Thursday, March 26, 2009

Keloid

what and how keloid?

keloid caused the wound healing process does not produce a scar (skin wounds network) is good. Injury referred to as shoot wound, piercing, tattoo, slice, the former operation, and so forth.

this was initially good, but because of the healing process continues, make keloid. Wound healing process itself includes 3 stages. First, inflamasi, lasts 1-5 days. Second, fibrolast, lasted 5 days-3 sunday. Third, maturasi, held sunday 3-6 months, can also for many years.

In keloid, this third stage, continue to run because the body continues to move regangan, and thus there is pressure on some part of it. In fact, in wound healing, the body must quiet.

Although only take place in the layer of skin epidermis and dermis, if not treated immediately, will be thick keloid. Originally a small wound, after a long time to open out to the fringe of injury and eventually grow above the prominent initial injury. Location appear in many breast, ear, shoulder, and thigh .

"People will not die because the keloid, but this reduces the aesthetic appearance and not feeling comfortable because the itchiness and pain. Wounded consecutive scratching the wound healing process is not finished so broad keloid and stimulate new injury," said dr gwendy.

Causes

There are three factors spark the emergence of keloid. First, the genetic factors that influence reaches 80 percent. Second, hormonal factors, such as pubertas, menstruasi, and menopause. Third, factors pigmentasi. The higher the pigment (hiperpigmentasi), the higher the likelihood of keloid arise, such as people of color.

Healing

Keloid indeed can not be total. However, a comprehensive business recovery will be slow growth rate. Range of treatment, as follows:

1. The emphasis, of which three can be selected, namely:
- Swelled with the press and elastic banded.
- Splint (splinting), used in particular regions, such as hands and feet for 3-sunday 3 months. The goal is not so much the activity body felt so calm.
- Sheets Silicon (silicon sheet), thicker texture of plaster.
- Intralesi with the injection of kortikosteroid (substances that prevent medication wound healing process). Kortikosteroid provided with a certain dose periodically to permanently reduced if keloid start low.

2. Topikal (cream)
Cream contains kortikosteroid be smeared on the wound every day, 2-3 times a day. The product contains cream kortikosteroid, is bleomycin, kenakort, and Mederma.

3. Operation
There are two options keloid surgery. The first option, the entire operation to remove keloid in which the risk is that the network must keep the skin healthy tension suture surgery. The second option, operating the only perifer still remain part to lock the wound healing process.
- Pulse Laser Die, action thermolysis or treatment with the searing heat.
- Creo surgery, so it does not freeze keloid to grow in these locations.
- Ray radiation, aimed at preventing the process of healing wounds that are not perfect. Ray radiation is given with a maximum total power in 1500 yacht for 5 days respectively, adjusted to the level of illness keloid

Tuesday, March 24, 2009

Vaginitis

Pathophysiology

Aerobic and anaerobic bacteria can be cultured from the vagina of prepubertal girls, pubertal adolescents, and adult women. The overgrowth of normally present bacteria, infecting bacteria, or viruses can cause symptoms of vaginitis. Chemical irritation also can be a significant factor. Atrophic vaginitis is associated with hypoestrogenism, and symptoms include dyspareunia, dryness, pruritus, and abnormal bleeding.

Frequency

United States

Vaginitis is common in adult women and uncommon in prepubertal girls. Vaginitis is one of the most common reasons for gynecologic consultation consisting of approximately 10 million office visits annually. Bacterial vaginosis accounts for 40-50% of vaginitis cases; candidiasis, 20-25%; and trichomoniasis, 15-20%.

Mortality/Morbidity

The presence of abnormal discharge, vulvovaginal discomfort, or both is required for the diagnosis of vaginitis.

Age

The age of the patient affects the anatomy and physiology of the vagina.

  • Prepubertal children have a more alkaline vaginal pH than pubertal and postpubertal adolescents and women. The vaginal mucosa is columnar epithelium, vaginal mucous glands are absent, normal vaginal flora is similar to that of postmenopausal women (eg, gram-positive cocci and anaerobic gram-negatives are more common), and labia are thin with a thin hymen.
  • Pubertal and postpubertal adolescents and women have a more acidic vaginal pH, stratified squamous vaginal mucosa, vaginal mucous glands, normal vaginal flora of lactobacilli, thick labia, and hypertrophied hymens and vaginal walls. Loss of vaginal lactobacilli appears to be the primary factor in the changes leading to bacterial vaginosis. Recurrences of vaginitis are associated with a failure to establish a healthy vaginal microflora dominated by lactobacilli.

Clinical

History

Adults and children must be questioned regarding specific aspects of the symptoms of vaginitis. Vaginal bleeding in prepubertal females is always abnormal and merits full investigation. Essential information to obtain during the history is the onset of symptoms, previous occurrence, associated abdominal pain, trauma, and urinary or bowel symptoms.

