Prednisone

Prednisone belongs to the class of drugs called corticosteroids. Used as immunosuppressant, it also prevents the release of substances in the body that causes inflammatory. Prednisone provides treatment in many different conditions such as some types of cancer and arthritis.

1,654 Questions
Medication and Drugs
Steroids
Prednisone

How Long do the side effects of Prednisone last?

The side effects of Prednisone should only last about three weeks after the initial dosage. Once your body gets used to the drug, the side effects usually taper.

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Women's Health
Periods and Conception
Menstruation
Prednisone

Can stress delay your menstrual cycle?

Yes it is possible to get late periods due to stress. Due to weakness and unhealthy diet our body hormones get changed that causes changes in period cycle.Stress is an essential factor that causes delay in monthly cycle.

437438439
Medication and Drugs
Steroids
Prednisone

Is it fine to take Prednisone with Gatorade?

Prednisone is a very strong drug, with many side effects. Prednisone must be taken with care, and only as directed by your Dr. Gatorade is a simple solution that replaces the electrolytes lost by the body, Gatorade does not react with drugs, and can be considered as safe as water.

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Medication and Drugs
Steroids
Prednisone

Why Prednisone causes elevated wbc?

Steroid use can "hide" signs and symptoms of an infection and also prolonged use of them may cause leukocytosis (or elevated white counts). Steroids cause increased bone marrow release of mature neutrophils, movement into the circulating neutrophil pool, and decreased tissue migration. An increase in white blood cells and neutrophilia occurs 4 to 8 hours after elevation of stress hormones or steroid use and return to normal 1 to 3 days after.

232425
Medication and Drugs
Codeine
Steroids
Prednisone

Can you take codeine and Prednisone?

Yes, there is no significant drug interactions. Codeine is a cough suppressant/ pain reliever and prednisone is a corticosteroid steroid.

414243
Medication and Drugs
Steroids
Prednisone

Is it safe to take topamax and Prednisone together?

yes

123
Medication and Drugs
Codeine
Steroids
Prednisone

Does Prednisone contain codeine?

Prednisone belongs to a class of drugs termed glucocorticoids and is mostly used to suppress the immune system and reduce inflammation. Presnisone does not contain any additional medications and does not have codeine.

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Prednisone

Can you take Alka-Seltzer while taking Prednisone?

There were no interactions found in our database between Alka-Seltzer Plus Day ... Prednisone is used to treat the following conditions: Acute Lymphocytic ... Do not stop taking any medications without consulting your healthcare provider. ... in no way should be construed to indicate that the drug or combination is safe.

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Prednisone

Nasal corticosteroid sprays?

Alternate Names

Steroid nasal sprays

What Are Nasal Corticosteroids?

A nasal corticosteroid spray is a treatment prescribed by your doctor. The medicine in the spray is placed directly in the nose to help reduce symptoms and make breathing through the nose easier.

How Nasal Corticosteroids Help You

Nasal corticosteroid sprays help to reduce swelling and mucus in the nasal passageway and relieve other bothersome nasal symptoms. The sprays work well:

  • For people with allergic rhinitis symptoms, such as congestion, runny nose, sneezing, itching, or swelling of the nasal passageway
  • To treat nasal polyps (benign growths in the lining of the nasal passage)

Nasal corticosteroid sprays are different from the sprays you can buy at the store without a prescription. They work best when used every day without stopping. Your doctor will recommend a daily schedule of sprays for each nostril.

It may take two weeks or more for your symptoms to improve the most. Be patient. Relieving the symptoms can help you or your child to feel and sleep better and have fewer symptoms during the day.

You may also use them on an as-needed basis only, or as-needed along with regular use. Regular use, however, will typically give you better benefit.

Starting nasal corticosteroids at the beginning of a pollen season will give you the best results in decreasing symptoms during that season.

Several brands of nasal corticosteroids are available, such as Flonase or Nasonex. They all have very similar effects.

How to Use Nasal Corticosteroids

Make sure you understand your dosing instructions. Make sure you apply only the prescribed number of sprays in each nostril. You may be asked to use the spray 1 - 2 times per day.

