Wrist pain

Wrist pain

Definition:

Wrist pain is a common complaint. Many types of wrist pain are caused by sudden injuries that result in sprains or fractures. But wrist pain also can be caused by more long-term problems — such as repetitive stress, arthritis and carpal tunnel syndrome.

Because so many factors can lead to wrist pain, diagnosing the exact cause of long-standing wrist pain sometimes can be difficult. An accurate diagnosis is crucial, however, because proper treatment depends on the cause and severity of your wrist pain.

Symptoms:

Wrist pain may vary, depending on what's causing it. For example, osteoarthritis pain is often described as being similar to a dull toothache, while tendinitis usually causes a sharp, stabbing type of pain. The precise location of your wrist pain also can give clues to what might be causing your symptoms.
When to see a doctor
Not all wrist pain requires medical care. Minor sprains and strains, for instance, usually respond to ice, rest and over-the-counter pain medications. But if pain and swelling last longer than a few days or become worse, see your doctor. Delays in diagnosis and treatment can lead to poor healing, reduced range of motion and long-term disability.

Causes:

Your wrist is a complex joint made up of eight small bones arranged in two rows between the bones in your forearm and the bones in your hand. Tough bands of ligament connect your wrist bones to each other and to your forearm bones and hand bones. Tendons attach muscles to bone. Damage to any of the parts of your wrist can cause pain and affect your ability to use your wrist and hand.
Injuries

• Sudden impacts. Wrist injuries often occur when you fall forward onto your outstretched hand. This can cause sprains, strains and even fractures. A scaphoid fracture involves a bone on the thumb side of the wrist. This type of fracture may not show up on X-rays immediately following the injury.
• Repetitive stress. Any activity that involves repetitive wrist motion — from hitting a tennis ball or bowing a cello to driving cross-country — can inflame the tissues around joints or cause stress fractures, especially when you perform the movement for hours on end without a break. De Quervain's disease is a repetitive stress injury that causes pain at the base of the thumb.

Arthritis

• Osteoarthritis. In general, osteoarthritis in the wrist is uncommon, usually occurring only in people who have injured that wrist in the past. Osteoarthritis is caused by wear and tear on the cartilage that cushions the ends of your bones. Pain that occurs at the base of the thumb may be caused by osteoarthritis.
• Rheumatoid arthritis. A disorder in which the body's immune system attacks its own tissues, rheumatoid arthritis is common in the wrist. If one wrist is affected, the other one usually is, too.

Other diseases and conditions

• Carpal tunnel syndrome. Carpal tunnel syndrome develops when there's increased pressure on the median nerve as it passes through the carpal tunnel, a passageway in the palm side of your wrist.
• Ganglion cysts. These soft tissue cysts occur most often on the top of your wrist opposite your palm. Smaller ganglion cysts seem to cause more pain than do larger ones.
• Kienbock's disease. This disorder typically affects young adults and involves the progressive collapse of one of the small bones in the wrist. Kienbock's disease occurs when the blood supply to this bone is compromised.

Treatments and drugs:

Treatments for wrist problems vary greatly, depending on the type, location and severity of the injury, as well as on your age and overall health.
Medications
Over-the-counter pain relievers, such as ibuprofen (Advil, Motrin, others) and acetaminophen (Tylenol, others), may help reduce wrist pain. Stronger pain relievers are available by prescription.
Therapy
If you have a broken bone in your wrist, the pieces will need to be aligned so that it can heal properly. A cast or splint can help hold the bone fragments together while they heal.
If you have sprained or strained your wrist, you may need to wear a splint to protect the injured tendon or ligament while it heals. Splints are particularly helpful with overuse injuries caused by repetitive motions.
Surgery
In some cases, surgery may be necessary. Examples include:

• Severely broken bones. A surgeon may connect the fragments of bone together with metal hardware.
• Carpal tunnel syndrome. If your symptoms are severe, you may need to have the tunnel cut open to relieve the pressure on the nerve.
• Tendon or ligament repair. Surgery is sometimes necessary to repair tendons or ligaments that have ruptured.

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Wrinkles

Wrinkles

Definition:

Wrinkles are a natural part of aging, but they're most prominent on sun-exposed skin, such as the face, neck, hands and forearms. Although genetics are the most important determinant of skin structure and texture, sun exposure is the major contributor to wrinkles.

 Environmental exposure, such as to heat, wind and dust, as well as smoking, also may contribute to wrinkling.
If your wrinkles bother you, you have more options than ever to help eliminate or at least diminish their appearance. Medications, skin-resurfacing techniques, fillers, injectables and surgery top the list of effective wrinkle treatments.

Symptoms:

Wrinkles are the lines and creases that form in your skin. Some wrinkles can become deep crevices or furrows and may be especially noticeable around your eyes, mouth and neck.

When to see a doctor
If you're concerned about the appearance of your skin, see a dermatologist. He or she can help you create a personalized skin care plan by assessing your skin type and evaluating your skin's condition. A dermatologist can also recommend medical wrinkle treatments.

Causes:

Wrinkles are caused by a combination of factors — some you can control, others you can't:

• Age. As you get older, your skin naturally becomes less elastic and more fragile. Decreased production of natural oils makes your skin drier and appear more wrinkled. Fat in the deeper layers of your skin, which gives the skin a plump appearance, starts to diminish. This causes loose, saggy skin and more-pronounced lines and crevices.
• Exposure to ultraviolet (UV) light. Ultraviolet radiation markedly speeds up the natural aging process and is the primary cause of early wrinkling. Exposure to UV light breaks down your skin's connective tissue — collagen and elastin fibers, which lie in the deeper layer of skin (dermis). Without the supportive connective tissue, your skin loses its strength and flexibility. As a result, skin begins to sag and wrinkle prematurely.
• Smoking. Smoking can accelerate the normal aging process of your skin, contributing to wrinkles. This may be due to changes in the blood supply to your skin.
• Repeated facial expressions. Facial movements and expressions, such as squinting or smiling, lead to fine lines and wrinkles. Each time you use a facial muscle, a groove forms beneath the surface of the skin. And as skin ages, it loses its flexibility and is no longer able to spring back in place. These grooves then become permanent features on your face.
• Gender. Women tend to develop more wrinkles around their mouths (perioral) than men do. That may be because women have fewer sweat glands and glands that secrete an oily matter known as sebum (sebaceous glands) to lubricate the skin and fewer blood vessels in this area.
• Poor nutrition. Nutritional deficiencies are believed to contribute to skin aging.

Treatments and drugs:

 If your wrinkles bother you, you have many options to help eliminate or at least reduce their appearance. Wrinkle treatments include:
Medications

• Topical retinoids. Derived from vitamin A, retinoids that you apply to your skin may be able to reduce fine wrinkles, splotchy pigmentation and skin roughness. Retinoids must be used with a skin care program that includes daily broad-spectrum sunscreen application and protective clothing because the medication can make your skin burn more easily. It may also cause redness, dryness, itching, and a burning or tingling sensation. Tretinoin (Renova, Retin-A) and tazarotene (Avage, Tazorac) are examples of topical retinoids.
• Nonprescription wrinkle creams. The effectiveness of anti-wrinkle creams depends in part on the active ingredient or ingredients. Retinol, alpha hydroxy acids, kinetin, coenzyme Q10, copper peptides and antioxidants may result in slight to modest improvements in wrinkles. However, nonprescription wrinkle creams contain lower concentrations of active ingredients than do prescription creams. Therefore results, if any, are limited and usually short-lived.

Surgical procedures and other techniques
A variety of skin-resurfacing techniques, injectables, fillers and surgical procedures are available to smooth out wrinkles. Each works a little differently and has its own set of potential results and side effects. Some studies indicate that a combination of treatments may yield the most satisfying results.

