Tag: TREATMENT

Retinoblastoma-Treatment


Retinoblastoma-Treatment


The treatment of retinoblastoma includes the following:

Focal-

  • Cryotherapy
  • Laser photocoagulation
  • Trans pupillary Thermotherapy

Systemic-

This involves chemotherapy, which is further divided into the following

Intravenous:

  • Success rates > 95%
  • [VEC] – 6 cycles
  • S/E – deafness

Intravitreal:

  • DOC- MELPHALAN

Intraarterial:

  • Into Ophthalmic Artery
  • MELPHALAN
  • TOPOTECTAN
  • CARBOPLATIN

Enucleation:

  • Advanced intra ocular RB with NVI (Neovascularization of Iris)
  • Secondary Glaucoma
  • AC invasion
  • 75 % of vitreous volume involvement
  • Hyphema
  • Necrotic tumors with orbital inflammation

Congenital Glaucoma-Treatment


Congenital Glaucoma-Treatment


If cornea is clear:

Goniotomy:

  • Safer method, but rare in India as:
  • Gonioscopy should be used to look at the angle
  • As pt. usually comes to the doctor very late
  • And the cornea is no clearer and hazier.
  • In hazy cornea it is difficult to perform Goniotomy
  • Barkan’s membrane is punctured by a needle allowing aqueous outflow through trabecular meshwork & helps in ↓IOP

If cornea is hazy:

Trabeculotomy

  • Scleral approach to trabecular meshwork → small hole is made in trabecular meshwork→ Normal aqueous flow → ↓IOP

Trabeculotomy + Trabeculectomy (TRAB+TRAB)

  • TRAB+TRAB →Along with a small hole, a piece of Trabecular mesh work is removed for the normal aqueous flow – ↓IOP

Treatment Of NPDR


Treatment Of NPDR


Treatment of NPDR is done by:

Laser photocoagulation:

  • DF-ND YAG LASER [DF –Double Frequency]
  • Wavelength → 1064/2 → 532nm
  • Green laser [applied peripherally]
  • 60-80⁰ C heat used [absorbs edema]

Anti VEGF Drugs:

  • BEVACIZUMAB
  • RANIBIZUMAB

Intra Vitreal Steroids:

  • TRIAMCINOLONE
  • OZURDEX

[Implantable Dexamethasone]

All the treatment modalities are explained along with images

Rhegmatogenous detachment-Treatment


Rhegmatogenous detachment-Treatment


1. Drain the fluid

2. Close holes, lattices & tears by Photocoagulation by laser beam [60-80⁰C]

  • Causes chorioretinal adhesions-NSL & RPE in apposition

3. In some cases, Tamponade on NSL is required

  • Tamponade by Inj. SILICON OIL through Pars Plana
  • Expansile gases → AIR

→ SF6 [Sulfur Hexa Fluoride]

→ C3F8 [Per Fluoro Propane]

4. Buckling [Silicon patch on Retina]

Schizophrenia-Treatment


Schizophrenia-Treatment


Pharmacological treatment of schizophrenia includes antipsychotics/neuroleptics.

Both typical and atypical antipsychotics are used

Typical antipsychotics (1st gen):

  • Acts Via D2 Receptor Antagonism
  • Effective Against Positive Symptoms
  • Minimal Effect on Negative Symptoms
  • Causes More Extrapyramidal Side Effects

Atypical antipsychotics (1st gen):

  • Acts Via D2 & 5HT 2 Receptor Antagonism
  • Effective Against (+) and (-) Symptoms
  • Causes Less Extrapyramidal Side Effects
  • Causes Less other Side Effects

Bipolar Disorder-Treatment


Bipolar Disorder-Treatment


Pharmacological treatment of bipolar disorder:

1. Mood Stabilizers

  • Lithium, Valproate, Carbamazepine, Oxacarbamazepine and Lamotrigine
  • Lithium – Prototypical mood stabilizer. Takes 1-2 weeks to start acting
  • Valproate – Preferred Drug for acute mania
  • Lamotrigine – Used in Acute depressive episode of bipolar disease [Bipolar Depression]

2. Antipsychotics

3. Benzodiazepines

  • High potency BDZ used for their calming effects [ Lorazepam and clonazepam]

4. Antidepressants

• NEVER USED ALONE in bipolar disease

Treatment guidelines used in bipolar disorders:

Acute Mania / Mixed Episode:

  • Severe Cases – Initiate Lithium in combination with valproate and or antipsychotic
  • Less Severe cases – Monotherapy with Lithium or valproate or atypical antipsychotic started
  • Short term BDZ also used.
  • For Mixed episodes valproate preferred over lithium

Acute Depression:

