Medical Report

Batista Surgery

2009-04-25T17:54:00.000+07:00

Batista Surgery

The Batista procedure was an experimental open-heart surgery that had been studied to reverse the effects of remodeling in cases of end-stage dilated cardiomyopathy. In this case, patients suffer from an enlarged left ventricle that cannot pump blood efficiently. It was developed by Brazilian surgeon Dr. Randas J. V. Batista, primarily as a treatment for heart failure. The Batista Operation is technically called a REDUCTION LEFT VENTRICULOPLASTY. It is an open-heart operation performed with the aid of a heart lung machine to maintain circulation while the heart is stopped. The essence of the procedure is to remove a wedge of left ventricle muscle (weighing about 40 to as much as 250 grams) and stitch together the two edges of the ventricle. In this manner the size of the left ventricle is reduced, and the ventricle is remodelled as well

The Batista procedure is used for patients whose heart muscles have been stretched or weakened by disease, such as infection or inflammation which have led to congestive heart failure. (Weakened heart muscle that results from heart attack does not seem to respond as well.) Because of their weakened condition, these hearts can’t pump enough blood to sustain themselves and the body.

In the Batista procedure a triangular or elliptical piece of living heart tissue about the size of a golf ball is sliced from the left ventricle . Then the heart is stitched back together. By removing part of the left ventricle (the heart’s main pumping chamber), the heart’s chamber is made smaller and it can contract more effectively to pump more blood.

Batista operation method begins with a hollow heart patients. Next step is clamp the aorta, a procedure with the patient's aorta breach intentionally. At this phase, the heart patient is no longer rattle. For that, there was a procedure called a back up. Meanwhile, the heart does not rattle, the body of the patient in the back-up by an electronic tool that serves to replace the function of the heart. When the back up takes place, the doctor rip off major heart patients, incisition, then discard the contents of a small heart, and finally close again with a few stitches. This process must be done quickly but neatly and carefully. After the "disposal of meat" is complete, the connection is returned from the aorta tool back up to the heart . In a few seconds after the back up stopped, the heart will return rattle. In addition, sometimes, the mitral valve (which lies between the left ventricle and left atrium) may need to be removed and replaced with an artificial valve. In patients who have heart rhythm disturbances as well, an artificial implantable defibrillator device may be implanted. If the coronary arteries are diseased, they may be grafted too.

Though the Batista procedure seemed promising at first, it was later found to have little benefit and considerable risk. Today, the Batista procedure is not a recommended treatment for dilated cardiomyopathy. In this form of cardiomyopathy, the heart fails to respond to conventional therapy, and patients suffer from severe heart failure. However, while the surgery has generally fallen out of favor, a few research groups are still examining the Batista procedure among patients who are unsuitable for heart transplantation, such as the elderly.

refferences
http://yourtotalhealth.ivillage.com
http://heartdeseaseonline.com

.

Migraine without Aura (Silent Migraine)

2009-04-25T17:31:00.000+07:00

Migraine without aura
Head pain similar to Migraine with aura but more unknown cause. Pain can be described and predicted with the beat-throbbing on one side of the head, pain intensity are severe and accompanied by nausea, fotofobia and fonofobia. With the manifestation of chronic head pain 4-72 hours.
Migraine variants have several different, namely:
1. Asephalic Migraine, Migraine with aura types without the headache the next.
2. Basilar Migraine, Migraine with aura dysarthria, vertigo, diplopia, and accompanied by a decrease in awareness anesthetized on both sides.
3. Migrainekronis, Migraine without aura with a pain at least half a day.
4. Hemiplegic Migraine, familial and occurred in a case with the possibility of irregular aura of hemiplegia
5. Status migrainosus, Migraine attacks more than 72 hours.
6. Childhood periodic symptoms, accompanied by paroxysmal vertigo, stomach aches and vomiting are regular.
Some also experience Migraine is caused by the complications, one of which is infrak Migraine, Migraine attacks neurologiknya same but there is still a deficit after three-week examination and CT Scan showed hipodensity.