• Dermabrasion. This procedure consists of sanding down (planing) the surface layer of your skin with a rapidly rotating brush. The planing removes the skin surface, and a new layer of skin grows in its place. Redness, scabbing and swelling generally last a couple of weeks. It may take several months for the pinkness to fade and for you to see the desired results.
• Microdermabrasion. This technique is similar to dermabrasion, but less surface skin is removed. It's done using a vacuum suction over your face while aluminum oxide crystals essentially sandblast your skin. Only a fine layer of skin is removed. You may notice a slight redness to the treated areas. Microdermabrasion usually requires repeated treatments to maintain the subtle, temporary results.
• Laser, light source and radiofrequency treatments. In ablative (wounding) laser resurfacing, a laser beam destroys the outer layer of skin (epidermis) and heats the underlying skin (dermis), which stimulates the growth of new collagen fibers. As the wound heals, new skin forms that's smoother and tighter. It can take up to several months to fully heal from ablative laser resurfacing. Newer developments in laser technology, such as nonablative fractional resurfacing, in which the laser divides the light up into many smaller pulses, have decreased the healing time. Nonablative lasers are less intense, so they don't injure the epidermis. These treatments heat the dermis and cause new collagen and elastin formation. After several treatments, skin feels firmer and appears refreshed. Nonablative laser treatment typically needs to be repeated more often and results are subtle. There's also a device that uses radiofrequency instead of light to heat the dermis and underlying tissue to achieve mildly to moderately tighter skin.
• Chemical peel. Your doctor applies an acid to the affected areas, which burns the outer layer of your skin. With medium-depth peels, the entire epidermis and a small portion of the dermis are removed. New skin forms to take its place. The new skin is usually smoother and less wrinkled than your old skin. Redness lasts up to several weeks. With superficial peels, only a portion of the epidermis is removed. After a series of peels, you may notice less fine wrinkling in your skin and a fading of brown spots.
• Botulinum toxin type A (Botox). When injected in small doses into specific muscles, Botox blocks the chemical signals that cause muscles to contract. When the muscles can't tighten, the skin flattens and appears smoother and less wrinkled. Botox works well on frown lines between the eyebrows and across the forehead, and crow's-feet at the corners of the eyes. Results typically last about three to four months. Repeat injections are needed to maintain results.
• Soft tissue fillers. Soft tissue fillers, which include fat, collagen and hyaluronic acid (Restylane, Juvederm), can be injected into deeper wrinkles on your face. They plump and smooth out wrinkles and furrows and give your skin more volume. You may experience temporary swelling, redness and bruising in the treated area. The procedure may need to be repeated every few months.
• Face-lift. The face-lift procedure involves removing excess skin and fat in your lower face and neck and tightening the underlying muscle and connective tissue. The results typically last five to 10 years. Healing times can be lengthy after a face-lift. Bruising and swelling are usually evident for several weeks after surgery.

Keep in mind that results vary depending on the location of your wrinkles and how deep your wrinkles are. However, nothing stops the aging process of skin, so you'll likely need the treatments repeated to maintain benefits.
These procedures aren't usually covered by insurance. In addition, any of the procedures can have side effects, so be sure to discuss them with your doctor. Make sure your dermatologist or plastic surgeon is specially trained and experienced in the technique you're considering

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Wolff-Parkinson-White (WPW) syndrome

Wolff-Parkinson-White (WPW) syndrome

Definition:
Wolff-Parkinson-White syndrome, or WPW syndrome, is the presence of an extra, abnormal electrical pathway in the heart that leads to periods of a very fast heartbeat (tachycardia).
The extra electrical pathway of Wolff-Parkinson-White syndrome is present at birth. People of all ages, including infants, can experience the symptoms related to Wolff-Parkinson-White syndrome.

Episodes of a fast heartbeat often first occur when people are in their teens or early 20s.
In most cases, the episodes of fast heartbeats aren't life-threatening, but serious heart problems can occur. Treatments for Wolff-Parkinson-White syndrome can stop or prevent episodes of fast heartbeats. A catheter-based procedure, known as ablation, can permanently correct the heart rhythm problems.

Symptoms:
Wolff-Parkinson-White syndrome symptoms are the result of a fast heart rate. Common signs and symptoms include:

• Sensation of rapid, fluttering or pounding heartbeats (palpitations)
• Dizziness
• Lightheadedness
• Fainting
• Tiring easily during exercise
• Anxiety

Symptoms most often appear for the first time in people in their teens or 20s. An episode of a very fast heartbeat can begin suddenly and last for a few seconds or several hours. Episodes often happen during exercise.
Symptoms in more-serious cases
If a person with Wolff-Parkinson-White syndrome also has a very rapid heart rate, more-serious symptoms can develop, including:

• Chest pain
• Chest tightness
• Difficulty breathing
• Sudden death

Symptoms in infants
Symptoms in infants with Wolff-Parkinson-White syndrome may include:

• Shortness of breath
• Not alert or active
• Poor eating
• Fast heartbeats visible on the chest

No symptoms
A person may have an extra electrical pathway in the heart but experience no fast heartbeat and no symptoms. This condition, called Wolff-Parkinson-White pattern, is discovered only by chance when a person is undergoing a heart exam for other reasons. Wolff-Parkinson-White pattern is harmless in many people.

When to see a doctor
A number of conditions can cause irregular heartbeats (arrhythmia). It's important to get a prompt, accurate diagnosis and appropriate care. See your doctor if you or your child experiences any symptoms associated with Wolff-Parkinson-White syndrome.
Call 911 or your local emergency number if you experience any of the following symptoms for more than a few minutes:

• Rapid or irregular heartbeat
• Difficulty breathing
• Chest pain

Also call 911 if you are with a person who faints.

Causes:
The extra electrical pathway of Wolff-Parkinson-White syndrome is present at birth. An abnormal gene (gene mutation) is the cause of a small percentage of cases of the disorder. Wolf-Parkinson-White syndrome is associated with some forms of congenital heart disease, such as Ebstein's anomaly. Otherwise, little is known about why this extra pathway develops.

Normal heart electrical system
Your heart is made up of four chambers — two upper chambers (atria) and two lower chambers (ventricles). The rhythm of your heart is normally controlled by a natural pacemaker — the sinus node — located in the right atrium. The sinus node produces electrical impulses that initiate each heartbeat.
From the sinus node, electrical impulses travel across the atria, causing the atria muscles to contract and pump blood into the ventricles. The electrical impulses then arrive at a cluster of cells called the atrioventricular node (AV node) — usually the only pathway for signals to travel from the atria to the ventricles.

The AV node slows down the electrical signal before sending it to the ventricles. This slight delay allows the ventricles to fill with blood. When electrical impulses reach the muscles of the ventricles, they contract, causing them to pump blood either to the lungs or to the rest of the body.

Abnormal electrical system related to Wolff-Parkinson-White syndrome
In Wolff-Parkinson-White syndrome, an extra electrical pathway connects the atria and ventricles. This means that an electrical signal can bypass the AV node. When electrical impulses use this detour through the heart, the ventricles are activated too early — a condition known as preexcitation.

Abnormal rhythm or fast heartbeat in patients with WPW:
Two major types of rhythm disturbances can be related to the presence of the extra electrical pathway:

• Looped electrical impulses. The problem with a fast heartbeat usually occurs in Wolff-Parkinson-White syndrome because electrical impulses travel down either the normal or the extra pathway and up the other one, creating a complete electrical loop of signals. This condition, called AV reentrant tachycardia, sends impulses to the ventricles at a very rapid rate. The ventricles, as a result, pump very quickly, causing symptoms.
• Disorganized electrical impulses. If electrical impulses don't begin correctly in the right atrium, they may travel across the atria in a disorganized way, causing them to beat very quickly and out of step with each other. This condition is called atrial fibrillation. These disorganized signals also increase the pumping rate of the ventricles to some extent. If there's an extra electrical pathway, as with Wolff-Parkinson-White syndrome, the ventricles can beat even faster. The ventricles don't have time to fill up with blood and don't pump enough blood to the body. This less common condition can be life-threatening.

Complications:
Wolff-Parkinson-White syndrome doesn't cause significant problems for many people, but complications can occur, and it's not always possible to know your risk of serious heart-related events. If the disorder is left untreated, and particularly if you have other heart conditions, you could experience the following:

• Sudden death
• Chaotic electrical signals through the ventricles and very rapid beating of the ventricles (ventricular fibrillation)
• Low blood pressure (hypotension)
• Inability of the heart to pump enough blood (heart failure)
• Frequent fainting spells

Treatments and drugs:
 The treatment goals for Wolff-Parkinson-White syndrome are to slow a fast heart rate when it occurs and prevent future episodes.

