Vascular retinopathies are eye conditions that result from poor blood supply to the eyes. The five types of vascular retinopathy are cental retinal vein occlusion, diabetic retinopathy, hypertensive retinopathy, sickle cell retinopathy, and central retinal artery occlusion.
What causes them?

When one of the arteries that supplies blood to the retina become, blocked, blood flow diminishes. This damages the eye and causes vision problems.

Causes of central retinal vein occlusion include external compression of the retinal vein, injury, diabetes, blood clots, granulomatous diseases, infections, glaucoma, and atherosclerosis. This form of vascular retinopathy is most prevalent in elderly people.

Diabetic retinopathy results from juvenile or adult diabetes. Micro­circulatory changes occur more rapidly when diabetes is poorly controlled. About 75% of people with juvenile diabetes develop retinopathy within 20 years of the disease’s onset. In adults with diabetes, incidence increases with the duration of diabetes. This condition is a leading cause of acquired adult blindness.

Hypertensive retinopathy results from prolonged high blood pressure, producing retinal vasospasm and consequent damage and narrowing of retinal blood vessels.

Sickle cell retinopathy results from the impaired ability of sickled cells to pass through the tiny capillary blood vessels, producing obstructions. This results in microaneurysms, chorioretinal tissue death, and retinal detachment.

Central retinal artery occlusion may have an unknown cause or may result from embolism, atherosclerosis, infection, or conditions that slow the blood flow, such as temporal arteritis, a narrowed carotid artery, and heart failure. This rare type of retinopathy occurs in one eye and affects elderly people.
What are their symptoms?

Central retinal vein occlusion reduces vision, allowing perception of only hand movement and light. This condition is painless, except when it results in secondary neovascular glaucoma (uncontrolled proliferation of weak blood vessels). The prognosis is poor - 5 % to 20% of people with this type of vascular retinopathy develop secondary glaucoma within 4 months.

Nonproliferative diabetic retinopathy produces changes in the lining of the retinal blood vessels that cause the vessels to leak plasma or fatty substances, which decrease or block blood flow within the retina. This disorder may also produce microaneurysms and small hemorrhages. Although some people with nonproliferative retinopathy lack symptoms, others have significant loss of central visual acuity (necessary for reading and driving) and diminished night vision.

Proliferative diabetic retinopathy causes fragile new blood vessels on the disk and elsewhere. These vessels can grow into the vitreous and then rupture, causing sudden vision loss. Scar tissue that may form along the new blood vessels can pull on the retina, causing macular distortion and even retinal detachment.

Symptoms of hypertensive retinopathy depend on the location of retinopathy. For example, mild visual disturbances, such as blurred vision, result from retinopathy located near the macula (a spot near the center of the retina concerned with visual acuity). Without treatment, 50% of people become blind within 5 years. With treatment, the prognosis varies with the severity of the disorder. Severe, prolonged disease eventually causes blindness; mild, prolonged disease causes visual defects.

Central retinal artery occlusion causes sudden, painless vision loss (partial or complete) in one eye. This condition typically causes permanent blindness. However, some people experience spontaneous resolution within hours and regain partial vision.
How are they diagnosed?

Appropriate diagnostic tests depend on the type of vascular retinopathy. Evaluation includes determination of visual acuity and ophthalmoscopic examination.
How Vascular Retinopathies are treated?
Vascular Retinopathies teatment approaches depend on the type of retinopathy. Therapy for central retinal vein occlusion may include aspirin, which acts as a mild anticoagulant. Laser photocoagulation can reduce the risk of glaucoma for some people.

Treatment of nonproliferative diabetic retinopathy is prophylactic.

Careful control of blood sugar levels during the first 5 years of the disease may delay its onset or reduce its severity. For people with early symptoms of microaneurysms, therapy includes frequent eye exams (3 to 4 times a year) to monitor their condition. For children with diabetes, therapy includes an annual eye exam by an ophthalmologist.

The best treatment for proliferative diabetic retinopathy is laser photocoagulation, which cauterizes the leaking blood vessels. Despite treatment, neovascularization doesn’t always regress and vitreous hemorrhage, with or without retinal detachment, may follow. If the blood isn’t absorbed in 3 to 6 months, vitrectomy may restore partial vision.

Treatment of hypertensive retinopathy includes control of blood pressure with appropriate drugs, diet, and exercise.

No particular treatment has been shown to control central retinal artery occlusion. To lower intraocular pressure, therapy includes Diamox, eyeball massage and, possibly, anterior chamber paracentesis. Another treatment, inhalation of carbogen (95% oxygen and 5% carbon dioxide), improves retinal oxygenation.