  • The most common etiologies in adults resulting in symptoms of vaginitis include Candida albicans, Trichomonas vaginalis, and bacterial vaginosis. Elicit symptoms with attention to these possible causes.
    • Candidiasis is a fungal infection common in women of childbearing age that results in pruritus, with a thick, white vaginal discharge. Patients often have a history of recurrent yeast infections or recent antibiotic treatment. Symptoms of candidiasis often begin just before menses. Precipitating factors include immunosuppression, diabetes mellitus, pregnancy, and hormone replacement therapy. Candidiasis is usually not contracted from a sexual partner. Seventy-five percent of all women have one episode of candidiasis in their lifetime. Recurrent episodes may indicate underlying immunodeficiency or diabetes.
    • Trichomoniasis is associated with risk factors for other sexually transmitted diseases (STDs); elicit a history of multiple sexual partners. The discharge is usually copious and frothy, resulting in local pain and irritation. Pruritus might be present. Symptoms often peak just after menses. Trichomonas vaginalis is the most common nonviral STD in the world. Infection during pregnancy has been associated with preterm deliveries and low birth weight infants.
    • Bacterial vaginosis is asymptomatic in up to 50% of women. If a discharge is present, it is typically a homogeneous grayish white or yellowish white. Bacterial vaginosis is common in pregnant women and is associated with preterm birth. Treating pregnant women that have a history of preterm birth with symptomatic bacterial vaginosis early in pregnancy has been shown to decrease the incidence of preterm birth.
    • In women with chronic vaginitis, atrophic vaginitis and hypoestrogenism must be considered. Elicit an accurate menstrual history.
  • Vulvovaginitis has multiple nonvenereal causes in prepubertal children; however, if a vaginal discharge suggests an STD, question all children (and/or their caretakers) regarding possible sexual abuse. Symptoms of vulvovaginitis in prepubertal girls generally include localized pain, dysuria, pruritus, erythema, and discharge.
    • Bacteria that can cause vulvovaginitis include streptococcal species (including group A streptococci), Escherichia coli, and Shigella sonnei. Symptoms (eg, pharyngitis, diarrhea) may result from infections in areas of the body other than the vagina. A Shigella infection may result in a bloody vaginal discharge without symptoms of diarrhea. A patient with group A streptococcal infection may present with itching or painful defecation. Purulent discharge may develop insidiously.
    • Viral infections may cause symptoms of vulvovaginitis. Elicit a history of recent viral infections, including varicella. Herpes simplex viruses (HSVs), particularly HSV-1 transmitted via autoinoculation from the oral mucosa, might be present; elicit a history of recurrent oral herpes or digital herpes in the caretaker of a child in diapers.
    • Consider helminthic infections (eg, Enterobius vermicularis infections) resulting in pruritus of the genital area. Ask about contact with pinworm-infected children, itching (particularly at night), and vaginal pain.
    • Ask questions to exclude the possibility of a foreign body in the vagina, chemical irritation (eg, recent bubble baths, washing hair with shampoo while bathing, douching, feminine hygiene sprays), latex, semen, mechanical irritation, and poor hygiene. Foreign bodies in the vagina result in a persistent, foul-smelling, serosanguineous discharge. Contact dermatitis from unusual exposures may occur; ask about this possibility and about bathing patterns.
    • Obtain a history of recent trauma to the vaginal area and a history of urination and defecation patterns and problems to exclude possible anatomic abnormalities (eg, rectovaginal fistula).
    • Lichen sclerosis et atrophicus may be seen in prepubertal children and in postmenopausal women. Symptoms of chronic fissures, pain, or pruritus are often present. Rectal fissures may lead to chronic constipation in children.
    • If candidal vulvovaginitis is considered (rare in healthy prepubertal girls), the history should include recent antibiotic use, possible diabetes mellitus, immunosuppression, and underlying skin disease. Ask about a family history of mucocutaneous candidiasis.
    • Trichomoniasis is rare in prepubertal children. Sexual abuse should be suspected if symptoms are present. Symptoms include a copious frothy discharge, local pain, irritation, and, occasionally, pruritus.

Physical

The physical examination of pubertal and adult women should include a complete pelvic examination. The Tanner stage of development should be noted. The examination for prepubertal girls should be performed as described in Pediatrics, Child Sexual Abuse.

  • Infectious causes of vaginitis may have the following specific physical findings:
    • Candidiasis may present with a well-demarcated erythema of the vulva with satellite lesions surrounding the redness. The vulva, vagina, and surrounding areas may be edematous and erythematous, possibly accompanied by excoriations and fissures. A clumpy adherent discharge may be seen.
    • Physical findings for trichomoniasis include a copious frothy discharge (white to greenish-yellow) and a raised punctate erythema of the cervix and upper portion of the vagina (strawberry cervix).
    • Physical findings in bacterial vaginosis include a homogeneous grayish white to yellowish white vaginal discharge. Typically, no underlying erythema exists. Bacterial vaginosis can be diagnosed if 3 of the 4 Amsel criteria are present: increased vaginal pH (>4.5), grayish white homogenous discharge, an amine smell with or without potassium hydroxide, and clue cells.
    • Physical findings associated with cervicitis from STDs include excessive vaginal discharge, erythema, and edema of the cervix.
    • Cervical ectopy or eversion may cause discharge with no apparent infectious etiology.
    • Physical findings associated with atrophy, dysplasia, and vulvar vestibulitis syndrome include localized atrophy or infection in skin and mucous membranes.
    • Vaginal foreign bodies in adults include forgotten tampons; in children, pieces of toilet tissue typically are found. Findings of foul odor and irritation with a purulent discharge are common.
    • A patient with pinworms may present with few physical findings. Occasionally, there may be erythema and excoriations around the perianal area. In severe cases, eggs and/or dead female nematodes may be seen on examination of the anal area.
    • Perianal streptococcal dermatitis usually results in a beefy red perineal area that is edematous and tender. Fissures, drainage, and hemorrhagic spotting may be present.

Causes

  • Causes of vulvovaginitis vary depending on the following:
    • Age
    • Sexual activity (or abuse)
    • Hormonal status
    • Hygiene
    • Immunologic status
    • Anatomy of the genital area
    • Underlying skin diseases

Pregnancy, Postpartum Infections

Emergency physicians are increasingly concerned about postpartum patients who come to the ED with a fever or evidence of infection. The number of cases of infection can be expected to increase because of the earlier discharge of postpartum patients from the hospital. Any infection following delivery is classified as postpartum or puerperal infection.

Pathophysiology

Endometritis is the most common source of postpartum infection. Other sources of postpartum infections include (1) postsurgical wound infections, (2) perineal cellulitis, (3) mastitis, (4) respiratory complications from anesthesia, (5) retained products of conception, (6) urinary tract infections (UTIs), and (7) septic pelvic phlebitis.

Frequency

United States

Overall, postpartum infection is estimated to occur in 1-8% of all deliveries.

Mortality/Morbidity

In most reviews, maternal death rates associated with infection range from 4-8%, or approximately 0.6 maternal deaths per 100,000 live births.

Clinical

History

The history and course of the delivery is important in the evaluation of postpartum patients.

