Holding Urine for a Prolonged Period of Time and Acute Urinary Retension

Acute urine retention is a common condition affecting most of the elder males. There are several etiological factors for acute retention of urine. Holding urine for a prolonged period of time is one such etiology. How does holding urine for a long period of time cause acute urinary retention.

This can be explained by the LaPlace Law. When you hold urine for a long time, urine accumulate slowly and the bladder volume slowly increases. Finally, the bladder gets over-distended.  When the detrusor muscles are overstretched, they cannot contract. As a result, the bladder cannot empty itself by contracting. This process finally results in acute urinary retention.

Menopausal and post menopausal hair loss

Menopause is an inevitable event in every woman’s life. It occurs at the age of 45-55 years. A woman is considered post menopausal when she has not menstruated for the past 6 months. Post menopausal period is an important time period where the body deprives of female sex hormones, which include estrogen and progesterone. As a result, all the functions carried out by these hormones are deranged. Finally it gives rise to a series of symptoms and sings, which are collectively known as postmenopausal symptoms.

These postmenopausal symptoms include, hot flushes, irritability, reduced sex drive, headacahe, night sweat, reduced sleep, urinary urgency and incontinence and dryness of the vagina. Even though hair loss is not taken as a cardinal feature of menopause, it is commonly seen among females who have reached their menopause.

Generally, females have more hair than males. That is because males lose their hair with time. The hair loss in males is mainly due to the action of male sex hormone, testosterone, on the hair follicles. People with a higher testosterone levels in their body tend to lose their hair fast. Similarly, females also have small amount of testosterone in their blood stream. But, in the premenopausal age the effects of testosterone is less due to the higher concentration of estrogen in their blood stream. Estrogen protects your hair from the action of testosterone. After menopause the estrogen levels drastically decline. The testosterone levels become higher when compared to the estrogen levels. So the protective effect of estrogen against hair loss is lost. Finally, hair loss occurs.

Hormone replacement therapy is the most effective method of treatment for postmenopausal symptoms including hair loss. As with any treatment method, hormone replacement therapy also has its side effects. Therefore, it is continued only for couple of years. It simply replaces the deprived hormones and brings the body’s homeostasis mechanisms to the previous state. It can relieve many postmenopausal symptoms including hair loss.

Apart from hormonal imbalances, other physical as well as psychological changes that occur during menopause can contribute to hair loss. For example, psychological stress is a well known cause for hair loss. Menopause is a stressful period for many women. It can be due to many reasons. This is the time period where women are found to have other diseases such as dyslipidema, diabetes, hypertension, etc. It is also the time period where they experience departure from their loved ones including their parents and children. These events can bring a significant level of stress.  Menstrual irregularities are also very common during perimenopausal period. As a result, you can lose a lot of iron from your body and become anemic. These nutritional deficiencies can also be a cause for hair loss in perimanopausal period.

While many people try to relate most of the symptoms that occur in menopausal period to the deprivation of estrogen, you should always consider other things that can give rise to hair loss. Failure to identify such etiological factors can waste a lot of time as well as money without getting any relief from the symptoms. Thyroid diseases are the commonest causes of hair loss. Both hypothyroidism and hyperthyroidism can give rise to hair loss. Therefore, it is wiser to get a thyroid profile done before you go in to any other intervention.

Why Venous Ulcers Commonly Occur Over the Medial Aspect of the Distal Leg?

Chronic venous insufficiency is a common disorder of legs. Most of the people with chronic venous insufficiency presents with varicose veins or with venous ulcer. One of the complication of varicose veins is lipodermatosclerosis of the medial aspect of the distal part of the leg. In lipodernatosclerosis the  skin gets hyperpigmented, edematous, purplish or reddish with or without ulceration. 

Even though lipodermatosclerosis can occur over the lateral part of the leg as well, the commonest site is the medial site. This is due to the presence of incompetent posterior arch vein perforaters which are present over the medial aspect of the tibia. 

What is Prophylactic Cholecystectomy?

