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Friday, August 12, 2011

Medical treatment of Fibroid uterus ( pros and cons )

         Consultant, if indicate and at the last , on willingness of patient  may prescribe drugs called gonadotropin-releasing hormone agonists (GnRH agonists) to treat fibroids. Most fibroids shrink by one-third to one-half of their original size after two to three months of treatment with these drugs.            
      Smaller fibroids may cause fewer problems and they are often easier to remove surgically.
             Women should not take GnRH agonists for more than six months. After that, the drugs can cause rapid bone loss, leading to osteoporosis. 
       Fibroids generally start to grow again once drug treatment stops. Most women stop having menstrual periods while they are taking GnRH agonists.
          GnRH agonists are drugs that are chemically similar to gonadotropin-releasing hormone (GnRH). This hormone is produced by the hypothalamus, a region in the brain.
         GnRH stimulates the release of other hormones from the pituitary gland, a pea-sized gland at the base of the brain. These other hormones are luteinizing hormone and follicle-stimulating hormone. They, in turn, stimulate the ovaries to produce estrogen. GnRH agonists block that process, shutting down estrogen production. Deprived of estrogen, fibroids shrink.
                 Some are also approved to treat fibroids in women with anemia (low blood count) who are planning to undergo surgery.
       Doctors may use these drugs in more than one way to treat fibroids.
  • If a woman is close to menopause, a doctor may prescribe GnRH agonists for a few months to shrink her fibroids. After menopause, fibroids shrink naturally because estrogen levels in the body decline.
  • A doctor may prescribe GnRH to shrink fibroids before a woman has surgery. Smaller fibroids may make it possible for a woman to have a vaginal hysterectomy instead of an abdominal one. She may also be able to have laparoscopic surgery, which requires a shorter hospital stay and has a faster recovery time.
              By blocking estrogen production, GnRH agonists mimic a process that occurs naturally at menopause. The side effects of these drugs are similar to the problems many women have when they go through menopause.
            The most common problem (experienced by about 19 out of 20 women) is hot flashes-episodes of suddenly feeling very warm in the face or upper body. During a hot flash, a woman may blush, perspire, or feel her pulse racing. A cold chill may follow the hot flash. Hot flashes are caused by declining or unstable estrogen levels in the body.
Other less common side effects of GnRH agonists include:
  • vaginal dryness
  • irregular vaginal bleeding
  • headaches
  • thinning of the hair
  • pain in the bones, joints, and muscles
  • sleep problems
  • mood changes
  • loss of sex drive
           Doctors may also prescribe synthetic hormones to reduce heavy bleeding caused by fibroids. Progestogen is a synthetic version of the female hormone progesterone, which-like estrogen-is made by the ovaries. Androgens (male sex hormones) may also be used to control excessive bleeding caused by fibroids. 
             These synthetic hormones do not shrink fibroids.
          Some doctors may prescribe a GnRH agonist in combination with a low dose of estrogen or progestogen. Low doses of these hormones may reduce the side effects of GnRH agonists, which may allow women to be treated safely with these drugs for a longer time.

         Fibroid Uterus are increasing in rate of frequency that other drugs are coming in the picture for the treatment.

        In context to Surgical treatment ( if not contraindicated ) the medical treatment is the only remedy available .

Sunday, July 10, 2011

CONGENITAL ANOMALY OF ONE UPPER LIMB IN NEWBORN

Really a horrible situation for the mother to have such a type of newborn delivered , but without knowing the cause ,who can help . Go on routine checkup , if patient afford . In most of the cases it is phenotype defects associated with some somatic abnormality also.
 Now Thallidomide is no more in picture , otherwise also this new born was having an imperforated  anus , the priority of parents was to get rid off later disease , operative intervention was done , but all in vain . Patient expired on Eleventh  day of delivery , giving parents physical, mental , economical and social losses.

Sunday, June 26, 2011

Bilateral Hydrosalpinx


            A Hydrosalpinx is a distally blocked fallopian tube filled with serous or clear fluid . The blocked tube may become substantially distended giving the tube a retort like shape. The condition is often Bilateral and predisposing symptom is infertility.



       Symptom can vary from Abdominal pain, Pelvic pain and infertility. IUD’s , endometriosis and abdominal surgery are sometimes  associated with the problem .
          As a reaction to injury, the body rushes inflammatory cells into the area, and inflammation and later healing result in loss of the fimbria and closure of the tube. These infections usually affect both fallopian tubes, and although a hydrosalpinx can be one-sided, the other tube on the opposite side is often abnormal. By the time it is detected, the tubal fluid usually is sterile, and does not contain an active infection. The diagnosis can be done by Ultra sonography , HSG and laparoscopy .
             As PID is the major cause of hydrosalpinx formation, steps to reduce sexually transmitted disease will reduce hydrosalpinx. Also, as hydrosalpinx is a sequel to a pelvic infection, adequate and early  antibiotic treatment of a pelvic infection .

Wednesday, June 22, 2011

BRAIN AND SPINAL CORD DEFECTS IN NEWBORN


     Brain damage can be fatal or result in Mild or severe disability, Mental retardation , Seizures and paralysis.,  while spinal cord defects result in Paralysis , Incontinence and loss of sensation of various part of body.

        What a horrible situation for a mother after giving birth to a live new born , but having defects that too of Brain and Spinal Cord.
        Usually these defects can occur early or in late foetal development. Typical Symptoms after birth are Intellectual disability , Paralysis , Incontinence.
      The diagnosis can only be confirmed by CT Scan or MRI.
       Some defects can be repaired surgically , but Brain and Spinal Cord damage is permanent.
        Neural tube defects develops with in first week of pregnancy ., others such as Proencephaly and hydranencephaly develope late in pregnancy.
       Many of the Brain and spinal cord defects results in visible abnormality in the Head or Back.
Then only parents starts worrying and take the advice of doctors , but cost of treatment is beyond the middle class families, in contrast Chances of  Morbidity and Mortality, can not be ruled out.