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The Chiari malformation, also known as the Arnold-Chiari malformation, is a relatively common syndrome involving displacement of the cerebellar tonsils below the level of the foramen magnum.
The definitive method of diagnosis is with a sagittal T1 magnetic resonance imaging (MRI) scan of the posterior fossa of the skull, which documents the typical downward herniation of the cerebellar tonsils (see Figure 1).
Symptoms suggestive of Chiari include posterior headaches, dizziness and ataxia, or poor coordination (especially associated with straining), fainting with a cough, and weakness or numbness. Signs of a significant Chiari malformation often include downbeat nystagmus, poor visual pursuit for age, and alternating skew deviation.
The only effective treatment is surgical treatment, and consists of a procedure called suboccipital decompression. At the American Hearing Research Foundation (AHRF), we are particularly interested in projects that might lead to improved management of the hearing symptoms that may result from the Chiari malformation.
The American Hearing Research Foundation is a non-profit foundation that funds research into hearing loss and balance disorders related to the inner ear and is also committed to educating the public about these health issues. The circulation of the synovial fluid between the knee joints and the bursa present in the popliteal area is maintained by a valve. The common symptoms of Baker’s cyst are swelling at the back of the knee and stiffness of the knee. Baker’s cyst could be easily cured by treating the arthritis or knee injuries, which are the underlying causes of the condition. This may also present with the above mentioned pain after eating greasy or fatty foods such as pastries, pies, and fried foods. This is usually accompanied by a low-grade fever, diarrhea, vomiting, nausea and granulocytosis.
More severe symptoms such as high fever, shock and jaundice indicate the development of complications such as abscess formation, perforation or ascending cholangitis. Chronic cholecystitis manifests with non-specific symptoms such as nausea, vague abdominal pain, belching, and diarrhea.
Cholecystitis is often caused by cholelithiasis (the presence of choleliths, or gallstones, in the gallbladder), with choleliths most commonly blocking the cystic duct directly. Less commonly, in debilitated and trauma patients, the gallbladder may become inflamed and infected in the absence of cholelithiasis, and is known as acute acalculous cholecystitis. Boas' sign - Increased sensitivity below the right scapula (also due to phrenic nerve irritation). Subsequent laboratory and imaging tests are used to confirm the diagnosis and exclude other possible causes. Functional bowel syndrome, it is defined pathologically by the columnar epithelium has reached down the muscular layer.
Cholecystitis - Caused by blockage of the cystic duct with surrounding inflammation, usually due to infection. Choledocholithiasis - This refers to blockage of the common bile duct where a gallstone has left the gallbladder or has formed in the common bile duct (primary cholelithiasis).
Cholangitis is a medical emergency as it may be life threatening and patients can rapidly succumb to acute liver failure or bacterial sepsis. It is worth noting that bile is an extremely favourable growth medium for bacteria, and infections in this space develop rapidly and may become quite severe. Laboratory values may be notable for an elevated alkaline phosphatase, possibly an elevated bilirubin (although this may indicate choledocholithiasis), and possibly an elevation of the WBC count.
Sonography is a sensitive and specific modality for diagnosis of acute cholecystitis; adjusted sensitivity and specificity for diagnosis of acute cholecystitis are 88% and 80%, respectively. Hepatobiliary scintigraphy with technetium-99m DISIDA (bilirubin) analog is also sensitive and accurate for diagnosis of chronic and acute cholecystitis.
For most patients, in most centres, the definitive treatment is surgical removal of the gallbladder.
Gallbladder removal, cholecystectomy, can be accomplished via open surgery or a laparoscopic procedure. In cases of severe inflammation, shock, or if the patient has higher risk for general anesthesia (required for cholecystectomy), the managing physician may elect to have an interventional radiologist insert a percutaneous drainage catheter into the gallbladder ('percutaneous cholecystostomy tube') and treat the patient with antibiotics until the acute inflammation resolves. Gall bladder perforation (GBP) is a rare but life-threatening complication of acute cholecystitis.
Approaches to this complication will vary based on the condition of an individual patient, the evaluation of the treating surgeon or physician, and the facilities' capability. A gram stain of urethral discharge is a test used to identify bacteria in fluid from the tube that drains urine from the bladder (urethra). How the Test is Performed Fluid from the urethra is collected on a cotton swab.
