Huntington's Disease

 MRI. Source: Radiopaedia

Authors: Mark Groves and al. Departments Beth Israel Medical Center, New York

Definition:

Huntington’s disease (HD) is a progressive neurodegenerative autosomal dominant disease characterized by disturbed movements, changes in behaviour, and cognitive decline. Although the motor disturbances are both choreatic and hypokinetic, chorea is the most characterizing.

Nontuberculous Mycobacteria

Author: Dr Charles L. Daley National Jewish Health 2008-07-28

Nontuberculous Mycobacteria: An Emerging Epidemic

Introduction 

Tuberculosis, one of the most recognized infections in the world, is caused by members of the Mycobacterium tuberculosis complex and can be transmitted from person to person. However, M. tuberculosis is just one of over 125 different species of mycobacteria most of which are referred to as nontuberculous mycobacteria (NTM).(1) NTM are dispersed widely in our environment and unlike tuberculosis, are not spread from person to person.  NTM are also less likely to cause disease in humans, but the frequency of NTM-related disease is increasing and in some areas of the world these infections are more common than tuberculosis. This article will review what we know about NTM, their epidemiology (where they occur and who and how many they affect), ability to cause disease, and treatment.

Tuberculosis

Author: Dr Charles L. Daley National Jewish Health 2008-07-28

Introduction

Tuberculosis is a disease that is spread from person-to-person through the air. It is caused by Mycobacterium tuberculosis, a slowly growing bacterium that is resistant to most antibiotics and, thus, difficult to treat. Despite the availability of effective therapy since the 1950’s, there are more cases of tuberculosis in the world today than in recorded history.
Left untreated, tuberculosis can kill approximately one half of patients within five years and produce significant morbidity (illness) in others. It is estimated that one-third of all HIV-infected patients die from tuberculosis and that it kills more adults than any other infectious disease. Inadequate therapy for tuberculosis can lead to drug-resistant strains of M. tuberculosis that are even more difficult to treat; the drugs needed to treat these strains are associated with more drug toxicities and greatly increased costs. This knol will review what is known about tuberculosis and how we diagnose and treat the disease.

Central Sleep Apnea

Author: Dr Robert C. Basner Columbia University 2008-06-10

Central Sleep Apnea: Non-obstructive sleep apnea

The following is a discussion of non-obstructive, or "central"  sleep apnea. As with its companion piece, "obstructive sleep apnea," its content is not intended to be a medical primer nor meant to exhaustively cover all of the risks and complications possible with the disorder and its diagnosis, treatment, and non-treatment. The author stresses that this discussion does not substitute for the need to personally discuss all aspects of the health effects, diagnosis, and treatment of sleep apnea with a health care professional and, generally, with an expert in sleep disorders medicine. It should also be noted that the focus of this piece is on adult central sleep apnea; although some aspects of central sleep apnea in children are discussed here, the risks and benefits involved in the decision making process for testing for and treating such a disorder in children are substantially different than those for adults, as pediatric sleep apnea is often very different in its manifestations and treatment requirements (see recommended readings at the end of this piece).

Obstructive Sleep Apnea

Author: Dr Robert C. Basner Columbia University 2008-10-23

The following is a discussion of obstructive sleep apnea (OSA); its content is not intended to be a medical primer nor meant to exhaustively cover all of the risks and complications possible with the disorder and its diagnosis, treatment, and non-treatment. The author stresses that this discussion does not substitute for the need to personally discuss all aspects of the health effects, diagnosis, and treatment of sleep apnea with a health care professional and, generally, with an expert in sleep disorders medicine. This review focuses on OSA in adults. Although some aspects of OSA in children are discussed here, the risks and benefits involved in the decision making process for testing for and treating OSA in children are substantially different than those for adults.

Scabies

Author: Dr Lindy P. Fox University of California San Francisco 2008-07-28

What is scabies?

Scabies is an intensely itchy infestation of the skin by the human mite Sarcoptes scabiei var hominis.  It has a global prevalence of 300 million cases per year [Strong and Johnstone 2007; Chosidow 2006].  The mite completes its entire life cycle on humans. Mites do not jump or fly, but can crawl on the skin at a rate of 2.5cm per minute [Chosidow 2006]. The female scabies mite tunnels into the top layer of the skin where she lays 10-25 eggs in burrows that are about 1 cm long [Leone 2007]. Two to three days later, larvae emerge from the burrows, dig new burrows, mature, and mate. This cycle repeats every two weeks [Johnston and Sladden  2005]. The total length of the life cycle is 30-60days [Leone 2007]. In most cases of scabies infestation, there are only 5-15 (average of 12) mites on human skin at a time, except in crusted scabies, where thousands to millions of mites can be present on the skin. 

Epidural steroid injections for spinal pain

Author: Dr Sibel Demir-Deviren University of California San Francisco 2008-07-10

Introduction

Spinal pain is the most common of all chronic pain disorders. The number of individuals that have, at some point in their life, experienced spinal pain has been reported as 54 to 80%. After the initial painful episode, the prevalence of persistent low back and neck pain ranges from 26 to 75%.

Axial (neck or low back pain) and radicular pain (radiating pain to arm or leg) may arise from any anatomic structure capable of transmitting pain (the pain generator).  Pain generators include vertebral discs, nerve roots, dura (the outer layer of membrane surrounding the brain and spinal cord), muscles, fascia (soft, connective tissue), ligaments, and facet joints. Injury to any of these structures results in the release of inflammatory mediators. Epidural injection of steroid (cortisone, corticosteroid) is one of the most commonly used interventions to decrease the inflammation in managing persistent spinal pain.