Gall stone disease is fairly common nowadays. Researchers have found out that 17% percent of people are having gall stones at the time of death. Only percent of these people with develop symptoms due to gall stones.

Cholecystectomy is the method of treatment available to treat gall stones. It is usually performed in patients with symptomatic gall stone disease. So, when do we do cholycystectomy in asymptomatic patients?

There are several instances where we do cholecystectomy, even the patient is not symptomatic. That is when,

• the patient is a known diabetic patient
• patients with congenital hemolytic anemias
• in those due to undergo bariatric surgery for morbid obesity

If your are having any of these conditions, your doctor will do an ultrasound scan of the abdomen to detect any gall stones. If they present, he might decide to do a prophylactic cholecystectomy.

Management of Pseudocysts of the Pancreas

Pseudocyst  formation is one of the complications of chronic pancreatitis. The diagnosis of pseudocyst is usually done performing a ultrasound scan. The management of pseudo cyst occurs in a sequential manner. 

• The initial management of all pseudocysts is conservative management. This is because some pseudocysts can disappear spontaneously. Also, the cysts should mature enough to perform any procedures. The maturation of the cyst usually take 6 weeks. Therefore, the patients with pseudocysts are reviewed in 6 months. The size of the tumor predicts the possibilities of disappearing. If the cyst is less than 6 cm wide, there is more chance that it will regress spontaneously. But, if it is more than 6 cm in size, it will persist more often. 

• After 6 weeks another ultrasound scan is done. If the scan shows the persistence of the cyst, it  is removed therapeutically. Several methods are available to do this. They are, 

• Ultrasound guided drainage -

This is a minimal invasive method, but the cyst can recur later some time. Therefore, it is not the ideal way of treating pseudo-cysts. 

• Open cystogastrostomy

In open cystogastrostomy, the abdomen is opened and the anterior and the posterior walls are opened. Then the cyst is also opened and the opening is sutured to the posterior opening of the stomach. The cyst contents will gradually drain in to the stomach and ultimately the cyst will disappear. 

• Laparoscopic cystogastrostomy

In laparoscopic procedures, there is no need of opening the abdomen by using a long incision.

• Endoscopic cystogastrostomy

This is performed by an endoscope send through the mouth. Endoscopic cystogstrostomy is better because it only divides the posterior wall of the stomach.

Chronic pancreatitis is a disease with a lot of morbidity. Managing each of these morbidities is important when managing a patient with chronic pancreatitis. 

How to Know Whether You are Having Hypercholesterolemia Without Doing Blood Test

Nowadays many illnesses are diagnosed by doing investigations. In older days, when there was no sophisticated instruments for investigations, most of the illnesses were diagnosed only by taking a proper medical history and by doing a careful physical examination. Even though the art of eliciting clinical features on becoming less and less, some clinicians still appreciate good clinical skills which makes the field of medicine more interesting. 

So, are you worried about having high cholesterol levels, but still hesitating to do a blood investigation to confirm it? Then the you can look at the following symptoms of hypercholesterolemia to get a clue about what is going on in your body. If you are having any of those features, it is better to meet a doctor and get a lipid profile done to confirm the diagnosis. Once confirmed, you should follow the instructions given by your doctor, because it is very important that you keep your cholesterol levels within the normal range. It is because hypercholesterolemia is associated with many illnesses including atherosclerotic disease which can give rise to ischemic heart diseases, peripheral vascular disease, strokes etc. 

The sings of hypercholesterolemia are,

• Corneal arcus

Corneal arcus is a whites band present around the cornea. This can present in elderly people who has normal cholesterol levels. This is called senile arcus. 

• Xanthalasma

Xanthalasma are seen around the eyes. They occur due to fat collection under the skin. They look like yellowish nodules in the skin around the eye including the eyelids. They are soft to touch with well demacated margins.

• Tendon xanthomas

Tendon xanthomas also appear like xanthalasma, but they occur around tendons. They can easily be found over the achilis tendon. Achilis tendon is a tendon of the leg which inserts to the back of the heel. 

