Wednesday, January 30, 2013

Flatulence

FLATULENCE
 An adult produces two gallons daily of flatus or intestinal gas which is expelled, a part, the rectum and the other is reabsorbed by the body.
Flatulence is the abnormal excess gas that sometimes is accompanied by abdominal swelling and pain caused by gas that is trapped in the folds of the colon.


The most common causes of flatulence are: Lactose intolerance,
The consumption of certain foods such as beans (beans, beans, beans, beans), beer (black), bran, broccoli, brussels sprouts, cabbage, carbonated drinks, cauliflower, onion and milk among others which gases tend to engender Constipation
Overeating what makes food that has not been finished completely digest turn into flatulence.
Chewing food incorrectly, big pieces are difficult to digest and take longer to ferment.
Eating with mouth open lets in too much air as chewing gum, smoking and drinking soda.
The take baking soda for indigestion can increase the amount of flatus
Anxiety and stress, Allergies
Some medications such as laxatives, cholesterol reducers and tranquilizers may promote or increase flatulence
Flatulence (Gas) Overview
Flatulence is the state of having excessive stomach or intestinal gas. This can result in uncomfortable feelings of bloating, as well as increased belching (burping) or passing of gas from the rectum.
Most people produce about 1-3 pints of gas a day, and pass gas about 14 times a day. Flatulence itself, although not life-threatening, can definitely cause social embarrassment. This embarrassment is often the reason why people might seek medical help for excessive gas.
If a person is concerned about excess gas, it is not a laughing matter. It is a medical concern that individual's will want to talk about with a health care professional.
The primary components of gas (known as flatus, pronounced FLAY-tuss) are five odorless gases: nitrogen, hydrogen, carbon dioxide, methane, and oxygen.
The characteristic smelly odor is attributed to trace gases such as skatole, indole, and sulfur-containing compounds.
The flammable character of flatus is caused by hydrogen and methane. The proportions of these gases depend largely on the bacteria that live in the human colon that digest, or ferment, food that has not been absorbed by the gastrointestinal (GI) tract before reaching the colon.
An estimated 30-150 grams of this undigested food reach the colon in the form of carbohydrate every day. But this amount can vary with diet and how well the GI tract is functioning.
      Flatulence (Gas) Causes
Excess gas in the digestive tract (esophagus, stomach, small intestine, and colon/large intestine) can come from two sources: 1) increased intake of gas, for example, from air swallowed; or 2) increased production of gas as certain undigested foods are broken down by harmless bacteria normally found in the colon. Swallowed air (aerophagia): This can occur with improper swallowing while eating or even unconscious swallowing of air out of habit.
Activities that cause a person to swallow air include rapid drinking, chewing gum, use of tobacco products, sucking on hard candy, drinking carbonated beverages, loose dentures, and hyperventilation.
Most people burp or belch to expel this excess swallowed air. The remaining gas moves into the small intestine. The air moves along to the large intestine for release through the rectum.
Analysis of the gas can help determine if it originated from aerophagia (mostly nitrogen, also oxygen, and carbon dioxide) or GI production (mainly carbon monoxide, hydrogen, and methane).
Breakdown of undigested foods: If the body does not digest and absorb some carbohydrates (for example, the sugar, starches, and fiber found in many foods) in the small intestine because of a shortage or absence of certain enzymes there, this undigested food then passes from the small intestine into the large intestine, where normal, harmless bacteria break down the food, producing hydrogen, carbon dioxide, and, in about a third of all people, methane. Eventually these gases exit through the rectum.
Foods that produce gas in one person may not cause gas in another. Some common bacteria in the large intestine can destroy the hydrogen that other bacteria produce. The balance of the two types of bacteria may explain why some people have more gas than others.
Most foods that contain carbohydrates can cause gas. By contrast, fats and proteins cause little gas. These common foods and their natural components may create gas:
Beans: Beans contain large amounts of the complex sugar known as raffinose. Smaller amounts are found in
Starches: Most starches (potatoes, corn, noodles, and wheat) produce gas as they are broken down in the large intestine. Rice is the only starch that does not cause gas.