Historically, the epidural steroid injection is the first-line invasive therapeutic procedure of choice in patients with spinal pain. In 1901, the first independent reports on the use of caudal epidural injections in the treatment of lumbar nerve root compression were published. The first reportedly successful use of lumbar epidural injections as a treatment for sciatica was in 1909. In 1930, a success rate of 61% was reported for the treatment of sciatica following the caudal injection of large volumes of local anesthetic and saline. The first reported use of epidural steroids was in 1957 as a treatment for radicular leg pain.

Spinal Stenosis

Author: Dr Sibel Demir-Deviren University of California San Francisco 2008-07-19

What is Spinal Stenosis? 

Spinal stenosis is defined as narrowing of the spinal canal (the canal in the center of the spine), lateral recess (the narrowing of the tunnels where the nerve roots exit the central spinal canal), or intervertebral foramina (holes in the vertebrae which nerve roots exit). It can occur at any age and is typically due to the degeneration and enlargement of the facet joints (small joints between upper and lower vertebrae), the protrusion or herniation of the intervertebral discs and/or ligamentum flavum hypertrophy (a strong ligament that connects the vertebrae together). The narrowing of the canals puts pressure on the neural elements of the spine, including the spinal cord and nerve roots. Pressure on the upper part of the spine (neck area) usually produces pain, numbness, tingling or weakness in the shoulders, or arms. Pressure on the lower part of the spine (low back area) usually causes similar symptoms in the legs.

Sciatica

Author: Dr Sibel Demir-Deviren University of California San Francisco 2008-06-10

Introduction

Sciatica is a buttock pain radiating down the back of the thigh and leg and possibly into the calf or foot.  Other characteristics of sciatica include varying degrees of weakness in the leg muscles and numbness and/or tingling that radiates down the leg.  These symptoms occur because of compression and/or irritation of the sciatic nerve or nerve roots which are forming the sciatic nerve. The areas in the buttock and leg affected by this compression are the areas that the sciatic nerve supplies with messages for normal function.  There are many other names for sciatica including lumbosacral radicular syndrome, radiating low back pain, nerve root pain, and nerve root entrapment. 

Scoliosis

Author: Dr Vedat Deviren University of California San Francisco 2008-07-09

Scoliosis: Pediatric Scoliosis/Adult Scoliosis

Scoliosis is defined as a lateral curvature of the spine in the frontal plane of the body, which means that the vertebral column bends from side-to-side. Normally, the spine is straight. With scoliosis, the spine curves to the side in the shape of the letter “S” or “C”.  This can cause small but noticeable changes in the alignment of the entire trunk of the body, and the ribs or hips may stick out more on one side than the other side. Additionally, one shoulder may be lower than the other. Furthermore, a severely scoliotic spine may create asymmetries in the shoulder, thoracic cage and pelvis leading to trunk imbalance and significant cosmetic deformity. Scoliosis curves of greater than 10° affect 0.5-3% of the adolescent population and studies reported scoliosis observed up to 32% of adult population after the age of 60.

Cartilage Injury and Repair

Author: Dr C. Benjamin Ma University of California San Francisco 2008-07-28
Cartilage Injury and repair: Current treatment of cartilage injuries Cartilage Injuries are common joint injuries and can lead to significant pain and suffering. We will go over the signs and symptoms of cartilage injuries and also some of the common and latest treatment available.

Shoulder Surgery

Author: Dr C. Benjamin Ma University of California San Francisco 2009-06-10

Shoulder Surgery: an article about common shoulder problems and treatment. Shoulder problems are very common ailments in our daily lives. This article will describe a number of common shoulder problems and its operative and non-operative treatments

Herpes zoster

Author: Dr Jack Resneck Jr University of California San Francisco 2008-07-28

Herpes Zoster: A Painful Skin Rash (also known as Shingles or Zoster) Caused by the Varicella Zoster Virus.

Introduction:

Herpes Zoster (also known as shingles or zoster) is a painful skin rash caused by the varicella zoster virus (VZV), the same virus that causes chickenpox.  This is a different virus than the one that causes genital herpes and fever blisters (herpes simplex).  Zoster was not known to be associated with chickenpox until 1888, and the two diseases were linked to a common virus in the early twentieth century.

Psoriasis

Author: Dr Jack Resneck Jr University of California San Francisco 2009-10-16

Psoriasis: A Common, Chronic Skin Disease with Many Distinctive Clinical Forms
Introduction

Psoriasis is a common, chronic skin disorder present in about 2-3% of the world’s population.  The most typical form is characterized by round, red skin lesions covered by silvery white scales, most commonly occurring on the knees, elbows, and scalp.  There are many distinctive clinical forms of psoriasis, and the severity of the disease varies greatly from patient to patient.  The course is usually chronic, with intermittent remissions.  Descriptions of patients with psoriasis date back over 2,400 years, at which time the disease was confused with leprosy.   Psoriasis is rarely life-threatening, but can profoundly impair the quality of life of affected patients.