Stopping a fast heart rate
A fast heartbeat may correct itself, and you may be able to slow your heart rate using simple physical movements. However, you may need medication or other medical treatment to slow down your heartbeat. Ways to slow your heartbeat include:

• Vagal maneuvers. Your doctor will ask you to perform an action called a vagal maneuver during an episode of a fast heartbeat. Vagal maneuvers affect the vagus nerve, which helps regulate your heartbeat. The maneuvers include coughing, bearing down as if you are having a bowel movement, and putting an ice pack on your face.
• Medications. If vagal maneuvers don't stop the fast heartbeat, you may need an injection of an anti-arrhythmic medication, such as adenosine, to restore a normal heart rate. An injection of this drug is administered at a hospital. Your doctor may also prescribe a pill version of an anti-arrhythmic drug, such as flecainide (Tambocor) or propafenone (Rythmol, Rythmol SR), to take if you have an episode of a fast heartbeat that doesn't respond to vagal maneuvers.
• Cardioversion. In this procedure, a shock is delivered to your heart through paddles or patches on your chest. The current affects the electrical impulses in your heart and restores a normal rhythm. It's typically used when maneuvers and medications aren't effective.

Preventing episodes of a fast heart rate
With the following treatments, it's possible to correct or manage problems related to Wolff-Parkinson-White syndrome in the majority of cases.

• Radiofrequency catheter ablation. This procedure is the most common treatment for Wolff-Parkinson-White syndrome. In this procedure, catheters are threaded through the blood vessels to your heart. Electrodes at the catheter tips are heated to damage (ablate) the extra electrical pathway and prevent it from sending electrical signals. This procedure is highly effective, and complications — which can include heart injury or infection — are uncommon.
• Medications. Anti-arrhythmic medications such as flecainide or propafenone may prevent a fast heart rate when taken regularly. Medications are usually given to people who can't undergo radiofrequency catheter ablation for some reason or don't want to have the procedure.
• Surgery. The success rate for surgical destruction (ablation) of the extra pathway using open-heart surgery is almost 100 percent. However, because radiofrequency catheter ablation is almost as effective and less invasive, surgery for Wolff-Parkinson-White syndrome is now rare. It's typically reserved for people who are having heart surgery for other reasons.

If you don't have symptoms
If you have the Wolff-Parkinson-White pathway but don't have any symptoms, you probably won't need treatment. In some people without symptoms, the extra pathway may spontaneously disappear over time.
Your doctor may be able to evaluate your risk of having episodes of a fast heartbeat based on findings from an ECG or electrophysiological testing. If he or she determines that you may be at risk of an event, your doctor may suggest radiofrequency catheter ablation.

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Wilson's disease

Wilson's disease

Definition:

Wilson's disease is an inherited disorder that causes too much copper to accumulate in your liver, brain and other vital organs. Another term for Wilson's disease is hepatolenticular degeneration.
Copper plays a key role in the development of healthy nerves, bones, collagen and the skin pigment melanin. Normally, copper is absorbed from your food, and any excess is excreted through bile — a substance produced in your liver.

But in people with Wilson's disease, copper isn't eliminated properly and instead accumulates, possibly to a life-threatening level. Left untreated, Wilson's disease is fatal. When diagnosed early, Wilson's disease is treatable, and many people with the disorder live normal lives.

Symptoms:



Wilson's disease causes a wide variety of signs and symptoms that are often mistaken for other diseases and conditions. Signs and symptoms vary depending on what parts of your body are affected by Wilson's disease.
Signs and symptoms of Wilson's disease include:

• Clumsiness
• Depression
• Difficulty speaking
• Difficulty swallowing
• Difficulty walking
• Drooling
• Easy bruising
• Fatigue
• Involuntary shaking
• Joint pain
• Loss of appetite
• Nausea
• Skin rash
• Swelling of arms and legs
• Yellowing of the skin and eyes (jaundice)

When to see a doctor
Make an appointment with your doctor if you have any signs and symptoms that worry you.
If a family member has been diagnosed with Wilson's disease, tell your doctor at your next appointment. Your doctor may recommend tests to determine whether you may have Wilson's disease.

Causes:

Wilson's disease occurs when a genetic mutation leads to an accumulation of copper in your body.

How the genetic mutation occurs
The genetic mutation that causes Wilson's disease is most commonly passed from one generation to the next. Wilson's disease is inherited as an autosomal recessive trait, which means that to develop the disease you must inherit two copies of the defective gene, one from each parent. If you receive only one abnormal gene, you won't become ill yourself, but you're considered a carrier and can pass the gene to your children.

How the genetic mutation causes Wilson's disease
The mutation that causes Wilson's disease causes problems with a protein that's responsible for moving excess copper out of your liver.
Your body collects copper from the food you eat during the digestive process. The copper is transported to your liver where liver cells use it for everyday tasks. Most people eat more copper than they need. In these cases, the liver takes what it needs and excretes the rest in bile, a digestive juice made by the liver.

But in people with Wilson's disease, the extra copper doesn't leave your body. Instead, copper builds up in the liver, where it can cause serious and sometimes irreversible damage. In time, excess copper leaves the liver and begins accumulating in and harming other organs, especially the brain, eyes and kidneys.

Complications:

 Wilson's disease can cause serious complications such as:

• Scarring of the liver (cirrhosis). As liver cells try to make repairs to damage done by excess copper, scar tissue forms in the liver. The scar tissue makes it more difficult for the liver to function.
• Liver failure. Liver failure can occur suddenly (acute liver failure), or it can develop slowly over many years. If liver failure progresses, a liver transplant may be a treatment option.
• Liver cancer. Damage to the liver caused by Wilson's disease may increase the risk of liver cancer.
• Persistent neurological problems. Neurological problems usually improve with treatment for Wilson's disease. However, some people may experience persistent neurological difficulty despite treatment.
• Kidney problems. Wilson's disease can damage the kidneys, leading to kidney problems such as kidney stones and an abnormal number of amino acids excreted in the urine (aminoaciduria).

Treatments and drugs:


If you've been diagnosed with Wilson's disease, your doctor may recommend medications to reduce the amount of copper in your body. Once that is achieved, treatment focuses on preventing copper from building up again. When liver damage is severe, a liver transplant may be necessary.

Medications that remove excess copper from your body
Medications called chelating agents prompt your organs to release copper into your bloodstream. The copper is then filtered by your kidneys and released into your urine.
Treatment for people with signs and symptoms of Wilson's disease usually begins with a chelating agent. Once your signs and symptoms are under control, your doctor may recommend a lower dose of medication to maintain a safe level of copper in your body.

Doctors sometimes also recommend chelating agents to people who've been diagnosed with Wilson's disease but don't have signs and symptoms. For these people, a chelating agent can reduce the risk of liver damage.
Side effects of chelating agents depend on the specific medication:

• Penicillamine (Cuprimine, Depen). Penicillamine can cause serious side effects, including skin problems, bone marrow suppression, worsening of neurological symptoms and birth defects.
• Trientine (Syprine). Trientine works much like penicillamine but tends to cause fewer side effects. Still, there is a risk that neurological symptoms can worsen when taking trientine, though it's thought to be a lower risk than is penicillamine.

Medication to maintain healthy copper levels
Zinc acetate prevents your body from absorbing copper from the food you eat. Zinc is sometimes used in people who've had successful treatment with a chelating agent. In these people, zinc may help maintain a healthy copper level. Zinc is also used in people who've been diagnosed with Wilson's disease but don't have any signs or symptoms.
Zinc acetate causes few side effects but can cause upset stomach.

Liver transplant
For people with severe liver damage, a liver transplant may be necessary. During a liver transplant, a surgeon removes your diseased liver and replaces it with a healthy liver from a donor. Most transplanted livers come from donors who have died. But in some cases a liver can come from a living donor, such as a family member. In that case, the surgeon removes your diseased liver and replaces it with a portion of your family member's liver.

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Wilms' tumor

Wilms' tumor

Definition:

Wilms' tumor is a rare kidney cancer that primarily affects children. Also known as nephroblastoma, Wilms' tumor is the most common cancer of the kidneys in children. Wilms' tumor most often affects children ages 3 to 4 and becomes much less common after age 5.
Wilms' tumor most often occurs in just one kidney, though it can sometimes be found in both kidneys at the same time.
Improvements in the diagnosis and treatment of Wilms' tumor have improved the prognosis for children with this disease. The outlook for most children with Wilms' tumor is very good.