Onions: The sugar known as fructose occurs naturally in onions, artichokes, pears, and wheat. It is also used as a sweetener in some soft drinks and fruit drinks.
Dark beer and red wine
Sorbitol: This sugar is found naturally in fruits including apples, pears, peaches, and prunes. It's also used as an artificial sweetener in sugar-free gum, candy, and other diet products.
Fiber: Many foods contain soluble and insoluble fiber. Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Found in oat bran, beans, peas, and most fruits, soluble fiber is not broken down until it reaches the large intestine, where digestion causes gas. Insoluble fiber, on the other hand, passes essentially unchanged through the intestines and produces little gas. Wheat bran and some vegetables contain this kind of fiber.
Lactase deficiency: Another major source of flatulence is lactase deficiency, which results in a decreased ability to digest lactose, a natural sugar found in milk and other dairy products such as cheese and ice cream and in certain processed food such as bread, cereal, and salad dressing. This flatulence is often associated with diarrhea and cramping but can appear as only gas. Many people normally have low levels of the enzyme lactase needed to digest lactose after childhood. Also, as people age, their enzyme levels decrease. As a result, over time people may experience increasing amounts of gas after eating food containing lactose.
Other problems: Certain conditions can result in other foods being poorly absorbed in the GI tract, allowing for increased bacterial activity.
Malabsorption syndromes can be the result of decreased production of enzymes by the pancreas or problems with the gallbladder or lining of the intestines.
If transit through the colon is slowed down for any reason, bacteria have increased opportunity to ferment remaining material. If a person is constipated or has decreased bowel function for any reason, flatulence can follow.
Alterations in bowel habits can be a result of the following:
Poor dietary fiber                                                     
Parasites
Inflammatory bowel disease
Intestinal obstruction (including cancer)
Diverticulosis or diverticulitis
Poor thyroid function
Narcotic and other drug use
     Flatulence (Gas) Symptoms
Symptoms of flatulence are increased passage of gas, and abdominal bloating or pain, and belching. Embarrassment can be caused by the increased passage of flatus or the often-offensive odor it causes.
Gas: Everyone passes gas normally each day. A certain amount of gas is present in the GI tract at any one time, mainly in the stomach and colon. The average person passes gas about 10 times each day and up to 20-25 times is considered normal. More than that may be excessive.
Belching: An occasional belch during or after meals is normal and releases gas when the stomach is full of food. But if a person belchs frequently, he or she may be swallowing too much air and releasing it before the air enters the stomach. Some people swallow air to make themselves belch, thinking it will relieve their discomfort. This practice may turn into an annoying habit. Belching may signal a more serious upper GI disorder such as peptic ulcer disease, gastroesophageal reflux disease (GERD), or gastroparesis.
Abdominal bloating: Many people believe that too much gas causes abdominal bloating. However, people who complain of bloating from gas often have normal amounts of gas. They actually may be unusually aware of gas in the digestive tract. A diet of fatty foods may delay stomach emptying and cause bloating and discomfort, but not necessarily too much gas. Certain conditions may cause bloating, such as irritable bowel syndrome, Crohn's disease, or colon cancer. People with scar tissue (adhesions) from abdominal operations or internal hernias may have a sensation of bloating because of increased sensitivity to gas.
Abdominal pain and discomfort: Some people have pain when gas is present in the intestine. When pain is on the left side of the colon, it can be confused with heart disease. When the pain is on the right side of the colon, it may mimic gallstones or appendicitis.
    When to Seek Medical Care
Visiting a health care professional is the best place to start. Seek medical attention whenever symptoms other than simply excess flatulence occur, such as:
Severe crampy abdominal discomfort
Change in bowel habits
Diarrhea
Constipation
Blood in the stool
Fever
Nausea
Vomiting
Abdominal pain and swelling, particularly in the right lower part of the abdomen
       Flatulence (Gas) Diagnosis
A health care professional may review what patient eats and the symptoms produced. You might keep a food and drink diary for a specific period of time and track the passage of gas during the day. Careful review of diet and the amount of gas passed may help relate specific foods to symptoms and determine the severity of the problem.