 

Basal Cell Carcinoma

Author: Dr Jack Resneck Jr University of California San Francisco 2008-07-28

Introduction:

Basal Cell Carcinoma (BCC) is the most common cancer in humans worldwide, with more than 800,000 new cases annually in the US alone, where its incidence has been rising at about 10% per year.  It is most common in fair-skinned individuals with a significant lifetime history of intense, intermittent sun exposure.  Most BCCs begin as a pink or translucent bump on the skin.  There are numerous treatments available for BCCs, and the overwhelming majority of patients are cured. If left untreated, BCC can be disfiguring and destroy tissue locally, but metastasis is extremely uncommon. Among those rare patients who develop metastatic disease, fewer than 10% survive more than 5 years. Most deaths from BCC are due to direct extension of the malignancy into a vital structure in patients who remain untreated for several years (rather than metastatic disease).

Approach to a Swollen Joint

Authors: Dr Kenneth H. Fye University of California San Francisco 2008-08-12

Approach to a Swollen Joint: Swelling in the joint, whether or not accompanied by pain and tenderness, is a sign of disruption in articular anatomy or function.

Rheumatoid Arthritis

Authors: Dr Kenneth H. Fye University of California San Francisco 2008-07-28

Introduction

Rheumatoid arthritis (RA) is a systemic inflammatory disease defined by its (joint) manifestations. The arthritis of RA is an inflammatory, symmetrical, progressive, destructive process that attacks primarily the small proximal joints of the upper and lower extremities, although all joints in the body, except for those of the thoracic and lumbosacral spine, can be affected. The disease afflicts about 1.5% of the North American population, meaning that approximately 4.5 million Americans have RA. Women are affected three times as often as men. The disease usually begins during the childbearing years, but because it is a chronic, incurable disorder, the peak prevalence is seen in the seventh decade of life. Although RA is often considered to be simply a painful, debilitating arthritis, it is, in fact, a systemic disorder that has a significant impact on mortality.

Preventive Health For Women

Author: Dr Jennifer Frank University of Wisconsin 2009-12-15

Preventive Health For Women: Find out what the "annual exam" is really all about. Do you really need an annual "physical" at the doctor's office? Well, that is a matter of some debate, but there are some preventive health measures - things to keep you healthy and detect problems early - that you do need, especially if you are 50 years or older. Read below to find out what is essential and what is not.

Seasonal Allergies

Author: Dr Paul Nadler University of California San Francisco 2008-07-22

Seasonal Allergies: Itchy eyes, runny nose and sneezing are common springtime symptoms for people with seasonal allergies. This article will explain what causes them, how to treat them, and when to see a clinician.

Vaginitis

Author: Dr Paul Nadler University of California San Francisco 2008-07-22

Vaginitis: Vaginal Discharge from Yeast infections, Bacterial Infections, and Other Causes A common, bothersome, gynecological condition with multiple causes. This article will help a woman better understand vaginitis, and explain what symptoms can be treated at home, and when should she go in for an exam.

Palpitations

Author: Dr Paul Nadler University of California San Francisco 2008-07-16

Palpitations: Skipped heart beats- serious or benign? This article will help you understand why palpitations happen, when they are serious or just an annoying symptom, and when you should see a clinician for evaluation and testing.

Acute Renal Failure

Author: Dr Christopher Keller University of California, San Francisco2008-07-28
Acute Renal Failure: Causes, Prognosis, and Treatment

What is acute renal failure?

               Acute renal failure (also known as acute kidney injury) is a decline in kidney function that occurs over hours to weeks.

Tremor

Author: Dr Daniel Tarsy Harvard Medical School 2008-07-28

Introduction

Tremor is a rhythmic movement of a portion of the body such as the arm, hand, leg, head, voice, or trunk which varies in size but has a relatively constant frequency for an individual patient. Tremor is the most common of all disorders causing involuntary movements. It also occurs from time to time in most normal individuals in the form of an exaggerated physiologic tremor.

Restless Legs Syndrome

Author: Dr Daniel Tarsy Harvard Medical School 2008-07-28

Clinical features of restless legs syndrome

• Restless legs syndrome (RLS) is a neurological disorder characterized by a very unpleasant discomfort in the legs that occurs when the affected individual is at rest and causes an uncontrollable urge to move the legs to relieve the symptoms. The diagnosis is based exclusively on the patient’s description of their symptoms since a physical and neurological examination of the patient shows no abnormalities.

Parkinson's Disease

Author: Dr Daniel Tarsy Harvard Medical School 2008-07-28

Background

Parkinson’s disease (PD) was described by Dr. James Parkinson in 1817 in “An Essay on the Shaking Palsy.” His description of a “relentlessly progressive disease” causing tremor, gait disturbance, slow movement, and disturbed sleep remains valid, although fortunately, modern treatments have done much to change this early description. Loss of dopamine producing cells in the midbrain was discovered in the middle of the last century, but the underlying cause of this continues to elude researchers. Despite modern technology, the diagnosis of PD continues to be based on the history and physical examination rather than brain imaging or laboratory tests.

Community Acquired Pneumonia

Author: Scott A. Flanders University of Michigan 2008-08-18

Introduction

Pneumonia generally refers to an infection of the lung tissue, or lung parenchyma (the functional parts of the lung), and is considered a type of upper respiratory infection. The term “pneumonia” is also used to describe non-infectious inflammatory conditions of the lung that often have no known origin, but this knol will focus solely on community acquired pneumonia, which has identifiable, infectious origins. Please note as well, that this knol will NOT cover conditions such as rhinitis, sinusitis, pharyngitis, tracheitis, and bronchitis, which are all upper respiratory infections that develop higher in the respiratory tree and are generally considered less severe than pneumonia.