Treatment of Migraine without aura
Rare or mild occurrences of Migraine without aura may not require treatment at all. However, for many people sans-migraine is not something to be shrugged off. The symptoms can still be completely debilitating. For cases like that, there is help.

Remember that Migraine without aura is still basically migraine. It's a common misconception that migraine is simply a bad headache - it's actually a neurological disease, and headache is only one possible symptoms. There are various types of treatment that work well for migraine, Migraine without aura included.

Abortive drugs are often helpful when it comes to Migraine without aura. Sometimes something as simple as aspirin can stop the symptoms (especially effervescent aspirin - the kind that fizzes when you drop it into water). Usually you want something fast acting, such as a beta-agonist inhalent (such as isoproterenol). Also helpful are sublingual (under the tongue) nitroglycerin, meclofenamate (Meclomen, frequently used for arthritis), and naproxen sodium. For prevention, calcium channel blockers, a common migraine preventative, may also be helpful. Anti-seizure drugs are sometimes tried, such as topiramate (again, these are used for other types of migraine as well, not just Migraine without aura) Talk to your doctor about the full range of migraine medication that's available today.

reffrence
http://www.scribd.com

MIgraine with Aura (Classical Migraine)

2009-04-23T03:38:00.000+07:00

Migraine with aura

Description?
Typical aura consisting of visual and/or sensory and/or speech symptoms. Preceded by a visual aura scotoma, flashlight, black and white line of vision, blurred vision, during 10-20 minutes.Then unilateral head pain that lasts more severe between 1-6 hours but sometimes longer, many symptoms often found are nausea, vomiting, photophobia, phonophobia, iritable and malaise.

Patofisiology?
Patofisiology of migraine with aura , known as the theory of cortical spreading depression (CSD). Aura occurs because there is excitation of neuron in substansia nigra spreads with the speed of 2-6 mm / min. The spread is followed by supression neuron wave with a similar pattern so formed of vasodilatation rhythm followed by a vasoconstriction. The principle is neurochemical CSD releases potassium or amino acid glutamat excitatori from the network so nervous going depolarisation and releases more neurotransmitter, depression, nervous even spread. CSD in the episode aura will stimulate nervus trigeminalis nucleuscaudatus, start of a migraine

Diagnostic criteria
A. At least 2 attacks fulfilling Headache lasting 4 to 72 hours (untreated or unsuccessfully treated)a
B. At least 3 of the following 4 characteristics:
1. One or more fully reversible aura symptoms indicating focal cerebral cortical and/or brain stem dysfunction
2. At least one aura symptom develops gradually over more than 4 minutes or 2 or more symptoms occur in succession
3. No aura symptom lasts more than 60 minutes. If more than one aura symptom is present, accepted duration is proportionally increased
4. Headache follows aura with a free interval of less than 60 minutes. (It may also begin before or simultaneously with the aura)
C. At least one of the following:
1. History, physical and neurological examinations do not suggest one
of the disorders listed in groups 5-11
2. History andlorphysical and/or neurological examinations do suggest such disorder, but it is ruled out by appropriate investigations
3. Such disorder is present, but migraine attacks do not occur for the first time in close temporal relation to the disorder

Diagnosis criteria in children:
1. In children, attacks may last 1–72 hours.
2. The headache of a Migraine attack is commonly bilateral (on both sides) in young children; an adult pattern of unilateral pain usually emerges in late adolescence or early adulthood.
3. In young children, photophobia and phonophobia may be inferred from observing their behavior.
4. The headache of a Migraine attack is usually frontotemporal (front and sides, toward the front, of head). Occipital (lower back of the head) headache in children, whether unilateral or bilateral, is rare and calls for caution in diagnosing as many cases are attributable to structural lesions.

refference:
1. www.healthcentral.com
2. http://astaqauliyah.com
3. http://www.kalbe.co.id