Hypercholesterolemia causes most of the diseases as a result of atheroma formation. People with hypercholesterolemia are more prone to get atherosclerotic disease. The features of atherosclerotic disease are,

• A past history of ischemic heart disease, stroke or peripheral vascular disease.
• Erectile dysfunction
• Thickened arteries

To feel for thickened radial artery, you should first apply pressure over the brachial artery. Then palpate the radial artery and see whether it is thickened. Also the palpate the femoral artery too.

• Locomotor brchialis, radialis and ulnaris

These are sings that occur in arteries as a result of loss of support from surrounding connective tissues plus the tortuocity of the arteries. You may see the tortuous arteries pulsating. 

• Feel for peripheral pulses

The peripheral pulses can be absent when there are atherosclerotic plaques occluding the arteries. 

• Bruits 

You need a stethoscope to hear bruits. Bruits can occur at any portion of the arterial system.

Above mentioned are only few signs of hypercholesterolemia and atherosclerotic disease. If you are having one or more of those symptoms, it is better to see a doctor and get a proper medical evaluation done. If the cholesterol levels are high, your doctor will either manage you with life style modifications. He can also give you drugs. Either way, you should adhere to the advice given. unless, hypercholeterolemia can give rise to diseases with significant rate mortality and morbidity. 

Basic principles of Management of Fractures

The goal of management of fracture is to restore function and structure of the affected part without any cosmetic problems. Management of fractures is carried out according to 3 major basic principles. 

1. reduction (R)
2. Immobilization (I)
3. Rehabilitation (R)

Reduction

Reduction of a fracture restores the distal part of the fracture segment to its normal position. The fractured segment can be displaced or angulated. To achieve this traction is applied along the long axis of the bone and the mechanism of fracture is reversed to put the fractured segment beck in to its normal position. Reduction be achieved either by open method or closed method.The patient is anaesthetised before the procedure because it can be very painful.

Immobilization

Immobilization is achieved by several methods. The appropriate method for a particular person is decided according to the nature of the fracture he or she is having. The following methods are used to immobilize the affected part. They are,

1. Splinting
2. Casting
3. Traction
4. Internal fixation
5. External fixation 

Splinting and casting are applied by using plaster of paris (POP). Splints are also called back slabs. All 5 methods help to keep the fractured segments approximated so they can heal fast. Even though, internal fixation allows early mobility, it does not accelerate the rate of healing process. 

External fixation is applied for compound fractures where internal fixation can not be achieved due to high risk of infection. In such situations the soft tissues should first be healed. 

Is Your Fractured Bone is Healing properly?

Fractures are very common nowadays. Usually, your fractured bone will be immobilized for a long time to allow it to heal. Optimum conditions should be there to allow the fractures to heal properly. These factors include,

• Good blood supply
• Proper nutrition
• Good approximation
• Less movements between the fracture segments

Therefore, any lack of any of above factors can give rise to delayed fracture healing. If you are having a fracture, your fractured area must be wrapped in a plaster cast or a splint and the fractured joint is immobilzed. You must be curious when the fracture will heal. You doctor will explain how long it will take for the fracture to heal. Usually, a fracture takes at least 3 weeks to heel. 

You can assess the progression of the healing process by yourself just by paying attention to the symptoms and signs. If there is pain in the fracture area, it means that the healing process is still going on. If there is no pain at all, it means that the fracture has healed completely. 

If there is no pain, it is better to be aware of the mobility of the fracture site. If the fractured segments are mobile at the fracture site and there is no pain, it means that the healing process has stopped, but the ends has not united. This is called malunion. In such cases, your doctor will have to do a surgery and remove the healed edges and to an internal fixation.

Meanwhile, you should help your body to heal the fracture. You can do this by giving the fracture site the proper environment to heal. Things you can do includes,

• Maintain good nutrition
• Keep the fracture immobilized.
• Avoid infections

Imaging in Fratures

Imaging of fractures involves the rule of two.