  1. Wash your hands.
  2. Gently blow your nose to clear the passageway.
  3. Shake the container several times.
  4. Keep your head upright. Breathe out.
  5. Block one nostril closed with your finger.
  6. Insert the nasal applicator into the other nostril.
  7. Aim the spray toward the outer wall of the nostril.
  8. Inhale slowly through the nose and press the spray applicator.
  9. Breathe out and repeat to apply the prescribed number of sprays.
  10. Repeat the steps for the other nostril.
  11. Avoid sneezing or blowing your nose right after spraying.
Side Effects

Nasal corticosteroid sprays are considered safe for all adults. Specific types are safe for children (over age 2). Pregnant women can safely use nasal corticosteroids.

Nasal corticosteroid sprays generally affect only the nasal passageway, where the medicine is deposited, and do not impact other parts of the body. They carry a low risk for widespread side effects unless the drug is used too much.

Side effects of nasal steroids may include:

  • Dryness, burning, stinging in the nasal passage. This can be helped by using the nasal corticosteroid after showering or placing your head over a steamy sink or steaming pot for 5 - 10 minutes.
  • Sneezing
  • Throat irritation
  • Headaches and nosebleed (uncommon, but you should report them to your doctor immediately)
  • More likely to have an infection in the nasal passages
  • Rarely, perforation (hole or crack) in the passageway may occur. This occurs more commonly if you do not use the proper technique of spraying away from the middle of your nose.

Make sure you, or your child, take the corticosteroid spray exactly as prescribed. This is the best way to avoid side effects. If you, or your child, use the spray regularly, see a doctor periodically for examination of the nasal passages to make sure problems are not developing

When to Call the Doctor
  • You have nasal irritation, bleeding or other new nasal symptoms.
  • You have continued allergy symptoms after repeated use of nasal corticosteroids.
  • You have questions or concerns about your symptoms.
  • You are having trouble taking the medication.
References

Sur DK, Scandale S. Treatment of allergic rhinitis. Am Fam Physician. 2010 Jun 15;81(12):1440-6.

Wallace DV, Dykewicz MS, Bernstein DI, Blessing-Moore J, Cox L, Khan DA, et al. The diagnosis and management of rhinitis: an updated practice parameter. J Allergy Clin Immunol. 2008 Aug;122(2 Suppl):S1-84.

Bahls C. In the clinic. Allergic rhinitis. Ann Intern Med. 2007 Apr 3;146(7):ITC4-1-ITC4-16.

American Family Physician. Nasal sprays: how to use them correctly. Available at: http://familydoctor.org/online/famdocen/home/common/allergies/treatment/104.html.

Reviewed By

Review Date: 10/27/2011

Stuart I. Henochowicz, MD, FACP, Associate Clinical Professor of Medicine, Division of Allergy, Immunology, and Rheumatology, Georgetown University Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Prednisone

White blood cell count - series?

Indication

The White Blood Cell (WBC) Count measures two components: the total number of WBC's (leukocytes), and the differential count. The differential count measures the percentages of each type of leukocyte present. WBC's are composed of granulocytes (neutrophils, eosinophils, and basophils) and non-granulocytes (lymphocytes and monocytes). White blood cells are a major component of the body's immune system. Indications for a WBC count include infectious and inflammatory diseases; leukemia and lymphoma; and bone marrow disorders.

Procedure

How the test is performed: Adult or child: Blood is drawn from a vein (venipuncture), usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic, and a tourniquet (an elastic band) or blood pressure cuff is placed around the upper arm to apply pressure and restrict blood flow through the vein. This causes veins below the tourniquet to distend (fill with blood). A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. During the procedure, the tourniquet is removed to restore circulation. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding. Infant or young child: The area is cleansed with antiseptic and punctured with a sharp needle or a lancet. The blood may be collected in a pipette (small glass tube), on a slide, onto a test strip, or into a small container. Cotton or a bandage may be applied to the puncture site if there is any continued bleeding. How to prepare for the test: Adults: No special preparation is necessary. Infants and children: The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experience, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child's age: infant test or procedure preparation (birth to 1 year) toddler test or procedure preparation (1 to 3 years) preschooler test or procedure preparation (3 to 6 years) schoolage test or procedure preparation (6 to 12 years) adolescent test or procedure preparation (12 to 18 years) How the test will feel: When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing. What the risks are: Risks associated with venipuncture are slight: excessive bleeding fainting or feeling lightheaded hematoma (blood accumulating under the skin) infection (a slight risk any time the skin is broken) multiple punctures to locate veins Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Results

