Easy Health Care

Feet Stink, Foot odor, Smelly Foot - different names same problem

2012-04-26T23:37:00.000-07:00

Foot odor or feet stink is an awkward problem. Many people falls in add situations for it. Many people mistake it as a disease. Foot odor is not a disease but may be the cause for some.

Cause: The main reason for foot odor or feet stink is sweaty foot. Some peoples foot sweats in the dry weather, some sweats year long. Foots of many people remain wet while wearing shoes. Those sweaty wet feet’s are the favorite place for bacteria to attack. This attack of bacteria produces the bad odor after a certain time.

Most of the time, the sweat cannot come out of our shoes. Staying in this condition for a long period of time causes bad odor.

Here are some tips you can follow which may help:

Check the inner sole of shoes before buying as this part absorbs the sweat from your foot.
Cloth shoes should be avoided for regular use as these shoes gets wet so as your feet. Cloth shoes attract dirt and bacteria easily.
Always use cotton shocks. Check before buying. Keep a few pairs of clean shocks handy. Clean your shocks every day to wear a clean pair every time.
People with sweaty feet and odor can use anti sweat powder or lotion to prevent sweating. Remember to use these kinds of products one hour prior to wearing shoes.
Clean your foot before and after wearing shoes.
Always try to keep your foot dry.
Keep shoes and shocks in dry and clean place.
Use antiseptic for skin diseases.
Wear quality shoes with good material.

Foot odor, foot stink or whatever you call it causes many people to fall in disappointing situations. People with these kinds of problems should try to avoid such disappointment by taking prompt action as soon as possible.

Keep visiting easyhealthare24 for future Foot odor related articles and updates.
Click to read an article related to sun protection and safety.

Heart Care Tips

2012-04-17T23:02:00.001-07:00

Heart Care is the most neglected part of our life .
Though our heart is pumping blood through our body every second to keep us alive by supplying oxygen and nutrients all over our body, we do very little to keep it healthy. A healthy heart can give us long, strong, happy and active life with full of energy.

Here are some heart are tips you can follow to keep your heart healthy.

1. Stop Smoking Inside The House

To ensure your and your child's health, stop smoking indoors
As a punishment of smoking indoors, the smoker will do more then his/her regular work at home. Make it as a rule.

2. Ensure Healthy Diet at Home

Keep fruits in your everyday menu, specially in the breakfast.
Prepare office/school tiffin at home. It is more healthy and hygienic then the ones brought from the food shops.
At-least 2-3 types of vegetables should be served at dinner.

3. Be Active

Be engaged in physical activities like sports, cycling, swimming, jogging with your family.
Keep your TV watching time below 2hrs per day.
Setup your computer and study tables ergonomically to keep your blood circulation and muscles in good condition.

4. Know your limits

You should know your body's current status, Blood pressure, cholesterol, blood glucose level, waist size and body mass index (BMI).
Try to keep track of your body periodically.
Keep the reports handy that it can be presented in front of your physician in need.

Following the heart care tips above and make your own plan to keep a healthy heart as well as a healthy body and mind.

Keep visiting us for future Heart care tips and updates.

Hairfall Causes

2012-04-10T22:51:00.001-07:00

Hairfall causes, a very common question among different age and group of people. Each and every person loses their hair every day. In fact people lose about 120 hairs every day. They usually fall out at the finish of the growth cycle. If a hair falls out then a new will grow in its place. Some people lose more hair than there's growing back.

The most common cause

The older you get the more you lose. This is as normal as lots of other processes people go through as they age. The most common cause of hair loss is androgenic alopecia and it runs genetically in the families. Men start losing hair as a receding line and they first notice baldness on the top of their heads. Females lose hair evenly all over the head.

Other causes that provoke hair loss

Androgenic alopecia is the main reason why people lose hair, but it is not the . There's some medical conditions known that makes hair loss, such as fungal infections and ringworm, hypothyroidism and even some medicines and birth control pills may cause this issue. Also, some researchers say that much vitamin A in a person's method may also cause that kind of issue.

Additionally, there's some mechanical stressors on the scalp that may cause hair loss. Individuals who like to wear pigtails or tight cornrows may finish up pulling the hair out and scar the surface of the scalp with these. The worst case scenario is of course permanent hair loss. Hair loss may even be an early warning of a more serious disease. So in the event you notice losing unusual amount of hair, you ought to consult your doctor as soon as feasible. There might be a serious issue behind it.

Loosing hair because of bad nutrition

The most needed supplements to grow hair are iron and protein. If someone has low levels of iron or not eating as much protein as needed, the consequence may be losing some curly locks. It is proven that when you eat more iron then more hair will grow. Protein is related to hair growth directly. Body needs protein for hair growth. In the event you are not eating protein,your body makes use of the existing protein for more necessary functions and your hair will fall out. One time you start eating protein, your hair ought to grow back in a few months.