Migraine

2009-04-23T02:25:00.000+07:00

Migraine is headache pain which recurring idiopatik, usually the one side (unilateral), and beat the headaches. Actually Migraine is not headache because headache can be the one symptom of a migraine attack, but it's just that- one of the possible symptoms, and some Migraineurs (people with migraine disease) have migraine attacks without a headache, these ara called acephalgic or silent Migraines. Migraine is caused by the occurrence of a combination of blood vessel dilation and releasing a substance's chemical fiber - nerve fibers that wrap the blood vessel. The attack onset usually 4-72 hours. During migraine attacks, temporal arterial (arterial that runs around the temple) will be broad. This widening temporal arteri will cause streching in nerve fibers around the arterial thus stimulate nerve fibers release this chemical substance. This substance will cause inflammation, pain and the extraordinary. Migraine can occur in children with the location of pain more often bifrontal

Migraine attacks generally will activate sympathetic nerve. The sympathetic nerve is part of the human nervous system which responsible for controlling the body's response to stress and pain. Increased activity in the intestinal sympathetic nerve causes nausea, vomiting and diarrhea. Increased sympathetic nerve activity will also causes increased sensitivity to light and sound, so migraine patient get photophobia and phonophobia.

Phase of Migraine!!!!!!
In general, there are 4 phases of symptoms, although not all people with migraine experience four phases of this. The four phases are prodromal phase, aura, seizures, and postdromal.

1. Prodromal phase
This phase consists of a collection of vague symptoms not clearly, that may precede migraine attacks. This phase can last for several hours, even 1-2 days before the attack. Symptoms include:
a. Psychological: depression, hiperactivity, euforia (rapture excessive), communicative (talkativeness), sensitive / iritable, anxiety, sleepy or lazy.
b. Neurologis: sensitive to light and / or sound (photophobia & phonophobia), difficulty concentrating, excessive vapor, sensitive to the smell (hiperosmia)
c. General: stiff neck, nausea, diarrhea or constipation, crave or increased appetite, cold, thirsty, felt slow, often dispose of urine.

2. Aura
Generally perceived aura symptoms precede the attack of migraine. Visually, aura is expressed in the form of positive or negative. Migraine sufferer can experience both at the same type of aura.
Aura looks like a positive light sparkler, as a form of cover around the edge pengelihatan field. This phenomenon is also known as a scintillating scotoma (scotoma = defect field perspective). Scotoma can eventually expand and cover the entire field perspective. Aura can also positively shaped like lines zig-zag, or the stars.
Aura negative hole looks like dark or black spots that cover the field of vision. Also shaped like a tunnel vision, where the field perspective into both sides of the dark or closed, so that the field perspective is focused only on the middle.
Some Neurologic symptoms can appear simultaneously with the occurrence of aura. The generally Symptoms are: talk interference; pins; sense of Baal; feeling weak at the bottom of the arm and leg; vision perception disturbances such as distortion of space and confusion.

3. The attack phase
Without treatment, migraine attack usually lasts between 4-72 hours. Migraine with aura are called classic migraine. While migraine without aura is a common migraine (Common Migraine). Symptoms commonly include:
a. Head aches that one side feels like a pulse-beat . Pain can sometimes spread to the whole head
b. Head aches weight gain when conducting activities
c. Nausea, sometimes accompanied by vomiting
d. Symptoms vision interference can occur
e. parestesy
f. Very sensitive to light and sound (photophobia and phonophobia)
g. Generally look pale face, cold body and
h. There are at least 1 aura symptoms (in the classical migraine), which developed gradually over more than 4 minutes. Head aches can occur before symptoms of aura or at the same time.

4. Phase Postdromal
After a migraine attack, usually occurs prodromal period, where patients can feel tired (exhausted) and feeling like mist.

There are types of Migraine
1. Classical Migraine (Migrain with Aura/MWA)
2. Varian Migraine
3. General Migraine (Migrain without Aura/MWOA)
4. Associated and dissociated Migraine
5. Complicated Migraine
6. Status Migrainous

Rabies

2009-04-21T07:37:00.000+07:00

Stadium excitatiton (convulsion)

Rabies (lyssa, hidrophobia, rege, toilwer) disease is an acute infection of the central nervous system that can attack all types of homoeothermic animals and humans. Rabies is caused by rabies virus which transmitted bite reservoir animal. Reservoir animal is the main type of animal canidae, for example: dog, cat and monkey.