The primary tests, if necessary, will likely include measuring the amount of hydrogen in the patient's breath after the person eats suspected foods. Because bacteria are largely responsible for the production of hydrogen, an increase in exhaled hydrogen as measured by the breath test will suggest a food intolerance, with the bacteria fermenting the undigested food to produce excess gas. After the patient eats a problem food, breath testing should show an increase in hydrogen in as little as 2 hours.
Another possible test is analysis of flatus for gas content. This should help differentiate gas produced by swallowing air from gas produced in the gastrointestinal (GI) tract.
If these tests produce no diagnosis, more broad testing can be accomplished to help exclude more serious disorders such as diabetes, cancer, malabsorption,cirrhosis of the liver, poor thyroid function, and infection.
If a patient has abdominal pain or appears to have a swollen abdomen, the health care professional may have X-rays taken to show intestinal obstruction or perforation. X-rays can also be taken after the patient drinks X-ray dye to show the GI tract, which can be followed up with an internal view of the colon through colonoscopy, if problems are noted.
If lactase deficiency is the suspected cause of gas, the health care professional may suggest the patient avoid milk products for a period of time. A blood or breath test may be used to diagnose lactose intolerance.
Flatulence (Gas) Self-Care at Home
Flatulence is most often related to diet, and sometimes to those habits that cause a person to swallow air. Begin by trying to remove problem foods from the diet. For many people, this is a trial-and-error procedure.
This may take careful observation to notice what foods cause increased gas. Keep a food diary and note excess passage of gas. Any of the gas-producing foods can be removed from the diet one group at a time until the person experiences relief. Sorbitol and fructose are common offenders, so try these first.
If this method does not work, a more restrictive approach is to start with a very limited number of safe foods, and add one new food every 48 hours in order to determine what food or food group causes difficulty. If the offending food is found, then the affected person can avoid eating that food or be prepared for its consequences.
Iflactose intolerance is suspected to cause the problem, remove all dairy foods from the diet for 10-14 days to assess the effect on flatulence (using a diary). The enzyme lactase, which aids with lactose digestion, is available in liquid and tablet form without a prescription (Lactaid, Lactrase, Dairy Ease). Adding a few drops of liquid lactase to milk before drinking it or chewing lactase tablets just before eating helps digest foods that contain lactose. Also, lactose-reduced milk and other products are available at many grocery stores (Lactaid, Dairy Ease).
If odor is a concern, there is also some reported success with charcoal filter undergarments.
If belching is a problem, avoid the behaviors that cause the affected person to swallow air, such as chewing gum or eating hard candy. Eat slowly. Make sure dentures fit properly.
In general, avoid overeating because this contributes to flatulence as well as obesity. Limit high-fat foods to reduce bloating and discomfort. The stomach will empty faster, allowing gases to move into the small intestine
Flatulence (Gas) Medical Treatment
Some promising studies have investigated feeding nonoffensive strains of bacteria to push out the bacteria that are offensive, although no established treatments are available at this time.
Regulation of bowel function is essential. Constipation should be treated with increased dietary fiber or certain laxatives.
In cases where anxiety causes the person to swallow air, the doctor may suggest he or she seek mental health counseling to change habit patterns
Flatulence (Gas) Medications
If the patient does not desire to avoid the foods that cause gas, many nonprescription medicines are available to help reduce symptoms.
Activated charcoal tablets (Charcocaps) may provide relief from gas in the colon. Gas can be reduced if tablets are taken before and after a meal. The usual dose is 2-4 tablets taken just before eating and one hour after meals.
Certain prescription medicines may help reduce symptoms, especially if you have a disorder such as irritable bowel syndrome. Some medicines such as metoclopramide (Reglan) have also been shown to decrease gas complaints by increasing gut activity.
Conclusion
It must be remembered that flatus is not a means to laugh but its a medical condition which ranges from a asymptomatic condition to a severe one. Its important to take a medical advise as soon as possible to get relieved from the symptomps.
 