Hair loss may even be caused by the lack of inositol. It is advised to eat foods that are rich in inositol. Some food examples that have lots of inositol are yeast, liver and molasses. Ladies usually have low requirement of inositol.

Menopause

Lots of ladies, when they reach their menopausal they start to lose hair. This is common due to some hormonal changes. Doctors haven't figured out the proper cause yet but have noticed the connection. Even ladies with strong hair might experience thinning when they go through menopause.

Maybe lots of things are responsible for hairfall causes, we will try to update you about them soon.

Secret of anti-aging vegetables

2012-03-30T21:32:00.003-07:00

Secret of anti-aging vegetables, really interesting topic. Between the age from 30 to 40 where crossing in to that young mature age can have a profound effect on your skin & body in case vegetables are an important part of our daily diet. Failure to consume enough vegetable will have a significant effect on our skin if you really pick to not take care of yourself as they age

Take broccoli for example. The health benefits that this amazingly vitamin rich green vegetable possesses are still being understood. Best steamed or boiled to contain its all necessary nutrients, the stock from broccoli is very often used in gravy while ensuring none of its goodness is lost.

Anti-Aging Broccoli:

From diabetes to the colon, breast, prostate & pancreatic cancers to brain injuries, broccoli's vitamin B6, C & E all help make it of the most important of longevity vegetables there exists.

Anti-Aging Green Cabbage:

According to a study carried out by Harvard & Stanford University, there is more nutrients present in green cabbage that will potentially this veggie first contains a tonne of iron, again all of us know how important iron is for keeping the blood of our body healthy, fresh & strong. It will also protect you from the cancer than any other vegetable in the world.

It is difficult to not recognize how lovely for you green cabbage is when freshly steamed or boiled. Accommodates nitrogenous compound indoles, fundamentally these help lower your blood pressure.

Green cabbage shakes, which to be fair are not the most satisfying in taste are a pleasant detox & dietitians recommend that if eaten fresh, they also help restore your gastrointestinal tract, heal ulcers & help restrict blood clots.

Once again, if the cancer is hereditary, the green cabbage is said to warn off ovarian, colon, breast & prostate cancer.

Anti-Aging Cauliflower:

Cauliflower will help inhibit the growth of cancer cells in the breast as recent studies have revealed in the Stat, whilst helping to maintain a healthy heart, detoxing the liver & potentially reducing the risk of having a stroke due to the compound allicin. It is also rich in vitamin C. Again, high in vitamin C.

Anti-Aging Spinach:

Often office workers are now regularly seen in the West to be chewing on a cluster of spinach.
Topped off with some very Balsamic vinegar, spinach is fabulous for maintaining mental clarity.
Brimming with vitamins from A to D, it is a vegetable great for avoiding lots of cancers.

Anti-Aging Knotweed:

Consumed as a staple part of an Okinawan diet, this community really boasts of the largest number of centenarians per capita along side the sardianians. The main reason for this has been suggested by the studies that both communities consume a immense percentage of the polyphenol resveratrol.

High levels of the cholesterol, all inflammatory diseases & diabetes have all been treated with knotweed in some medicinal form or another.

Placed near the very top of the anti-aging vegetable pyramid, it contains a immense array of anthocyanins - anti oxidants which fight free radicals.

Known for its ability to tidy your arteries, Okinawans' have been using resveratrol in a medicinal form for hundreds of years now.which fight free radicals.

Men searching for the secret of anti-aging vegetables and still searching for more. But taking the simple steps by taking little daily effort is the best way for you.

Sun Protection and Safety

2012-03-28T10:10:00.001-07:00

how much do we think about Sun protection and safety? All of us fondly recollect the lots of afternoon hours spent in the work of our childhood playing to our heart's content & oblivious to any pressures of life. Whether it was walking or playing footy, cricket or building castles or being with best friends, those were perhaps the best and fascinating times ever of our lives. In the event you recollect those times, you will also keep in mind the care our mothers used to take to make positive that they always had the right moisturizer creams on our faces & our noses. Though it would have irritated us no finish in those times, thanks to those creams & the sun protection they accorded to us, they could continue playing for as long as they wanted & stay outside for long durations.

Regrettably, modern times & the advent of computers have robbed children of those heady moments out in the sun. Children now prefer staying inside playing all kinds of computer & animation games. However, in the event you have children who still need to go out & play outside, then you ought to encourage them by all means, but ensuring on a regular basis that they have the right sun protection measures in place like your parents did for you.

The ultraviolet rays of the sun is omnipresent & something that they cannot see or sense. These rays are at their strongest in the work of midday & before the evening sets in. Children who love to play in the work of this time would be vulnerable to damage from the sun's rays due to their tender skin & this may finish up in peeling of the skin along with the clogged pores. Repeated exposure like this can lead anyone to skin malignancy & skin cancer issues later on & that is why it is vital to protect your children early on through appropriate sun protection measures.

So what are the necessary sun protection and safety measures you can or you should take?