Rabies in humans have 3-8 weeks incubation period, the average longer than the incubation period in other animals. Women have shorter incubation period than men, and children shorter than the adult
Early symptoms include fever, general malaise, nausea and pain in the throat for several days, in addition to the patient also feels pain, heartburn accompanied pareses place on the wound. followed with the symptoms of fear and reaction against excessive excitatory sensorik or called stimulus sensitive myoclonus. Tonus muscle sympathetic activity and the symptoms escalate into hiperhidrosis, hipersalivation, hiperlacrimation and pupil dilatation.

Stadium excitation have any special mark, that is hydrophobic. If the patient is given a drink, the patient will receive cause they thirsty, and try to drink it, but this will be inhibit by a great spasm on muscle faring. Patients so afraid of water, so to hear the sound of water and even hear the word "water", causing severe throat muscle contraction.

Apnoea, cyanotic, convulsion, tachycardia can happen in this stadium. patient's behaviour is not rational. Symptoms can be in the stadium this continues until the patient died, but at close death, it is more often weakened muscle, to occur flaksid muscle paresis.

Vector of Dengue Fever

2009-04-21T06:15:00.000+07:00

Important vectors of disease transmission in the DHF is the mosquito Aedes aegypti. This mosquito is genus Aedes, including Tribe Culicini, family Culicidae (Mosquitoe), ordo Diptera. Aedes aegypti life cycle has metamorfosis complete, in which there are 4 stages of its development, namely eggs, flyblow, chrysalis, adult. Cycle Maintenance mosquitoes ranged between 10-12 days

Larva of Aedes mosquitoes usually lay eggs in water that cool and clean, such as flower pot, crock, and so forth. Aedes aegypti doesnt like grubby or dirty place,. Places preferred by this mosquito is a crock or a place that is open water, bathtub, water holes on the rain gutter or street clean, pot plants or flowers that filled water, the cans used to be rain water, and other.

Adult mosquitoes look brown-black strip with a strip of white contrast in the abdomen, thoraks and ekstremity. There is a sign of characteristics in adult Aedes aegypti mosquitoes that can be used as a criterion to distinguish the species Aedes other, which is "Marking Lyre" (a description of silvery white strip at the dorsal than thoraks, and white color on the last segment of the back foot ).

Aedes aegypti has habits "day biter" (suck up food on the day), especially young mosquitoes (age 1-8 days). The old age, tend to change the habit to "night biter" (suck up food on the night)

trasmission cycle

These next two slides review the transmission cycle in more detail. This slide represents the part of the transmission cycle that takes place within the human body.

The virus is inoculated into humans with the mosquito saliva.
The virus localizes and replicates in various target organs, for example, local lymph nodes and the liver.
The virus is then released from these tissues and spreads through the blood to infect white blood cells and other lymphatic tissues.
The virus is then released from these tissues and circulates in the blood.

Etiology of Dengue Fever

2009-04-21T05:58:00.000+07:00

Dengue virus

Dengue virus is flavivirus genus from flaviviridae family. This virus is a RNA virus ecosahedral shaped, have infectious Envelope vertebrata including human intermediaries with mosquito and can result in fatal .

There are four serotipe of dengue virus antigenic , the DEN-1, DEN-2, DEN-3 and DEN-4. DEN-1 strain is the most frequently isolated from all isolat. Each strain has power of virulence. Therefore its difficult to be distinguished between the strain is only based on clinical symptoms and patologis but can be distinguished with neutralisation using monoclonal antibody tests and Polymerase Chain Reaction.