Sebaceous cysts are little bumps that arise and develop from the skin glands that produce oily substances. Generally the sebaceous cysts are white or yellow in color, but it may also elicit a blacking or dark pigmented appearance in individuals with dark complexion. Sebaceous cysts are round shaped, painless, noncancerous little bumps that can be removed easily by incision.
Sebaceous cysts can occur on any part of the body, but generally it occurs on neck, trunk and face. Sebaceous cysts are identified by the presence of a black closed head, which indicates that they are the remnants of hair follicles. Trichilemmal or pilar cystsare the tiny bumps that occur over the scalp which are different type of cysts that move freely under the skin. Flow of yellow fluids that come out from the cysts are the protein keratin secreted in the interiors by epidermal cells, which form the walls for cysts.
Damage of hair follicles:Dermis is the thin layer of skin, just beneath the epidermis and the hairs grow from the dermis follicle pockets. Rupture of sebaceous glands: Sebaceous glands produce an oily substance called sebum, which nourishes the health of the hair and skin. Defects in the growth process:Sebaceous cysts can be caused when a growing baby’s stem cells of skin, nails, and hair get trapped in cells of other tissues. Hereditary:Growths in colon caused by the Gardner’s syndrome, and basal cell nervous syndrome which causes many health disorders are the hereditary diseases. Sebaceous cysts which do not result in functional or cosmetic damage does not need treatment. Sebaceous cysts can be surgically removed forever, but only after controlling the inflammation. Procedure preferred by doctors involves removal of the cyst walls and the fluid by minimal excision,which causes minimum scarring. Cysts that occur on face or on other vital parts can be vaporized, by the help of lasers, which reduce the risk of scars. Posted On October 7, 2015 Last Updated On June 8, 2016 By surekha Elephantiasis is an infection caused by filaria that causes abnormal enlarged limbs or other area of the body. Elephantiasis can be described as lymphatic filariasis in medical terms which causes abnormal enlargement of organs.


It is reported that about 1.2 billion people across the globe are suffering from elephantiasis. According to the statistics available more than 120 million people in the word are infected with this disease and among them 40 million have become incapacitated on account of this disease.
Lymphatic system operates as immune system in the body thus preventing the body against many infectious diseases. Any block in the free-flow of the lymph through the lymphatic vessels causes elephantiasis. The worms or parasites are generally carried by mosquitoes and when they bite it transfers the parasites (in larval stage) into the bloodstream. Elephantiasis causing enlargement of genitals can be caused by bacteria called lymphogranuloma venereum which can be transmitted through sexual intercourse. People living in tropical regions like India, Africa, Southeast Asia and Southern America can develop elephantiasis. Based on the test results the doctor would start the treatment for underlying condition of lymph damage. Unwanted lymph tissue is removed from the vulva region of females through surgery or radiation.
At present, research work is going on to give preventive medicine to reduce the rate of transmission. Even after completing the course of medication, the health of the patient will be regularly monitored for at least one year or more to observe any changes. It may indicate disease or a problem within the urethra, testicles, epididymis, or prostate. Blood in the semen is usually the result of inflammation of the seminal vesicles, and will almost always go away on its own. Associated with the Chiari malformation may be hydrocephalus (accumulation of fluid within the central cavities of the brain), spina bifida (a malformation of the spinal cord), and syringomyelia (accumulation of fluid within the spinal cord).
However, in some instances, mild Chiari malformations may be caused by low cerebrospinal fluid (CSF) pressure. These studies found abnormal SEPs to correlate with symptomatic Chiari malformation, suggesting that this is a useful tool to monitor progression of the disorder.
A review of the otologic manifestations of Chiari in 16 patients indicated that 81% reported episodic aural fullness, 81% tinnitus, 69% vertigo, and 56% fluctuating hearing. In essence, this procedure involves removal of bone from the back of the skull to make more room for the brain.
Abnormalities in auditory evoked potentials of 75 patients with Arnold-Chiari malformations types I and II. Chiari I malformation presenting with hearing loss: surgical treatment and literature review.