Trusted brands offers a variety of sun protection products with SPF 50 which are most suitable for the sensitive skin of the children. If your children do insist on spending their time in the pool in the work of these times, then make positive they have appropriate swimwear as well.

First, restrict playing hours of your children & make positive they are not out there in the sun between 12 & 3pm. This is when the rays are at their strongest. In the event that they still need to be active & need to play, then you can provide them with sun shades, hats & sun block creams that are broad spectrum with a SPF or sun protection factor of at least 35. These sun protection measures ought to be adequate to keep your children shielded from the harsh rays of the sun.

Elizabeth Wright is a UK based skin care & beauty enthusiast, they has been an avid contributor to online resources discussing skin care treatments & treatments for over 12 years. For further knowledge on Heliocare & suggested treatments visit her preferred site at Effortless Skin.

So, by all means please encourage your children to spend time playing in the sun but only in the event that they are willing to obey your instructions regarding sun protection.

Acid Reflux - The most common health problem

2012-03-28T01:20:00.002-07:00

Acid Reflux must be the most common health problem

In case you are concerned about continuous use of prescriptions or over the counter medications for acid reflux that only provide temporary relief for the signs, then it may be wise for you to learn how to prevent this condition in a more natural way, so that finally your body's whole digestive process will benefit.
Also taking medications that fundamentally lower your stomach acidity or ability to even make stomach acid may unbalance your whole digestive process.

Plenty of people feel uncomfortable with using drugs on a long-term basis & none more so than individuals who suffer continuous bouts of acid reflux. The pain & discomfort associated with this condition demands that some relief be found but because it is often the final result of doing something enjoyable like feasting, partying or consuming much of your favourite foods, it can fundamentally become a recurring issue for someone.

Heartburn caused by the acidic reflux can usually be broken down in to different areas.This makes it harder for your body to process & absorb the essential nutrients from the foods you do eat, which could compromise your health.

Lifestyle habits like the smoking, wearing tight-fit cloths or being fat.

Diet habits; overeating, eating the wrong or bad kinds of foods or eating before you lie down.

Or medical causes from taking positive medications like aspirin, some antibiotics, & frequent use of non-steroidal anti-inflammatory drugs.

Plenty of these causes can be avoided & some will mean simple changes of habits. You may not be able to fine-tune all of your bad habits or even require to but in case you do sufferer frequent bouts of acid reflux & you needn't stay on medications then you will require to start to address plenty of them.
Recurring bouts will probably have damaged your own esophagus. Possibly burning it all or affecting the lower esophageal sphincter which normally opens & closes allowing food and drink to enter the stomach. After embarking on a natural treatment for heartburn you will permit these areas to heal & you will be surprised how quickly this can happen.

Eating the same food, & doing the same things that damaged the esophagus will never help in healing the issue. But after you permit these areas to heal you will be pleasantly surprised how well your body can cope with the odd indiscretion.
Why ought to you always feel nervous about eating your favorite foods or celebrating life to its fullest wondering if that burning throat sensation caused by acid reflux will come to spoil your party. Learning how to prevent acid reflux won't only cease those fears but let you get more enjoyment from life.

Cardiovascular Exercise - For healthy life

2012-03-27T21:25:00.004-07:00

Cardiovascular exercise for healthy life is a very important thing. While home cardiovascular exercise training devices are not nearly as good as that equipment accessible at the health club, the product quality at the health club is generally adequate to assist normal exercises. Always be certain to take proper care of them. Taking care of the home gym machines is the most obvious way to make sure you will get your money's worth from them.

What is wonderful about possessing cardiovascular exercise devices in your residence is that you don't have to be concerned about getting dressed for freezing weather lasting months to go work out. You can also exercise for several minutes or even hours devoid of having to be concerned about someone else seeking a turn on the cardiovascular exercise apparatus.

If you are uneasy regarding the expense of acquiring your personal residence cardio exercise devices, you should always pay a visit to your nearby fitness center then you can evaluate the expense. Bear in mind after you include your initiation expenditures, regular membership charges, and fuel to get to and from, you could have invested in the equipment for your own use.

When choosing cardio exercise devices, stay away from equipment that positions excess weight or level of resistance on the hip-joint. Although it isn't a piece of equipment, swimming pools provide a safe and sound device equally for muscle-strengthening and cardio.

The elliptical exercise machine and fitness bike, placed to percentage incline, offer you low-impact alternatives for cardiovascular exercise. Going for walks using a home treadmill, fixed to per cent slope, generates minimum effect on the hip-joint.

Jogging or speed-walking on the fitness treadmill machine may possibly position an excessive amount of excess weight to the joint. Nevertheless, you need to talk about even light jogging or speedy jogging together with your medical professional prior to taking part in this exercise.

Regrettably, most cardiovascular workout devices could cost a couple of hundred to thousands of dollars. The great news is that we now have vendors that offer inexpensive cardio exercise work out devices. Therefore, it's actually dependent on looking for the ideal merchandise as well as the supplier.