Pneumothorax

Author: Dr Michael Hanley University of Colorado Denver 2008-07-28
Pneumothorax or "Collapsed Lung"

INTRODUCTION

A pneumothorax exists when air or another gas is introduced into the pleural space within the chest, causing the lung to collapse away from the chest wall.

Prostate Cancer

Author: Dr Charles J. Ryan University of California San Francisco 2008-07-28

Introduction

Approximately 230,000 new cases of prostate cancer are diagnosed in the United States annually, making it the most common cancer affecting American men besides superficial skin cancers.  Although it is a highly curable malignancy when treated in its early stages, approximately 50-60,000 men experience a relapse of the disease annually, and approximately 5-10% harbor advanced disease at the time of diagnosis, and are thus considered unable to be cured with surgery or radiation. Approximately 30,000 American men die of the disease every year. Death rates from prostate cancer have been steadily declining since the 1990s, a result of the combination of early detection and improved treatment of localized disease as well as improved therapies for men with advanced disease.

Urinary Tract Infection – Recurrent and Complicated

Author: Dr Anthony J. Schaeffer University of Chicago 2008-07-28

Recurrent and complicated urinary tract infections occur in both men and women, are a common cause of morbidity, and can lead to significant mortality. Management of these infections requires careful assessment of past history, risk factors, and a thorough evaluation of the urinary tract. This Knol discusses these urinary tract infections, how they occur, common misconceptions about them, and strategies for prevention and treatment.

Urinary Tract Infection in Women- Uncomplicated

Author: Dr Anthony J. Schaeffer University of Chicago 2008-07-28
Urinary tract infection in women is a common disorder that can be diagnosed and treated with simple and reliable techniques. The majority of these infections occur in a healthy woman with a normal urinary tract, and this article addresses the occurrence, misconceptions, and strategies for its prevention and treatment.

Prostatitis

Author: Dr Anthony J. Schaeffer University of Chicago 2008-07-28

Introduction

 Prostatitis is a common, frequently inflammatory disorder of the prostate, affecting approximately 5% of men in the United States and associated with considerable quality of life and financial impact. This term is used to describe three distinct clinical conditions (Table 1):

1. An acute or chronic bacterial infectious disease
2. A non-infectious pain syndrome (known as Chronic Pelvic Pain Syndrome or CPPS) 
3. An asymptomatic inflammatory disease   

Pulmonary Embolism

Author: Dr Taylor Thomson Harvard Medical School 2008-07-22

What is a pulmonary embolism?

Pulmonary Embolism (PULL-mun-ary; EM-bo-lizm) is a condition caused by a blood clot that has suddenly blocked one or more of the arteries of the lung.  Health care professionals often refer to pulmonary embolism by its initials, PE.  It is a serious medical condition that afflicts over 100,000 people in the United States each year.  Almost a third of patients with pulmonary embolism die, usually within two hours of the blood clots arrival in the lung.  If the condition is diagnosed and anticoagulant therapy (also known as “blood thinner”) is given promptly, the prognosis dramatically improves.  Mortality from properly treated PE is around 3%.

Peyronie's Disease

Authors: Drs Tom F Lue and Alan Shindel University of California San Francisco 2008-11-12

Peyronie's Disease: Acquired Deformity of the penis A primer for men and their partners Peyronie's Disease is a common but poorly understood condition. This article is written to give men and their sexual partners information about the disease and what treatment options may be helpful in some cases.

Male Sexual Function and Dysfunction

Authors: Drs Tom F Lue and Alan Shindel University of California San Francisco 2008-11-12

Male Sexual Function and Dysfunction: A guide for men and their partners. This article is a review of normal sexual function in men. It also contains information on sexual problems that may affect a man at different points in his life. It is written for men and their sexual partners.

Female Sexual Function and Dysfunction

Authors: Drs Tom F Lue and Alan Shindel University of California San Francisco 2008-08-30

Female Sexual Function and Dysfunction: A guide for women and their sexual partners In this article we will discuss female sexual function and some of the sexual problems women may experience at different points in their life. This information has been written for women and their sexual partners.

Introduction 

Priapism

Authors: Drs Tom F Lue and Alan Shindel University of California San Francisco 2008-09-01

Priapism: Prolonged Erection of the Penis. A guide for men This manuscript reviews priapism, the condition in which a man has a penile erection that is not associated with sexual desire or excitement.

Shoulder instability

Author: University of Washington Orthopaedics and Sports Medicine Seattle, WA 2008-08-13

Shoulder instability and shoulder dislocations. treatment of the unstable shoulder:
A Bankart repair is usually successful in stabilizing a shoulder with recurring dislocations. However, sometimes surgery can fail to stabilize the shoulder, either because the repair is not strong enough or because the socket of the shoulder is compromised. In these situations, a contoured bone graft may provide the needed stability by deepening the socket.

Shoulder rotator cuff tear arthropathy

Author: University of Washington Orthopaedics and Sports Medicine Seattle, WA 2008-08-13

Shoulder rotator cuff tear arthropathy treatment with shoulder replacement surgery Rotator cuff tear arthropathy (arthritis with a massive rotator cuff tear) is a devastating condition that seriously compromises the comfort and function of the shoulder. This condition is characterized by the permanent loss of the rotator cuff tendons and the normal surface of the shoulder joint. These tissues cannot be restored to their normal condition and the lost comfort and function of the shoulder cannot be totally regained. However, in the hands of an experienced surgeon and in a well-motivated individual, shoulder replacement surgery with a cuff tear arthropathy (CTA) head prosthesis along with post-surgical rehabilitation can help restore substantial comfort and function to shoulders damaged by cuff tear arthropathy.