It occurs when excess synovial fluid, present in the knee joint, is forced out of the area between the joint bones to the back of the knee, which is also called the popliteal area. Inflammation of the knee joints, which might result from arthritis or tear of cartilage, increases production of the synovial fluid. In rare instances the cyst might burst, causing the synovial fluid to leak into the calf region of the leg. If the cyst causes intense discomfort, the fluid present in the sac behind the knee may be drained with a needle. Another complication, gallstone ileus, occurs if the gallbladder perforates and forms a fistula with the nearby small bowel, leading to symptoms of intestinal obstruction.
This leads to inspissation (thickening) of bile, bile stasis, and secondary infection by gut organisms, predominantly E. This can arise in patients with anorexia nervosa, as the lack of stimulation of the gallbladder leads to an infectious process. The patient might develop a chronic, low-level inflammation which leads to a chronic cholecystitis, where the gallbladder is fibrotic and calcified. It is associated with sharp and constant epigastric pain in the absence of fever and usually there is a negative Murphy's sign.
Typically, the pain is initially 'colicky' (intermittent), and becomes constant and severe, mostly in the right upper quadrant. As with other biliary tree obstructions it is usually associated with 'colicky' pain, and because there is direct obstruction of biliary output, obstructive jaundice. The classical sign of cholangitis is Charcot's triad, which is right upper quadrant pain, fever and jaundice. The diagnostic criteria are gallbladder wall thickening greater than 3mm, pericholecystic fluid and sonographic Murphy's sign. CT is more sensitive than ultrasonography in the depiction of pericholecystic inflammatory response and in localizing pericholecystic abscesses, pericholecystic gas, and calculi outside the lumen of the gallbladder. It can also assess the ability of the gall bladder to expel bile (gall bladder ejection fraction), and low gall bladder ejection fraction has been linked to chronic cholecystitis. The early diagnosis and treatment of GBP are crucial to decrease patient morbidity and mortality. Perforation can happen at the neck from pressure necrosis due to the impacted calculus, or at the fundus. It may also have a central opening.It can be seen that a thick and cheesyfluid comes out when a sebaceous cyst is squeezed. Any wound or injury or abrasions caused to the hair follicles block the surface over the cells. Sebaceous cysts are caused by the rupture of these glands due to inflammatory skin disorders. Infection and scarring by the sebaceous cysts can be prevented if the squeezing of cysts is avoided. This micro-organism causes obstruction in the free flow of lymphatic system resulting in accumulation of fluid (causing enlarged limb).
Lymph vessels are arranged in the form of network through which water like fluid called lymph flows.
Normal color of the skin changes in the infected area resulting in dark skin due to hyperkeratosis.
Lymphatic system is distributed throughout the body and obstruction is caused by parasites called filariasis. Another bacterium called Chlamydia trachomatis can also cause obstruction of lymphatic system leading to swelling of genitals. Elephantiasis can develop after surgery or radiation therapy also wherein the removal of lymph nodes can lead to accumulation of lymph fluid resulting in swelling of organs. He would collect the complete medical history of the patient and order for collection of tissue sample from the enlarged limb to test it in the lab.
Infection is the invasion of disease-causing organisms in host organism’s body, where disease-causing organisms multiplies, reacts and produces toxins in host organism’s bodily tissues.
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A closely related condition called basilar invagination may also be congenital or acquired from arthritis. In some instances, MRI CSF flow studies are used to decide if a displacement is causing any damage.
We think it best for persons with the Chiari malformation be particularly careful to avoid head injuries.
The neurophysiological balance in Chiari type 1 malformation (CM1), tethered cord and related syndromes.
The excess fluid fills the popliteal bursa making it swell like an inflated balloon, causing Baker’s cyst.
Although, knee pain is a symptom of Baker’s cyst, but nonetheless, some Baker’s cyst patients hardly experience any pain. Inflammation often spreads to its outer covering, thus irritating surrounding structures such as the diaphragm and bowel.
Liver function tests are within normal limits since the obstruction does not necessarily cause blockage in the common hepatic duct, thereby allowing normal bile excretion from the liver.
Liver function tests will therefore show increased serum bilirubin, with high conjugated bilirubin. Liver function tests will likely show increases across all enzymes (AST, ALT, ALP, GGT) with raised bilirubin.
The degree of elevation of these laboratory values may depend on the degree of inflammation of the gallbladder.