Symptoms:

Wilms' tumor doesn't always cause signs and symptoms. Children with Wilms' tumor may appear healthy, or they may experience:

• Abdominal swelling
• An abdominal mass you can feel
• Abdominal pain
• Fever
• Blood in the urine

When to see a doctor
Make an appointment with your child's doctor if you notice any signs or symptoms that worry you. The signs and symptoms associated with Wilms' tumor aren't specific to the condition and are much more likely to be caused by something else.

Causes:

It's not clear what causes Wilms' tumor. Doctors know that cancer begins when cells develop errors in their DNA. The errors allow the cells to grow and divide uncontrollably and to go on living when other cells would die. The accumulating cells form a tumor. In Wilms' tumor, this process occurs in the kidney cells.
In a small number of cases, the errors in DNA that lead to Wilms' tumor are passed from parents to children. In most cases, there is no known connection between parents and children that may lead to cancer. Instead, something happens in the child's early development that causes DNA errors and leads to Wilms' tumor.

Treatments and drugs:

Standard treatment for Wilms' tumor is surgery and chemotherapy. The stage of the tumor and appearance of the cancer cells under a microscope help determine whether your child also needs radiation therapy. At this point, your doctor may tell you the tumor appears to be either favorable or unfavorable (anaplastic) — the histology of the tissue.

 Children whose tumors have a favorable histology have better survival rates. However, many children with unfavorable histology also have good outcomes.
Because this type of cancer is rare, your doctor may recommend that you seek treatment at a children's cancer center that has experience treating this type of cancer.
Surgery
Surgical removal of kidney tissue is called nephrectomy. The various types of nephrectomy include:

• Simple nephrectomy. In this surgery, the surgeon removes the entire kidney. The remaining kidney can increase its capacity and take over the entire job of filtering the blood.
• Partial nephrectomy. This involves removal of the tumor and part of the kidney tissue surrounding it. It's usually performed when the other kidney is damaged or has already been removed.
• Radical nephrectomy. In this type of surgery, doctors remove the kidney and surrounding tissues, including the ureter and adrenal gland. Neighboring lymph nodes also may be removed.

At surgery, your child's doctor may examine both kidneys and the abdominal cavity for evidence of cancer. Samples from the kidney, lymph nodes and any tissues that appear abnormal are removed and examined by microscope to identify cancer cells.
If both kidneys need to be removed, your child will need dialysis until he or she is healthy enough for a transplant.
A doctor specializing in pathology examines your child's tumor cells under a microscope and looks for features that indicate whether the cancer is aggressive or is susceptible to chemotherapy.

Chemotherapy
Chemotherapy uses medication to kill cancer cells throughout the body. This treatment affects rapidly dividing cells; thus, normal cells with fast turnover — such as hair follicles, cells in the gastrointestinal tract and bone marrow, the tissue at the core of bone that manufactures blood cells — are affected as well as cancer cells. As a result, these medications can have the side effects of nausea, vomiting, loss of appetite, hair loss and low white blood cell counts. Most side effects will improve after the drug is stopped, and some may lessen during therapy.

 Ask your child's doctor what side effects may occur during treatment, and if there are any potential long-term complications. 
At high doses, chemotherapy can destroy bone marrow cells. Although it's not usually standard treatment, if your child is to undergo high-dose chemotherapy, your child's doctor may suggest that marrow cells be removed in advance and frozen. After chemotherapy, the marrow will be returned through an intravenous line, a procedure called autologous bone marrow reinfusion.

Radiation therapy
Radiation therapy uses X-rays or other sources of high-energy rays to kill cancer cells. It's usually started within a few days after surgery. If your child is very young, he or she may need a sedative to remain still during treatment. A doctor specializing in radiation therapy will mark the area to be treated with a special dye. Areas that should not receive radiation are shielded. Possible side effects include nausea, fatigue and skin irritation. Diarrhea may occur after radiation to the abdomen — ask your doctor to suggest an over-the-counter or prescription medication for relief.

Treatment regimens by stage
The treatment your child undergoes depends on the stage of the cancer, the type of cancer cell, and the child's age and general health.

• Stage I or II cancer. If the cancer is restricted to the kidney or nearby structures — and the cell type is not aggressive, your child will undergo removal of the affected kidney and tissues and some of the lymph nodes near the kidney, followed by chemotherapy. Some stage II cancers are also treated with radiation.
• Stage III or IV cancer. If the cancer has spread within the abdomen and can't be completely removed without jeopardizing structures such as major blood vessels — radiation will be added to surgery and chemotherapy. Your child may undergo chemotherapy before surgery to shrink the tumor.
• Stage V cancer. If the tumor cells are in both kidneys — part of the cancer from both kidneys will be removed during surgery and neighboring lymph nodes taken to see if they contain tumor cells. Chemotherapy is used to shrink the remaining tumor. Surgery is repeated to remove as much tumor as possible while leaving functioning kidney tissue. More chemotherapy and radiation therapy may follow.

Children react differently to therapies, so adjustments may be necessary. Discuss your child's treatment plan with his or her doctor and make certain that you understand the benefits and risks before giving your consent. Ask the doctor about side effects of treatments and when to report them, and what can be done to ease them.
Your child's prognosis depends on the stage and cell type of the tumor.

Considering a clinical trial
Your child will receive the best care at a major medical center whose staff has expertise in treating this form of cancer. Your child's regular doctor can arrange a referral.
Because advances in treating children with Wilms' tumor have come through research, you may be asked to consider letting your child participate in a clinical trial, a carefully planned study to evaluate the benefits and risks of experimental treatments.

 Researchers must give you all of the available information about the trial before asking you to sign consent forms. Many children with cancer are treated in a clinical trial at some point in their illness. However, enrollment in a clinical trial is up to you and your child. Talk to your child's doctor to find out more about clinical trials.

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Whooping cough

Whooping cough

Definition  :

Whooping cough (pertussis) is a highly contagious respiratory tract infection. In many people, it's marked by a severe hacking cough followed by a high-pitched intake of breath that sounds like "whoop."

Before the vaccine was developed, whooping cough was considered a childhood disease. Now whooping cough primarily affects children too young to have completed the full course of vaccinations and teenagers and adults whose immunity has faded.

Deaths associated with whooping cough are rare but most commonly occur in infants. That's why it's so important for pregnant women — and other people who will have close contact with an infant — to be vaccinated against whooping cough.

Symptoms:

Once you become infected with whooping cough, it can take one to three weeks for signs and symptoms to appear. They're usually mild at first and resemble those of a common cold:

• Runny nose
• Nasal congestion
• Sneezing
• Red, watery eyes
• A mild fever
• Dry cough

After a week or two, signs and symptoms worsen. Thick mucus accumulates inside your airways, causing uncontrollable coughing. Severe and prolonged coughing attacks may:

• Provoke vomiting
• Result in a red or blue face
• Cause extreme fatigue
• End with a high-pitched "whoop" sound during the next breath of air

However, many people don't develop the characteristic whoop. Sometimes, a persistent hacking cough is the only sign that an adolescent or adult has whooping cough.
When to see a doctor
Call your doctor if prolonged coughing spells cause you or your child to:

• Vomit
• Turn red or blue
• Inhale with a whooping sound

Causes:

 Whooping cough is caused by bacteria. When an infected person coughs or sneezes, tiny germ-laden droplets are sprayed into the air and breathed into the lungs of anyone who happens to be nearby.

Complications:

Most people recover from whooping cough with no problems. When complications occur, they tend to be side effects of the strenuous coughing, such as:

• Bruised or cracked ribs
• Abdominal hernias
• Broken blood vessels in the skin or the whites of your eyes

Infants
In infants — especially those under 6 months of age — complications from whooping cough are more severe and may include:

• Ear infections
• Pneumonia
• Slowed or stopped breathing
• Dehydration
• Seizures
• Brain damage

Because infants and toddlers are at greatest risk of complications from whooping cough, they're more likely to need treatment in a hospital. Complications can be life-threatening for infants less than 6 months old.