Interfering factors: Acute emotional or physical stress can increase WBC counts. There are various types of white blood cells (WBCs) that normally appear in the blood: neutrophils (polymorphonuclear leukocytes; PMNs), band cells (slightly immature neutrophils), T-type lymphocytes (T cells), B-type lymphocytes (B cells), monocytes, eosinophils, and basophils. T and B-type lymphocytes are indistinguishable from each other in a normal slide preparation. Any infection or acute stress will result in an increased production of WBCs. This usually entails increased numbers of cells and an increase in the percentage of immature cells (mainly band zcells) in the blood. This change is referred to as a "shift to the left" People who have had a splenectomy have a persistent mild elevation of WBCs. Drugs that may increase WBC counts include epinephrine, allopurinol, aspirin, chloroform, heparin, quinine, corticosteroids, and triamterene. Drugs that may decrease WBC counts include antibiotics, anticonvulsants, antihistamine, antithyroid drugs, arsenicals, barbiturates, chemotherapeutic agents, diuretics and sulfonamides. Normal values: WBC: 4,500 to 10,000 cells/mcl Note: cells/mcl = cells per microliter What abnormal results mean: Low numbers of WBCs (leukopenia) may indicate: bone marrow failure (for example, due to granuloma, tumor, fibrosis) presence of cytotoxic substance collagen-vascular diseases (such as lupus erythematosus) disease of the liver or spleen radiation High numbers of WBCs (leukocytosis) may indicate: infectious diseases inflammatory disease (such as rheumatoid arthritis or allergy) leukemia severe emotional or physical stress tissue damage (for example, burns)

Reviewed By

Review Date: 02/13/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Prednisone

Canker sore?

Definition

A canker sore is a painful, open sore in the mouth. Canker sores are white or yellow and surrounded by a bright red area. They are not cancerous.

A canker sore is not the same as a fever blister (cold sore).

Alternative Names

Aphthous ulcer; Ulcer - aphthous

Causes, incidence, and risk factors

Canker sores are a common form of mouth ulcer. They may occur with viral infections. In some cases, the cause cannot be determined.

Canker sores may also be linked to problems with the body's immune (defense) system. The sores may occur after a mouth injury due to dental work, aggressive tooth cleaning, or biting the tongue or cheek.

Canker sores can also be triggered by:

Anyone can develop a canker sore. Women are more likely to get them than men. Canker sores may run in families.

Symptoms

Canker sores usually appear on the inner surface of the cheeks and lips, tongue, soft palate, and the base of the gums.

Symptoms include:

  • One or more painful, red spots or bump that develops into an open ulcer
  • Middle of the sore is white or yellow
  • Usually small (under 1 cm) but occasionally larger
  • Sore may turn gray just before starting to heal

Less common symptoms include:

Pain usually goes away in 7 to 10 days. It can take 1 to 3 weeks for a canker sore to completely heal. Large ulcers can take longer to heal.

Sometimes, a severe outbreak of canker sores may be accompanied by nonspecific symptoms of illness, such as fever.

Signs and tests

Your health care provider can often make the diagnosis by looking at the sore.

If canker sores persist or continue to return, tests should be done to look for other causes, such as erythema multiforme, drug allergies, herpes infection, and bullous lichen planus.

A biopsy may be used to distinguish a canker sore from other causes of mouth ulcers.

Canker sores are not cancer and do not cause cancer. There are types of cancer, however, that may first appear as a mouth ulcer that does not heal. See: Squamous cell carcinoma.

Treatment

Treatment is usually not necessary. In most cases, the canker sores go away by themselves.

If you have a canker sore, you should not eat hot or spicy foods, which can cause pain. Mild, over-the-counter mouth washes or salt water may help. There are over-the-counter medicines that soothe the painful area. These medicines are applied directly to the sore area of the mouth.

The easiest home remedy is a mixture of half hydrogen peroxide and half water. Use a cotton swab to apply the mixture directly to the canker sore. Then, dab a small amount of Milk of Magnesia on the canker sore, three to four times a day. This is soothing and may also help it heal.

Another home remedy is to mix half Milk of Magnesia and half Benadryl liquid allergy medicine. Swish this mixture in your mouth for about 1 minute, then spit it out.