  • Ascertain if the delivery was vaginal or cesarean.
  • Ascertain if premature rupture of the membranes occurred.
  • Assess the patient's symptoms.
  • Features vary depending on the source of infection and may include the following:
    • Flank pain, dysuria, and frequency of UTIs
    • Erythema and drainage from the surgical incision or episiotomy site, in cases of postsurgical wound infections
    • Respiratory symptoms, such as cough, pleuritic chest pain, or dyspnea, in cases of respiratory infection or septic pulmonary embolus
    • Fever and chills
    • Abdominal pain
    • Foul-smelling lochia
    • Breast engorgement in cases of mastitis

Physical

Focus the physical examination on identifying the source of fever and infection. A complete physical examination, including pelvic and breast examinations, is necessary. Findings may include the following:

  • Endometritis may be characterized by lower abdominal tenderness on one or both sides of the abdomen, adnexal and/or parametrial tenderness elicited with bimanual examination, temperature elevation (most commonly >38.3°C)
  • Some women have foul-smelling lochia without other evidence of infection. Some infections, most notably caused by group A beta-hemolytic streptococci, are frequently associated with scanty, odorless lochia.
  • Patients with wound infections, or episiotomy infections, have erythema, edema, tenderness, and discharge from the wound or episiotomy site.
  • Patients with mastitis have very tender, engorged, erythematous breasts. Infection frequently is unilateral.
  • Patients with pyelonephritis or UTIs may have tenderness at the costovertebral angle and an elevated temperature.
  • Respiratory signs, such as rales, consolidation, or rhonchi in pneumonia, are possible.
  • Patients with septic pelvic thrombosis, although rare, may have palpable pelvic veins. These patients also have tachycardia that is out of proportion to the fever.

Causes

Causes and risk factors may include the following:

  • Endometritis
    • In most cases of endometritis, the bacteria responsible for pelvic infections are those that normally reside in the bowel, vagina, perineum, and cervix.
    • The uterine cavity is usually sterile until the rupture of the amniotic sac. As a consequence of labor, delivery, and associated manipulations, anaerobic and aerobic bacteria can contaminate the uterus.
    • The risk of endometritis increases dramatically after cesarean delivery (10-20% of patients).
  • Genital tract infections
    • Genital tract infections are generally polymicrobial.
    • Gram-positive cocci and Bacteroides and Clostridium species are the predominant anaerobic organisms involved. Escherichia coli and gram-positive cocci are commonly involved aerobes.
  • Mastitis
    • The most common organism reported in mastitis is Staphylococcus aureus.
    • The organism usually comes from the breastfeeding infant's mouth or throat.
  • Thrombosis
    • Numerous factors cause pregnant and postpartum women to be more susceptible to thrombosis. Pregnancy is known to induce a hypercoagulable state secondary to increased levels of clotting factors. Also, venous stasis occurs in the pelvic veins during pregnancy.
    • Although relatively rare, septic pelvic thrombosis is occasionally observed in the postpartum patient, who might have fever.
  • Perineal cellulitis and episiotomy site infections
    • Most often, the etiologic organisms associated with perineal cellulitis and episiotomy site infections are Staphylococcus or Streptococcus species and gram-negative organisms, as in endometritis.
    • Vaginal secretions contain as many as 10 billion organisms per gram of fluid. Yet, infections develop in only 1% of patients who had vaginal tears or who underwent episiotomies.
  • Urinary tract infections
    • Bacteria most frequently found in UTIs are normal bowel flora, including E coli and Klebsiella, Proteus, and Enterobacter species.
    • Any form of invasive manipulation of the urethra (eg, Foley catheterization) increases the likelihood of a UTI.
  • Risk factors
    • History of cesarean delivery
    • Premature rupture of membranes
    • Frequent cervical examination (Sterile gloves should be used in examinations. Other than a history of cesarean delivery, this risk factor is most important in postpartum infection.)
    • Internal fetal monitoring
    • Preexisting pelvic infection
    • Diabetes
    • Nutritional status
    • Obesity

Friday, March 20, 2009

Play Futsal Tips and Prevent Injury


Playing futsal than as a means of refreshing rush hours a day as well as activities to maintain health, but sometimes the body is not obtained fresh after playing futsal, but even feel stiff and sore all over the body, what futsal is too hard for us?
Not that it factors into the problem, every type of sports especially dynamic exercise due to the two healthy or injured, now sports the way how the risk of greater health and a small injury or greater injury than the healthy, this depends on the process before we make the core of sports ..
if this process in the tabrak greater injury will occur, but if the process is done correctly then the sound will tend to be larger in the can, and if in the process of meaning? The process here is Tense and before heating the core sports in this futsal, and cooling after exercise core.
Tips healthy before and after sports futsal:
1.tense comprehensive section on the body from head to foot,
2. adequate heating, heat in the context here is different for each person, do the heating as closely as possible, usually on the mark with sweat, do jogging jogging before starting a small sports futsal.
3.Ended sports futsal with the muscles relax after use in sports, and leave the body temperature down with it.
4.Stop activities after smoking at least 1 to 2 hours, let the body breathe fresh oxygen nicotine without smoke.
5.kontrol drink energy drinks, because this is not good for the body, drink the best white water is not cold.
If the above tips do with consistent, then the risk of injury will be smaller and the benefits of exercise will we get the maximum.


Wednesday, March 11, 2009

Traditional Medicine

RUIT property

Star fruit (Averrhoa pentandra) with a wide variety of property to cure various diseases, such as:

Parotitis
Take 10 young branches following star fruit leaves and 4 red onion grains. Wash clean smooth mixed ago. put to place the sick.

Whelk
a. Take fruit a little star fruit, wash and finely mixed and filtered with salt water as necessary. Use to rub a pimply face. Do 3 times a day.

b. Take 6 pieces wuluh star fruit and 1 / 2 teaspoon powdered sulfur, finely grinding filtered ago with 2 tablespoon lime juice. Use to rub a pimply face. Perform 2-3 times a day.

tinea corporis
Take the 10 fruit star fruit, washed ago grinding finely, add the whiting of tamarind seeds, filtered until flat. This herb is used to polish the skin fell ill tinea corporis. Do 2 times a day.

Meanwhile, for the use in such as drink, it takes a special way.