Treatments and drugs:
 
Infants are typically hospitalized for treatment because whooping cough is more dangerous for that age group. If your child can't keep down liquids or food, intravenous fluids may be necessary. Your child will also be isolated from others to prevent the infection from spreading.
Treatment for older children and adults usually can be managed at home.
Medications
Antibiotics kill the bacteria causing whooping cough and help speed recovery. Family members may be given preventive antibiotics. Unfortunately, not much is available to relieve the cough. Over-the-counter cough medicines, for instance, have little effect on whooping cough and are discouraged.

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Whipple's disease

Whipple's disease

Definition  :

Whipple's disease is a rare bacterial infection that most often affects your gastrointestinal system. Whipple's disease interferes with normal digestion by impairing the breakdown of foods, such as fats and carbohydrates, and hampering your body's ability to absorb nutrients.
Whipple's disease also can infect other organs, including your brain, heart, joints and eyes.
Without proper treatment, Whipple's disease can be serious or fatal. However, a course of antibiotics can treat Whipple's disease.

Symptoms:

Common signs and symptoms
Gastrointestinal signs and symptoms are common in Whipple's disease and may include:

• Diarrhea
• Abdominal cramping and pain, which may worsen after meals
• Weight loss, associated with the malabsorption of nutrients

Other frequent signs and symptoms associated with Whipple's disease include:

• Inflamed joints, particularly your ankles, knees and wrists
• Fatigue
• Weakness
• Anemia

Less common signs and symptoms
In some cases, signs and symptoms of Whipple's disease may include:

• Fever
• Cough
• Enlarged lymph nodes
• Skin darkening (hyperpigmentation) in areas exposed to the sun and in scars
• Chest pain
• Enlarged spleen

Neurological signs and symptoms may include:

• Difficulty walking
• Visual impairment, including lack of control of eye movements
• Seizures
• Confusion
• Memory loss

Symptoms tend to develop slowly over a period of many years in most people with this disease. In some cases, some symptoms, such as joint pain and weight loss, develop years before the gastrointestinal symptoms that lead to diagnosis.

When to see a doctor
Whipple's disease is potentially life-threatening, yet usually treatable. Contact your doctor if you experience unusual signs or symptoms, such as unexplained weight loss or joint pain. Your doctor can perform tests to determine the cause of your symptoms.

Even after the infection is diagnosed and you're receiving treatment, let your doctor know if your symptoms don't improve. Sometimes antibiotic therapy isn't effective because the bacteria are resistant to the particular drug you're taking. The disease can recur, so it's important to watch for the re-emergence of symptoms.

Causes:

The cause of Whipple's disease is infection with the bacterium Tropheryma whipplei. This bacterium initially affects the mucosal lining of your small intestine, forming small lesions within the intestinal wall. The bacterium also damages the fine, hair-like projections (villi) that line the small intestine. With time, the infection can spread to other parts of your body.

Not much is known about the bacterium. Although it seems readily present in the environment, scientists don't really know where it comes from or how it's transmitted to humans. Not everyone who carries the bacterium develops the disease. Some researchers believe that people with the disease may have a genetic defect in their immune system response that makes them more susceptible to becoming ill when exposed to the bacterium.

Whipple's disease is extremely uncommon.

Complications:

 The lining of your small intestine has fine, hair-like projections (villi) that help your body absorb nutrients. Whipple's disease damages the villi, impairing nutrient absorption. Nutritional deficiencies are common in people with Whipple's disease and can lead to fatigue, weakness, weight loss and joint pain.
Whipple's disease is a progressive and potentially fatal disease. Although the infection is rare, associated deaths continue to be reported, due in large part to late diagnoses and delayed treatment. Death often is caused by the spread of the infection to the central nervous system, which can cause irreversible damage.

Treatments and drugs:

Treatment of Whipple's disease is with antibiotics, either alone or in combination, which can destroy the bacteria causing the infection.
Treatment is long term, generally lasting a year or two, in an effort to destroy the bacteria.  But relief from symptoms typically comes much quicker, often within the first week or two. Most people with no brain or nervous system complications recover completely after a full course of antibiotics.

When choosing antibiotics, doctors often select those that not only wipe out infections of the intestinal tract but also cross the blood-brain barrier — a layer of tissue around your brain — in order to eliminate bacteria that may have entered your brain and central nervous system.
Because of the lengthy use of antibiotics, your doctor will need to monitor your condition for development of resistance to the drugs. If you relapse during treatment, your doctor may change your antibiotics.

Treatment for standard cases
In most cases, Whipple's disease therapy begins with 14 days of intravenous (IV) ceftriaxone (Rocephin). Following that initial therapy, you'll likely take an oral course of sulfamethoxazole-trimethoprim, or SMX- TMP, (Bactrim, Septra), for one to two years. A shorter duration of antibiotic treatment may lead to a relapse.
Possible side effects of ceftriaxone and SMX- TMP include mild diarrhea, nausea and vomiting.

Treatment for severe cases
If you have neurologic symptoms, you may be started immediately on a 12- to 18-month course of oral doxycycline (Vibramycin) combined with the antimalarial drug hydroxychloroquine (Plaquenil). You'll also be given long-term antibiotics that can enter the cerebrospinal fluid and brain, such as TMP-SMX.
Possible side effects of doxycycline include loss of appetite, nausea, vomiting and sensitivity to sunlight. Hydroxychloroquine may cause loss of appetite, diarrhea, headache, stomach cramps and
 dizziness.

Symptom relief
Your symptoms should improve within one to two weeks of starting antibiotic treatment and go away entirely within about one month.
But even though symptoms improve quickly, further laboratory tests may reveal presence of the bacteria for two or more years after you begin taking antibiotics. Follow-up testing will help your doctor determine when you can stop taking antibiotics. Regular monitoring can also indicate development of resistance to a particular drug, often reflected in a lack of improvement of your symptoms.
Even after successful treatment, Whipple's disease can recur. Doctors usually advise regular checkups. If you've experienced a recurrence, you'll need to repeat antibiotic therapy.

Taking supplements
Because of the nutrient-absorption difficulties associated with Whipple's disease, your doctor may recommend taking vitamin and mineral supplements to ensure adequate nutrition. Your body may require additional vitamin D, folic acid, calcium, iron and magnesium.

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Whiplash

Whiplash

Definition:

 Whiplash is a neck injury that can occur during rear-end automobile collisions, when your head suddenly moves backward and then forward — similar to the motion of someone cracking a whip. These extreme motions push your neck muscles and ligaments beyond their normal range of motion.

Whiplash injuries can be mild or severe. Treatment typically begins with over-the-counter pain relievers and ice applied to the painful neck muscles. If pain persists, prescription medications and physical therapy may be helpful.
Most people recover from whiplash in just a few weeks, but some people may develop chronic pain after a whiplash injury.

Symptoms:

Most whiplash symptoms develop within 24 hours of the injury and may include:

• Neck pain and stiffness
• Headaches, most commonly at the base of the skull
• Dizziness
• Blurred vision
• Fatigue

Some people also experience:

• Difficulty concentrating
• Memory problems
• Ringing in the ears
• Sleep disturbances
• Irritability

When to see a doctor
Contact your doctor promptly if:

• The pain spreads to your shoulders or arms
• It becomes painful to move your head
• You experience numbness, tingling or weakness in your arms

Causes:

Whiplash typically occurs when a person's head is thrown backward and then forward, straining the neck's muscles and ligaments. This type of injury may result from:

• Auto accidents. Rear-end collisions are the most common cause of whiplash.
• Physical abuse. Whiplash may also result from incidents of being punched or shaken. Whiplash is one of the injuries sustained in shaken baby syndrome.
• Contact sports. Football tackles and other sports-related collisions can sometimes cause whiplash injuries.

Complications:

 Most people who experience whiplash will recover in the first two to three months. Fewer people may continue to have pain for several months — possibly up to two years — after the injury occurred. In some people, this chronic pain can be traced to damage in the joints, disks and ligaments of the neck. But in many cases, no abnormality can be found to explain this persistent neck pain.

Treatments and drugs:

 Medications
If over-the-counter pain medications and self-care treatments at home aren't enough, your doctor may suggest:

• Prescription painkillers. People with more severe pain may benefit from short-term treatment with prescription pain relievers.
• Injections. An injection of lidocaine (Xylocaine) — a numbing medicine — into painful muscle areas may relieve the muscle spasms that can be associated with whiplash injuries.
• Muscle relaxants. These drugs can help ease muscle spasms but often cause drowsiness, so your doctor may want you to take them only at bedtime.

