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Peripheral nerve tumors

Schwannoma in the leg
A schwannoma is a type of nerve tumor of the nerve sheath. It’s the most common type of benign peripheral nerve tumor in adults. It can occur anywhere in your body, at any age.
A schwannoma typically comes from a single bundle (fascicle) within the main nerve and displaces the rest of the nerve. When a schwannoma grows larger, more fascicles are affected, making removal more difficult. In general, a schwannoma grows slowly.
If you develop a schwannoma in an arm or leg, you may notice a painless lump. Schwannomas are rarely cancerous, but they can lead to nerve damage and loss of muscle control. See your doctor if you have any unusual lumps or numbness.
Diagnosis
To diagnose a schwannoma, your doctor may ask you about signs and symptoms, discuss your medical history, and perform both a general physical and neurological exam. If signs suggest that you could have a schwannoma or other nerve tumor, your doctor may recommend one or more of these diagnostic tests:
  • Magnetic resonance imaging (MRI). This scan uses a magnet and radio waves to produce a detailed, 3-D view of your nerves and surrounding tissue.
  • Computerized tomography (CT). A CT scanner rotates around your body to record a series of images. A computer uses the images to make a detailed view of your growth so that your doctor can evaluate how it may be affecting you.
  • Electromyogram (EMG). For this test, your doctor places small needles in your muscles so an electromyography instrument can record the electrical activity in your muscle as you try to move it.
  • Nerve conduction study. You’re likely to have this test along with your EMG. It measures how quickly your nerves carry electrical signals to your muscles.
  • Tumor biopsy. If imaging tests identify a nerve tumor, your doctor may remove and analyze a small sample of cells (biopsy) from your tumor. Depending on the tumor’s size and location, you may need local or general anesthesia during the biopsy.
  • Nerve biopsy. If you have a condition such as progressive peripheral neuropathy or enlarged nerves that mimic nerve tumors, your doctor may take a nerve biopsy.
Treatment
Schwannoma treatment depends on where the abnormal growth is located and whether it is causing pain or growing quickly. Treatment options include:
  • Monitoring. Your doctor may suggest observing your condition over time. Observation may include regular checkups and a CT or MRI scan every few months to see if your tumor is growing.
  • Surgery. An experienced peripheral nerve surgeon can remove the tumor if it is causing pain or growing quickly. Schwannoma surgery is done under general anesthesia. Depending on the location of the tumor, some patients can go home the day of surgery. Others may need to stay in the hospital for one or two days. Even after successful removal of the tumor during surgery, a tumor may recur.
  • Radiation therapy. Radiation therapy is used to help control the tumor growth and improve your symptoms. It may be used in combination with surgery.
  • Stereotactic radiosurgery. If the tumor is near vital nerves or blood vessels, a technique called stereotactic body radiation therapy may be used to limit damage to healthy tissue. With this technique, doctors deliver radiation precisely to a tumor without making an incision.
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Skin biopsy generally safe procedure