  • Initiate Lithium or Lamotrigine. In Severe case Lithium + Antidepressants
  • Quetiapine alone or with olanzapine and fluoxetine
  • ECT if suicide risk

Maintenance:

  • Lithium and Valproate used for at least 2 years especially if 2 or more acute attack in Bipolar I illness

Buerger Disease

BUERGER DISEASE


BUERGER’S DISEASE (THROMBOANGITIS OBLITERANS)

  • Buerger’s disease is a non- atherosclerotic, progressive, segmental, occlusive inflammatory disorder involving small and medium sized arteries with cell mediated sensitivity to Type I and Type II collage in upper and lower extremities.
  • Inflammatory process does involve adjacent nerves and veins.
  • Triad of thromboangitis obliterans- occlusion of small and medium sized vessels, superficial thrombophelbitis, Raynaud’s phenomenon.

ETIOLOGY-

  • Mainly seen in smokers and tobacco users.
  • Common in Jewish people
  • Hormonal influence
  • Familial nature
  • Poor hygiene

PATHOLOGY-

  • Smoke → vasospasm & hyperplasia initma → thrombus & obliteration medium sized vessels → Panarteritis → Artery, vein & nerve are involved  → Blockage leads to collateral open up → Blood supply to ishchaemic areas → Compensatory peripheral vascular disease
  • Microabscesses, giant cells are found.

CLASSIFICATION-

  • Type I- upper limb TAO (rare)
  • Type II- involving legs & infrapopliteal
  • Type III- femoropopliteal
  • Type IV- aortoiliofemoral
  • Type V- generalised

CLINICAL FEATURES-

  • Common in male smokers between 20- 40 years
  • Intermittent claudication in foot & calf progressing to rest pain, ulceration & gangrene.
  • Absence of atheromas.
  • Small & medium sized vessels such as dorsalis, pedis, posterior tibial, popliteal are commonly involved.

INVESTIGATIONS-

1. Arterial Doppler & Duplex scan

2. Transformed retrograde angiogram-

  • Shows blockage
  • Cork screw appearance of the vessel
  • Inverted tree/ spider leg collaterals
  • Severe vasospasm causing rippled artery

3. Transbranchial angiogram- if femorals are not felt then transbranchial angiogram is done.

4. USG abdomen- shows abdominal aorta for block 

TREATMENT-

  • Stop smoking
  • Vasodilators- nifedipine, xanthinol nicotinate
  • Antithrombin activity- low dose of aspirin
  • Analgesics
  • Lumbar sympathectomy- for rest pain and ulcerations
  • Omentoplasty, profundoplasty
  • Amputation in gangrene

Exam Important

PATHOLOGY-

  • Smoke → vasospasm & hyperplasia initma → thrombus & obliteration medium sized vessels → Panarteritis → Artery, vein & nerve are involved  → Blockage leads to collateral open up → Blood supply to ishchaemic areas → Compensatory peripheral vascular disease
  • Microabscesses, giant cells are found.

ETIOLOGY-

  • Mainly seen in smokers and tobacco users.
  • Common in Jewish people
  • Hormonal influence
  • Familial nature
  • Poor hygiene

CLINICAL FEATURES-

  • Common in male smokers between 20- 40 years
  • Intermittent claudication in foot & calf progressing to rest pain, ulceration & gangrene.
  • Absence of atheromas.
  • Small & medium sized vessels such as dorsalis, pedis, posterior tibial, popliteal are commonly involved.
Don’t Forget to Solve all the previous Year Question asked on BUERGER DISEASE

Module Below Start Quiz

Buerger Disease

Buerger Disease

Q. 1

All of the following are the clinical feature of thromboangitis obliterans except :

 A Raynaud’s phenomenon

 B

Claudication of extremeties

 C

Absence of popliteal pulse

 D

Migratory superficial thrombophlabitis

Q. 1

All of the following are the clinical feature of thromboangitis obliterans except :

 A

Raynaud’s phenomenon

 B

Claudication of extremeties

 C

Absence of popliteal pulse

 D

Migratory superficial thrombophlabitis

Ans. C

Explanation:

Ans. is ‘c’ i.e., Absence of popliteal pulse


Q. 2

Commonest site of thromboangitis obliterans is 

 A

Femoral artery

 B

Popiteal artery

 C

iliac artery

 D

None

Q. 2

Commonest site of thromboangitis obliterans is 

 A

Femoral artery

 B

Popiteal artery

 C

iliac artery

 D

None

Ans. D

Explanation:

Ans. is ‘None’ 
Distal circulation is involved in Buerger’s disease, usually distal to popliteal and brachial artery.