Osteoporosis

Author: University of Washington Orthopaedics and Sports Medicine Seattle, WA 2008-08-15

Osteoporosis: Loss of bone mass Osteoporosis (Greek: bone with too many passages) is a condition in which the holes in the bones become larger. Instead of bone, the spaces are filled with fat or bone marrow cells and the bone density is decreased. The bones are weak and break easily.

Osteoporosis

Author: Dr Nelson B. Watts University of Cincinnati 2008-10-29

Osteoporosis:  Osteoporosis is defined as a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture.

Jaw Fractures

Author: Dr Andrew H. Murr University of California San Francisco 2008-08-14

Jaw Fractures: Fractures of the Mandible Fractures of the jaw or mandible are a fairly common occurrence in our society. Although jaw fractures very often occur because of interpersonal trauma or fights, motor vehicle accidents and sporting injuries or falls also can cause jaw fractures. Typically, jaw fractures require treatment, and surgery is often recommended. This Knol will discuss jaw fractures and describe different methods of promoting healing of the fracture.

Nasal Fractures

Author: Dr Andrew H. Murr University of California San Francisco 2008-07-28

INTRODUCTION 

The nose is the most common facial bone that is broken and is perhaps the most commonly broken bone in the human body. Because the nose is a prominent facial feature, a broken nose can dramatically alter one’s appearance. This Knol is designed to educate people about nasal fractures and the treatment options available to people who have suffered a fracture.

Nasal Polyps

Author: Dr Andrew H. Murr University of California San Francisco 2008-07-28

INTRODUCTION

Inflammation of the sinuses (sinusitis) is the most common chronic condition for which a patient seeks the advice of a physician in the United States. There are about 30 million patient visits per year pertaining to sinusitis, but the cause of the condition remains unclear. Nasal polyps – known as chronic rhinosinusitis with nasal polyposis – are a sub-category of sinusitis that represents roughly two to five percent of patients with sinusitis.

Nose Bleed (epistaxis)

Author: Dr Andrew H Murr University of California San Francisco 2008-07-28

INTRODUCTION

Epistaxis is another name for a nose bleed. Nose bleeds are extremely common and are usually minor. However, some people experience either recurrent nose bleeds or persisting nasal bleeding that will not stop despite typical measures. If this happens, a visit to a doctor or even an emergency department may be necessary. Rarely, nose bleeds may be a sign of other disease processes that need attention. This Knol is dedicated to improving the understanding of factors that contribute to the fairly common phenomenon of nasal bleeding.

Nephrotic Syndrome

Author: Dr Sharon Kang University of California San Francisco 2008-05-28  

Introduction

A serious complication of kidney disease, the nephrotic syndrome is a specific collection of signs and symptoms caused by the loss of large amounts of protein from the blood into the urine (more than 3.5 grams per day). The syndrome can occur in infants, children, and adults, as well as in all racial and ethnic groups. Some patients with the nephrotic syndrome are at high risk for end-stage kidney failure. Once a kidney fails, survival is dependent upon either dialysis or a kidney transplant.

Menstruation

Author: Dr Paula Hillard Stanford University 2008-08-11

Menstruation: Menstruation is the monthly vaginal bleeding that occurs in reproductive age women. The menstrual cycle refers to the monthly hormonal cycle that results in the shedding of the lining of the uterus, termed menstruation.

Migraine

Author: Dr Richard P Kraig University of Chicago 2008-07-24

Migraine: Mechanisms and Management.
Migraine is the most common form of headache for which patients seek medical attention. Migraine also is an immense health care burden to those who suffer from this malady, as well as to society in general.

Multiple Sclerosis

Author: Dr Ari J Green University of California San Francisco 2008-07-28

This page is written for patients with MS, their families, and those who share our commitment to end this devastating and debilitating disease. 
What is MS?

Multiple sclerosis is an autoimmune, demyelinating disease of the central nervous system (CNS).   It most commonly begins during late adolescence, young adulthood, or mid-life, and can occur in people of any age or any race. MS causes attacks of neurological dysfunction (loss of vision, difficulty walking or moving a limb, incoordination, vertigo, loss of sensation) and/or progressive dysfunction in these same areas. 

Muscle Cramping

Author: Dr Martin Schwellnus University of Cape Town South Africa 2008-07-28

What is a muscle cramp?

The word “cramp” is probably derived from the old High German and Norse root word “cram” which means an uncomfortable squeezing, pressing or pinching ¹. Muscle cramping is a common symptom that is likely to affect most people at some stage during life. It has been reported that 35-60% of elderly persons suffer from cramping ¹, and in one study it has been documented that 37% of the adult population will experience muscle cramping in a year ².

Skin Cancer Melanoma

Melanoma. Source: CDC

Author: Dr Mohammed Kashani-Sabet University of California San francisco 2008-07-21

Melanoma is a cancer of pigment-producing cells known as melanocytes. Melanocytes are developmentally part of the nervous system, and migrate to the skin and other organs, where their chief role is the production of the pigment known as melanin. Melanin is in turn responsible for protecting various tissues from the effects of ultraviolet (UV) light (sunlight). Freckles develop when there is an excess of pigment produced by melanocytes (without an increase in the number of melanocytes). Moles (also known as nevi) develop when there is a growth or increase in the number of benign melanocytes (with or without excess pigment). Melanomas are produced when abnormal, cancerous melanocytes grow (with or without excess pigment production). Melanoma is most commonly encountered on the skin (over 90% of the cases) but can be detected anywhere that normal melanocytes are found, such as inside the mouth and nose, in the anal or genital tract, in the eye, lymph nodes, and the lining of the brain.