Rod-shaped virus of dengue, are termolabil, sensitive to be inactivated by dietileter and natrium dioxsicolat, stable at temperature of 70 C ¬ 0 C. Virion structure consists of 3 protein; Capsid, Membrane, and Envelope, 7, and protein is unstructured (NS) with a known abbreviation NS1, NS2A, NS2B, NS3, NS4A, NS4B, and NS5.

Clinical Diagnosis of DHF

2009-04-21T05:31:00.000+07:00

The disease manifests as a sudden onset of severe headache, muscle and joint pains (myialgias and arthragials) severe pain that gives it the nick-name break-bone fever or bonecrusher disease), fever, and rash. The dengue rash is characteristically bright red petechiae and usually appears first on the lower limbs and the chest; in some patients, it spreads to cover most of the body. There may also be gastritis with some combination of associated abdominal pain, nausea, vomiting, or diarrhea. Some cases develop much milder symptoms which can be misdiagnosed as influenza or other viral infection when no rash is present. Thus travelers from tropical areas may pass on dengue in their home countries inadvertently, having not been properly diagnosed at the height of their illness. Patients with dengue can pass on the infection only through mosquitoes or blood products and only while they are still febrile. The classic dengue fever lasts about six to seven days, with a smaller peak of fever at the trailing end of the disease (the so-called biphasic pattern). Clinically, the platelet count will drop until the patient's temperature is normal. Cases of DHF also show higher fever, variable haemorrhagic phenomena, thrombocytopenia, and haemoconcentration. A small proportion of cases lead to dengue shock syndrome (DSS) which has a high mortality rate. DHF combined with a cirrhotic liver has been suspected in rapid development of hepatocellular carcinoma (HCC). Given that the DEN virus is related to the Hepatitis C virus, this is an avenue for further research as HCC is among the top five cancerous causes of death outside Europe and North America. Normally HCC does not occur in a cirrhotic liver for ten or more years after the cessation of the poisoning agent. DHF patients can develop HCC within one year of cessation of abuse.

The increasing value hematocryte is a sensitive indicator of the occurrence of shock. Hematocryte increase in value more than 20% showed clinical diagnosis DHF. If there isn’t tool for hemoconcentration test hemoconcentration can be measured with the examination use haemoglobin method sahli regularly and performed by the same examination. The increase in Hb level of 30% support the clinical diagnosis DHF.

DBD classified into four levels of illness. Degree III and IV are considered DSS. There is thrombositopenia with hemoconsentration distinguish degrees I and II in the DBD of dengue fever.

DBD according to the degree of division of the WHO (1986):

Degree I: a fever accompanied by non-specific constitutional symptoms; the only manifestation is bleeding tourniqet test positive.

Degree II: spontaneous bleeding manifestations in addition to the degree I patients, usually in the form of bleeding or bleeding skin of the other.

Degree III: fever, spontaneous bleeding, accompanied or not accompanied hepatomegaly and found symptoms of failure include pulse circulation rapid and weak pulse pressure decreased (<20>

Degree IV: fever, spontaneous bleeding, accompanied or not accompanied hepatomegaly and found shock great, not palpated pulse and blood pressure is not measurable.

Manifestasion Dengue Shock Syndrome in children

2009-04-21T04:21:00.000+07:00

Dengue Shock Syndrome manifestation of the child consists of
(1) pale skin, cold and humid, especially on the tip of the toes, hands and nose, while a blue nails. This is caused by the circulation insufisien activity which caused the rise in simpatikus reflex,
(2) children that fussy, fractious and awareness decreased slowly become apatic, sopor and coma. This is due to circulation failure in cerebral;
(3) changes in pulse, both the frequency of any amplitudo. Pulse quickly become soft and can not be touched up because circulation collapts;
(4) tension decreased to 20 mm Hg or less;
(5) the child sistolik pressure be decreased 80 mm Hg or less, and
(6) because of oliguria to anuria perfusi decreasing arterial renalis blood .
During clinical shock, hematocryt is increasing until 20% or greater than the value hematocryt healing. Trombositopenia (less than 10.000/mm3) leukositosi, long bleeding time, and decreased protrombin rate also found during shock. Fibrinogen level may be subnormal and products fibrin fraction increased .
Aberration is being increased serum transaminase level, complement consumption, asidosis metabolik light with hiponatremia, and sometimes hipokoremia, slightly increased serum urea nitrogen, and hipoalbunemia. Roentgenogram chest shows effusion of pleura in almost all patients .
At approximately one third of patients with fever after DHF take several days, the common patients suddenly worsen. This usually happens at or after the fever decreases, that is between the day-to-3-7 . Found on the sign of circulatory failure, touched up skin moist and cold, sianosis around the mouth, rapid pulse and become soft and finally a decrease in blood pressure. People look haggard, nervous, and quickly enter into a critical phase of shock. People often complain pain in the stomach shortly before shock arise.