Q. 3

Thromboangitis obliterans is associated with

 A

HLA B27

 B

HLA – DR4

 C

HLA – B5

 D

HLA – DR2

Q. 3

Thromboangitis obliterans is associated with

 A

HLA B27

 B

HLA – DR4

 C

HLA – B5

 D

HLA – DR2

Ans. C

Explanation:

Ans. is ‘c’ i.e., HLA – B5 

Thromboangitis obliterans (Berger disease)

  • Thrombangitis obliterans is a distinctive disease that is characterized by segmental, thrombosing acute and chronic inflammation of medium sized and small sized arteries, and sometimes secondarily extending to veins and nerves.
  • Thromboangitis obliterans occurs almost exclusively among heavy-cigarrete-smoking persons.
  • It is more common in men but incidence is increasing in women because of increasing smoking habit in women. o Buerger disease is associated with HLA B-5 and HLA-A9.
  • In thrombongitis obliterans there is acute and chronic segmental inflammation of vessels with accompanied thrombosis in the lumen.
  • Typically, the thrombus contains microabscesses with a central focus of neutrophils surrounded by gran u lomatous inflammation.
  • Later, the inflammatory process extends into contiguous veins and nerves and in time all three structures (arteries, veins and nerves) become encased in fibrous tissue, a characterstic that is very rare with other form of vasculitis.
  • Clinical manifestations
  • Thrombangitis obliterans affects vessels of upper and lower extremities.
  • Symptoms are due to vascular insufficiency, i.e. Ischemia of toes, feet and fingers that can lead to ulcer and frank gangrene.
  • Due to neural involvement, there may be severe pain, even at rest.

Q. 4 True about Buerger disease

 A

Affects larger artery only

 B

Younger males are more commonly affected

 C

Phlebitis migrans is characteristic

 D

Cold intolerance

Q. 4

True about Buerger disease

 A

Affects larger artery only

 B

Younger males are more commonly affected

 C

Phlebitis migrans is characteristic

 D

Cold intolerance

Ans. B:C:E

Explanation:

Answer- B,Younger males are more commonly affected C,Phlebitis migrans is characteristic E,Veins may involved
Also called as Thromboangiitis Obliterans
It is a inflammatory occlusive vascular disorder involving small and medium sized arteries and veins in upper and lower extremities.
It involves tibial and radial arteries and sometimes secondarily extending to veins and nerves of extremities.
The clinical features of thromboangiitis obliterans includes a triad of claudication of the affected extremity, Raynaud’s phenomenon, and migratory superficial vein thrombophlebitis.

Quiz In Between



Ectopic Testis

ECTOPIC TESTIS


ECTOPIA TESTIS

  • An ectopic testicle descends normally through the inguinal canal but then moves into an abnormal position in the groin area.
  • The main hazard is liability to injury.
  • Sites of ectopic testis-

a) Superficial inguinal pouch

b) Perineum

c) Root of the penis

d) Femoral triangle (thigh)

  • Ectopic testis is usually fully developed

EMBRYOLOGY-

  • Testis reaches the scrotum by the scrotal tail gubernaculum.
  • The gubernaculums helps to guide the descent of the testicles.
  • Most ectopic testicles are palpable.

TREATMENT-

  • Surgical treatment after age of about 6 months but no later than 2 years
  • Orchidopexy in a new scrotal pouch.
COMPLICATIONS- 
  • Liability to injury (torsion)

Exam Important

  • Sites of ectopic testis-

a) Superficial inguinal pouch

b) Perineum

c) Root of the penis

d) Femoral triangle (thigh)

  • Ectopic testis is usually fully developed
COMPLICATIONS- 
  • Liability to injury (torsion)
Don’t Forget to Solve all the previous Year Question asked on ECTOPIC TESTIS

Module Below Start Quiz

Ectopic Testis

ECTOPIC TESTIS

Q. 1 Ectopic testis is found in all location except ‑

 A

Lumbar

 B

Perineal

 C

Intra abdominal

 D

Inguinal

Q. 1

Ectopic testis is found in all location except ‑

 A

Lumbar

 B

Perineal

 C

Intra abdominal

 D

Inguinal

Ans. C

Explanation:

Ans. is C

  • Sites of ectopic testis-

a) Superficial inguinal pouch
b) Perineum
c) Root of the penis
d) Femoral triangle (thigh)


Q. 2

Complication of ectopic testis is ‑

 A

Seminoma

 B

Atrophy

 C

Torsion

 D

All

Q. 2

Complication of ectopic testis is ‑

 A

Seminoma

 B

Atrophy

 C

Torsion

 D

All

Ans. C

Explanation:

Ans. is ‘c’ i.e., Torsion 

Quiz In Between



Free Mini Course on Stomach

Mini Course – Stomach

22 High Yield Topics in Stomach

in Just 2 Hours

Submission received, thank you!

Close Window
Malcare WordPress Security