The internet marketers should provide an outstanding supply of this since there are a large number of dealers on the internet. Make sure you look into the trustworthiness of the vendor prior to adding any purchases. Enquirers would additionally be essential along with studying client comments regarding the supplier per see.

Gym memberships, fitness treadmills and other cardio exercise training devices are normally not advisable for small children simply because their physiques aren't prepared for that form of activity. As an alternative, promote enjoyable routines like the jump rope or hopscotch and four square even bike rides. If there are other children in the household or in the community, recommend a game of tag or conceal & go look for. These are fascinating methods for children to be active.

Versa climbers are about the most effective & demanding cardiovascular exercise work out equipment. This device is the least democratic with cardiovascular devices in virtually any fitness middle. Do not be shocked if it is not used & accumulates airborne dirt & dust. However it is a beneficial cardiovascular device. It makes a movement like your mounting vertically. They would be pushed to go in opposite to the normal force of gravitational forces. The use of the device could fundamentally & effectively increase your cardiovascular rate.

The Twister becomes an excellent undesirable fat burning aerobic exercise workout equipment. It permits you have an efficient toning resistance that provides exercise routines for the upper body. The Twister is a stimulating & pleasant way of firming & toning your body, buttocks, & upper thighs, while burning unwelcome fat. It is been found that twister functions as excellent physical fitness equipment that assists a person to keep healthy & in condition
.

Cardiovascular exercise has been proven to help with weight loss & enhance your total physical and mental condition. Now the decision to buy equipment for your home or join a health & fitness club is the giant query.

What is Mecobalamin

2012-03-26T11:18:00.003-07:00

What is Mecobalamin:

Mecobalamin or methylcobalamin is the neurologically active form of the Vitamin B12. It is a co-factor in the enzyme methionine synthase which functions to transfer methyle groups for the regenerations of methionine form homocysteine.

Mecobalamin is considered 130% to 150% more potent then B12 and helps in the formation of myelin sheath, promotes growth and regeneration of nerve cells.

It is the only form of vitamin B12 which can be directly used by the central nervous system and it is effective for giving a healthy brain and spinal cord support. Mecobalamin supplementation is necessary as the liver is unable to sufficiantly transform cobalamin, the common b12 form into superior Mecobalamin form.

Where used:

Meobalamin is widely used in various neuronal degeneration

Peripheral Neuropathy
Diabetic Neuropathy
Drug Induced Neuropathy
Alzheimer's Disease
Parkinson's Disease
Vertebral Syndrome
Nerve Compression Syndrome
Diabetic Retinopathy
Amyotrophic Leteral Sclerosis (ALS)
Multiple Sclerosis
Intercostal Neuralgia
Entrapment Neuropathy
Lumbago

Reported to used for:

Reduce neurotoxicity
Lower excess glutamate levels which results in reduction of fatigue
Stabilization of mood
Improvement of memory
Executive function.

Mecobalamin at a glance:

The only neuro active form of the vitamin B12
Most special in neurological disorder management
The most effective for providing a healthy brain along-with spinal cord
More effective than vitamin B12 in symptoms relief
Widely used in various neuronal degeneration

However the clinical trials of Mecobalamin is still small and have not yet been replicated or confirmed.

Enterocutaneous Fistula Treatment

2012-03-22T05:35:00.001-07:00

Figure:Enterocutaneous fistula

An external fistula communicating with the gut mucosa to the skin surface. It may occur following an operation for gangrenous appendicitis or the draining of the appendix abscess. A faecal fistula can occur from necrosis of a gangrenous patch of intestine after the relief of a strangulated hernia, or from a leak from an intestinal anaestomosis. The opening of an abscess connected with chronic diverticulitis or carcinoma of the colon frequently results in faecal fistila. Radiation damage is also another cause of faecal fistula. The most common cause of cutaneous fistula is however previous surgery. This happens most often in patients with adhesions following previous operations. Enterocutaneous fistula can be divided into:-

1) Those with a high output, more than 1 L/day

2) Those with a low output, less than 1 L/ day.

They can also be describe anatomically as simple, with a direct communication between the gut and the skin, or complex, i.e. those with one or more tracts they are tortuous and sometimes associated with an intervening abscess cavity half way along the tract.

The discharge from a fistula connected with the duodenum or jejunum is bile stained and causes severe excoriation of the skin. When the ileum or caecum is involved is involved, the discharge is fluid faecal matter; when the distal colon is the affected site, it is solid or semisolid faecal matter. The site of the leakage and the length of the fistula can be determined by small bowel enema and Ba-enema, by fistulogram and more importantly, by CT scan of the abdomen will show up any associated abscesses.

Treatment

This can be very challenging in patients with a high output fistula. Low output fistula can be expected to heal spontaneously, provided that there is no distal obstruction. Reasons for failure of spontaneous healing also include:

1) epithelial continuity between the gut and the skin;

2) the presence of active disease where, for example there is crohn’s disease or carcinoma at the site of anaestomosis or in the tract;

3) an associated complex abscess.