Therapy
Physical therapy interventions are the mainstay of treatment for whiplash. Therapy treatments may include:

• Ice
• Heat
• Manual therapies, including myofascial release
• Ultrasound

As pain permits, exercises to stretch and strengthen neck muscles can help to minimize symptoms and help protect your neck in the future.

Foam collars
Although soft foam cervical collars were once commonly used for whiplash injuries, they no longer are recommended routinely. Immobilizing the neck for long periods of time can lead to decreased muscle bulk and strength and impair recovery.
If worn temporarily, cervical collars should be worn for no longer than three hours at a time and for only the first few days after the injury. If you're continually being awakened at night by whiplash pain, especially early on after the injury, wearing a cervical collar may help you sleep.

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Wheat allergy

Wheat allergy

Definition  :

Wheat allergy is an allergic reaction to foods containing wheat. It's one of the more common food allergies in children. Wheat can be found in many foods, including some you might never suspect, such as breads, cakes, breakfast cereals, pasta, crackers, beer, soy sauce and condiments, such as ketchup.

Avoiding wheat is the primary treatment for wheat allergy. Medications may be necessary to manage allergic reactions when you accidentally eat wheat.
Wheat allergy may sometimes be confused with celiac disease, but these conditions are different. A wheat allergy generates an allergy-causing antibody to proteins found in wheat. But, one particular protein in wheat — gluten — causes an abnormal immune system reaction in the small intestines of people with celiac disease.

Symptoms:


If you or your child has wheat allergy, you or your child will likely experience symptoms within a few minutes to a few hours after eating something containing wheat. Wheat allergy symptoms include:

• Swelling, itching or irritation of the mouth or throat
• Hives, itchy rash or swelling of the skin
• Nasal congestion
• Itchy, watery eyes
• Difficulty breathing
• Cramps, nausea or vomiting
• Diarrhea
• Anaphylaxis

Anaphylaxis
For some people wheat allergy may cause a life-threatening reaction called anaphylaxis. In addition to other signs and symptoms of wheat allergy, anaphylaxis may cause:

• Swelling or tightness of the throat
• Chest pain or tightness
• Severe difficulty breathing
• Trouble swallowing
• Pale, blue skin color
• Dizziness or fainting
• Fast heartbeat

Age of onset
A wheat allergy may not be a lifelong disorder. Whether you outgrow it may depend, in part, on when the allergy first appears.

• Young children. Wheat allergy in children usually develops during infancy or early toddler years. Most children with wheat allergy have other food allergies. Children usually outgrow wheat allergy between ages 3 and 5.
• Adolescents and adults. Wheat allergy isn't as common in adolescents and adults.

When to see a doctor
Anaphylaxis is a medical emergency that requires immediate care. People who already know they can have an anaphylactic reaction to wheat or another allergy-causing substance should carry two injectable doses of a drug called epinephrine (adrenaline). The second dose is a backup in case emergency services aren't immediately available.
If someone has signs of anaphylaxis, call 911 or your local emergency number. Emergency care is essential even if the person has just used an epinephrine shot.
If you suspect that you or your child is allergic to wheat or another food, see your doctor. A number of conditions can cause signs or symptoms associated with wheat allergy. So, an accurate diagnosis is important.

Causes:


An allergic reaction is somewhat like a case of mistaken identity by your body's immune system. Normally, your immune system generates antibodies to protect your body against bacteria, viruses or toxic substances.
If you have wheat allergy, your body creates an allergy-causing antibody to a protein found in wheat. In other words, your immune system mistakenly identifies this protein as something that could harm you. Once your body develops an allergy-causing antibody to a particular agent (allergen) — in this case, a wheat protein — your immune system is sensitive to it. When you eat wheat, your immune system mounts an attack.
There are four different classes of proteins in wheat that can cause allergies: albumin, globulin, gliadin and gluten. Any of them can cause an allergic reaction.
Sources of wheat proteins
Some sources of wheat proteins are obvious, such as bread, but all wheat proteins — and gluten in particular — may be used in a number of prepared foods and sometimes in cosmetics. Foods that may include wheat proteins include:

• Breads
• Cakes and muffins
• Cookies
• Breakfast cereals
• Pasta
• Couscous
• Farina
• Semolina
• Spelt
• Crackers
• Beer
• Hydrolyzed vegetable protein
• Soy sauce
• Condiments, such as ketchup
• Meat products, such as hot dogs or cold cuts
• Dairy products, such as ice cream
• Natural flavorings
• Gelatinized starch
• Modified food starch
• Vegetable gum
• Licorice
• Jelly beans
• Hard candies

If you have a wheat allergy, you may also be allergic to other grains with similar proteins. These related grains include:

• Barley
• Oat
• Rye

Wheat-dependent, exercise-induced anaphylaxis
Some people with a wheat allergy develop symptoms only if they exercise within a few hours after eating wheat. Changes in your body related to exercise either trigger an allergic reaction or worsen an immune system response to a wheat protein. This condition usually results in life-threatening anaphylaxis.
If you have exercise-related allergy to wheat, you may also experience an anaphylactic reaction when you eat or drink something with wheat and take aspirin or diclofenac (Cataflam, Voltaren) within a few hours.
The connection between these seemingly unrelated factors may be that exercise and aspirin use similar biological mechanisms to trigger an allergic reaction to wheat.

Baker's asthma
Baker's asthma is an allergic reaction to wheat flour and other types of flour. As the name of the disorder suggests, it's a particular problem for bakers or anyone who works with uncooked wheat flours. The allergic reaction is triggered by inhaling flour rather than eating it. Baker's asthma primarily results in problems breathing. But, people with Baker's asthma can usually eat cooked wheat products without having a reaction.

Celiac disease
Celiac disease, or gluten-sensitive enteropathy, is considered a food sensitivity rather than a food allergy. Celiac disease is an abnormal immune system reaction to gluten that affects the small intestine. This condition can result in poor absorption of essential nutrients from your food. A person may have both wheat allergy and celiac disease.

Treatments and drugs:

 The best treatment for wheat allergy is to avoid exposure to wheat proteins. Because wheat proteins appear in so many prepared foods, you'll need to read product labels carefully.
Drugs

• Antihistamines may reduce signs and symptoms of wheat allergies. These drugs can be taken after exposure to wheat to control your reaction and help relieve discomfort. Ask your doctor if a prescription or over-the-counter allergy drug is appropriate for you.
• Epinephrine is an emergency treatment for anaphylaxis. If you're at risk of having a severe reaction to wheat, you may need to carry two injectable doses of epinephrine (such as EpiPen, EpiPen Jr.) with you at all times. A second pen is recommended for people with high risk for life-threatening anaphylaxis in case anaphylactic symptoms return before emergency care is available.

Emergency care
Emergency medical care is essential for anyone who experiences an anaphylactic reaction to wheat, even after receiving an injection of epinephrine. It's important to call 911 or your local emergency number as soon as possible.

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Wet macular degeneration

Wet macular degeneration

Definition:

 Wet macular degeneration is a chronic eye disease that causes vision loss in the center of your field of vision. Wet macular degeneration is generally caused by abnormal blood vessels that leak fluid or blood into the region of the macula (MAK-u-luh). The macula is in the center of the retina (the layer of tissue on the inside back wall of your eyeball).

Wet macular degeneration is one of two types of age-related macular degeneration. The other type — dry macular degeneration — is more common and less severe. Wet macular degeneration almost always begins as dry macular degeneration. It's not clear what causes wet macular degeneration.
Early detection and treatment of wet macular degeneration may help reduce vision loss and, in some instances, improve vision.

Symptoms:

Wet macular degeneration symptoms usually appear and progress rapidly. Symptoms may include:

• Visual distortions, such as straight lines appearing wavy or crooked, a doorway or street sign looking lopsided, or objects appearing smaller or farther away than they really are
• Decreased central vision
• Decreased intensity or brightness of colors
• Well-defined blurry spot or blind spot in your field of vision
• Abrupt onset
• Rapid worsening
• Hallucinations of geometric shapes, animals or people, in cases of advanced macular degeneration

When to see a doctor
See your eye doctor if:

• You notice changes in your central vision
• Your ability to see colors and fine detail becomes impaired

These changes may be the first indication of macular degeneration, particularly if you're older than age 50.