1. Two joints - Both joints, proximal and distal to the fracture should be included in the radiograph. 
2. Two views - There should be two views, anteroposterior and lateral. 
3. Two limbs - When the lesion is in a paired organ, you should never forget to compare it with the other. Therefore, a radiograph of the normal limb should also be taken.
4. Two times - radiographs should be taken both before and after the procedure. 

description of radiographs is remembered as the rule of A's.

1. Anatomy - e.g. proximal tibia
2. Articular - e.g. intra-articular, extra-articular
3. Alignment - e.g. first plane
4. Angulation - e.g. second plane
5. Apex - e.g. apex pointing medially
6. Apposition - e.g. 25%, 50%.....

An Overwiew of Fractures

Fracture is defined as disruption in the integrity of a living bone involving injury to the bone marrow, periosteum and the the surrounding soft tissues. Fracture can cause a significant amount of morbidity and therefore, should be prevented at all times. 

How to Prevent Fractures

Prevention of fractures involves the following.

• Increase bone strength

This can be achieved by getting enough calcium through foods. Usually a person should take 1500 micrograms of calcium per day. This amount can easily be achieved only by eating enough calcium containing foods such as small fish, milk and fortified foods or drinks such as orange juice. 

Taking enough calcium diet is not enough to strengthen the bones. The bones get stronger according to the stress they are put in to. This can be achieved by carrying out aerobics and weight training. 

• Avoiding and protecting from potential accidents that can cause fractures. 

Road traffic accidents plays a leading role in fractures. Therefore, various measures has been taken to minimize road traffic accidents. Adhering to these rules and regulations and thereby avoiding accidents can keep you away from fractures. Make sure you and everyone else in the vehicle wears seat belts before starting your vehicle. Never drive when you are drunk. 

Management of Fractures At the Site of the Accident

Management of fracture involves management at the site of the infections and proper medical and surgical management after arrival to the hospital. At the site of the hospital, the following measures should be taken to minimize the complications and to optimize the recovery.

Most of the fractures occurs in poly trauma patients. So, the person should be attended as a whole. The person who have a training in managing fractures should approach the patient safely and carry out A,B,C and stabilize the patient before attending his or her fractures. Once the patient is table the injuries can be managed. Many serious fractures are open fractures and therefore, can bleed continuously, In such situations, you should apply pressure over the wound by putting several layers of gauze or cloth over it. Before doing this you should protect your self by putting on latex gloves or by covering the hands using a polythene bag. When applying the pressure, try not to displace the fragmented bones. 

Then the fracture should be immobilized. Immobilization reduces pain and reduced the chances of the patient going in to shock. Immobilization is done by applying a splint. Splint should be applied to involve both the proximal and distal joints involving the fracture. An umbrella, folded news papers or magazines etc, can be used as a splint. 

You can also immobilize the fractured lower limb by tying it onto the normal lower limb. An injured upper limb can be immobilized by tying it on to the chest wall. If the elbow is bent, you can rest the forearm on a broad arm sling. 

Management of Fractures at the Hospital

Once the patient arrives to the hospital, the doctors take a brief history regarding the incident which lead to the injury. He will also take a brief history regarding the past history of fracture, associated comorbidities and other social factors. Radiographs will be taken.

The management of fractures can be wither operative or non-operative. Non operative management involves closed reduction followed by a period of immobilization with splinting or casting. 

How Can You Get Long Term Sensory Loss of Upper Chest After Clavicle Fracture?

Fracture of clavicle is very common. Earlier these fractures were managed conservatively. People with fracture of the clavicle are diagnosed by taking radiographs. After diagnosis, usually a broad arm sling is given to the patient and the fracture is allowed to heal. But now there are new methods used throughout the world besides conservative management.

The cutaneous nerves supplying the upper chest arise from the spinal cord and pass  downwards towards the upper chest across the clavicle. These nerves can get damaged when the clavicle fractures. In such situations, the patient can suffer long term sensory loss over the upper part of the chest.