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A skin biopsy is a generally safe procedure, but complications can occur, including:
  • Bleeding
  • Bruising
  • Scarring
  • Infection
  • Allergic reaction to the topical antibiotic
How you prepare
Before the skin biopsy, tell your doctor if you:
  • Have been diagnosed with a bleeding disorder
  • Have experienced excessive bleeding after other medical procedures
  • Are taking blood-thinning medications, such as aspirin, aspiring-containing medications, warfarin (Coumadin) or heparin
  • Have a history of skin infections, including impetigo
  • Are taking medications that suppress the immune system, such as diabetes medications or medications used after an organ transplant
What you can expect
Depending on the location of the skin biopsy, you may be asked to undress and change into a clean gown. A doctor or nurse then cleans the area of the skin to be biopsied. Your skin may be marked with a surgical marker or marking pen to outline the biopsy area.
You then receive a local anesthetic to numb the biopsy site. This is usually given by injection with a thin needle. The numbing medication can cause a burning sensation in the skin for a few seconds. Afterward, the biopsy site is numb and you shouldn’t feel any pain or discomfort during the skin biopsy.
During the skin biopsy
What you can expect during your skin biopsy depends on the type of biopsy you’ll undergo.
  • For a shave biopsy, your doctor uses a sharp tool, double-edged razor or scalpel to cut the tissue. The depth of the incision varies depending on the type of biopsy and the part of the body being biopsied. A shave biopsy causes bleeding. Bleeding is stopped by applying pressure to the area or by a combination of pressure and a topical medication applied to the biopsy site.
  • For a punch biopsy or an excisional biopsy, the procedure involves cutting into the top layer of fat beneath the skin, so stitches may be needed to close the wound. A dressing or adhesive bandage is then placed over the site to protect the wound and prevent bleeding.
A skin biopsy typically takes about 15 minutes total, including the preparation time, dressing the wound and instructions for at-home care.
After the skin biopsy
Your doctor may instruct you to keep the bandage over the biopsy site until the next day. Occasionally, the biopsy site bleeds after you leave the doctor’s office. This is more likely in people taking blood-thinning medications. If this occurs, apply direct pressure to the wound for 10 to 20 minutes. If bleeding continues, contact your health care provider.
All biopsies cause a small scar. Some people develop a prominent, raised scar. The risk of this is increased when a biopsy is done on the neck or upper torso, such as the back or chest. Initially, the scar will be pink and then fade to white or sometimes brown. Scars fade gradually. The scar’s permanent color will be evident one or two years after the biopsy.
Try not to bump the biopsy site area or do activities that might stretch the skin. Stretching the skin could cause the wound to bleed or enlarge the scar.
Healing of the wound can take several weeks, but is usually complete within two months. Wounds on legs and feet tend to heal slower than those on other areas of the body.
How to care for the biopsy site while it heals:
  • Wash your hands with soap and water before touching the biopsy site.
  • Wash the biopsy site with soap and water. If the biopsy site is on your scalp, use shampoo.
  • Rinse the site well.
  • Pat the site dry with a clean towel.
  • Cover the site with an adhesive bandage that allows the skin to ventilate.
Continue caring for the biopsy site until the stitches are removed. For shave biopsies that don’t require stitches, continue wound care until the skin is healed.
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Female infertility Ovulation disorders

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Ovulation disorders, meaning you ovulate infrequently or not at all, account for infertility in about 1 in 4 infertile couples. Problems with the regulation of reproductive hormones by the hypothalamus or the pituitary gland, or problems in the ovary, can cause ovulation disorders.

  • Polycystic ovary syndrome (PCOS). PCOS causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It’s the most common cause of female infertility.
    Hypothalamic dysfunction. Two hormones produced by the pituitary gland are responsible for stimulating ovulation each month — follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt production of these hormones and affect ovulation. Irregular or absent periods are the most common signs.
    Premature ovarian failure. Also called primary ovarian insufficiency, this disorder is usually caused by an autoimmune response or by premature loss of eggs from your ovary (possibly from genetics or chemotherapy). The ovary no longer produces eggs, and it lowers estrogen production in women under the age of 40.
    Too much prolactin. The pituitary gland may cause excess production of prolactin (hyperprolactinemia), which reduces estrogen production and may cause infertility. Usually related to a pituitary gland problem, this can also be caused by medications you’re taking for another disease.

