Thursday, March 18, 2010
Molluscum Contagiosum (Dimple Warts)
3:37 PM | 
Diposkan oleh
Hermanto
Molluscum contagiosum is a viral disease that caused pox virus family that clinically form papuls, and there are grooves on the surface with a mass contain molluscum bodies. Molluscum warts occur characteristically in small children and in young adults, although they may be seen occasionally in any age group. The incubation of this warts is estimated to vary from 14 days to 6 months.
This warts usually starts from single or small lesion and then spread wide to face, trunk, extremities. For Young adults more often present with lesions on the lower abdomen, pubic escutcheon, or inner thighs contracted during sexual transmission.
For children, molluscum warts are usually spread by close physical contact. Especially with their activities such as swimming in pool facilities, communal shower facilities, and contact sports.
For young adult, the most common of transmission is sexual contact.
For people with low immunity such as AIDs, Leukemia, people with chemotherapy, this warts can be the provoking factor too.
Histopathologic examination can help us to diagnose this disease. We can find molluscum bodies that contain virus particles from infected epidermis.
Patient should avoid communal swimming pools, baths, and shared clothing items. Because that activities can make contamination to other people.
The principle of treatment is to remove the mass containing molluscum bodies. We can use tools such as blackheads extractor, syringes, or curette. For young adults, should also be therapy for their sexual partner.
The most effective in adult cases is Light freezing with liquid nitrogen (LN2). This treatment useful, non scaring and must be repeated every 10 to 14 days until clear.
The prognosis of this disease better if all the lesions have been removed.
Friday, March 12, 2010
Acute Pancreatitis
Acute pancreatitis is an inflammatory process arising in the exocrine pancreas, with variable involvement of peripancreatic tissues or remote organ systems. Incidence of acute pancreatitis from about 10 to 50 case per 100,000 per year.
Gallstone disease and alcoholism are the most common etiology of this disease in industrialized country. Other etiologies are infection (ascariasis, mumps, cytomegalo virus infection), hyperlipidemia, chronic hypercalcemia, abdominal trauma (blunt or penetrating), surgery.
Acute pancreatitis primary complain is abdominal pain (about 95%). The characteristic of this pain are epigastric location and radiates to the back in one-half to two-thirds of patients and usually worsened by ingesting food or alcohol or by vomiting. Patient usually assume a knee-to-chest position to relief their pain. Other symptoms are nausea, vomiting and distention of abdominal.
On examination, abdominal tenderness is usually present. It may be mild and limited to the epigastrium or marked, diffuse, and accompanied by abdominal rigidity and rebound tenderness.
Fever, tachycardia, tachypnea and hypotension manifest depend of the severity of this disease. Patient with biliary obstruction usually present icterus.
Serum amylase consentration has been used to diagnose acute pancreatitis for more than 70 years. But serum amylase levels may also be elevated in several conditions that can closely mimic acute pancreatitis (e.g., cholangitis, gastrointestinal perforation or ischemia, ruptured ectopic pregnancy).
Abdominal CT scan also has a great contribution to help us diagnose acute pancreatitis. Abdominal ultrasonography may be useful in determining whether gallstones are the cause of an episode of acute pancreatitis.
Providing supportive care, Decreasing pancreatic inflammation and preventing the complications are the goal of treatment. For mild acute pancreatitis, patient need full bed rest, intravenous hydration and electrolytes, analgesia to relief pain. For severy acute pancreatitis, patient usually need an intensive care unit with careful attention to monitoring of hemodynamics , urine output, and respiratory and renal function. Patients should initially be kept at bed rest with no oral intake, and large amounts of intravenous narcotic analgesics are typically needed for pain relief as well as nasogastric suction for treatment of severe ileus, nausea, and vomiting. Several pharmacologic agents have been tried to inactivate trypsin and other serine proteases, decrease pancreatic secretion and reduce inflammation.
The most lethal complication is hypovolemia shock due to transudation and exudation of fluid into the retroperitoneum and peritoneum.
Friday, March 5, 2010
Learning about Antrax
Antrax isi zoonotic infection caused by Bacillus anthracis (an aerobic, nonmotile, gram-positive bacillus). Antrax causes human disease by way of direct animal contact or through exposure to contaminated animal hides, meat or other products. No human-to-human transmission has been demonstrated.
In 1979, in Sverdlovsk in the former Soviet Union, the largest known epidemic of inhalational anthrax occurred; it was later found to have been the result of an accidental release of anthrax spores from a military research facility.