Causes:

 It's not clear what causes wet macular degeneration. The condition almost always develops in people who have had dry macular degeneration. But doctors can't predict who will develop wet macular degeneration, which is more severe and progresses more rapidly than dry macular degeneration.
Wet macular degeneration can develop in different ways:

• Vision loss caused by abnormal blood vessel growth. Wet macular degeneration may develop when abnormal new blood vessels grow from the choroid — the layer of blood vessels between the retina and the outer, firm coat of the eye, called the sclera — under and into the macular portion of the retina. This condition is called choroidal neovascularization.
  These abnormal vessels may leak fluid or blood between the choroid and macula. The fluid interferes with the retina's function and causes your central vision to blur. In addition, what you see when you look straight ahead becomes wavy or crooked, and blank spots block out part of your field of vision.
  
• Vision loss caused by fluid buildup in the back of the eye. Wet macular degeneration sometimes may develop when fluid leaks from the choroid and collects between the choroid and a thin cell layer, called the retinal pigment epithelium (RPE). This may cause retinal pigment epithelium detachment.
  The fluid beneath the RPE causes what looks like a blister or a bump under the macula.

 Treatments and drugs:


Wet macular degeneration can't be cured. If diagnosed early, treatment may help slow progress of wet macular degeneration and reduce the amount of vision lost.
Medications to stop growth of abnormal blood vessels
Medications may help stop growth of new blood vessels by blocking the effects of growth signals the body sends to generate new blood vessels. These drugs are considered the first-line treatment for all stages of wet macular degeneration.
Medications used to treat wet macular degeneration include:

• Bevacizumab (Avastin)
• Ranibizumab (Lucentis)
• Pegaptanib (Macugen)
• Aflibercept (Eylea)

Your doctor injects these medications directly into your eye. You may undergo repeat injections every four weeks to maintain the beneficial effect of the medication. In some instances, you may partially recover vision as the blood vessels shrink and the fluid under the retina absorbs, allowing retinal cells to regain some function.
Some of these medications may increase the risk of stroke.

Using light to activate an injected medication (photodynamic therapy)
Photodynamic therapy is used to treat abnormal blood vessels at the center of your macula.
In this procedure, your doctor injects a medication called verteporfin (Visudyne) into a vein in your arm, which travels to blood vessels in your eye. Your doctor shines a focused light from a special laser to the abnormal blood vessels in your eye. This activates the medication within the abnormal blood vessels. The medication then can cause the abnormal blood vessels in your eye to close, which stops the leakage.
Photodynamic therapy may improve the vision and reduce the rate of vision loss. You may need repeated treatments over time, as the treated blood vessels may reopen.
After photodynamic therapy, you'll need to avoid direct sunlight and intensely bright lights until the drug has cleared your body, which may take a few days.

Using a laser to destroy abnormal blood vessels (photocoagulation)
During laser therapy, your doctor uses a high-energy laser beam to destroy abnormal blood vessels under the macula. The procedure is used to prevent further damage to the macula and slow continued vision loss.
Laser therapy is used to treat wet macular degeneration only in certain situations. It generally isn't an option if you have abnormal blood vessels directly under the center of the macula. Also, the more damaged your macula is, the lower the likelihood of functional success. Because of these restrictions, few people who have wet macular degeneration are candidates for laser therapy.

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West Nile virus

West Nile virus

Definition:

West Nile infection is caused by a virus transmitted by mosquitoes. Most people infected with West Nile virus don't experience any signs or symptoms, or may experience only minor ones, such as fever and mild headache. However, some people who become infected with West Nile virus develop a life-threatening illness that includes inflammation of the brain.

Mild signs and symptoms of a West Nile virus infection generally go away on their own. But severe signs and symptoms — such as a severe headache, fever, disorientation or sudden weakness — require immediate attention.
Exposure to mosquitoes where West Nile virus exists increases your risk of getting West Nile virus infection. Protect yourself from mosquitoes by using mosquito repellent and wearing clothing that covers your skin to reduce your risk.

Symptoms:

Most have no signs or symptoms
Most people infected with the West Nile virus have no signs or symptoms.
Mild infection signs and symptoms
About 20 percent of people develop a mild infection called West Nile fever. Common signs and symptoms of West Nile fever include:

• Fever
• Headache
• Body aches
• Fatigue
• Back pain
• Skin rash (occasionally)
• Swollen lymph glands (occasionally)
• Eye pain (occasionally)

Serious infection signs and symptoms
In less than 1 percent of infected people, the virus causes a serious neurological infection. Such infection may include inflammation of the brain (encephalitis) or of both the brain and surrounding membranes (meningoencephalitis). Serious infection may also include infection and inflammation of the membranes surrounding the brain and spinal cord (meningitis), inflammation of the spinal cord (West Nile poliomyelitis) and acute flaccid paralysis — a sudden weakness in your arms, legs or breathing muscles. Signs and symptoms of these diseases include:

• High fever
• Severe headache
• Stiff neck
• Disorientation or confusion
• Stupor or coma
• Tremors or muscle jerking
• Lack of coordination
• Convulsions
• Pain
• Partial paralysis or sudden muscle weakness

Signs and symptoms of West Nile fever usually last a few days, but signs and symptoms of encephalitis or meningitis can linger for weeks, and certain neurological effects, such as muscle weakness, may be permanent.

When to see a doctor
Mild symptoms of West Nile fever usually resolve on their own. If you experience signs or symptoms of serious infection, such as severe headaches, a stiff neck, disorientation or confusion, seek medical attention right away. A serious West Nile virus infection generally requires hospitalization.

Causes:

Infection transmitted by mosquitoes
Typically, West Nile virus spreads to humans and animals via infected mosquitoes. Mosquitoes become infected when they feed on infected birds. You can't get infected by touching or kissing a person with the virus.
Most West Nile virus infections occur during warm weather, when mosquito populations are active. The incubation period — the period between when you're bitten by an infected mosquito and the appearance of signs and symptoms of the illness — ranges from three to 14 days.
West Nile virus is present in areas such as Africa, parts of Asia and the Middle East. It first appeared in the United States in the summer of 1999 and since then has been found in all 48 contiguous states.

Other possible routes of transmission
In a few cases, West Nile virus may have been spread through other routes, including organ transplantation and blood transfusion. However, blood donors are screened for the virus, substantially reducing the risk of infection from blood transfusions.
There have also been reports of possible transmission of the virus from mother to child during pregnancy or breast-feeding, but these have been rare and not conclusively confirmed.

Treatments and drugs:

 Supportive therapy
Most people recover from West Nile virus without treatment. Over-the-counter pain relievers can help ease mild headaches and muscle aches.
Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children.
There's no direct cure for encephalitis or meningitis, but you may need supportive therapy in a hospital with intravenous fluids and medicines to prevent other types of infections.

Interferon therapy
Scientists are investigating interferon therapy — a type of immune cell therapy — as a treatment for encephalitis caused by West Nile virus. Some research shows that people who receive interferon may recover better than those who don't receive the drug, but more study is needed.

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Wegener's granulomatosis

Wegener's granulomatosis

Definition:

Wegener's granulomatosis (VEG-eh-nerz gran-u-loe-muh-TOE-sis) is an uncommon disorder that causes inflammation of your blood vessels. This inflammation restricts blood flow to various organs.
Wegener's granulomatosis, which is also called granulomatosis with polyangiitis (GPA), often affects your kidneys, lungs and upper respiratory tract.

The restricted blood flow to these organs can damage them. Wegener's can affect other organs, but this isn't as common, and generally isn't as serious.
Wegener's granulomatosis also produces a type of inflammatory tissue known as a granuloma that's found around the blood vessels. Granulomas can destroy normal tissue. There is no known cause for Wegener's granulomatosis.
Early diagnosis and treatment of Wegener's granulomatosis may lead to a full recovery. Without treatment, Wegener's granulomatosis can be fatal, most commonly from kidney failure.