The abdominal wall must be protected from erosion by the use of appliances. The patients must remain nil by mouth; intravenous nutrition is started and signs of a decrease in fistula output are sought. The higher the fistula in the intestinal tract, the more skin excoriation must be expected, and this is worst in the case of a duodenal fistula. High output fistula cause rapid dehydration and hypo-proteinaemia. Vigorous fluid replacement and nutritional support is essential. The drainage of an intra-abdominal abscess can be life saving. This can be achieved by either CT guided drainage or occasionally laparotomy. In patients with a complex fistula, it may be necessary to bring out a de-functioning stoma upstream of the fistula site, even if this result in a high output stoma.

Operative treatment

Operative repair should be attempted only after a trial of conservative management. The surgery can on occasion be extremely technically demanding and an anaestomosis should not be fashioned in the presence of continuing intra-abdominal sepsis or when the patient is hypo proteinaemic.

Intestinal Colostomy

2012-03-22T03:31:00.000-07:00

Intestinal colostomy is an artificial opening made in the large bowel to divert faeces and flatus to the exterior, where it can be collected in an external appliance. Depending on the purpose for which the diversion has been necessary, a colostomy may be temporary or permanent.

Figure:Colostomy bag

SUMMRY

Stomas

· May be colostomy or ileostomy

· May be temporary or permanent

· Temporary or defunctioning stomas are usually fashioned as loop stomas

· An ileostomy is spouted; a colostomy is flush

· Ileostomy effluent is usually liquid whereas colostomy effluent is usually solid

· Ileostomy patients are more likely to develop fluid and electrolyte problems

· An ileostomy is usually sited in the right iliac fossa

· A temporary colostomy may be transverse and sited in the right upper quadrant

· End colostomy is usually sited in the left iliac fossa

· All patients should be counselled by a stoma care nurse before operation

· Complications include skin irritation, prolapse, retraction, necrosis, stenosis, parastromal hernia, bleeding and fistulation.

Temporary colostomy

A transverse loop colostomy has in the past been most commonly used to de function an anaestomosis after an anterior resection. It is now less commonly employed as it is fraught with complications and is difficult to manage; a loop ileostomy is preferred.

A loop left iliac fossa colostomy is still sometimes used to prevent faecal peritonitis developing following traumatic injury to rectum, to facilitate the operative treatment of a high fistula in ano and incontinence.

A temporary loop colostomy is made bringing a loop of colon to the surface, where it is held in place by a plastic bridge passed through the mesentery. Once the abdomen has been closed, the colostomy is opened, and the edges of the colonic incision are sutured to the adjacent skin margin. When firm adhesion of the colostomy to the abdominal wall has taken place, the bridge can be removed after 7 days.

Following the surgical cure or healing of the distal lesion for which the temporary stoma was constructed, the colostomy can be closed. It is usual to perform a contrast examination (distal lopogram) to check that there is no distal obstruction or continuing problem at the site of previous surgery. Colostomy closure is most easily and safely accomplished if the stoma is mature i.e. after the colostomy has been established for 2 months. Closure is usually performed by an intra peritoneal technique, which is associated fewer closure breakdowns with faecal fistulae.

Double barrelled colostomy

This colostomy was designed so that it could be closed by crushing the intervening spur by using an enterotome or a stapling device. It is rarely used now, but occasionally the colon is divided so that both ends can be brought to the surface separately, ensuring that the distal segment is completely defunctioned.

Permanent colostomy

This is usually formed after excision of the rectum for a carcinoma by the abdomino-perineal technique. It is formed by bringing the distal end(end colostomy) of the divided colon to the surface in the left iliac fossa, where it is sutured in place, joining the margin to the surrounding skin. The point at which the colon is brought to the surface must be carefully selected to allow a colostomy bag to be applied without impinging on the bony prominence of the antero superior iliac spine. The best site is usually through the lateral edge of the rectus sheath, 6 cm above and medial to the bony prominence.

Complications of colostomies

The following complications can occur to any colostomy but are more common after poor technique or siting of the stoma:

Prolapse
Retraction;
Necrosis of the distal end;
Fistulae formation;
Stenosis of the orifice
Colostomy hernia
Bleeding
Colostomy diarrhoea; this is usually an infective enteritis and will respond to oral metronidazole 200 mg three times daily.

Many of these complications require revision of the colostomy.

Loop ileostomy

An ileostomy is now often used as an alternative to colostomy, particularly for defunctioning a low rectal anaestomosis. The advantages of a loop ileostomy over a loop colostomy are the ease with which the bowel can be brought to the surface and the absence of odour. Care is needed, when the ileostomy is closed, that the suture line obstruction does not occur.