There are degrees of uremia. Early symptoms are headache, loginess, itching, muscle discomfort, with or followed by nausea and vomiting. The patient becomes drowsy, perhaps has convulsions, and lapses into coma and death.

Insufficiency is relative to the capabilities of a particular pair of kidneys. Insufficiency may result from some acute, repairable condition, or from gradual and irreversible damage and destruction of kidney tissue over a period of years. A major purpose of good urological care is to prevent insidious kidney injury and whenever possible to eradicate causes of insufficiency by such measures as clearing up infections and removing or by­passing obstructions.

Great advances in treatment of renal insufficiency have been made in recent years. One of the mechanisms artfully employed by the kidneys is dialysis. This is the separation of substances in solution, having different diffusibilities, by passing them through a porous membrane, such as membranes of the kidney filters. Similar filtration can be achieved by techniques of peritoneal dialysis, in which membranes of the abdominal cavity do the work of the diseased kidneys temporarily. Blood passed through peritoneal membranes is cleansed and returned to the body. The technique has proved very successful in treatment. Absorptive resins placed in the gastrointestinal tract are useful adjuncts.

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Volvulus is a 180-degree or more twist of the intestine. The twist pinches blood vessels and cuts off the blood supply to that section of the bowel.

What causes it?

The twist may be caused by an unusual curve in the intestine, something swallowed, or an adhesion. In some cases, however, the cause is unknown. The most common site, especially in adults, is the S-shaped section of the intestine before it reaches the rectum. In children, volvulus usually occurs in the small bowel.

What are its symptoms?

The person has vomiting and rapid, marked abdominal distention following the sudden onset of severe abdominal pain. Without immediate treatment, volvulus can lead to strangulation of the twisted bowel loop, loss of blood supply, deterioration, perforation, and fatal peritonitis when the bowel material infects the abdominal cavity.

How is it diagnosed?

The doctor will recognize the person’s description of sudden, severe abdominal pain and can probably feel the bulge of the intestine. Other special tests include the following:

• Abdominal and chest X-rays may show the obstruction and abnormal air-fluid levels in the bowels.
• Barium enema X-ray shows typical volvulus shapes.
• The person’s white blood cell count will be higher than normal.

How is it Treated?

Surgery is recommended for children with midgut volvulus. For adults with lower colon volvulus, the doctor will use a scope to check for packed feces. If possible, the doctor removes the blockage by inserting a scope or a long rectal tube to deflate the bowel.

If volvolus surgery is required and the bowel is distended but healthy, the surgeon will untwist the bowel. If there’s tissue damage, the damaged part will be cut away and the healthy intestine reconnected.

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Sinusitis

What is this condition?

Sinus infection refers to infection of the paranasal sinuses - the four pairs of air pockets that drain into the nose. Sinus infection may be acute, subacute, chronic, allergic, or hyperplastic. In this last, the number of sinus cells is abnormally increased.

What causes it?

Sinus infection usually is caused by viral or bacterial infection. Acute sinus infection is primarily caused by the common cold; it lingers in the subacute form in only about 10% of cases. Chronic sinus infection follows persistent bacterial infection.

Predisposing factors for sinus infection include any condition that interferes with sinus drainage and ventilation, such as:

•  chronic nasal swelling

•  a deviated septum

•  thickened mucus

•  nasal polyps

• allergic inflammation of the nasal mucous membranes (allergic rhinitis)

• a weakened state from chemotherapy, malnutrition, diabetes, a blood disease, chronic steroid use, or a depressed immune system.

Bacterial sinus invasion commonly is caused by the conditions listed above or after a viral infection. It may also result from swimming in polluted water.

Allergic sinus infection accompanies allergic rhinitis. Hyperplastic sinus infection is a combination of pus-producing acute sinus infection and allergic sinus infection or allergic rhinitis.

What are its symptoms?

Symptoms vary depending on the type of sinus infection.

Acute sinus infection

The main symptom of this type of sinus infection is a stuffy nose, followed by gradually increasing pressure in the affected sinus. For 24 to 48 hours after symptoms first appear, the person may have a runny nose. Later, the nasal discharge contains pus. Other symptoms include an overall ill feeling, sore throat, headache, and slight feye (temperature of 99° to 99.5° F [37.2° to 37.5° C]). Pain location depends on the affected sinus, but may occur over the cheeks and upper teeth, over the eyes, over the eyebrows, or behind the eyes.

Subacute sinus infection

In this type of sinus infection, pus-filled nasal drainage lasts longer than 3 weeks after an acute infection subsides. Other symptoms include stuffy nose, vague facial discomfort, fatigue, and a nonproductive cough.