Dengue Fever

2009-04-21T04:03:00.000+07:00

Today is the last day of my survey about dengue fever in Balung General hospitals. I get the data that 200 more childrens who are patients suffering from dengue fever, dengue fever and dengue dengue shock syndrome, in a period of three years. 5 childrens died because of dengue shock syndrome. Are they dangerous?

What is dengue fever, DHF and DSS?

Dengue fever is febril acute fever caused by one of four closely related, but antigenically distinct, virus serotypes (DEN-1, DEN-2, DEN-3, and DEN-4), of the genus Flavivirus ,with clinical signs fever, muscle pain, joint pain that accompanied leukopenia, rash, headache, also trombocyteopenia. Dengue haemorrhagic fever is dengue fever is accompanied by the signs of bleeding, such as Tourniquet test positive, ptechiae, echimosis, epistaksis, gum bleeding and melena. Dengue shock Syndrome that dengue fever is accompanied by signs of shock. Shock on the dengue fever patient is hipovolemic shock.

SIGNS AND SYMPTOMS

Clinical picture varies greatly, from very mild (silent dengue infection) to the medium such as dengue fever, to the DHF with the manifestation of acute fever, and bleeding tendency occurred shock that could result in fatal. Incubation period of dengue between 5-8 days.

Classical form of DHF are marked with high fever, sudden 2-7 days, accompanied with a reddish face. Complaints such as anoreksia, headache, muscle pain, bone, joints, nausea, and vomiting are often found. In addition, gastritis can also appear with a combination of pain in the stomach, feeling of nausea, vomiting or diarrhea. Some patients complain of painful swallow faring hiperemis found on inspection, but rarely found a cold cough. Usually found also felt pain in stomach and epigastrium below the rib bones.

Pain is often prominent on the abdomen of a child suffering from DSS. Found this on the symptoms of DSS, is marked danger because of the likely occurrence of gastrointestinal bleeding. Between 3 -5 days, symptoms develop bleeding rash, petechie, echimosis, epistaksis going to hematemesis and melena. Scarlet fever rash discrete red light, petekiae spread to cover up almost the entire body. Petekie spontaneous skin bleeding is most often found, then the symptom is always sought when the suspected case of DHF, while epistaksis bleeding is the second most. Hematemesis is the vomiting of black blood from the top of the channel indigestion, where the blood come out mixed with stomach acid and melena is constipate black blood from the top of the channel digested. Bleeding digested this channel is of serious bleeding.

In the DHF, there are plasma leakage due to increased capillary permeability, with a marked increase in PCV by hematocryt or ≥ 20%, efusi pleura, ascites even arise. In the adult male, hematocryt increased> 45% percent, whereas in women hematocrit increased> 40%, and> 38% in children aged less than 12 years .

Decrease in the number of trombocyte (trombocytopeni) <100.000/pl>

During the initial infection, leukosit polimorfonuklear increased leukositosis so visible, but at the end of a critical phase and the early stage of shock, so that decreased the number of leukosit obtained leukopenia.

Critical period of the disease occurred in the late phases of fever (day 3 and day-to-7), at the time of this decrease in temperature that suddenly the often accompanied by disturbances in the circulation of various heavy or light. In the case of interference with the circulation of light changes, and at least temporarily, in the case of patients may experience a shock.