Prescriptions may be required for severe cases. This may include fluocinonide gel (Lidex) or chlorhexidine gluconate mouthwash. Powerful anti-inflammatory medicines called corticosteroids are sometimes used.

To prevent bacterial infection, brush and floss your teeth regularly and get routine dental check-ups.

Expectations (prognosis)

Canker sores usually heal on their own. The pain usually decreases in a few days. Other symptoms disappear in 10 to 14 days.

Complications

Antibiotic treatment for canker sores may lead to oral thrush (a type of mouth infection) or other Candida infections. Rarely, bacterial infections such as cellulitis and Ludwig's angina may occur.

Canker sores are not cancer and don't lead to cancer. But if you have a mouth ulcer lasts more that 2 weeks, you should see your doctor to rule out possible cancer.

Calling your health care provider

Apply home treatment and call your health care provider if symptoms of canker sores persist or worsen, or canker sores recur more often than 2 or 3 times per year.

Call your health care provider if symptoms are associated with other problems such as fever, diarrhea, headache, or skin rash.

References

Munoz-Corcuera M, Esparza-Gomez G, Gonzalez-Moles MA, Bascones-Martinez A. Oral ulcers: clinical aspects. A tool for dermatologists. Part I. Acute ulcers. Clin Exp Dermatol. 2009 Apr;34(3):289-94.

Munoz-Corcuera M, Esparza-Gomez G, Gonzalez-Moles MA, Bascones-Martinez A. Oral ulcers: clinical aspects. A tool for dermatologists. Part II. Chronic ulcers. Clin Exp Dermatol. 2009 Jun;34(4):456-61. Epub 2009 Apr 14.

Reviewed By

Review Date: 02/17/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Prednisone

17-OH progesterone?

Definition

17-OH progesterone is a blood test that measures the amount of 17-OH progesterone, a hormone produced by the adrenal glands and gonads.

Alternative Names

17-hydroxyprogesterone; Progesterone - 17-OH

How the test is performed

A blood sample is needed. For information on how this is done, see: Venipuncture.

The blood sample is sent to a laboratory for examination.

How to prepare for the test

Your doctor may tell you to stop taking any drugs that may cause false test results. Such drugs include corticosteroids and birth control pills.

Your doctor may also recommend that the test be done at a specific time of day, since it is sensitive to circadian rhythms, the natural highs and lows that the body experiences during a 24-hour period.

How the test will feel

When the needle is inserted to draw blood, you may feel moderate pain, or only a prick or stinging sensation. Afterward, there may some throbbing.

Why the test is performed

This test is mainly used to check infants for an inherited disorder that affects the adrenal gland, called congenital adrenal hyperplasia (CAH). It is often performed on infants who are born with outer genitals that do not clearly look like those of a boy or a girl.

This test is also used to identify people who have nonclassical adrenal hyperplasia. This condition occurs when the body does not make enough of a substance that helps the adrenal gland make cortisol.

Your doctor may recommend this test if you are a woman who has excess hair growth in places where adult men grow hair, or if you have male characteristics, such as a deep voice or an increase in muscle mass.

Normal Values

Normal and abnormal values differ for babies born with low birth weight. In general, normal results are as follows:

  • Cord blood - 1,000 - 3,000 ng/dL
  • >24 hours - less than 100 ng/dL
  • Adults - less than 200 ng/dL

Note: ng/dL = nanograms per deciliter.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.

What abnormal results mean

High levels of 17-OH progesterone may be due to:

In infants with CAH, 17-OHP levels range from 2,000 - 40,000 ng/dL. In adults, a level greater than 200ng/dL may be due to nonclassical adrenal hyperplasia.

What the risks are

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks may include:

  • Excessive bleeding
  • Fainting or feeling light-headed
  • Hematoma (blood accumulating under the skin)
  • Infection (a slight risk any time the skin is broken)
Special considerations

Your doctor may suggest an ACTH test if your 17-OH progesterone level is between 200 - 800 ng/dL.

References

Fritz MA, Speroff L. Normal and abnormal sexual development. In: Speroff L, Fritz MA, eds. Clinical Gynecologic Endocrinology and Infertility. 8th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2011:chap 9.