What is Diptheria

2012-03-22T02:34:00.002-07:00

DIPHTHERIA

It is an acute infection caused by Gram positive bacillus, Corynebacterium Diphtheriae.
It spreads by droplet infection.
Incubation period : 2-6 days

Incidence :
The incidence has fallen markedly in the last quarter of a century.
Children are particularly affected , especially those between 2-5 years of age. But any age group can be affected.

Because of widespread and routine childhood DPT immunizations, diphtheria is now rare in many parts of the world.
Risk factors include crowded environments, poor hygiene, and lack of immunization.

Symptoms :
Sore throat
Painful swallowing
Neck swelling
Low grade fever, headache, malaise
Vomiting
Sign :
Enlarged and tender cervical lymph nodes.
Sometimes presenting a “bull-neck” appearance.
Patches of false membrane are present on the tonsils, faucial pillars, soft palate and occasionally on the posterior pharyngeal pharyngeal wall. It is usually grey in colour. It is firmly attached and when detached, leaves a bleeding surface on which it tends to re-form. It often has a strong foetor. In atypical cases no false membrane is present and picture resembles a simple streptococcal infection.
Pyrexia : The temperature is rarely above 38.30C(1010F), but the pulse rate is usually raised out of proportion.
Toxaemia is marked.( Patient is ill and toxic but fever seldom rises above 380C)

Complications :
Myocarditis
Cardiac arrythmia
Acute circulatory failure
Paralysis of soft palate, diaphragm and ocular muscles.
Laryngeal diphtheria may cause airway obstruction.

Treatment :
Antitoxin must be given immediately, without waiting for the bacteriological results of a swab, when the disease is suspected. 20,000 – 100,000 units are injected.
Systemic penicillin : helps to control the primary and any secondary infection.

Other treatments may include:

Fluids by IV
Oxygen
Bed rest
Heart monitoring
Insertion of a breathing tube
Correction of airway blockages

What is Hypertrophy

2012-03-22T02:27:00.001-07:00

Definition : Hypertrophy of the nasopharyngeal tonsil sufficient enough to obstruct the airway.

Age incidence : Usually 3-7 years
Regress : From 10 years
Complete regress : Within 20 years

Clinical features are due to –
Hypertrophy of the adenoid causing mechanical obstruction

Fig:Enlarge adenoid

Inflammation
Generalized symptoms

Symptoms due to nasal obstruction --    Mouth breathing
     Dryness of throat
     Dribbling of saliva
     Sore throat due to associated pharyngitis
     Deafness, earache( Due to blockage of Eustachian tube)

Due to inflammation :
     I. Nasal discharge
     II. Post-nasal drip
     III. Recurrent acute suppurative otitis
          media
      IV. Persistence of chronic suppurative
          otitis media
       V. Rhinitis/Sinusitis

Generalized disturbances :
Mental apathy
Mental dullness
Nocturnal enuresis
Night terror

In long standing cases patient may develop adenoid facies.

Adenoid facies :
Open mouth
Pinched nose
Retraction of upper lip
Prominent upper incisor
High arched palate
Flat chest and rounded shoulder

Sign :
Mouth breath
Digital examination
Posterior rhinoscopy

Diagnosis :
By symptoms and Xray nasopharynx lateral view

Differential diagnosis :
Deviated nasal septum
Hypertrophied posterior end of inferior turbinate
Antrochoanal polyp
Congenital chonal atresia

Complications :
Pharyngitis
Tonsillitis
Secretory otitis media
Recurrent acute suppurative otitis media
Persistance of chronic suppurative otitis media
Sleep apnoea
Mental dullness

Treatment :
When symptoms are mild-
Nasal decongestants
Antihistamine

When there is recurrent symptoms and/or complications- Adenoidectomy
In secretory otitis media, myringotomy and possibly insertion of ventilation tube(Grommet) are done together with adenoidectomy.

What is Hernia

2012-03-22T02:16:00.001-07:00

What Is Hernia:

A hernia is a protrusion of a viscus or part of a viscus through an abnormal opening in the wall of its containing cavity. The external abdominal hernia is the most common form, the most frequent varieties being the inguin

Figure:Hernia

Aetiology

Any condition that rises the intra-abdominal pressure such as powerful muscular efforts, may produce a hernia. Whooping cough is a predisposing cause in childhood, whereas chronic cough, straining on micturation or straining on defaecation may precipitate a hernia in adult. Hernias are more common in smokers, intra-abdominal malignancy can be a cause of hernia. Stretching of the abdominal musculature because of an increase in contents as in obesity can be another factor. Fat acts to separate muscle bundles and layers, weaken aponeuroses and favour the appearance of para-umbilical, direct inguinal and hiatus hernia. An indirect inguinal hernia may occur in a congenital preformed sac- the remains of the processus vaginalis.

Composition of hernia

A hernia consists of three parts- the sac, the covering of the sac, and the contents of sac.

The sac- The sac is a diverticulum of peritoneum consisting of mouth, neck, body and fundus.

