Archive for June, 2011

KNEE FRACTURE: STRESS FRACTURES

Posted on June 21, 2011, under Healthy bones Osteoporosis Rheumatic.

“I played a lot of tennis over the weekend, and I woke up Monday morning and my knee was killing me. I limped around for a week or so, and then I felt a lot better.” When I hear this kind of complaint from a patient who otherwise checks out to be completely normal, I immediately consider the possibility that he may have had a stress fracture. A stress fracture is a microscopic crack in the bone’s surface. Although it is not a serious injury, it can be a very painful one.
Stress fractures can occur when bones are overworked. If you sliced a piece of bone and looked at it under a high-powered microscope, you would see that bone is a hotbed of activity. Bone cells are constantly engaged in a process called remodeling: new bone is being laid down by bone-building cells called osteoblasts while old bone is being absorbed by cells called osteoclasts. In fact, an adult skeleton turns over every 7 years, and a child’s skeleton turns over even more rapidly. Stress fractures can occur when normal force is applied to bone at a time when it is remodeling. Overworked and overstressed, the bone gives way, resulting in microscopic cracks. The only symptom of a stress fracture is pain and tenderness to the touch. Most people have had stress fractures at one time or another and may not have even have realized it. The pain may be here one day and gone the next, and all is forgotten. However, if the pain persists—and sometimes it does—it may warrant an examination by a physician, mostly to rule out other potential problems.
Diagnosis
Physical Examination. The only positive finding on a physical examination is localized tenderness at the site of the stress fracture. Occasionally, there might be associated swelling. The stress fracture is rarely, if ever, intraarticular (within the joint) but more characteristically on the tibia (shinbone).
An MRI or Bone Scan. Because it is so small, a stress fracture cannot be detected on plain X rays until the bone begins to heal, and the body lays down a callus, a layer of new bone over the crack. A normal X ray may not be able to pick up an early stress fracture, but a bone scan or an MRI will note the increased vascularity, which will have a characteristic pattern for stress fractures.
Treatment
Stress fractures normally heal by the themselves within 3 to 6 weeks. Ice and over-the-counter analgesics can help to relieve pain. Any activity that causes a great deal of discomfort during this healing period should be avoided, otherwise, you can pursue your usual activities.
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SURGICAL APPROACHES TO EPILEPSY: SURGERY FOR PARTIAL (FOCAL) SEIZURES – EVALUATION OF LANGUAGE

Posted on June 19, 2011, under Epilepsy.

Speech is usually located on the left side of the brain, in the posterior temporal lobe (see Chapter 6). However, in 10 to 15 percent of left-handed people speech is on the right side. It is vital to know where it is before proceeding with surgery.
The Wada test, named after the neurosurgeon Dr. Juhn Wada, is designed to localize speech and memory. A catheter is threaded from the groin of the awake patient up to the internal carotid artery, the main artery supplying one side of the brain. After a small injection of a dye, which can be seen on x-ray, a small amount of barbiturate is injected and that side of the brain is briefly “put to sleep.”
As the test begins, the patient is asked to hold his arms up in the air and to count. If the injection is done on the left side of the brain, the right arm becomes weak as the left side of the brain goes “to sleep.” If speech is on that same side, the child will simultaneously, but briefly, lose the ability to speak or count. Memory is also tested by showing objects and pictures. When the medication wears off, the patient will be asked to recall the objects he has seen. If lost, speech and memory quickly return when the drug wears off. In this crude fashion the laterality (side) of speech is determined. The same procedure may also be carried out on the other side of the brain, because occasionally speech is located on both sides.
If injecting the right side produces no alteration in speech or memory, then it can be assumed that it is safe to operate on that side. If speech is on the left and the surgery is to be done near that area, then far more careful evaluation of speech, language, and the epileptic focus must precede a decision about surgery.
Detailed neuropsychological testing may be performed prior to surgery to assess the person’s intellectual function and personality. This may help in understanding if certain parts of the brain previously have been damaged.
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DIABETES AND EXERCISE THERAPY: EXERCISE AND TYPES-1,2 DIABETES EXERCISE AND TYPE-1 DIABETES

Posted on June 8, 2011, under Diabetes.

Special Instructions:
General guide lines for type-1 diabetes patients.
1. Metabolic control before exercise.
avoid exercise if FBS>250 + ketosis.
avoid exercise if FBS>300 without ketosis.
Ingested added carbohydrate if glucose levels are <100 mg/dl.
2. Blood glucose monitoring before and after exercise.
Identifying when changes in insulin or food intake are necessary.
Learn the blood sugar responses to different exercise conditions.
3. Food Intake
Consume added carbohydrate as needed to avoid hypoglycaemia (low sugar reactions).
Carbohydrate food should be readily available during and after exercise.
Extra food for extra exercise.
EXERCISE AND TYPE-2 DIABETICS (NON -INSULIN
DEPENDENT OR INSULIN REQUIRING DIABETICS)
In type 2 diabetes insulin resistance syndrome is one of the important risk factor for premature CAD, concomitant hypertension, hyperinsulinaemia, central obesity, hypertriglyceridaemia, Low HDLC, high LDL, elevated FFA.
Important: In many of these, risk factors are linked with improvement (decrease) in plasma insulin levels and it is likely that many of the beneficial effects of exercise on cardiovascular risk are related to improvement in insulin sensitivity.
HYPERLIPIDEMIA
VLDL   …. Regular exercise effective in reducing levels of Triglyceride (TG) richVLDL.
LDL     …. However, effects on LDL by regular exercise have not been
consistently documented. HDL    …. Most studies fail to document increase in HDL cholesterol with
type 2 diabetes.
HYPERTENSION
Effects of exercise on reducing blood pressure levels have been demonstrated most consistently in hyperinsulinemic subjects.
OBESITY
Data suggesting that exercise may enhance weight loss when used along with appropriate caloric controlled meal plan.
FIBRINOLYSIS
Many patients with type 2 diabetes have impaired fibrinolytic activity associated with elevated levels of plasminogen activator inhibitor-1 (PAI-1). There is no clear cut consensus whether physical training results in improved fibrinolytic activity in these patients.
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