Lambert SM, Vilain EJ, Kolon TF. A practical approach to ambiguous genitalia in the newborn period. Urol Clin North Am. 2010; 37(2):195-205.

Reviewed By

Review Date: 05/31/2011

Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Prednisone

HDL test?

Definition

HDL stands for high-density lipoprotein. It's also sometimes called "good" cholesterol. Lipoproteins are made of fat and protein. They carry cholesterol, triglycerides, and other fats, called lipids, in the blood from other parts of your body to your liver.

This article discusses the blood test used to measure the level of HDL cholesterol in your blood.

See also:

Alternative Names

High-density lipoprotein test

How the test is performed

A blood sample is needed.

Blood is typically drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.

Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm.

Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

How to prepare for the test

You may be told not to eat or drink anything for 9 - 12 hours before the test.

The health care provider may tell you to stop taking certain drugs before the procedure.

How the test will feel

When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the test is performed

This test is done to check the level of cholesterol in your blood and to see if you are at high risk for a heart attack, stroke, or other cardiovascular problem. Studies of both men and women have shown that the higher your HDL, the lower your risk of coronary artery disease. This is why HDL is sometimes referred to as "good" cholesterol.

The main function of HDL is to help soak up excess cholesterol from the walls of blood vessels and carry it to the liver, where it breaks down and is removed from the body in the bile.

The laboratory test for HDL actually measures how much cholesterol is in each high-density lipoprotein particle, not the actual amount of HDL in the blood.

Normal Values

In general, your risk for heart disease, including a heart attack, increases if your HDL cholesterol level is less than 40 mg/dL.

An HDL 60 mg/dL or above helps protect against heart disease.

Women tend to have higher HDL cholesterol than men.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What abnormal results mean

Low HDL levels may be a sign that you have an increased risk for atherosclerotic heart disease.

A low HDL level may also be associated with:

What the risks are

There is very little risk involved with having your blood taken. Veins and arteries vary in size from one patient to another and from one side of the body to the other. Taking blood from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

  • Excessive bleeding
  • Fainting or feeling light-headed
  • Hematoma (blood accumulating under the skin)
  • Infection (a slight risk any time the skin is broken)
Special considerations

HDL may be done as part of an overall lipid profile, where "bad" cholesterol (LDL) and triglycerides will also be measured. The combined information gathered from all of these tests may help your risk of heart attack, stroke, and peripheral vascular disease.

Your health care provider may recommend therapy if your risk is found to be high. Regular exercise can increase HDL levels by several points.

References

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285:2486-2497. Updated 2004.

U.S. Preventive Services Task Force. Screening for lipid disorders in adults: U.S. Preventive Services Task Force recommendation statement. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2008 Jun.

U.S. Preventive Services Task Force. Screening for Lipid Disorders in Children. US Preventive Services;Task Force recommendation statement. Pediatrics. 2007;120(1):e215-9.

Semenkovich CF. Disorders of lipid metabolism. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 217.

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Prednisone

Total protein?

Definition

The total protein test measures the total amount of two classes of proteins found in the fluid portion of your blood: albumin and globulin.

Proteins are important parts of all cells and tissues. For example, albumin helps prevent fluid from leaking out of blood vessels. Globulins are an important part of your immune system.

How the test is performed

A blood sample is needed. For information on how this is done, see: Venipuncture

How to prepare for the test

Your health care provider may tell you to stop taking certain drugs that can affect the test.

Drugs that can increase total protein measurements include anabolic steroids, androgens, corticosteroids, dextran, growth hormone, insulin, phenazopyridine, and progesterone.

Drugs that can decrease total protein measurements include ammonium ions, estrogens, hepatotoxic drugs, and birth control pills.

Why the test is performed

This test is often done to diagnose nutritional problems, kidney disease or liver disease. If total protein is abnormal, further tests must be done to identify the specific problem.

Normal Values

The normal range is 6.0 to 8.3 gm/dL (grams per deciliter).

Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

The examples above show the common measurements for results for these tests. Some laboratories use different measurements or may test different specimens.

What abnormal results mean

Higher-than-normal levels may be due to:

Lower-than-normal levels may be due to:

Special considerations

Total protein measurement may be increased during pregnancy.

References

Bazari H. Approach to the patient with renal disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 115.

Klein S. Protein-energy malnutrition. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 234.