   
 



 
 

Inverted papilloma and Management


INVERTED PAPILLOMA & ITS MANAGEMENT
 
: Inverted papilloma is a benign lesion occurring in the nasal cavity and paranasal sinuses. Even though these tumors areclassified as benign they are known to cause local destruction, known to recur and also can undergo malignant transformation to squamous cell carcinoma. Inverted papilloma is a benign, locally aggressive neoplasm that arises in the nasal cavity and is associated with squamous cell carcinoma in approximately 5% of patients. Squamous cell carcinoma may be present with inverted papilloma at the initial diagnosis or it may occur metachronously after prior treatment. The condition has been given different terminologies like:-
 
1) Schneiderian papilloma.                                                
2) Inverted papilloma.
3) Benign papilloma of nose.
4) Cylindroma.
5) Malignant papilloma of nose
 
Definition: The mucosal lining of nose and paranasal sinuses is known as Schneiderian membrane in memory of Victor conrod Schnider who described its histology. Papillomas arising from this membrane are very unique in that they are found to be growing inwards and hence the term inverted papilloma. These papillomas are unique in their history, biology and location. Papillomas involving the vestibule is not included in this group because histologically, biologically and behaviour wise it is different.It should be borne in mind that the lining mucosa of nose and paranasal sinuses is unique Embryologically in the sense that it is derived from the ectoderm, in contrast to the lining epithelium of laryngobronchial tree which is derived from endoderm.
Incidence:
Inverted papilloma of nose is one of the commonest benign tumors involving the nose and paranasal sinuses.
Histology:
Inverted papillomas arise from reserve / replacement cells located at the basement membrane of the mucosa. The stimulus for this proliferation is largely unknown..Human papilloma virus have been implicated as an etiological agent.
 
Etiology:
Very little is known regarding the etiology of inverted papilloma. Studies have implicated Human papilloma virus as the probable etiology. Human papilloma virus DNA have been isolated from nasal papilloma cells. It should also be pointed out that HPV DNA have not been identified in all the papilloma cells.
Age group affected: Majority of these patients fall in the age group between 5070years.
Sex predisposition: It is three times more common in males than in females.
Anatomic classification:
Inverted papilloma can be classified according to its site of occurrence i.e. lateral wall and septal papillomas. They show differences in their behaviour patterns. The septal papillomas remain confined to the nasal septum and may very rarely involve the roof and floor of the nasal cavity.
Characteristic attributes of inverted papilloma:                                
1.Tendency to recur even after complete surgical                                 
     removal of mass
2.Its destructive capacity
3.Presence of associated nasal polypi
4.Malignant transformation
Symptoms: Include
Unilateral nasal obstruction
This occurs when the mass is sufficiently large to cause airway obstruction.
Nasal discharge
This is due to retained secretions in the nasal cavity and the excessive mucous secretions from mucoid glands present in the nasal mucosa.
Epistaxis
Commonly unilateral and occurs unprovoked. Usually self limiting in nature.
Head ache
Is caused due to blockage of the normal sinus drainage. If the head ache is intense and nocturnal then malignant transformation eroding the skull base should be suspected.
Sinusitis & swelling involving the nose
This is usually due to the mass obstructing the sinus drainage. Swelling is seen in the alar region (flaring of the ala).
Anosmia
This is very rare and is seen only in patients with bilateral mass lesions.
Hearing impairment
Is caused when the mass expands into the naso pharynx to involve the eustachean tube. This can also cause tinnitus rarely.
Epiphora
This is caused due to blockage of naso lacrimal duct at the inferior meatus
Numbness over cheek
Due to involvement of infraorbital nerve
Altered speech
Occurs when the mass involves the nasopharynx
Proptosis
Is seen in patients in whom the lamina papyracea has been breached.
 