Cough
Take a handful flower star fruit, some grains fennel, enough sugar and 1 cup water. All materials mixed for several hours, lift, and cooling. Filter and drink two times, morning and night when stomach is empty.

Or, take 25 flower bud star fruit, finger rimpang temu 1 bell, 1 finger leather cinnamon, 1 finger rimpang kencur, 2 grains of red onion, 1 / 4 hold pegagan, 1 / 4 handheld saga leaves, 1 / 4 hold the leaves inggu , 1 / 4 hold the spoon leaves, washed and cut-cut as, boiled with 5 glass of clean water until remaining 2 1 / 4 cup. After the cold, filtered water stew, add a little honey. Drink 3 times a day, each 3 / 4 cup.

Whooping cough
Take the 10 fruit star fruit, washed ago mixed pulp, and then filtered with 2 tablespoon of salt water, then filtered. Drink 2 times a day.

stomatitis
a. Take a handful flower star fruit, enough palm sugar and 1 cup water boiled until thick. After filtered cold, use to clean and lubricate the mouth stomatitis.

b. Take 2 / 3 interest handheld star fruit, boiled ago washed with 3 clean water glass until remaining 2 1 / 4 cup. After the cold filtered, and drink 3 times a day, each 3 / 4 cup.

c. Take 3 pieces star fruit, red onion 3 clove, nutmeg 1 young, 10 pieces of sprue leaves, 3 / 4 teaspoon fennel, 3 / 4 finger pulosari, washed ago mixed fine, filtered with 3 tablespoon coconut oil, filtered . Is used to lubricate injured due stomatitis, 6-7 times a day.

Monday, March 9, 2009

Adenoidectomy

What are the adenoids?

The adenoids are swellings in the space at the back of the throat, called the nasopharynx. You cannot easily see them by looking in the mouth as they are higher, at the back of the nose, behind the floppy part of the roof of the mouth. They are about the size of a broad bean and are soft and fleshy. We use special instruments to see your child’s adenoids or sometimes we may take an x-ray.

The adenoids are made of lymphoid tissue, which helps the body fight infection. There are lots of other areas in the head and neck and the rest of the body made of lymphoid tissue, so even without adenoids the body can still fight infection.

Adenoidectomy - child

The adenoids lie quite close to the Eustachian tube. This tube connects the back of the throat to the middle part of the ear. Swollen adenoids can block this tube, leading to a condition called secretory otitis media or, more commonly, glue ear. In this condition, fluid collects behind the eardrum causing deafness. This will reduce your child’s hearing until the blockage is relieved. Sometimes enlarged adenoids are responsible for causing recurrent ear infections.

What has gone wrong?

After a lot of repeated attacks of infection, the adenoids may remain enlarged. They may even keep infection trapped inside. You may notice that your child:

  • has difficulty breathing through their nose and is a mouth breather
  • talks as if the nostrils are pinched
  • breathes noisily
  • snores while sleeping.

Swollen adenoids can be linked with tonsillitis and are often removed as part of an operation to remove the tonsils, called an adenoidectomy and tonsillectomy. Having said this, adenoid infection does not cause tonsillitis or vice versa.

The aims

The aim of an adenoidectomy is to completely remove the adenoids. Your child will have a general anaesthetic and will be unconscious for the operation.

The benefits

Removing the adenoids from the back of your child’s nose will enable them to breathe more easily through the nose. There will also be less chance of a blockage to the Eustachian tubes, which connect the back of the nose to the ears. An adenoidectomy can prevent further nose and ear problems.

Are there any alternatives?

There are no tablets or medicines that will permanently prevent enlarged adenoids. Antibiotics can make the swelling better but if the adenoids are infected frequently, antibiotics may not work well.

The only way to stop repeated attacks of acute infection is to remove your adenoids. The only way to treat large adenoids blocking the back of the nose is to remove the adenoids.

What if you do nothing?

Your child’s adenoids will eventually shrink away on their own, as they get older. Adenoids usually shrink away by the time a child reaches 12 or 13 years of age. However, until this happens, your child may continue to have problems with breathing and possibly with their ears and hearing.

Who should have it done?

If your child has large adenoids blocking the back of their nose, they should have them removed. An adenoidectomy should also be considered if your child has recurrent ear infections or glue ear.

Who should not have it done?

The following groups of children should not have the operation:

  • Children who have problems with the roof of their mouths, called the palate. The floppy part at the back of the roof of the mouth is called the soft palate. This moves to block the nose from the mouth when we swallow so that food and drink does not come out of the nose. When we speak the soft palate also closes off the back of the nose. Some children have a short soft palate but nothing wrong is noticed because the soft palate rests against the adenoids to block off the nose when swallowing and speaking. In these children, if the adenoids are removed, the short soft palate can no longer close off the back of the nose. This causes a nasal type of speech and the possibility of fluids or food coming down the nose. Because of this risk, when assessing a child for possible adenoidectomy all surgeons will check the soft palate. If there is doubt about its movement, adenoidectomy will not be advised.
  • Children with a blood disorder, such as haemophilia, which makes them bleed or bruise easily after minor injuries. It may still be possible to do the operation but the doctor will have to take a sample to test the clotting of the blood.
  • Children who have other medical conditions that make a general anaesthetic unsafe.

Saturday, March 7, 2009

breast Self-Examination

What is observed from the breast?

Symptoms observed in general there are three things. Namely the existence of nodule, the breast skin changes, and the deviation niple hilt. nodule be distinguished from the other size, great speed increase, consistency, separated from the base or not, and location. This skin is easy to change the scale, squeeze or not, and swelling. Changes in nipple discharge is viewed as fluid, the form of nipple into the trap, such as citrus

So this change-which must be observed. When changes are made, immediately to the doctor for further examination.

When made aware?

Usually conducted once a month, which at the time of 7-10 days after menstruation. At that time in the breast due to hormonal software.


Continuing any posts yesterday about breast cancer and relation to the realized (breast
Self-Examination), then there are some things you should know the women in the rate of cancer itself.

There are three things to note in assessing breast cancer or cancer mammae. Three things are as follows:
Who is exposed to high risk breast Cancer?
Complaints that the ordinary general toward breast cancer?
When we consider possible breast cancer?

