and vital nutrients — that reaches your body's tissues. Diminished blood flow to your eyes can cause sudden, painless vision loss in one or, in rare cases, both eyes. Unfortunately, blindness is usually permanent.
• Aortic aneurysm. Having giant cell arteritis increases your risk of aneurysm. An aneurysm is a bulge that forms in a weakened blood vessel, usually in the aorta, the large artery that runs down the center of your chest and abdomen. An aortic aneurysm is a serious condition because it may burst, causing life-threatening internal bleeding. Because it may occur even years after the initial diagnosis of giant cell arteritis, your doctor may monitor the health of your aorta with annual chest X-rays or other imaging tests, such as ultrasound, CT scan or MRI.
• Stroke. In some cases, a blood clot may form in an affected artery, obstructing blood flow completely, depriving part of your brain of necessary oxygen and nutrients, and causing stroke. This serious condition is an uncommon complication of giant cell arteritis.

Treatments and drugs:
Treatment for giant cell arteritis consists of high doses of a corticosteroid drug such as prednisone. Because immediate treatment is necessary to prevent vision loss, your doctor is likely to start medication even before confirming the diagnosis with a biopsy.
You should start feeling better within just a few days, but you may need to continue taking medication for one to two years or longer. After the first month, your doctor may gradually begin to lower the dosage until you reach the lowest dose of corticosteroids needed to control inflammation as measured by sed rate and CRP tests. Some of your symptoms may return during this tapering period.

What are corticosteroids?
Corticosteroids are powerful anti-inflammatory drugs whose effects mimic those of hormones produced by your adrenal glands. The drugs can effectively relieve pain, but prolonged use — especially at high doses — can lead to a number of serious side effects.
Older adults, who are most likely to be treated for giant cell arteritis, are particularly at risk of side effects because they're more prone to certain conditions that also may be caused by corticosteroids. These include:

• Osteoporosis
• High blood pressure
• Muscle weakness
• Glaucoma
• Cataracts

Other possible side effects of corticosteroid therapy include:

• Weight gain
• Increased blood sugar levels, sometimes leading to diabetes
• Thinning skin and increased bruising
• Weakened immune system, leading to susceptibility to infection and delayed healing

To counter the potential side effects of corticosteroid treatment, your doctor is likely to monitor your bone density and may prescribe calcium and vitamin D supplements or other medications to help prevent bone loss. Your doctor is also likely to monitor your blood pressure and may recommend an exercise program, diet changes and medication to keep blood pressure within a normal range. Most side effects go away when the corticosteroid treatment is stopped.
Ask your doctor about taking between 81 and 100 milligrams of aspirin daily (anti-platelet therapy). Taken on a daily basis, aspirin may reduce the risk of blindness and stroke.

Read more...

Genital warts

Genital warts

Definition:

Genital warts are one of the most common types of sexually transmitted infections. At least half of all sexually active people will become infected with the virus that causes genital warts at some point during their lives.
As the name suggests, genital warts affect the moist tissues of the genital area. Genital warts may look like small, flesh-colored bumps or have a cauliflower-like appearance. In many cases, the warts are too small to be visible.
Like warts that appear elsewhere on your body, genital warts are caused by the human papillomavirus (HPV). Some strains of genital HPV can cause genital warts, while others can cause cancer. Vaccines can help protect against certain strains of genital HPV

Symptoms:

In women, genital warts can grow on the vulva, the walls of the vagina, the area between the external genitals and the anus, and the cervix. In men, they may occur on the tip or shaft of the penis, the scrotum, or the anus. Genital warts can also develop in the mouth or throat of a person who has had oral sexual contact with an infected person.
The signs and symptoms of genital warts include:

• Small, flesh-colored or gray swellings in your genital area
• Several warts close together that take on a cauliflower shape
• Itching or discomfort in your genital area
• Bleeding with intercourse

Often, genital warts may be so small and flat that they can't be seen with the naked eye. Sometimes, however, genital warts may multiply into large clusters.
When to see a doctor
See a doctor if you or your partner develops bumps or warts in the genital area.

Causes:

 The human papillomavirus (HPV) causes warts. There are more than 40 different strains of HPV that specifically affect the genital area. Genital HPV is spread through sexual contact. In most cases, your immune system kills genital HPV and you never develop signs or symptoms of the infection.

Complications:

• Cancer. Cervical cancer has been closely linked with genital HPV infection. Certain types of HPV also are associated with cancer of the vulva, cancer of the anus and cancer of the penis. Human papillomavirus infection doesn't always lead to cancer, but it's still important for women, particularly if you've been infected with higher risk types of HPV, to have regular Pap tests.
• Problems during pregnancy. Genital warts may cause problems during pregnancy. Warts could enlarge, making it difficult to urinate. Warts on the vaginal wall may reduce the ability of vaginal tissues to stretch during childbirth. Rarely, a baby born to a mother with genital warts may develop warts in his or her throat. The baby may need surgery to prevent airway obstruction.

Treatments and drugs:


If your warts aren't causing discomfort, you may not need treatment. But if your symptoms include itching, burning and pain or if visible warts are causing emotional distress, your doctor can help you clear an outbreak with medications or surgery. However, the lesions are likely to recur after treatment.
Medications
Genital warts treatments that can be applied directly to your skin include:

• Imiquimod (Aldara, Zyclara). This cream appears to boost your immune system's ability to fight genital warts. Avoid sexual contact while the cream is on your skin. It may weaken condoms and diaphragms and may irritate your partner's skin.
• Podophyllin and podofilox (Condylox). Podophyllin is a plant-based resin that destroys genital wart tissue. Your doctor must apply this solution. Podofilox contains the same active compound, but can be safely applied by you at home. Your doctor may want to administer the first application of podofilox, and will recommend precautionary steps to prevent the medication from irritating surrounding skin. Never apply podofilox internally. Additionally, this medication isn't recommended for use during pregnancy.
• Trichloroacetic acid (TCA). This chemical treatment burns off genital warts. TCA must always be applied by a doctor.

Don't try to treat genital warts with over-the-counter wart removers. These medications aren't intended for use in the moist tissues of the genital area. Using over-the-counter medications for this purpose can cause even more pain and irritation.
Surgery
You may need surgery to remove larger warts, warts that don't respond to medications, or — if you're pregnant — warts that your baby may be exposed to during delivery. Surgical options include:

• Freezing with liquid nitrogen (cryotherapy). Freezing works by causing a blister to form around your wart. As your skin heals, the lesions slough off, allowing new skin to appear. You may need repeated cryotherapy treatments.
• Electrocautery. This procedure uses an electrical current to burn off warts.
• Surgical excision. Your doctor may use special tools to cut off warts. You'll need local anesthesia for this treatment.
• Laser treatments. This approach, which uses an intense beam of light, can be expensive and is usually reserved for very extensive and tough-to-treat warts.

Read more...