High Triglycerides (Hypertriglyceridemia)

Author: Dr Elena Citkowitz Yale University 2008-12-28

Triglycerides are fat molecules. They serve as the body’s primary source of stored energy. However, high levels of triglycerides in the blood are associated with serious health problems (link to Coronary Artery Disease or CAD, link to pancreatitis). Treatment options include diet, exercise, weight loss, and medication.

Metabolic Syndrome

Author: Dr Elena Citkowitz Yale University 2009-01-24

The Metabolic Syndrome (Syndrome X, insulin resistance syndrome) : The metabolic syndrome is made up of a constellation of abnormalities that increase the risk for developing diabetes and possibly for coronary artery disease.

Laparoscopic Surgery

Author: Dr John Maa University of california SF 2008-07-29

Evolving Trends in Laparoscopic Surgery

Keywords: minimally invasive surgery, hand-assisted laparoscopic surgery, bandaid, keyhole and pinhole surgery, laparoscope, Da Vinci, NOTES

Laparoscopic surgery is a modern surgical technique that has transformed the practice of surgery.  This minimally invasive surgical intervention allows surgeons to perform operations through small incisions (usually less than one centimeter) compared to the larger incisions required in traditional “open” surgical operations.  Patients benefit by reduced post-operative pain, shortened hospital stays, improved cosmetic results, and faster recovery times.

Acute Liver Failure

Author: Dr Tim Davern California Pacific Medical Center 2008-08-12

Acute Liver Failure: Acute liver failure (ALF) is a rare, potentially devastating syndrome characterized by the abrupt collapse of liver function and hepatic encephalopathy, which is a sine qua non of the syndrome. The prognosis without urgent liver transplant is often grim. This knol reviews the various causes of ALF, its symptoms, diagnosis, prognosis and treatment.

Hepatic Encephalopathy

Author: Dr Tim Davern California Pacific Medical Center 2008-08-12

What is hepatic encephalopathy?

Hepatic encephalopathy is a potentially reversible disturbance of brain function due to liver (hepatic) failure. The syndrome is characterized by a broad spectrum of neuropsychiatric derangements including personality changes, intellectual impairment, and a depressed level of consciousness, and appears to be the result of neurotoxins that accumulate with liver failure.  Ammonia, which is usually metabolized by the liver, is a critical neurotoxin in the development of hepatic encephalopathy, but other toxins are also involved. The neuropsychiatric manifestations of hepatic encephalopathy are reversible with appropriate medical therapy, but the syndrome is a hallmark of advanced, decompensated liver disease and has an overall poor prognosis. Thus, certain patients with hepatic encephalopathy should be referred for liver transplantation.

Drug-induced hepatitis

Author: Dr Tim Davern California Pacific Medical Center 2009-05-14

What is drug-induced hepatitis?

Drug-induced hepatitis, also known as hepatoxicity, refers to liver injury caused by drugs or other chemical agents and represents a special type of adverse reaction. The condition is called many things, but the one that experts currently favor is drug-induced liver injury (DILI); this is the term that will be used throughout this article. In addition, the generic term “drugs” shall be used to encompass the entire range of potentially injurious agents, also called hepatoxins.

Liver cancer (Hepatocellular Carcinoma)

Author: Dr Tim Davern California Pacific Medical Center 2008-10-05

Hepatocellular Carcinoma Hepatocellular carcinoma (HCC) is an increasingly recognized complication of cirrhosis. This article briefly reviews the epidemiology of HCC, its diagnosis, prognosis and treatment.

Leukemia

Author: Dr Frederick Appelbaum Fred Hutchinson Cancer Research Center Seattle 2008-07-28

Definition

Leukemia is a term used to describe a number of related cancers of the blood-forming cells, characterized by their abnormally increased growth and impaired maturation.

Leukemia (specific information)

Author: Dr Frederick Appelbaum Fred Hutchinson Cancer Research Center Seattle 2008-07-28

Contents:
Acute Myeloid Leukemia (AML)
Acute Promyelocytic Leukemia (APL)
Acute Lymphocytic Leukemia (ALL)
Chronic Myeloid Leukemia (CML) Chronic Lymphocytic Leukemia (CLL)

Lung cancer

Author: Dr Jessica Donington New York University 2008-07-28

Lung Cancer: Lung cancer is a disease of uncontrolled cell growth in tissues of the lung. A malignant tumor arising from the cells of the respiratory epithelium. By definition, tumors arising from non epithelial cells (sarcoma and lymphoma) or from mesothelial lining (mesothelioma) of the lung are excluded. This uncontrolled cell growth may lead to metastasis, invasion of adjacent tissue and infiltration beyond the lungs.

Lupus

Author: David I. Daikh University of California San Francisco 2008-07-28

Lupus (Systemic Lupus Erythematosus): A systemic autoimmune disease Lupus is an autoimmune disease that primarily affects women. It can produces many different symptoms that may also occur in other conditions. No single test can prove that a person does or does not have lupus, thus the diagnosis frequently must be made by an internist or a rheumatologist, who specializes in autoimmune diseases. Although lupus can cause severe, life threatening illness, many patients can be treated successfully with medications to minimize their symptoms.