Chronic sinus infection

Symptoms of chronic sinus infection resemble those of acute sinus infection, except that the chronic form causes continuous mucusand pus-filled discharge.

Allergic sinus infection

The major symptoms of this type of infection are sneezing, a headache in the front of the head, watery nasal discharge, and a stuffy, burning, itchy nose.

Hyperplastic sinus infection

This type of infection causes a chronically stuffy nose and headache.

How is it diagnosed?

To diagnose sinus infection, the doctor examines the inside of the persons nose. The doctor may also take sinus X-rays, perform a sinus puncture (rare), or order ultrasound or a computed tomography scan (commonly called a CAT scan).

How is it Treated?

The doctor may try a variety of treatments, depending on the type of sinus infection.

Acute sinus infection

Usually, the doctor prescribes local decongestants before trying oral decongestants and may also recommend inhaling steam. To combat pus­producing or persistent infection, [he doctor will prescribe antibiotics, usually for 2 to 3 weeks, because sinus infection is deep seated. Applying heat to the sinus area may also help relieve pain and congestion.

Subacute sinus infection

In subacute sinus infection, antibiotics and decongestants may be helpful.

Allergic sinus infection

To treat allergic sinus infection, the doctor must also treat allergic rhinitis. Typically, the doctor prescribes antihistamines, orders skin testing to identify the cause of allergy, and may prescribe immunotherapy, which desensitizes the person to the offending allergens bv administering them in increasingly large doses. Severe allergic symptoms may call for steroids and epinephrine.

Chronic and hyperplastic sinus infection

In both these types of infection, the doctor may prescribe antihistamines, antibiotics, and a steroid nasal spray to relieve pain and congestion. If irrigation fails to relieve symptoms, sinus surgery may be necessary.

• Sad feeling
• Crying without any reason.
• No interest in activities which you used to enjoy before.
• guilty feeling
• loss of interest in work
• Laziness
• Unable to take decisions
• Attempts of suicide

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Spina bifida, meningocele, myelomeningocele

What are these conditions?

Defective neural tube closure in the embryo during the first trimester of pregnancy causes various spinal malformations. Generally, these defects occur in the lumbosacral area, but they are occasionally found in the sacral, thoracic, and cervical areas.

Spina bifida occulta is the most common and least severe spinal cord defect. Although one or more vertebrae fail to close completely, the spinal cord or meninges (membranes covering the brain and spinal cord) do not protrude.

However, in more severe forms of spina bifida, incomplete closure of one or more vertebrae causes the spinal contents to protrude and form an external sac or cystic lesion. In spina bifida with meningocele, this sac contains meninges and cerebrospinal fluid. In spina bifida with myelomeningocele, this sac contains meninges, cerebrospinal fluid, and a portion of the spinal cord or nerve roots distal to the conus medullaris.

Spina bifida is relatively common, affecting about 5% of the population. In the United States, approximately 12,000 infants each year are born with some form of spina bifida.

The prognosis varies with the degree of accompanying neurologic deficit. It’s worst in people with large open lesions, neurogenic bladders (which predispose to infection and kidney failure), or total paralysis of the legs. Because such features are usually absent in spina bifida occulta and meningocele, the prognosis is much better than in myelomeningocele, and many people with these conditions can lead normal lives.

What causes them?

Normally, about 20 days after conception, the embryo develops a neural groove in the dorsal area. This groove rapidly deepens, and the two edges come together to form the neural tube. By about day 23, this tube is completely closed except for an opening at each end. If the posterior portion of the neural tube fails to close by the fourth week of pregnancy, or if it closes but then splits open from a cause such as an abnormal increase in cerebrospinal fluid later in the first trimester, a spinal defect is likely to result.

Viruses, radiation, and other environmental factors may be responsible for such defects. However, spinal cord defects occur more often in offspring of women who have previously had children with similar defects, so genetic factors may contribute.

What are their symptoms?

Spina bifida occulta is often accompanied by skin abnormalities­such as a depression or dimple, tuft of hair, soft fatty deposits, port-wine nevi (skin discoloration), or a combination of these -located over the spinal defect; however, such signs may be absent. Spina bifida occulta doesn’t usually cause neurologic dysfUnction but occasionally is associated with foot weakness or bowel and bladder disturbances. Such disturbances are especially likely during rapid growth phases.

In both meningocele and myelomeningocele, a saclike structure protrudes over the spine. Like spina bifida occulta, meningocele rarely causes neurologic deficits. But myelomeningocele, depending on the level of the defect, causes permanent neurologic dysfUnction, such as flaccid or spastic paralysis and bowel and bladder incontinence.