The neck is usually well defined but in some direct inguinal hernia and many incisional hernias, there is no actual neck.

The body of the sac varies greatly in size and is not necessarily occupied. In long standing case the wall of the sac may be comparatively thick.

The coverings of the sac-Coverings are derived from the layers of the abdominal wall through which the sac passes. In longstanding cases they become atrophied from stretching and so amalgamated that they are indistinguishable from each others.

Contents

These can be-

Omentum- Omentocele
Intestine- Enterocele
A portion of circumference of the intestine- Richter’s hernia
A portion of bladder may constitute part of or sole content of direct inguinal, a sliding inguinal or a femoral
Ovary with or without the corresponding fallopian tube.
A meckle’s diverticulum- a little’s hernia.
Fluid as a part of ascites or residuum there of.

Classification- Irrespective of site, a hernia can be classified into five different types-

· Reducible hernia- The hernia either reduces itself when the patient lies down or can be reduced by the patients or the surgeon. The intestine usually gurgles on reduction and the first portion is more difficult to reduce than the last. Omentum in contrast is described as doughy and the last portion is more difficult to reduce than the first. A reducible hernia imparts an expansile impulse on coughing.

· Irreducible hernia- In this case the contents cannot be return to the abdomen but there is no evidence of other complications. It is usually due to adhesions between the sac and its contents or overcrowding with in the sac.

· Obstructed hernia- This is an irreducible hernia containing intestine that is obstructed from without or within but there is no interference to the blood supply to the bowel. The symptoms are less severe and the onset more gradual than in strangulated hernia (colicky abdominal pain).

· Incarcerated hernia- The term incarceration is often used loosely as an alternative to obstruction or strangulation but is correctly employed only when it is considered that the lumen of that portion of the colon occupying hernial sac is loaded with feces.

· Strangulated hernia- A hernia becomes strangulated when the blood supply of its contents is seriously impaired, rendering the contents are ischaemic. Gangrene may occur as early as 5-6 hours after the onset of first symptoms. Although inguinal hernia may be 10 times more common than femoral hernia, a femoral is more likely to strangulate.

Pathology-

The intestine is obstructed and its blood supply impaired. Initially only the venous return is impeded; the wall of intestine becomes congested and bright red with the transudation of serous fluid into the sac. As congestion increases the wall of the intestine becomes purple in color. The intestinal pressure increase, distending the intestinal loop and impairing the venous return further. As venous stasis increase, the arterial supply becomes more and more impaired. Blood is extravasated under the serosa and is effused into the lumen. The fluid in the sac becomes blood stained and the shining serosa dull because of a fibrinous, sticky exudate. At this stage the walls of the intestine have lost their tone and becomes friable. Bacterial transudation occurs secondary to the lowered intestinal viability and the sac fluid becomes infected. Gangrene appears at the rings of constriction, which become deeply indented and grey in color. The gangrene then develops in the anti mesenteric border. The mesentery involved by the strangulation also becomes gangrenous. If the strangulation is unrelieved perforation of wall of the intestine occurs.

Clinical features

Sudden pain, at first situated over the hernia, is followed by generalized abdominal pain, colicky in nature and often located mainly at the umbilicus. Nausea and subsequently vomiting ensue. The patient may complain of an increase in hernia size. On examination, the hernia is tense, extremely tender and irreducible, and there is no expansile cough impulse.

Strangulated hernias

· Present with local then general abdominal pain and vomiting.

· A normal hernia can strangulate at any time.

· Most common in hernias with narrow necks such as femoral hernias.

· Require urgent surgery.

Types of hernia

· Reducible- Contents can be return to abdomen

· Irreducible- Contents cannot be returned but there are no other complications.

· Obstructed- bowel in the hernia has good blood supply but bowel is obstructed.

· Strangulated- blood supply of bowel is obstructed.

· Inflamed- contents of the sac have become inflamed.

Natural history of hernias

· Irreducible hernias-there is a risk of strangulation at any time

· Obstructed hernias- usually go on to strangulation

· Strangulated hernias-Gangrene can occur within 6 hours.

Richter’s hernia

Richter’s hernia is a hernia in which the sac contains only a portion of the circumference of the intestine (usually small intestine). It usually complicates femoral and rarely, obturator hernias.

Inflamed hernia

Inflammation can occur from inflammation of the contents of the sac, e.g. acute appendicitis or salphingitis, or from external cause, e.g. the tropic ulcers that develop in the dependent area of large umbilical or incisional hernias. The hernia is usually tender but not tense and the overlying skin red and edematous. Treatment is based on treatment of underlying cause.

Inguinal hernia

Surgical anatomy- The superficial inguinal ring is a triangular aperture in the aponeurosis of the external oblique muscle and lies 1.25cm above the pubic tubercle.