Antrax can manifest to cutaneus type (the most cases), inhalational, oropharyngeal, gastrointestinal, sepsis, and meningeal disease. The cutaneus type is beginning as a nonspecific, erythematous, painless, pruritic papule or macule that appears after an incubation period of 3 to 4 days. This type is usually more severe on the neck or face than on the trunk or extremities. The vesicle subsequently ulcerates and forms a characteristic centrally depressed black chancre (or malignant pustule). For inhalation type or wool sorter's disease, this disease begins with an influenza-like prodrome that lasts for 1 to 6 days, followed by sudden deterioration with dyspnea, strider, cyanosis, and hypoxemia. Spesific clinical manifestation of this type is widening of the mediastinum due to hilar adenopathy.
Laboratory confirmation can be made by demonstration of the causative organism in blood, tissue fluids, and exudates by direct microscopic examination and culture, or by animal inoculation. Another laboratory studies are ELISA, PCR and a rapid hand-held immunochromatographic assay. Drug of choice of this disease is Penicillin that virtually eliminates the spread of cutaneous anthrax and essentially reduces the mortality rate to zero. Another alternative drugs are tetracycline, erythromycin, chloramphenicol, and ciprofloxacin.
To prevent Antrax, we should give vaccination of domestic livestock, prohibition of the slaughter of unvaccinated animals, and burning of animals suspected of having anthrax.
Wednesday, March 3, 2010
Brain Abscess
Brain abscess affects the brain's parenchyma directly, whereas parameningeal infections produce suppuration in potential spaces covering the brain and spinal cord (epidural abscess and subdural empyema) or produce occlusion of the contiguous venous sinuses and cerebral veins (cerebral venous sinus thrombosis).
The condition that predispose to the development brain abscess are : otogenic (otitis media, mastoiditis), dental (dental abscess), penetrating or non penetrating head injury, cerebral infarction and tumor, post operative neurosurgical procedure, sinus (sinusitis), cardiac (infective endocarditis), pulmonary (lung abscess, bronchiectasis).
Clinical manifestation that usually present are fever, meningeal sign, increasing intracranial mass effect (nausea, depressed level of consciousness, and papilledema). Focal neurologic deficits depend on the site of the lesion, which in turn will be determined by the causal or predisposing condition. Headache is an important initial symptom in 80 to 90% of patients with bacterial abscess.
Examination of the cranium, ears, paranasal sinuses, oral cavity, heart, and lungs may provide important clues to the etiology. lumbar puncture is contraindicated for patients with signs of increased intracranial pressure. Cultures of blood and sputum may identify the organism and its antimicrobial sensitivity.
Magnetic resonance imaging (MRI) allows detection of early changes, such as brain edema, and is preferable to computed tomography (CT).
Brain abscess need urgent intervention. Because of the risk for cerebral herniation with large lesions, treatment of cerebral edema (intravenous dexamethasone) may be needed even while initiating surgical intervention.
Nonsurgical treatment may be considered in patients with : small lesion size, an already identified pathogen, no symptoms or signs of increased intracranial pressure requiring neurosurgical intervention, a deep or inaccessible lesion, multiple abscesses, a contraindication to surgery (e.g., a bleeding diathesis).
Factors associated with a poor prognosis include age, multiple abscesses, and diagnostic delay in the absence of systemic signs of infection.
Tuesday, March 2, 2010
Silicosis
Silicosis refers to the parenchymal lung diseases associated with crystalline silica exposure, including acute, accelerated, and chronic or classic silicosis. For acute silicosis, an alveolar filling process follows heavy exposure within a few years. 5-10 years for accelerated silicosis and more than 10 years for chronic silicosis.
Free silica (SiO2), or crystalline quartz, is still a major occupational hazard. The major occupational exposures include: mining, employment in abrasive industries (e.g. stone, clay, glass, and cement manufacturing), packing of silica flour, stonecutting, foundry work.People with acute silicosis presents with rapidly progressive dyspnea, they are also at increased risk for mycobacterial infection (with weight loss and fever manifestation).
The diagnosis of chronic silicosis is made on the basis of characteristic radiographic findings and history of employment in a job associated with exposure to silica-containing dust. But we must consider another differential diagnosis for lung masses such as lung cancer, mycobacterial infection.
The chest radiography of chronic silicosis shows small nodules that tend to predominate in the upper lobes. Calcification of the nodules is rare, as is so-called eggshell calcification of enlarged hilar nodes. In acute silicosis, we can find widespread consolidation in chest radiograph. CT may be helpful both in identifying nodules, which are preferentially located in the posterior aspect of the upper lobes, as well as in identifying larger opacities and more coalescence than might be noted on regular chest x-rays.Treatment of silicosis are supportive therapy such as oxygen and rehabilitation. Diagnosis and treatment of mycobacterial infection also important, because silicosis can increase risk factor of this infection.
The prognosis of accelerated silicosis and acute silicosis is poor because of progressiveness loss of lung function. For chronic silicosis, it can lead to progressive impairment and respiratory failure.
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