Let us study one by one in short:

* Who is exposed to high risk breast Cancer?

In the women must be extra vigilant affected risk cancer are:
Age more than or equal to 35 years.
first time earlier than the age of 13 years
Stop bleeding (menopause) aged more than 50 years
First childbearing age more than 30 years
No or few children
Not at all or does not breastfeed her child
Factor fattiness
That the breast is exposed to breast cancer

* Complaints-common complaint that the usual towards breast cancer

Complaint is something that is felt by the patient or the patient himself.
Complaints to the direction of possible cancer are:

May not have a complaint. believe, if there is no complain suddenly so breast cancer? Complaints usually relate to the pain threshold. When the channel has not been involved then the nerve does not complain at all.
Pain in the breast. Now that this system is involved so that the nerve pain relief.
Bleeding or fluid out of the nipple
There is a wound in the breast and bleeding also occur
Changes in the form of a breast. What was originally a different form or have any additional changes because of the mass.
Complaint because the child metastase). Metastase to which the children have .. then a complaint will arise in the complaint like headache, nodule in the armpit, hands so swollen.

* When we consider possible breast cancer?

From these two things we can suspect someone is exposed to possible breast cancer if:

Have tumor in the breast that arose at the age above 35 years, showed that the situation is not tame. This additional acceleration of the tumor mass is very fast.
There is a change in the form of both contract and breast swelling
Supplementary examination, such as mamaografi, USG etc. indicate the direction to get there.

Friday, March 6, 2009

What is Diphteria

Definition
Diphtheria is an acute infection of the respiratory channels of the top
caused by the bacteria Corynebacterium diphtheriae. More often attacked
children.
Causes
The causes are the bacteria Corynebacterium diphtheriae. The bacteria are usually
the respiratory channel, especially laring, tonsil and throat. But
not less toxic, and also attacks the skin and even cause nerve damage
and heart.
Illustration clinic
- The period of the shoot 2 - 7 days
- People complain pain and swallow breath stridor,
the children not infrequently followed by fever, nausea, vomiting, shivering and headache.
- People with shortness of breath appear with or without signs obstruksi breath.
- Fever is not high.
- On examination the throat membrane appear grayish white that is easily
bleed when touched.
- Symptoms are not always available:
§ Sumbatan way so that the breath of sianosis
§ breath odor
§ bleeding nose
- The enlargement limfe gland in the neck (bullneck)
- Inflamasi with many local eksudat faring, eksudat in the sticky
mukosa gray or dark edema and network software. In the children,
phases of this disease can lead to road obstruksi breath.
- A systemic disease caused by a bacterial toxin started 1 - 2
sunday after the local symptoms. Toxin affects the heart (miokarditis,
aritmia especially during the second sunday of disease) and nerve system
(paralisis, neuritis 2 - 7 sunday after disease). When patients
recover from the acute phase of disease, usually recover without deviation broadcaster.

Diagnosis
Therapy needs to be decided on the basis of anamnesis and description
clinical.
Diagnosis is confirmed with a bacterial culture taken from eksudat in
tube to sample bacteria. Samples must kultur on special media, for that
need to first notify the laboratory. Lear preparat taken 3 days
respectively.
Treatment
- Patients asimtomatik given profilaktik either erythromycin antibiotics.
- Patients should be referred to simtomatik hospital.

Thursday, March 5, 2009

Allergies in Children

Allergies in children not simply as we never know. Previous often we hear that the allergic symptoms are cough, runny nose, itchy and congested. While allergies can attack all organs without exception, from the tip of the hair to toe with a variety of hazards and complications which may occur. Later revealed that the allergic complications of dangerous enough, because the reaction can all disrupt the body's organs or systems, including our brain disfunction. Because that is the interference function of the brain arising and development of behavioral disturbances in children, such as disruption of concentration, emotional disturbances, speech delays, disruption of concentration to aggravate symptoms of ADHD and autism.

When you see the extent of such interference is happening and the number of organs that subject, it seems a reaction is a "systemic disease". When there can understand opinion, that the expression is too excessive because all the complaints are always associated with allergy. However, this opinion will loss, when many people with the allergy, it is true and correct harassment complaint that was going on himself. In this case supported by scientific research and reports from various scientific disciplines who associate the various symptoms that are allergic to it.

Controversy Allergies

In some forty years of controversy allergic diseases are often faced by society in general. A doctor forbids certain types of food, allow doctors other food while other doctors say that is because a lot of interference because of the food reaction. If medical experts have different opinions are sharp, then the people become confused because of various different doctors. The controversy should we trust the fact that experienced by children. When you avoid a certain food then a lot of interference and interference organs behavior can be reduced. Parents can share experiences with parents who have children with complaints of chronic allergies. They will recount how jahatnya food allergy.

Know ALERTS AND SYMPTOMS allergic to Baby

Clinical manifestations Allergies relating to child

Frequent cough, cough duration (> 2 weeks), runny nose, ( night and morning day lost) sinusitis, sneezing, nosebleed. tonsilitis (tonsillectomy), packed, raucous voice.

Gland enlargement in the neck and head back down.

Frequently hematoma on foot / hand as the former hit.

Skin ulcer relief, redness, The speck of white and black used as mosquito bitten. Often rub the eyes, nose or ear. Ear excessive dirt.

Sore muscles & bones repeated night. Frequent urinating, bed wetting (Ngompol)

Frequent vomiting, stomach pain, It's hard to eat with less body weight (usually after the age of 4-6 months).

Sariawan often, the tongue often white / dirty painful gum / teeth, halitosis, excessive saliva, dry lips.

Discard the water is often large (> 2 times / day), difficult to defecate (obstipasi), small rounded black dirt like dirt goat, hard, often un-wind, mired in the pants.

Sleep late at night / are often awakened.

Head, foot / hand often hot .sweating (excessive)

Itchy eyes, break out in the eyelid, eye blinking frequently, using a glass eye since very young age (6-12 years of age).

Hormonal disturbances: grow hair in feet / hands,

Frequent headaches, migraine.