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Evening primrose

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Evening primrose is a plant with yellow flowers.
primrose oil extracted from plant seeds is usually sold in capsules. The supplement contains the fatty acid gamma-linolenic acid (GLA).
People take evening primrose oil orally to treat a wide variety of conditions.
Research on evening primros use for specific conditions shows:
  • Atopic dermatitis (eczema). Research on oral use of evening primros oil to treat eczema has produced conflicting results. The most comprehensive evaluation is that evening primros taken orally doesn’t effectively relieve the signs and symptoms of eczema.
  • Diabetic neuropathy. Research on the use of evening primros oil to treat this type of nerve damage that can occur if you have diabetes has been inconclusive.
  • Premenstrual syndrome (PMS). Research suggests no benefit for oral use of evening primros oil to treat symptoms of PMS.
While evening primros oil is probably safe for most people to take short term, research doesn’t support the use of the supplement as a treatment for any condition.
Safety and side effects
When taken in appropriate amounts short term, oral use of evening primros oil is most likely safe.
Evening primros oil can cause:
  • Upset stomach
  • Headache
Don’t take evening primrose if you have a bleeding disorder. Oral use of the supplement might increase the risk of bleeding. If you’re planning to have surgery, stop taking evening primrose two weeks beforehand.
Also, don’t take evening primrose if you have epilepsy or schizophrenia. The supplement might increase your risk of seizures.
Evening primrose oil might increase the risk of pregnancy complications.
Interactions
Possible interactions include:
  • Anticoagulants and anti-platelet drugs, herbs and supplements. These types of drugs, herbs and supplements reduce blood clotting. Combining oral use of evening primrose oil with them might increase the risk of bleeding.
  • Cytochrome P450 3A4 (CYP3A4) substrates. Use evening primrose cautiously if you’re taking a drug affected by these enzymes, such as lovastatin (Altoprev).
  • Lopinavir and ritonavir (Kaletra). This combined medication is used in the treatment of the infection caused by the human immunodeficiency virus (HIV). Evening primrose oil might slow down how quickly this medication is broken down in the body.
  • Phenothiazines. Taking evening primrose oil with these drugs used to treat serious mental and emotional disorders might increase risk of seizures in some people.
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Pseudotumor cerebri

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Pseudotumor cerebri (SOO-doe-too-mur SER-uh-bry) occurs when the pressure inside your skull (intracranial pressure) increases for no obvious reason. It’s also called idiopathic intracranial hypertension.

Symptoms mimic those of a brain tumor. The increased intracranial pressure can cause swelling of the optic nerve and result in vision loss. Medications often can reduce this pressure and the headache, but in some cases, surgery is necessary.

Pseudotumor cerebri can occur in children and adults, but it’s most common in women of childbearing age who are obese.

Symptoms

Pseudotumor cerebri signs and symptoms might include:

  • Often severe headaches that might originate behind your eyes
  • A whooshing sound in your head that pulses with your heartbeat
  • Nausea, vomiting or dizziness
  • Vision loss
  • Brief episodes of blindness, lasting a few seconds and affecting one or both eyes
  • Difficulty seeing to the side
  • Double vision
  • Seeing light flashes
  • Neck, shoulder or back pain

Sometimes, symptoms that have resolved can recur months or years later.

Causes

The cause of pseudotumor cerebri is unknown. If a cause is determined, the condition is called secondary intracranial hypertension, rather than idiopathic.

Your brain and spinal cord are surrounded by cerebrospinal fluid, which cushions these vital tissues from injury. This fluid is produced in the brain and eventually is absorbed into the bloodstream at a rate that usually allows the pressure in your brain to remain constant.
The increased intracranial pressure of pseudotumor cerebri might result from a problem in this absorption process.
Risk factors
The following factors have been associated with pseudotumor cerebri:
Obesity
Obese women of childbearing age are more likely to develop the disorder.

Medications

Substances linked to secondary intracranial hypertension include:

  • Growth hormone
  • Tetracycline
  • Too much vitamin A

Health problems

Conditions and diseases that have been linked to secondary intracranial hypertension include:

  • Addison’s disease
  • Anemia
  • Blood-clotting disorders
  • Kidney disease
  • Lupus
  • Polycystic ovary syndrome
  • Sleep apnea
  • Underactive parathyroid glands

Complications

For some people with pseudotumor cerebri, their vision continues to worsen, leading to blindness.