The deep inguinal ring is a U shaped condensation of the transversalis fascia and lies 1.25cm above the inguinal ligament, midway between the symphysis pubis and the anterior superior iliac spine. The transversalis fascia is the fascial envelope of the abdomen and the competency of the deep inguinal ring depends on the integrity of this fascia.

Figure:Inguinal Hernia

The inguinal canal

In infant the superficial and deep inguinal rings are superimposed and the obliquity of the canal is slight. In adult the inguinal canal which is about 3.75cm long and directed downwards and medially from the deep to superficial inguinal ring. In male the inguinal canal transmit the spermatic cord, the ilio-inguinal nerve and the genital branch of genito-femoral nerve. In the female the round ligament replaces the spermatic cord. The anterior boundary comprises mainly the external oblique aponeurosis with the conjoined muscle laterally. The posterior boundary is formed by the fascia transversales and the conjoined tendon. The inferior epigastric vessels lie posteriorly and medially to the deep inguinal ring. The superior boundary is formed by the conjoined muscle and the inferior boundary is the inguinal ligament.

An indirect inguinal hernia travels down the canal on the outer side of the spermatic cord. A direct hernia comes out directly towards directly forwards through the posterior wall of the inguinal canal. The neck of the indirect inguinal hernia is lateral to the inferior epigastric vessels, the direct hernia usually emerges medial to this.

Natural history of inguinal hernia

Inguinal hernia in babies are the result of a persistent processus vaginalis.
Indirect inguinal hernia is the most common hernia of all specially in the young.
Direct inguinal hernia becomes more common in the elderly.

Indirect (oblique) inguinal hernia

This is the most common form of hernia. Indirect hernias are most common in the young whereas direct hernias are most common in the old. In the first decade of life, inguinal hernia is more common on the right side in the male. In adult males 65% of the inguinal hernias are indirect and 55% are right sided. The hernia is bilateral in 12% of cases.

Natural history of inguinal hernias

· Inguinal hernias in babies are the result of a persistent processus vaginalis

· Indirect inguinal hernia is the most common hernia of all, specially in the young

· Direct inguinal hernia becomes more common in the elderly.

Types of indirect inguinal hernia

1) Bubonocele-The hernia is limited to the inguinal canal.

2) Funicular - the processus vaginalis is closed just above the epididymis. The contents of the sac can be felt separately from the testes,which lies below the hernia.

3) Complete – A complete inguinal hernia is rarely present at birth but is commonly encountered in infancy. It also occurs in the adolescence or in adulthood. The testis appears to lie within the lower part of the hernia.

Differential diagnosis in the male

Vaginal hydrocele
Encysted hydrocele of the cord
Spermatocele
Femoral hernia
Incompletely descended testis in the inguinal canal- an inguinal hernia is often associated with this condition;
Lipoma of the cord

Differential diagnosis in the female

Hydrocele of the canal of Nuck
Femoral hernia.

Treatment

Operation is the treatment of choice.

Treatment of hernias

Surgery is the treatment of choice
Surgery is either open or laparoscopic
Any hernia can strangulate.

Direct inguinal hernia

In adult 35% of the inguinal hernia are direct. A direct inguinal hernia is always acquired. The sac passes through a weakness or defect of transversalis fascia in the posterior wall of the inguinal canal. In some cases the defect is small and is represented by a discrete in the transversalis fascia, whereas in others there is a generalized bulge.

Direct hernias do not often attain a large size or descend into the scrotum. In contrast to an indirect inguinal hernia, a direct inguinal hernia lies behind the spermatic cord. The sac is often smaller than the hernial mass would indicate, the protruding mass mainly consisting of extra-peritoneal fat. As the neck of the sac is wide, direct inguinal hernias do not often strangulate.

Direct inguinal hernias

All are acquired
They are most common in older man
They rarely strangulate

Operation for direct inguinal hernia

The principles of repair of direct inguinal hernias are the same as those of indirect hernia, with the exception that the hernia sac can usually be simply inverted after it has been dissected free and the transversalis fascia reconstructed in front of it. The reconstruction of the posterior wall of the inguinal canal should be undertaken by the Shouldice repair or by using a mesh implant according to the Lichtenstein technique. The ‘Bassini’ darn operation is no longer acceptable because of its high recurrence rate and slow rehabilitation.

Sliding hernia (hernia-en-glissade)

As a result of slipping of the posterior parietal peritoneum on the underlying retroperitoneal structures, the posterior wall of the sac is not formed of peritoneum alone, but the sigmoid colon and its mesentery on the left side, the caecum on the right side and sometimes on either side by a portion of the bladder.

Clinical features

A sliding hernia occurs almost exclusively in men. Five out of six sliding hernias are situated on the left side; bilateral sliding hernias are rare. The patient is always over 40 years of age, the incidence rising with age. It should be suspected in a very large globular inguinal hernia descending well into the scrotum.

Treatment

A sliding hernia is impossible to control with a truss and as a rule, the hernia is a cause of considerable discomfort. Consequently, operation is indicated and the result is very good.