Early detection manifestation of a reaction to Baby

Clinical manifestations often associated with the allergy sufferer in the baby.

INTERFERENCE digested Channels: Frequent vomiting / gumoh, , "hiccup", often un-wind, often "ngeden / mulet", often fussy / restless / COLIK especially at night), often defecate (> 3 times per day), not CHAPTER every day, dysentery. Hernia Umbilikalis (protruding navel), Scrotalis, inguinalis ( prick the fruit or navel or "hernia") so often because the pressure in the stomach increases.

Sensitive skin, often arising reddish spot or ulcer, especially in the cheeks, ears and a closed area nappies. Crust in the area of the former black .grow hair such as mosquito bitten. Eye, ear and the area around the hair often itchy, accompanied gland enlargement in the back of the head. Excessive dirt ear a bit smelly sometimes.

White tongue often arise (such as mushrooms). Lips appear dry mouth or the middle of the darker color (blue).

stridor breath, sometimes accompanied by a cough, especially the night and morning day lost. Babies like this often at risk when a cough or coughing are often long (> 7hari) and excessive sputum)

Stertorous new born baby with thimus belly gland (TRDN / TTNB). Babies like this according to research at risk of asthma before the age of pre.

Frequent sneezing, runny nose, nose dirt lots, often head to one of the sloping sides (so that the head at risk "peyang") because the nose is clogged, or drink only one dominant side of breast. Because the nose is clogged and breathing with the mouth of the drinking breastmilk often choke

Eyes are often watery stool or haunting eyes (belekan), one side / both sides.

Often sweating (excessive)

Due to excessive drinking or drinking have often result in more weight loss and obesity (age <1tahun)

struma nodule thryroid

Classification

They are classified in different ways:

  • A "diffuse goiter" is a goiter that has spread through all of the thyroid (and can be a "simple goitre", or a "multinodular goitre").
  • "Toxic goiter" refers to goiter with hyperthyroidism. These most commonly due to Graves' disease, but can be caused by inflammation or a multinodular goiter.
  • "Nontoxic goiter" (associated with normal or low thyroid levels) refers to all other types (such as that caused by lithium or certain other autoimmune diseases).

Other type of classification:

  • I - palpation struma - in normal posture of head it cannot be seen. Only found when palpating.
  • II - struma is palpative and can be easily seen.
  • III - struma is very big and is retrosternal. Pressure and compression marks.

Causes

Worldwide, the most common cause for goiter is iodine deficiency. In countries that use iodized salt, Hashimoto's thyroiditis becomes the most common cause.

Other causes are:

Occurrence

Iodine is necessary for the synthesis of the thyroid hormones thyroxine (T4) and triiodothyronine (T3). In endemic goitre, iodine deficiency leaves the thyroid gland unable to produce its hormones because the hormones are made out of iodine. When levels of thyroid hormones fall, thyrotropin-releasing hormone (TRH) is produced by the hypothalamus. TRH then prompts the pituitary gland to make thyrotropin or thyroid stimulating hormone (TSH), which stimulates the thyroid gland’s production of T4 and T3. It also causes the thyroid gland to grow in size by increasing cell division.

Nodular goitre of a young woman.

Goiter is more common among women, but this includes the many types of goitre caused by autoimmune problems, and not only those caused by simple lack of iodine.

Treatment

Treatment may not be necessary if the goitre is small. Goiter may be related to hyper- and hypothyroidism (especially Graves' disease) and may be reversed by treatment of hyper- and hypothyroidism. Graves' disease can be corrected with antithyroid drugs (such as propylthiouracil and methimazole), thyroidectomy (surgical removal of the thyroid gland), and iodine-131 (131I - a radioactive isotope of iodine that is absorbed by the thyroid gland and destroys it). Hypothyroidism may raise the risk of goitre because it usually increases the production of TRH and TSH. Levothyroxine, used to treat hypothyroidism, can also be used in euthyroid patients for the treatment of goitre. Levothyroxine suppressive therapy decreases the production of TRH and TSH and may reduce goitre, thyroid nodules, and thyroid cancer. Blood tests are needed to ensure that TSH is still in range and the patient has not become subclinically hyperthyroid. If TSH levels are not carefully monitored, it is alleged that levothyroxine may increase the risk of osteoporosis but no peer reviewed studies on levothyroxine replacement of Hypothyroid patients causing this effect have actually been produced.

Thyroidectomy with 131I may be necessary in euthyroid goitrous patients who do not respond to levothyroxine treatment, especially if the patients have difficulty breathing or swallowing. 131I, with or without the pre-injection of synthetic TSH, can relieve obstruction and reduce the size of the goitre by thirty to sixty-five percent. Depending on how large the goiter is and how much of the thyroid gland must be removed or destroyed, thyroidectomy or 131 may produce hypothyroidism requiring life-long treatment.

Symptoms

The symptoms of goiter are mainly the swelling of the front part of the neck and protruding eyes.

Tuesday, March 3, 2009




Avoid Sports and activities

During pregnancy there is a good idea to avoid capital these activities:
Lift the burden.
Walking distance to the load is quite heavy.
High impact sports, sports with a high risk, such as aerobic sports or self-care, and activities in the altitude.

senam pregnant

Some hospitals now have a general class exercises pregnant. Ask the nearest maternity hospital to join. Some classes require registration or pregnant before class registration underway. Class will be guided by pregnant midwives and usually consist of only 5 to 20 pregnant women. Use comfortable clothes and the mother can also bring their own bed when the mother callisthenics want. Senam pregnant are encouraged to attend with the mother's husband or birth partner.


'Mandatory requirements' Senam pregnant

Sports, not just wearing T-shirts and gym shoes. Moreover, for the mother who is pregnant. The following, it is important to note:

Do not let mother's body heat in the long period of time. Istirahatlah moment.
Use a bra is quite good for the sport and such decker can endorse feet.
Drinking enough water
Note the balance of the body (pregnant mother to change the balance of the body)
Do sports and do not fit the portion of overcharging. If you feel dizzy, float, cramps, tired or too hot, just rest.

Why should sport?