Management of Inverted papilloma.
There is only surgical treatment in the management of  inverted paapilloma basically endoscopic.
Types of endoscopic techniques in the management of inverted papilloma:
Three different types of endoscopic techniques are available to the surgeon for managing inverted papillomas. The decision on the technique is arrived at on detailed study of pre op images and intra op endoscopic findings.
Type I resection:
 If the naso lacrimal ductis involved or in order to provide better exposure, the duct can be sectioned just below the Krause valve
Type II resection:
This is also known as endoscopic medial maxillectomy procedure. It is indicated for inverted papillomas originating from ethmo nasal complex and secondarily involves maxillary sinus or when the lesion originates from the mucosal lining of the medial wall of maxillary sinus.
Type III resection:
This procedure is indicated in patients with inverted papilloma with involvement of mucosa of antero lateral and posterior walls of maxillary sinus. These patients require a rather wide exposure of maxillary sinus. This can be achieved by combining medial maxillectomy with resection of the medial portion of the anterior wall of maxillary sinus.
Medial maxillectomy is the radical surgery for the management of medial maxillectomy mostly in cases of malignant transformation of inverted papilloma. It maybe done by a endoscopic procedure of by an open operation with lateral rhinotomy incision.
 
Complications of medial maxillectomy:
1.Lid oedema
2.Asymmetry of palpebral fissures
3.Diplopia
4.Enophthalmos
5.Transient blindness due to retinal artery spasm
6.Orbital hemorrhage
7.CSF leaks.
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Sunday, January 20, 2013

Tree growing in the lung

Tree growing in the lung



An X-ray that apparently shows a fir tree growing inside a 28-year-old man's lung. Doctors initially believed it was a tumour




Surgeons in Russia thought they were going to remove a cancerous tumor from a 28-year-old patient – but instead they found a 5-centimeter tree growing inside his lung.

It happened in Russia’s Urals region while doctors were operating on Artyom Sidorkin, the Russian newspaper, Komsomolskaya Pravda Daily reported.
Doctors suspected Sidorkin had cancer after he complained of extreme pain in his chest and had been coughing up blood.

Doctors believe Sidorkin somehow inhaled a seed, which later sprouted inside his lung.

Surgeons claim this is the fir tree growing inside the man's lung after it was removedThe spruce, which was touching the man's capillaries and causing severe pain, was removed.

The tree, measuring 5cm, was discovered by Russian doctors when they opened up Artyom Sidorkin, 28, to remove what they thought was a tumour.
Medical staff believe that Mr Sidorkin somehow inhaled a seed, which later sprouted into a small fir tree inside his lung.
The patient had complained of extreme pain in his chest and had been coughing up blood. Doctors were convinced he had cancer.
'We were 100 per cent sure,' said surgeon Vladimir Kamashev from Izhevsk in the Urals. 'We did X-rays and found what looked exactly like a tumour. I had seen hundreds before, so we decided on surgery.'

Before removing the major part of the man's lung, the surgeon investigated the tissue taken in a biopsy.
'I thought I was hallucinating,' said Dr Kamashev. 'I asked my assistant to have a look: "Come and see this - we've got a fir tree here".
'He nodded in shock. I blinked three times as I was sure I was seeing things.'
They believed the coughing of blood was caused by the tiny pine needles piercing blood capillaries. 'It was very painful. But to be honest I did not feel any foreign object inside me,' said Mr Sidorkin. 'I'm so relieved it's not cancer.'
The report appeared in popular tabloid Komsomolskaya Gazeta, and was picked up by Russian news service Novosti.