Symptoms:

Signs and symptoms of Wegener's granulomatosis may develop suddenly or over several months.
The first Wegener's granulomatosis symptoms usually involve areas of your respiratory tract, such as your sinuses, throat or lungs. However, the condition often worsens rapidly, affecting blood vessels and the organs they supply, such as the kidneys. Signs and symptoms may include:

• Constantly runny nose, with pus-filled discharge
• Nosebleeds
• Sinus pain and inflammation (sinusitis)
• Ear infections
• Cough
• Chest pain
• Coughing up blood (hemoptysis)
• Shortness of breath
• General ill feeling (malaise)
• Unintended weight loss
• Joint aches and swelling
• Blood in urine (hematuria)
• Skin sores
• Eye redness, burning or pain
• Fever

For some people, the disease is limited to the lungs and doesn't involve the kidneys. Kidney involvement usually doesn't cause symptoms early in the course of the disease, and may be detected only by blood and urine tests. However, in time kidney failure and anemia often occur.
When to see a doctor
See your doctor if you have a persistently runny nose that doesn't respond to over-the-counter (OTC) cold medicines, especially if it's accompanied by nosebleeds and pus-like material, coughing up blood, or other possible signs and symptoms of Wegener's granulomatosis. Because this disease can get worse quickly, early diagnosis is critical to receiving effective treatment.

Causes:

 The cause of Wegener's granulomatosis is unknown. It appears to develop after an initial inflammation-causing event triggers an abnormal reaction from your immune system. The combination of these events can lead to inflamed, constricted blood vessels and harmful inflammatory tissue masses (granulomas). The triggering event may be an infection, but no specific infection has been identified as the cause.

Complications:


Besides affecting your upper and lower respiratory tracts, Wegener's granulomatosis may affect other organs, including your skin, eyes, ears, kidneys, spinal cord and heart. Complications may include:

• Hearing loss. Inflammation of granulated tissue in the middle ear can lead to hearing loss.
• Skin scarring. Sores may develop and may lead to severe scarring.
• Heart attack. Wegener's granulomatosis can affect the arteries of your heart, resulting in chest pain or a heart attack, though this is rare.
• Kidney (renal) damage. As Wegener's granulomatosis progresses, it's likely to affect your kidneys. It can lead to glomerulonephritis, a type of kidney disease that hampers your kidneys' ability to remove waste and excess fluid from your body, leading to a buildup of waste products in your bloodstream (uremia). Kidney failure is a leading cause of death from Wegener's granulomatosis.

Treatments and drugs:


With early diagnosis and appropriate treatment, you may recover from Wegener's granulomatosis within a few months. Maintenance therapy often needs to be continued for 18 to 24 months. In some cases, longer treatment may be necessary. Because the disease can recur, your doctor will continue monitoring your condition closely after treatment.
Medications
Your doctor may prescribe:

• Corticosteroids. Medications such as prednisone help suppress the immune system and treat the early signs and symptoms of Wegener's granulomatosis.
• Immune suppressant medications. Most people require another immunosuppressive drug, such as cyclophosphamide (Cytoxan), azathioprine (Azasan, Imuran) or methotrexate (Rheumatrex, Trexall), to counteract the body's immune reaction.
• Biologic therapy. Rituximab (Rituxan) is approved by the Food and Drug Administration for Wegener's. It reduces the number of a type of cell in your body (B cell) involved with inflammation. Rituximab may be as effective as cyclophosphamide in treating severe cases of Wegener's, and may be even better for treating Wegener's that recurs.

When standard treatments aren't effective, some doctors who are experienced in treating Wegener's use experimental drugs. Drugs currently under investigation include mycophenolate mofetil (CellCept), infliximab (Remicade), intravenous immunoglobulin, deoxyspergualin and antithymocyte globulin.
Side effect treatments
Because of potential side effects of the drugs used to treat Wegener's, such as lowering your body's ability to fight off infection, your doctor will monitor your condition while you're taking them. Drugs your doctor may prescribe to help prevent drug-related side effects include:

• Sulfamethoxazole-Trimethoprim (Bactrim, Septra) to prevent lung infection
• Medicine such as bisphosphonates (Fosamax) to prevent bone loss (osteoporosis) associated with prednisone use
• Folic acid, a synthetic form of the B vitamin folate, to prevent sores and other signs and symptoms associated with the depletion of folate in your body from methotrexate use

Other treatments

• Plasmapheresis. Also known as plasma exchange, this treatment removes the liquid portion of your blood (plasma) and separates it from the blood cells. The blood cells are then put back into your body, and your body produces new plasma to make up for what was removed. In people who have very serious Wegener's granulomatosis, plasmapheresis can help the kidneys recover.
• Surgery. If you've had kidney failure as a result of Wegener's granulomatosis, you may need a kidney transplant to restore normal kidney function. Talk to your doctor to determine whether a kidney transplant might be an option for you. Your eligibility to receive a donated kidney will depend, in part, on how your other organs have been affected by the disease.

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Water on the knee

Water on the knee

Definition  :

Water on the knee is a general term for excess fluid accumulation in or around your knee joint. Your doctor may refer to this condition as an effusion (uh-FU-zhun) in your knee joint.
Water on the knee may be the result of trauma, overuse injuries, or an underlying disease or condition.

To determine the cause of water on the knee, your doctor may need to obtain a sample of the fluid to test for infection, disease or injury.
Removing some of the fluid also helps reduce the pain and stiffness associated with water on the knee. Once your doctor determines the underlying cause of your water on the knee, appropriate treatment can begin.

Symptoms:

Signs and symptoms of water on the knee typically include:

• Swelling. The flesh around your kneecap may puff up noticeably. This swelling is most apparent when you compare the affected knee to the normal one.
• Stiffness. When your knee joint contains excess fluid, you may not be able to bend or straighten your leg completely.
• Pain. Depending on the cause of the fluid buildup, the knee may be very painful — to the point that it's impossible to bear weight on it.

When to see a doctor
Seek prompt medical attention if:

• Self-care measures or prescribed medications don't relieve the pain and swelling
• One knee becomes red and feels warm to the touch as compared to your other knee

Causes:


Water on the knee can be caused by many different types of problems, ranging from traumatic injuries to diseases and conditions.
Injuries
Damage to any part of your knee can cause the painful buildup of excess joint fluid. Examples of traumatic injuries that cause fluid buildup in and around the knee joint are:

• Broken bones
• Meniscus tear
• Ligament tear
• Overuse injuries

Diseases and conditions
Underlying diseases and conditions that may produce fluid buildup in and around the knee joint include:

• Osteoarthritis
• Rheumatoid arthritis
• Infection
• Gout
• Pseudogout
• Bursitis
• Cysts
• Bleeding disorders
• Tumors

Complications:

 If left untreated, water on the knee can severely limit your mobility. If the swelling is caused by an infection, it can destroy the joint.

Treatments and drugs:


Pain medications and procedures to remove fluid from the knee joint reduce the symptoms of water on the knee. Treatment varies for diseases and conditions causing water on the knee, but depending on the severity of the swelling and your medical history, options may include:
Medications
Drugs used to treat the symptoms or underlying causes of water on the knee include:

• Pain medications. If over-the-counter pain medications don't work well enough, your doctor may prescribe stronger drugs to help control your pain.
• Antibiotics. If your symptoms are being caused by an infection, your doctor may prescribe antibiotics to fight the infection.
• Corticosteroids. These strong anti-inflammatory drugs, such as prednisone, can be taken orally or may be injected directly into your knee joint. Corticosteroids can cause serious side effects, so you shouldn't use them too often or for a very long period of time.

Surgical and other procedures
Minimally invasive surgery and other methods of treating water on the knee and its most common underlying causes include:

• Joint aspiration (arthrocentesis). Removing fluid from your knee joint can help relieve the pressure of joint fluid buildup. After aspirating joint fluid, your doctor may inject a corticosteroid into the joint to treat inflammation.
• Arthroscopy. During this procedure, the surgeon makes a small incision in the skin over your knee joint, then inserts a small, lighted tube (arthroscope) that sends real-time images of the inside of your knee to a video terminal. Your surgeon may also use small, precise tools — sometimes placed in the joint through an attachment to the arthroscope — to remove loose tissue or repair damage in your knee.
• Joint replacement. If bearing weight on your knee joint becomes intolerable, your doctor may refer you to an orthopedic surgeon for knee replacement.

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