Sports light energy will increase the capital. But the point is not just that, sports also:
Overcoming constipation (constipation), back pain and cramps.
Make the body fresh and strong in the day-to-day activities.
Sleep more soundly.
Reduce stress.
Help restore the body shape more quickly after giving birth.
More ready body and strong in the process of childbirth.
Meet with the prospective mother to do when Mother class exercises pregnant.


Sports is a safe time for Mother's pregnancy?

If during this Mother's rare sport, then do not start the sport of weight when pregnant mother. Moreover, without a medical consultation. Sports do not light a risk for mother and baby. Some of the following sports may be tried.

Pilates or yoga. Sports with the pattern of breathing and relaxation peregangan this safe enough for pregnant women.

Light jogging and relaxed way

Swimming

Senam pregnant or aquanatal (this is similar to the exercises but aquarobik designed specifically for pregnant women)

Dancing

Cycling. Wow, happiness remains safe cycling while pregnant. But, if want to use a comfortable bicycle seat and select a soft even though the street is safer. When the big belly, the balance of the body of Mother will change and likely will fall more. So it may be best if the mother uses a static bike.

Breast Treatment Tips

When a pregnant women, changes occurred in the body that is natural to be prepared to welcome the coming of the heart. Changes for the body weight increases, changes in the skin, changes in the breast, etc..

Breast care is very important during pregnancy and breastfeeding period. This is because the breast is the only of breastfeeding is a staple food of the new born baby must be done so as early as possible.
This is the gift of God to the great women in which breastfeeding is the most suitable food for babies, most complete composition, and can not find artificial human milk formula.

Breast care during pregnancy has many benefits, including:
• Maintain hygiene, especially hygiene breast nipple.
• flex and strengthen the nipple making it easier for baby to suckle.
• stimulate gland gland-water, so milk production and breastfeeding more smoothly.
• Can detect a difference in breast-deviation early and make efforts to address them.
• Preparing mental (psychological) for breastfeeding mothers.

When a pregnant mother does not do well with the breast care and treatment only to the birth or after birth and often found cases that will harm the mother and baby. These cases frequently occur are:
• ASI does not exit. This is what often happens. Just days after the second or more.
• Putting prominent milk does not suck so hard baby.
• Production ASI quite a bit so it does not eat babies.
• Infection in the breast, breast swelling or purulent.
•Nodule Appears in the breast, etc..

These cases Allah can be prevented with early breast care possible. Following treatment of breast can be done:

a. Age 3 months of pregnancy
Check the nipple to see if the nipple or even go into how to squeeze the nipple base slowly. Teat the normal exit will be prominent. If the nipple still or even go back to the breast, since then 3 months pregnant to be done so that improvements can be prominent.
Way is to use both index finger or thumb, the area around the nipple sorted to the opposite direction to the primary breast until all the breast. Carried out twice a day for 6 minutes.

b. Age 6-9 months of pregnancy
• Both the hands drabble with coconut oil.
• areola mamae (the area around the hilt with a darker color) with a compressed coconut oil for 2-3 minutes. The goal is to soften the dirt or scaly patch on the nipple so easily cleaned. Do not clean with alcohol or other irritation of the nipple can cause a blister.
• The nipple are drawn ago, played to the direction in and to the outside (the opposite direction and counter-clockwise).
• breast with both hands held, and sorted to the nipple as 30 times a day.
• Massage the areola mamae to exit 1-2 tetas.
• The nipple and surrounding areas clean and dry with a clean towel.
• Wear a bra is not tight and sustain breast, do not wear a tight bra and a breast.

That these tips breast care. Do regularly and as early as possible.

Constipation during pregnancy

Tips Overcoming constipation dificult Or Dispose of Water During pregnancy.


Constipation or difficult to defecate is often a complaint during pregnancy. Why is this complaint occurred during pregnancy? tips and how to address them? ....

Why does constipation occur or difficult waste water during pregnancy is because:

The increase of the hormone progesterone that causes muscle relaxation so that the gut is less efficient.

In the third trimester of pregnancy where the stomach is up, constipation emphasis added by the uterus in the abdomen swell.

Tablet Zat Fe (iron) given by the doctor usually cause constipation problem also, besides iron tablets will cause the color feses (feces) nigrescence you, so do not worry.

What can you do to overcome the complaint is constipation during pregnancy?

Follow a few tips to constipation or difficult to defecate during pregnancy:

Drinking 6-8 glasses a quite a day.

Eat foods high as fibrous vegetables & fruits.

Perform regular sports such as running light (joging).

Consult your doctor if you are still difficult to defecate, after trying to do these tips.

Fractur

Introduction to fracture

Bones form the skeleton of the body and allow the body to be supported against gravity and to move and function in the world. Bones also protect some body parts, and the bone marrow is the production center for blood products.

Bone is not a stagnant organ. It is the body's reservoir of calcium and is always undergoing change under the influence of hormones. Parathyroid hormone increases blood calcium levels by leeching calcium from bone, while calcitonin has the opposite effect, allowing bone to accept calcium from the blood.

What causes a fracture?

When outside forces are applied to bone it has the potential to fail. Fractures occur when bone cannot withstand those outside forces. Fracture, break, or crack all mean the same thing. One term is not better or worse than another. The integrity of the bone has been lost and the bone structure fails.

Broken bones hurt for a variety of reasons including:

  • The nerve endings that surround bones contain pain fibers and and these fibers become irritated when the bone is broken or bruised.

  • Broken bones bleed, and the blood and associated swelling (edema) causes pain.

  • Muscles that surround the injured area may go into spasm when they try to hold the broken bone fragments in place, and these spasms cause further pain.

Often a fracture is easy to detect because there is obvious deformity. However, at times it is not easily diagnosed. It is important for the physician to take a history of the injury to decide what potential problems might exist. Moreover, fractures don't always occur in isolation, and there may be associated injuries that need to be addressed.

Fractures can occur because of direct blows, twisting injuries, or falls. The type of forces on the bone may determine what type of injury that occurs. Descriptions of fractures can be confusing. They are based on:

  • where in the bone the break has occurred,

  • how the bone fragments are aligned, and

  • whether any complications exist.