How are they diagnosed?

Spina bifida occulta is often overlooked, although it’s occasionally palpable and spinal X-ray can show the bone defect. Myelography can differentiate it from other spinal abnormalities, especially spinal cord tumors.

Meningocele and myelomeningocele are obvious on examination; backlighting the protruding sac can sometimes distinguish between them. (Light typically passes through a meningocele, but not through a myelomeningocele.) In myelomeningocele, a pinprick exam of the legs and trunk shows the level of sensory and motor involvement; skull X-rays, skull measurements, and computed tomography scan (commonly called a CAT scan) demonstrate associated fluid in the brain. Other appropriate lab tests in people with myelomeningocele include urinalysis, urine cultures, and tests for kidney function - starting in the neonatal period and continuing at regular intervals.

Although amniocentesis can detect only open spinal defects, this procedure is recommended for all pregnant women who have previously had children with spinal cord defects because there is a greater risk of having another child with similar defects. If these defects are present in the fetus, amniocentesis shows increased alpha-fetoprotein levels by the 14th week of pregnancy. Ultrasonography can also detect or confirm the presence and extent of neural tube defects.

How are they treated?

Spina bifida occulta usually requires no treatment. Treatment of meningocele consists of surgical closure of the protruding sac and continual assessment of growth and development. Treatment of myelomeningocele requires repair of the sac and supportive measures to promote independence and prevent further complications. Surgery doesn’t reverse neurologic deficits. A shunt may be inserted to relieve associated fluid in the brain.

Rehabilitation measures may include waist supports, long leg braces, walkers, crutches, and other orthopedic appliances; diet and bowel training to manage fecal incontinence; neurogenic bladder management to reduce urinary stasis; possibly intermittent catheterization; and antispasmodics such as Urecholine or Pro-Banthine. In severe cases, insertion of an artificial urinary sphincter is often successful; urinary diversion is used as a last resort to preserve kidney function.

Multiple neuritis, peripheral neuritis, peripheral neuropathy, polyneuritis

What is this condition?

This disorder involves degeneration of peripheral nerves supplying the distal muscles of the extremities. It results in muscle weakness with sensory loss and atrophy as well as decreased or absent deep tendon reflexes. Although peripheral nerve degeneration can occur at any age, incidence is highest in men between ages 30 and 50. Because onset is usually subtle, a person may compensate by overusing unaffected muscles; however, the disease may begin rapidly with severe infection and chronic alcohol intoxication. If the cause can be identified and eliminated, the prognosis is good.

What causes it?

Causes of peripheral nerve degeneration include:

• chronic intoxication (with ethyl alcohol, arsenic, lead, carbon disulfide, benzene, phosphorus, and sulfonamides)

• infectious diseases (meningitis, diphtheria, syphilis, tuberculosis, pneumonia, and mumps)

• metabolic and inflammatory disorders (gout, diabetes, rheumatoid arthritis, polyarteritis nodosa, and lupus)

• nutritional disorders (beriberi and other vitamin deficiencies, and malnourishment) .

What are its symptoms?

The signs and symptoms of peripheral nerve degeneration develop slowly, and the disease usually affects the motor and sensory nerve fibers. The condition typically produces flaccid paralysis, wasting, loss of reflexes, pain of varying intensity, loss of ability to perceive vibratory sensations, and numbness, tingling, increased sensitivity to pain or touch, or anesthesia in the hands and feet. Deep-tendon reflexes are diminished or absent, and atrophied muscles are tender or hypersensitive to pressure or palpation. Footdrop may also be present. Skin manifestations include glossy red skin and decreased sweating. Many people with the disease have a history of clumsiness and complain of frequent vague sensations.

How is it diagnosed?

The person’s history and physical exam reveal characteristic distribution of motor and sensory deficits. Electromyography may show a delayed action potential if peripheral nerve degeneration impairs motor nerve function.

How is it treated?

Effective treatment consists of supportive measures to relieve pain, adequate bed rest, and physical therapy, as needed. Most important, however, the underlying cause must be identified and corrected. For instance, it’s essential to identify and remove the toxic agent, correct nutritional and vitamin deficiencies (the person needs a high-calorie diet rich in vitamins, especially the B-complex group), or counsel the person to avoid alcohol.
What can a person with peripheral nerve degeneration do?

• Rest frequently and avoid using the affected arm or leg. To avoid bed sores, use a foot cradle. To prevent contractures, use splints, boards, braces, or other orthopedic appliances

• After the pain subsides, passive range-of-motion exercises or massage may be beneficial. The doctor may recommend electrotherapy for nerve and muscle stimulation.