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Caution : Vitamin E

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Most people get enough vitamin E from a balanced diet. If you’ve been diagnosed with mild to moderate Alzheimer’s disease, some research suggests that vitamin E therapy might help slow disease progression.
However, oral use of vitamin E might increase the risk of prostate cancer. Use of the supplement can pose other serious risks, particularly at high doses and if you have other health conditions or have had a heart attack or stroke.
Safety and side effects
When taken at appropriate doses, oral use of vitamin E is generally considered safe. Rarely, oral use of vitamin E can cause:
  • Nausea
  • Diarrhea
  • Intestinal cramps
  • Fatigue
  • Weakness
  • Headache
  • Blurred vision
  • Rash
  • Gonadal dysfunction
  • Increased concentration of creatine in the urine (creatinuria)
Taking higher doses of vitamin E might increase the risk of side effects. Also, there is concern that people in poor health who take high doses of vitamin E are at increased risk of death.
Use of vitamin E can interact with many conditions. For example, research suggests that oral use of vitamin E might increase the risk of prostate cancer. Other research suggests that vitamin E use might increase the risk of death in people with a severe history of heart disease, such as heart attack or stroke. Talk with your doctor before taking vitamin E if you have:
  • A vitamin K deficiency
  • An eye condition in which the retina is damaged (retinitis pigmentosa)
  • Bleeding disorders
  • Diabetes
  • A history of a previous heart attack or stroke
  • Head and neck cancer
  • Liver disease
The supplement might increase your risk of bleeding. If you’re planning to have surgery, stop taking vitamin E two weeks beforehand. Also, talk to your doctor about vitamin E use if you’re about to have or you just had a procedure to open blocked arteries and restore normal blood flow to your heart muscle (angioplasty).
Interactions
Use of some drugs can affect your vitamin E  balanced diet levels. Possible interactions include:
  • Alkylating agents and anti-tumor antibiotics. There’s concern that high doses of vitamin E might affect the use of these chemotherapy drugs.
  • Anticoagulants and anti-platelet drugs, herbs and supplements. Use of vitamin E with these drugs, herbs and supplements to reduce blood clotting might increase the risk of bleeding.
  • Cytochrome P450 3A4 (CYP3A4) substrates. Use caution when taking vitamin E and other drugs affected by these enzymes, such as omeprazole (Prilosec, Zegerid).
  • Statins and niacin. Taking vitamin E with statins or niacin, which might benefit people with high cholesterol, could reduce niacin’s effect.
  • Vitamin K. Taking vitamin E with vitamin K might decrease the effects of vitamin K.

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High blood pressure (hypertension)

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High blood pressure (hypertension) is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.
Blood pressure (hypertension) is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps hypertension and the narrower your arteries, the higher your blood pressure. A blood pressure reading is given in millimeters of mercury (mm Hg). It has two numbers.
  • Top number (systolic pressure). The first, or upper, number measures the pressure in your arteries when your heart beats.
  • Bottom number (diastolic pressure). The second, or lower, number measures the pressure in your arteries between beats.
You can have high blood pressure for years without any symptoms. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.
Symptoms
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.
A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms aren’t specific and usually don’t occur until high blood pressure has reached a severe or life-threatening stage.
When to see a doctor
You’ll likely have your blood pressure taken as part of a routine doctor’s appointment.
Ask your doctor for a blood pressure reading at least every two years starting at age 18. If you’re age 40 or older, or you’re 18 to 39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year.
Blood pressure generally should be checked in both arms to determine if there’s a difference. It’s important to use an appropriate-sized arm cuff.
Your doctor will likely recommend more-frequent readings if you’ve already been diagnosed with high blood pressure or have other risk factors for cardiovascular disease. Children age 3 and older will usually have blood pressure measured as a part of their yearly checkups.
If you don’t regularly see your doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free.
Public blood pressure machines, such as those found in pharmacies, may provide helpful information about your blood pressure, but they may have some limitations. The accuracy of these machines depends on several factors, such as a correct cuff size and proper use of the machines. Ask your doctor for advice on using public blood pressure machines.
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Cortisone shots

Are Cortisone Injections Safe

Cortisone shots are injections that can help relieve pain and inflammation in a specific area of your body. They’re most commonly injected into joints — such as your ankle, elbow, hip, knee, shoulder, spine or wrist. Even the small joints in your hands or feet might benefit from cortisone shots.

The injections usually contain a corticosteroid medication and a local anesthetic. Often, you can receive one at your doctor’s office. Because of potential side effects, the number of shots you can get in a year generally is limited.

Why it’s done

Cortisone shot might be most effective in treating inflammatory arthritis, such as rheumatoid arthritis. They can also be part of treatment for other conditions, including:

  • Back pain
  • Bursitis
  • Gout
  • Osteoarthritis
  • Psoriatic arthritis
  • Reactive arthritis
  • Rheumatoid arthritis
  • Tendinitis

Risks

Potential side effects of cortisone shots increase with larger doses and repeated use. Side effects can include:

  • Cartilage damage
  • Death of nearby bone
  • Joint infection
  • Nerve damage
  • Temporary facial flushing
  • Temporary flare of pain and inflammation in the joint
  • Temporary increase in blood sugar
  • Tendon weakening or rupture
  • Thinning of nearby bone (osteoporosis)
  • Thinning of skin and soft tissue around the injection site
  • Whitening or lightening of the skin around the injection site

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Gonorrhea

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Gonorrhea is an infection caused by a sexually transmitted bacterium that infects both males and females. Gonorrhea most often affects the urethra, rectum or throat. In females, gonorrhea can also infect the cervix.