Non-Hodgkin's Lymphoma

author: Dr. Lawrence D. Kaplan University of california San Francisco 2008-07-28
Introduction

Non-Hodgkin’s lymphoma (NHL) is a cancer of lymphocytes, a type of white blood cell that plays an important role in the immune system. At present, more than 20 different types of non-Hodgkin’s lymphoma have been identified. The choice of how to treat a lymphoma may be dependent on being able to identify the precise NHL subtype. Survival rate also tends to be dependent upon the type of lymphoma.

Kidney biopsy

Author: Dr Mei Zhu Peng University of California San Francisco 2008-07-28
Introduction

According the recent National Health and Nutrition Examination Surveys (NHANES III), kidney disease is on the rise in the United States (1). This trend is of concern for a number of reasons. Not only are people with kidney disease at higher risk for heart disease and cardiovascular events such as heart attacks and stroke, but many who have kidney disease are without symptoms and so are not aware that they have the disease; it is often diagnosed with routine blood and urine tests. Moreover, untreated kidney disease can progress to advanced chronic kidney disease, which requires dialysis or kidney transplantation.

Benign Prostatic Hyperplasia

Authors: Drs Marshall Stoller (university of California SF) and Aaron Berger (Chicago) 2008-10-13
What is Benign Prostatic Hyperplasia (BPH)?

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland that occurs commonly as men age. This enlargement can contribute to bothersome lower urinary tract symptoms (LUTS) and may include: urinary frequency, urgency of urination, nocturia or waking up at night to urinate, weak urinary stream, sensation of incomplete bladder emptying, and dribbling after urination. This constellation of symptoms known as LUTS is likely caused not only by BPH, but also by changes that occur in the bladder as a result of aging or as a result of changes brought on by BPH. BPH affects about half of men over the age of 50 and increases to 90% or more for men in their 80’s.

Laparoscopic renal surgery

Authors: Drs Marshall Stoller (university of California SF) and Aaron Berger (Chicago) 2009-03-06

Laparoscopic renal (kidney) surgery

What is Laparoscopy?

Laparoscopy is the term used to describe abdominal surgery performed with a camera (laparoscope) and small, thin instruments placed through several small incisions. Laparoscopy is used for a wide variety of operations and results in decreased post-operative pain, decreased recovery time, and improved cosmetic results as the incisions are much smaller than traditional open surgery.

Urinary tract obstruction

Authors: Drs Marshall Stoller (university of California SF) and Aaron Berger (Chicago) 2009-12-10

Introduction: 

The kidneys are paired organs with the primary function of helping to remove toxins from the body and regulate water balance; they are vital to survival.  After urine is produced in the kidneys, it must pass down to the bladder where it can be stored before being eliminated from the body through the urethra.  At almost any point in this pathway, urine can become obstructed and may lead to kidney damage.  When severe, this can cause a patient to require a kidney transplant or dialysis to sustain life.  Obstruction can be present from birth or it may develop later in life.  The most common causes of obstruction include stones, strictures, tumors, and bladder dysfunction.  This article will discuss the various causes and treatments of urinary tract obstruction.

Laparoscopic Ureteral Reimplantation

Author: Dr Aaron Berger (Chicago) 2008-08-25 6mn02

Percutaneous Nephrolithotomy

Author: Dr Aaron Berger (Chicago) 2008-06-10 2mn22

Kidney stones

Authors: Drs Marshall Stoller (university of California SF) and Aaron Berger (Chicago) 2009-03-06

Introduction

Kidney stones or calculi are solid collections of urinary components that have formed crystals, precipitated out of the urine and formed into stones.  The medical term for the presence of kidney stones is nephrolithiasis.  Most often, stones are calcium based but there are many other types of stones that may form.  The five most common stone types are calcium oxalate, calcium phosphate, uric acid, struvite, and cystine.  Pain from stones can develop when the stones obstruct any part of the urinary system.  This article will discuss the different types of stones, risk factors for forming stones, and the treatment and prevention of calculi. 

Infectious Mononucleosis

Epstein Barr Virus. Source: CDC

Author: Dr Paul Auwaerter Johns Hopkins University Baltimore 2008-07-19
Introduction

Infectious mononucleosis [IM] is a viral illness that most commonly afflicts adolescents and young adults. IM causes fever, severe sore throat, swollen lymph glands, and fatigue; it is caused by the Epstein-Barr virus [EBV], a member of the human herpesvirus family that occurs throughout the globe. At some point in their lives, most people eventually become infected with EBV, but the age that EBV is acquired is a significant determinant of whether IM may develop. When EBV infects during childhood, most often it causes no symptoms or only minimal problems that may appear like a routine viral infection. However, in teenagers and adults, significant symptoms may arise in 35-70% of newly infected. Why IM develops appears to be due to the variability of an individual's immune response that can be more vigorous against EBV as one ages. The precise explanations are unknown, but likely depend on individual genetic factors directing the immune system as well as prior encounters with infections that have molded the immune responses.

Infertility

Authors: Drs Craig Niederberger (University of Illinois) and Brad Van Voorhis (University of Iowa) 2010-04-20

Infertility Male and Female Infertility Infertility is a common condition affecting approximately 10%-15% of couples. One unusual aspect of this field of medicine is that it involves two patients who each need to be evaluated; in many cases, both also need to be treated.

Insomnia

Author: Dr Rachel Manber Stanford University 2009-11-15

Insomnia:  Risk Factors, Diagnosis, & Treatment Insomnia is a treatable sleep disorder. This article explains how insomnia develops and how it can be treated. It also provides practical guidelines for treating insomnia, discusses common misconceptions, and provides links to important resources pertaining to the problem and its treatment.

