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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Broken wrist/broken hand

Broken wrist/broken hand

Definition:

A broken wrist or broken hand is a break or crack in one of the many bones within your wrist and hand. The most common of these injuries occurs in the wrist when people try to catch themselves during a fall and land hard on an outstretched hand.

Risk factors for a broken wrist or broken hand range from participation in certain sports — such as American football, soccer, skiing or snowboarding — to having osteoporosis, a condition in which bones become thinner and more fragile.
It's important to treat a broken wrist or broken hand as soon as possible. Otherwise, the bones may not heal in proper alignment, which can affect your ability to perform everyday activities, such as grasping a pen or buttoning a shirt. Early treatment will also help minimize pain and stiffness.

Symptoms:

If you have a broken wrist or broken hand, you may experience these signs and symptoms:

• Severe pain that tends to increase during gripping or squeezing
• Swelling
• Tenderness
• Bruising
• Obvious deformity, such as a bent wrist or crooked finger
• Stiffness or inability to move your fingers or thumb
• Numbness or coldness in your hand

When to call a doctor
If you think you may have a broken wrist or hand, see a doctor immediately, especially if you have numbness, swelling or trouble moving your fingers. Delays in diagnosis and treatment can lead to poor healing, decreased range of motion and decreased grip strength.

Causes:

A direct blow or crushing injury to your hands and wrists can break any of the bones in them. Common causes include:

• Falls. Falling onto an outstretched hand is one of the most common causes of a broken wrist or broken hand.
• Sports injuries. Many wrist or hand fractures occur during contact sports or sports in which you might fall onto an outstretched hand — such as in-line skating or snowboarding. Finger fractures are common with baseball, basketball and football.
• Motor vehicle crashes. High-velocity injuries that can occur during motor vehicle crashes may cause wrist or hand bones to fracture into many pieces, requiring surgical repair.

Complications:

Complications of a broken wrist or broken hand are rare, but they may include:

• Ongoing stiffness, aching or disability. Stiffness, pain or aching in the affected area generally goes away a month or two after your cast is removed or after surgery, but you may have some permanent stiffness or aching if your injury was severe. It may also take a few months to regain your ability to use your hand and fingers normally. Be patient with your recovery, and talk to your doctor about exercises that might help or for a referral to physical or occupational therapy.
• Osteoarthritis. Fractures that extend into the joint may cause arthritis years later. If your wrist or hand starts to hurt or swell long after a break, see your doctor for an evaluation.
• Nerve or blood vessel damage. Trauma to the wrist or hand can injure adjacent nerves and blood vessels. Seek immediate attention if you notice any numbness or circulation problems

Treatments and drugs:

If the broken ends of the bone aren't aligned properly, your doctor will need to manipulate the pieces back into their proper positions — a process called fracture reduction. Depending on the amount of pain and swelling you have, you may need a muscle relaxant, a sedative or even a general anesthetic before this procedure.

Immobilization
Restricting the movement of a broken bone in your wrist or hand is critical to proper healing. To do this, you may need a splint or a cast.

Medications
To reduce pain and inflammation, your doctor may recommend an over-the-counter pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). If you're experiencing severe pain, you may need an opioid medication, such as codeine.

Therapy
After your cast or splint is removed, you'll likely need rehabilitation exercises or physical therapy to reduce stiffness and restore movement in your wrist and hand. Rehabilitation can help, but it may take up to several months — or even longer — for complete healing of severe injuries.

Surgical and other procedures
Immobilization heals most broken bones. However, you may need surgery to implant internal fixation devices, such as plates, rods or screws, or bone grafts to maintain proper position of your bones during healing. These internal fixation devices may be necessary if you have the following injuries:

• Multiple fractures
• An unstable or displaced fracture
• Loose bone fragments that could enter a joint
• Damage to the surrounding ligaments
• Fractures that extend into a joint
• A fracture that is the result of a crushing accident

In some cases, the surgeon may immobilize your fracture by using an external fixation device. This consists of a metal frame with two or more pins that go through your skin and into the bone on either side of the fracture.

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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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Impacted wisdom teeth

Impacted wisdom teeth

Definition:

Impacted wisdom teeth are third molars at the back of the mouth that don't have enough room to emerge or grow normally.
Wisdom teeth are the last adult teeth to come into the mouth (erupt). Most people have four wisdom teeth at the back of the mouth — two on the top, two on the bottom.

Impacted wisdom teeth can result in pain, damage to other teeth and other dental problems. In some cases, impacted wisdom teeth may cause no apparent or immediate problems. But because they're hard to clean, they may be more vulnerable to tooth decay and gum disease than other teeth are.
Impacted wisdom teeth that cause pain or other dental complications are usually removed. Some dentists and oral surgeons also recommend removing impacted wisdom teeth that don't cause symptoms to prevent future problems.