Gonorrhea is most commonly spread during vaginal, oral or anal sex. But babies of infected mothers can be infected during childbirth. In babies, gonorrhea most commonly affects the eyes.

Abstaining from sex, using a condom if you have sex and being in a mutually monogamous relationship are the best ways to prevent sexually transmitted infections.

Symptoms
Male reproductive system
Male reproductive systemOpen pop-up dialog boxFemale reproductive organs
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In many cases, gonorrhea infection causes no symptoms. Symptoms, however, can affect many sites in your body, but commonly appear in the genital tract.

affecting the genital tract
Signs and symptoms of gonorrhea infection in men include:

Painful urination
Pus-like discharge from the tip of the penis
Pain or swelling in one testicle
Signs and symptoms of gonorrhea infection in women include:

Increased vaginal discharge
Painful urination
Vaginal bleeding between periods, such as after vaginal intercourse
Abdominal or pelvic pain at other sites in the body can also affect these parts of the body:

Rectum. Signs and symptoms include anal itching, pus-like discharge from the rectum, spots of bright red blood on toilet tissue and having to strain during bowel movements.
Eyes. Gonorrhea that affects your eyes can cause eye pain, sensitivity to light, and pus-like discharge from one or both eyes.
Throat. Signs and symptoms of a throat infection might include a sore throat and swollen lymph nodes in the neck.
Joints. If one or more joints become infected by bacteria (septic arthritis), the affected joints might be warm, red, swollen and extremely painful, especially during movement.
When to see your doctor
Make an appointment with your doctor if you notice any troubling signs or symptoms, such as a burning sensation when you urinate or a pus-like discharge from your penis, vagina or rectum.

Also make an appointment with your doctor if your partner has been diagnosed with gonorrhea. You may not experience signs or symptoms that prompt you to seek medical attention. But without treatment, you can reinfect your partner even after he or she has been treated for gonorrhea.

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Chronic Back Pain Might Suggest Ankylosing Spondylitis

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Back pain with different severity degrees can be caused by a wide range of medical conditions. Acute back pain can be treated effectively if accurate diagnosis can be timely made. However, if back pain progresses to chronic and severe pain without adequate response to given treatments, it might strongly indicate arthritic disease, called ankylosing spondylitis. Ankylosing spondylitis is defined as an inflammatory disease that, over time, can cause some of the small bones in the spine (vertebrae) to fuse. This fusing makes the spine less flexible, resulting in stiffness and chronic back pain that can largely interfere with quality of life. If warning signs and symptoms of ankylosing spondylitis arise, medical attention and treatment must be sought immediately.  

Causes And Risk Factors

Definite cause of ankylosing spondylitis remains unknown, although genetic alterations seem to be involved. People who have the HLA-B27 gene are at a greatly increased risk of developing ankylosing spondylitis. However, other contributing factors are certain infections and exposure to particular substances.

Get To Know Ankylosing Spondylitis

Spondyloarthritis is a group of diseases characterized by inflammation in the spine (spondylitis) and joints (arthritis). Ankylosing spondylitis is one type of spondyloarthritis, defined as a long-term inflammation of the joints of the spine. This fusion can stiffen the spine, leading to less flexibility, severe back pain and inability to move. In some patients, stiffness of other joints might be present e.g. ankle, knee and hip.

 Diagnosis

Diagnostic tests of ankylosing spondylitis usually involve:

  • Medical history: The doctor conducts medical reviews to identify pain location, pain intensity and duration as well as to collect patient’s medical history.

  • Physical examination: During physical examination, the doctor might ask the patient to bend in different directions for testing the range of motion in the spine.

  • Blood tests: Blood tests can check for markers of inflammation and the HLA-B27 gene which is a major factor to develop the disease. Nonetheless

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