Gallstones are not part of the diagnostic criteria as acute cholecystitis may occur with or without them. However, since most patients with right upper quadrant pain do not have cholecystitis, primary evaluation is usually accomplished with a modality that can diagnose other causes, as well. Open procedures are usually done if complications have developed or the patient has had prior surgery to the area, making laparoscopic surgery technically difficult. A series of stains called a gram stain is applied to the specimen. The stained smear is then examined under the microscope for the presence of bacteria.
Sebaceous cysts are painless and slow growing that generally appear on the neck, trunk, genital area, and the face.
Primarily elephantiasis is caused by 3 worms by name Brugia timri, Brugia malayi and Wuchereria bancrofti.
Research is going on to identify the complete gene structure of Brugia Malayi worm that causes this disease. If the blood does not clear and ejaculate is persistently stained with blood, more tests should be done. The synovial fluid flows between the knee joint and the bursae, which are tissue pouches present in the knee area. During the initial stages, the pain may be felt in an area totally separate from the site of pathology, known as referred pain. An ultrasound scan is used to visualise the gallbladder and associated ducts, and also to determine the size and precise position of the obstruction. Liver enzymes will also be raised, predominately GGT and ALP, which are associated with biliary epithelium. Patients with acute cholecystitis are much more likely to manifest abnormal laboratory values, while in chronic cholecystitis the laboratory values are frequently normal. A laparoscopic procedure may also be 'converted' to an open procedure during the operation if the surgeon feels that further attempts at laparoscopic removal might harm the patient. Since the enlarged limb looks like the leg of an elephant, the term “elephantiasis” is used. When the lymph vessels are blocked by overgrowth of micro-organism it can stop the regular flow of lymph resulting in fluid accumulation.
These worms enter into the body and grow in the lymphatic system multiplying in number ultimately leading to blockage of lymph (liquid).
The inflammation of skin due to bacterial skin infection is called as infective dermatitis. These tests may include urinalysis and culture, semen analysis and culture, and ultrasound of the seminal vesicles. Home Care Minor injuries may be treated with rest, applying ice, and monitoring symptoms. Anti-inflammatory medications such as aspirin or ibuprofen can help to reduce the pain and inflammation.
The pain is originally located in the right upper quadrant but the referred pain may occur in the right scapula region. The diagnosis is made using endoscopic retrograde cholangiopancreatography (ERCP), or the nuclear alternative (MRCP). Open procedure may also be done if the surgeon does not know how to perform a laparoscopic cholecystectomy. Patients were treated with analgesics and antibiotics within the first 36 hours after admission (with a mean of 9 hours), and proceeded to surgery for a cholecystectomy.
Lymph is the fluid that flows in the lymphatic system and when the normal flow is blocked it leads to fluid accumulation in the body. Murphy's sign is positive, particularly because of increased irritation of the gallbladder lining, and similarly this pain radiates (spreads) to the shoulder, flank or in a band like pattern around the lower abdomen. One of the more serious complications of choledocholithiasis is acute pancreatitis, which may result in significant permanent pancreatic damage and brittle diabetes. Elephantiasis is caused by 3 kinds of worms and sometimes due to sexually transmitted diseases of bacterial infection. In addition to the above, if elephantiasis is not treated it can lead to secondary infection in any organs causing more complications. Laboratory tests frequently show raised hepatocellular liver enzymes (AST, ALT) with a high white cell count (WBC). This disease can be managed by suitable medications and in many cases by combined approach of surgical procedure.
The infection or the inflammation of the skin occurs in the deep epidermis (outermost layer of the skin) with lymphatic spread.Signs and symptoms – Fever with chills, fatigue, vomiting, headaches and generalized weakness within 48 hours of infection. Severe infections can lead to vesicles and petechiae with skin necrosis (premature death of cells of human tissue).
On the other hand, ‘bullous impetigo’ is mainly seen in children younger than 2 years with complaints of fluid-filled, painless blisters mostly on the legs, arms and trunk with itchy skin.In ecthyma, lesions are painful with fluid or pus-filled with redness and soreness, usually seen on legs and arms can lead to deep ulcers in the skin. Staphylococcus aureus and Streptococcus pyogenes are the types of bacteria responsible for this bacterial skin infection, which invades through cuts, blisters, lacerated or surgical wounds, break of skin or insect bites.



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