The first step in describing a fracture is whether it is open or closed. If the skin over the break is disrupted, then an open fracture exists. The skin can be cut, torn, or abraded (scraped), but if the skin's integrity is damaged, the potential for an infection to get into the bone exists. Since the fracture site in the bone communicates with the outside world, these injuries need to be cleaned out aggressively and many times require anesthesia in the operating room to do the job effectively.

Next, there needs to be a description of the fracture line. Does the fracture line go across the bone (transverse), at an angle (oblique) or does it spiral? Is the fracture in two pieces or is it comminuted, in multiple pieces?

What are common types of fractures?

Stress fracture

A stress fracture is an overuse injury. Because of repeated micro-trauma, the bone can fail to absorb the shock that is being put upon it and become weakened. Most often it is seen in the lower leg, the shin bone (tibia), or foot. Athletes are at risk the most, because they have repeated footfalls on hard surfaces. Tennis players, basketball players, jumpers, and gymnasts are typically at risk. A March fracture is the name given to a stress fracture of the metatarsal or long bones of the foot. (It is named because it often occurs in soldiers who are required to march long distances.)

Diagnosis is made by history and physical exam, though on occasion a bone scan may be done to confirm the diagnosis.

Treatment is conservative, rest, ice, and anti-inflammatory medication like ibuprofen. These fractures can take six to eight weeks to heal (as long as the fracture can be seen on x-ray). Trying to return too quickly can cause re-injury, and may also allow the stress fracture to extend through the entire bone.

Shin splints may have very similar symptoms as a stress fracture of the tibia but they are due to inflammation of the lining of the bone, called the periosteum. Shin splints are caused by overuse, especially in runners, walkers, dancers, including those who do aerobics. Muscles that run through the periosteum and the bone itself may also become inflamed.

Treatment is similar to a stress fracture and physical therapy can be helpful.

Compression fracture

As people age, there is a potential for the bones to develop osteoporosis, a condition where bones lose their calcium content. This makes bone more susceptible to breaking. One such type of injury is a compression fracture to the spine, most often the thoracic or lumbar spine. Since we are an upright animal, if the bones of the back are weaker than the force of gravity these bones can crumple. Pain is the major complaint, especially with movement.

Compression injuries of the back may or may not be associated with nerve or spinal cord injury. An x-ray of the back can reveal the bone injury, however, sometimes a CT scan or MRI will be used to insure that no damage is done to the spinal cord.

Treatment includes pain medication and often a back brace. Some compression fractures can also be treated with vertebroplasty. Vertebroplasty involves inserting a glue-like material into the center of the collapsed spinal vertebra in order to stabilize and strengthen the crushed bone. The glue (methylmethacrylate) is inserted with a needle and syringe through anesthetized skin into the midportion of the vertebra under the guidance of specialized x-ray equipment. Once inserted, the glue soon hardens, forming a cast-like structure with the locally broken bone.

What is the treatment of a fracture?

Initial treatment for fractures of the arms, legs, hands and feet in the field include splinting the extremity in the position it is found, elevation and ice. Immobilization will be very helpful with initial pain control. For injuries of the neck and back, many times, first responders or paramedics may choose to place the injured person on a long board and in a neck collar to protect the spinal cord from potential injury.

Once the fracture has been diagnosed, the initial treatment for most limb fractures is a splint. Padded pieces of plaster or fiberglass are placed over the injured limb and wrapped with gauze and an elastic wrap to immobilize the break. The joints above and below the injury are immobilized to prevent movement at the fracture site. This initial splint does not go completely around the limb. After a few days, the splint is removed and replaced by a circumferential cast. Circumferential casting does not occur initially because fractures swell (edema). This swelling would cause a build up of pressure under the cast, yielding increased pain and the potential for damage to the tissues under the cast.

Surgery

Surgery on fractures are very much dependent on what bone is broken, where it is broken, and whether the orthopedic surgeon believes that the break is at risk (for staying where it is) once the bone fragments have been aligned. If the surgeon is concerned that the bones will heal improperly, an operation will be needed. Sometimes bones that appear to be aligned normally are splinted, and at a recheck appointment, are found to be unstable and require surgery.

Surgery can include closed reduction and casting, where under anesthesia, the bones are manipulated so that alignment is restored and a cast is placed to hold the bones in that alignment. Sometimes, the bones are broken in such a way that they need to have metal hardware inserted to hold them in place. Open reduction means that, in the operating room, the skin is cut open and pins, plates, or rods are inserted into the bone to hold it in place until healing occurs. Depending on the fracture, some of these pieces of metal are permanent (never removed), and some are temporary until the healing of the bone is complete and surgically removed at a later time.

Monday, March 2, 2009

Influenza


Definition
Influenza infections are acute breath channel (ISPA), which usually occurs in
epidemi.common form when cold symptoms in the nose more
prominent, while the "influenza" refers to the deviation along
faringitis with a fever and a more sluggish real.
Causes
Many types of viruses cause, among others, Rhinovirus, Coronavirus, virus
Influenza A and B, Parainfluenza, Adenovirus. Usually this disease is cured
itself in 3 - 5 days.
Clinical picture
- Systemic symptoms typical form of acute virus infection symptoms, namely fever, headache,
muscle pain, joint pain, and lost appetite, accompanied by symptoms such as local
to encourage a sense painful throat, dry cough sometimes, nose
choke, sneezing, and nasal mucus thin.
- Throat hiperemia appear.
- In hollow nose looks swollen and konka that hipermia.
- Sekret can be serus, seromukus or mukopurulen when there is infection
secondary.
Diagnosis
- To know the complications, the examination should be performed: auskultasi
tuberculosis, ear status in children, who complained to the EKG chest pain
Treatment
- Advice relax and drink a lot of very important at this influenza.
Simtomatis treatment required to eliminate the symptoms felt
or the weight.
- Paracetamol 500 mg 3 x day or asetosal 300 - 500 mg x 3 a day either
to eliminate pain and fever.
- For children, paracetamol is a dose: 10 mg / kgBB / time, 3 - 4 times a day
- Antibiotics are given only if there is secondary infection.