Symptoms:

Impacted wisdom teeth don't always cause symptoms. However, when an impacted wisdom tooth becomes infected, damages other teeth or causes other dental problems, you may experience some of these signs or symptoms:

• Pain
• Red or swollen gums
• Tender or bleeding gums
• Swelling around the jaw
• Bad breath
• An unpleasant taste in your mouth
• Headache

When to see a doctor
See your dentist if you experience pain, swelling or other symptoms in the area behind your last molar that may be associated with an impacted wisdom tooth.
Keep all regularly scheduled dental appointments for cleanings and checkups. Regularly updated dental X-rays may indicate impacted wisdom teeth before any symptoms develop.

Causes:

Wisdom teeth (third molars) become impacted because they don't have enough room to come in (erupt) or grow normally.
Wisdom teeth usually emerge sometime between the ages of 17 and 25. Some people have wisdom teeth that emerge without any problems and line up with the other teeth behind the second molars. In many cases, however, the mouth is too crowded for third molars to develop normally. These crowded third molars become trapped (impacted).
An impacted wisdom tooth may partially emerge so that some of the crown is visible (partially impacted), or it may never break through the gums (fully impacted). Whether partially or fully impacted, the tooth may:

• Grow at an angle toward the next tooth (second molar)
• Grow at an angle toward the back of the mouth
• Grow at a right angle to the other teeth, as if the wisdom tooth is "lying down" within the jawbone
• Grow straight up or down like other teeth but stay trapped within the jawbone

Complications:

Impacted wisdom teeth can cause several problems in the mouth:

• Damage to other teeth. If the wisdom tooth pushes against the second molar, it may damage the second molar or make it more vulnerable to infection. This pressure can also cause problems with crowding of the other teeth or orthodontic treatments to straighten other teeth.
• Cysts. The wisdom tooth grows in a sac within the jawbone. The sac can fill with fluid, forming a cyst that can damage the jawbone, teeth and nerves. Rarely, a tumor — usually a noncancerous tumor — develops. This complication may require removal of tissue and bone.
• Decay. Partially impacted wisdom teeth appear to be more vulnerable to tooth decay (caries) than other teeth. This probably occurs because wisdom teeth are harder to clean and because food and bacteria get easily trapped between the gum and a partially erupted tooth.
• Gum disease. The difficulty of cleaning impacted, partially erupted wisdom teeth also makes them a vulnerable site for the development of a painful, inflammatory gum condition called pericoronitis (per-ih-kor-o-NI-tis).

Treatments and drugs:

Impacted wisdom teeth that are causing pain or other dental problems are usually surgically removed, or extracted.
If you have medical conditions that may increase surgical risks, your dentist will likely ask you to see an oral surgeon to discuss the best course of action.
Managing asymptomatic wisdom teeth
If impacted wisdom teeth aren't causing symptoms or apparent dental problems, they're called asymptomatic. Some disagreement exists in the dental community about how to manage asymptomatic impacted wisdom teeth. Research on this topic doesn't strongly favor one strategy over the other.
Some dentists and oral surgeons recommend removing asymptomatic wisdom teeth to prevent future potential problems. They argue:

• An asymptomatic tooth may not be free of disease and may be a particularly vulnerable site for gum disease and tooth cavities.
• The procedure rarely results in serious complications in younger adults.
• The procedure is more difficult and more likely to cause complications later in life, particularly among older adults.

Other dentists and oral surgeons recommend a more conservative approach. They note:

• There isn't enough evidence to suggest that impacted wisdom teeth not causing problems in young adulthood will later cause problems.
• The expense and risks of the procedure don't justify the expected benefit.

With a conservative approach, your dentist will monitor your teeth for decay, gum disease or other complications. He or she may recommend removing a tooth if problems arise.
Surgical removal
Surgical removal (extraction) of a wisdom tooth is almost always done as an outpatient procedure, meaning you'll go home the same day. You may have local anesthesia, which numbs your mouth; sedation that depresses your consciousness; or general anesthesia, which makes you lose consciousness.
During an extraction your dentist or oral surgeon makes an incision in your gums and removes any bone that blocks access to the impacted tooth. After removing the tooth, the dentist or oral surgeon typically closes the wound with stitches and packs the empty space (socket) with gauze.
You'll receive instructions for caring for wounds and for managing pain and swelling.
Most wisdom tooth extractions don't result in long-term complications. Problems that can occur include:

• Dry socket, or exposure of bone if the post-surgical blood clot gets dislodged from the socket, which can be painful and delay healing
• Infection in the socket from bacteria or trapped food particles
• Damage to sinuses near the upper wisdom teeth
• Weakening of the lower jawbone
• Damage to nerves that results in altered sensation in the lower lip, tongue or chin

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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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