Ischemic Stroke

Author: Dr S Andrew Josephson University of California San Francisco 2012-02-20

A stroke is defined as the sudden onset of a neurologic deficit attributable to a vascular cause. A stroke results from lack of blood flow to an area of the brain. Without adequate blood flow, neurons (nerve cells) in the brain will begin to die. Symptoms of a stroke are variable based on the area of the brain involved; sudden weakness and numbness on one side of the body is one common symptom of stroke. If the symptoms completely resolve within 24 hours, the condition is instead termed a transient ischemic attack (TIA).

Intracerebral Hemorrhage (ICH)

Author: Dr S Andrew Josephson University of California San Francisco 2012-02-20
Introduction

A stroke is defined as the sudden onset of a neurologic deficit attributable to a vascular cause. A stroke results from lack of blood flow to an area of the brain. Without adequate blood flow, neurons (nerve cells) in the brain will begin to die. Symptoms of a stroke are variable depending on the area of the brain involved but can include weakness or numbness on one side of the body, new problems with vision, dizziness, or severe headache. A stroke is classified as either (1) ischemic (also termed “cerebrovascular accident” [CVA]), where an occluded blood vessel deprives an area of the brain of blood flow or (2) hemorrhagic (also termed intracerebral hemorrhage [ICH]), where there is bleeding into the brain tissue itself; approximately 15-20% of strokes are hemorrhagic in nature and these are the focus of this review.

Hodgkin Lymphoma

Author: Dr Joseph Connors British Columbia Cancer Agency 2008-07-28

Introduction

Hodgkin lymphoma is a cancer that originates from B-lymphocytes of the immune system and the most common type is marked by the presence of a very specific type of cell known as the Hodgkin Reed-Sternberg cell. Once a uniformly fatal disease, today Hodgkin lymphoma is routinely curable. This knol provides a history of the disease and then goes on to describe the typical symptoms, diagnosis, treatment options, and prognosis after treatment.

MRSA Infections of the Skin

Author: Dr Bryan Cho University of California SF 2008-07-28

Methicillin Resistant Staphylococcus Aureus (MRSA) Infections of the Skin
NTRODUCTION

Bacteria are microorganisms that are found almost everywhere. Most bacteria are harmless but some can cause infection. Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that has emerged as a major cause of skin infections among otherwise healthy adults and children in the community. This bacterium is dangerous because it causes infections that cannot be treated with commonly used antibiotics that in the past would destroy the bacteria and cure the infection. Moreover, left untreated these infections can have serious complications. This article will discuss the risk factors for MRSA infections, what MRSA skin infections look like, and how they can be treated and avoided.

Protecting Skin from UV Radiation

Author: Dr Bryan Cho University of California SF 2008-07-28
Sunblocks

Chemical sunblocks absorb UV radiation and convert light energy to heat. Physical sunblocks (Zinc oxide or titanium dioxide) reflect UV radiation away from your skin.

Eczema

Author: Dr Bryan Cho University of California SF 2009-01-22
Eczema: Atopic Dermatitis. Eczema is a common skin problem.

Eczema is a common skin disorder that affects about one of every ten children. The condition can occur at any age but is most common in infants and young adults. Eczema occurs in all races. Ninety percent of patients who will develop eczema will have symptoms by five years of age; ninety-five percent by fifteen years of age. There is no single lab test or biopsy that will diagnose eczema. The diagnosis is based upon the appearance and symptoms of the skin rash, as well as whether related medical conditions, such as hay fever or asthma, are present in the patient or the patient’s family members.

Squamous Cell Carcinoma of the Skin

Author: Dr Bryan Cho University of California SF 2009-01-22
Squamous Cell Carcinoma of the Skin: Appearance,Risk Factors, Treatment and Prevention

Squamous cell carcinoma (SCC) is a cancer of cells that make up the uppermost layer of the skin. Cancer is a condition where skin cells grow haphazardly, invade surrounding tissue and disrupt normal tissue function.  When diagnosed and treated early, most SCCs are not serious and can be cured. About 98-99% of SCCs are localized—the cancer is only present in the skin. However, if treatment is significantly delayed, SCC can spread and invade surrounding bone, cartilage or muscle. Only in rare cases can SCC metastasize (travel to nearby lymph nodes or distant organs) which can be life threatening. When SCC occurs in the most superficial layers of the skin it is called in situ. Squamous cell carcinoma that has invaded the underlying skin layers is known as invasive.

Squamous cell carcinoma is the second most common form of skin cancer with over 250,000 new cases per year in the United States. Roughly twenty percent of the skin cancers diagnosed each year is SCC.

Hair loss / Alopecia

Author: Dr Bryan Cho University of California SF 2009-01-22

Common Causes of Hair Loss from the Scalp. Non Scarring Alopecias: A brief review of common causes of hair loss in men and women.

Hair loss, or alopecia, is a common and often emotionally distressing condition. Genetic predisposition, disease and improper hair care can all contribute to hair loss. They do so by increasing the rate of hair shedding (hair coming out by the root) or by increasing hair fragility leading to hair that can be broken by even minor trauma. 

Depending on the cause, there are a number of treatments for scalp hair loss with varying degrees of effectiveness and patient satisfaction. This knol will discuss the typical hair cycle, as well as the various types of scalp hair loss and their associated treatments.