Tricot G. Multiple myeloma. In: Hoffman R, Benz EJ Jr, Shattil SJ, et al, eds. Hoffman Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2008:chap 87.

Reviewed By

Review Date: 05/30/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Prednisone

Anisocoria?

Definition

Anisocoria is unequal pupil size. The pupil is the black part in the center of the eye. It gets larger in dim light and smaller in bright light.

Alternative Names

Enlargement of one pupil; Pupils of different size; Eyes/pupils different size

Considerations

Slight differences in pupil sizes are found in up to 1 in 5 healthy people. Usually, the diameter difference is less than 0.5 mm, but it can be up to 1 mm (0.05 inch).

Babies born with different sized pupils may not have any underlying disorder. If other family members also have similar pupils, then the pupil size difference is possibly genetic and nothing to worry about.

Also, for unknown reasons, pupils may temporarily differ in size. If there are no other symptoms and if the pupils return to normal, then it is nothing to worry about.

Unequal pupil sizes of more than 1 mm that develop later in life and do NOT return to equal size may be a sign of an eye, brain, blood vessel, or nerve disease.

Common Causes

The use of eyedrops is a common cause of a harmless change in pupil size. Other medicines that get in the eyes, including medicine from asthma inhalers, can change pupil size.

Other causes of unequal pupil sizes may include:

  • Aneurysm
  • Bleeding inside the skull caused by head injury
  • Brain tumor or abscess
  • Excess pressure in one eye caused by glaucoma
  • Increased intracranial pressure
  • Infection of membranes around the brain (meningitis or encephalitis)
  • Migraine headache
  • Seizure (pupil size difference may remain long after seizure is over)
  • Tumor, mass, or lymph node in the upper chest or lymph node causing pressure on a nerve may cause decreased sweating, a small pupil, or drooping eyelid all on the affected side (Horner syndrome)
Home Care

Treatment depends on the cause of the unequal pupil size. You should see a doctor if you have sudden changes in pupil size.

Call your health care provider if

You should see a doctor if you have persistent, unexplained, or sudden changes in pupil size. The new development of different sized pupils may be a sign of a very serious condition.

If you have differing pupil size after an eye or head injury, get medical help immediately.

Always seek immediate medical attention if differing pupil size occurs along with:

What to expect at your health care provider's office

Your health care provider will perform a physical exam and ask questions about your symptoms and medical history, including:

  • Is this new for you or have your pupils ever been different sizes before?
  • When did it start?
  • What other symptoms do you have?
    • Is there a headache?
    • Is there nausea?
    • Is there vomiting?
    • Is there blurred vision?
    • Is there double vision?
    • Is there a fever?
    • Is there a stiff neck?
    • Are the eyes light-sensitive (photophobia)?
    • Is there eye pain?
    • Is there loss of vision?

Tests that may be done include:

Treatment depends on the cause of the problem.

References

Baloh RW. Neuro-ophthalmology. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 450.

Griggs RC, Jozefowicz RF, Aminoff MJ. Approach to the patient with neurologic disease. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 418.

Rucker JC. Pupillary and eyelid abnormalities. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Bradley: Neurology in Clinical Practice. 5th ed. Philadelphia, Pa: Butterworth-Heinemann Elsevier; 2008:chap 17.

Reviewed By

Review Date: 04/30/2011

Kevin Sheth, MD, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine;David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Prednisone

Scar revision?

Definition

Scar revision is surgery to improve or reduce the appearance of scars. It also restores function, and corrects skin changes (disfigurement) caused by an injury, wound, or previous surgery.

Alternative Names

Keloid revision; Hypertrophic scar revision; Scar repair; Z-plasty; Tissue expansion

Description

Scar tissue forms as skin heals after an injury (such as an accident) or surgery. The amount of scarring may be determined by the wound size, depth, and location; the person's age; heredity; and skin characteristics including color (pigmentation).

Depending on the the extent of the surgery, scar revision can be done while you are awake (local anesthesia), sleeping (sedated), or deep asleep and pain-free (general anesthesia).

Medications (topical corticosteroids, anesthetic ointments, and antihistamine creams) can reduce the symptoms of itching and tenderness. A treatment called silicone gel sheeting or ointment has been shown to benefit swollen, hypertrophic scars. There is no evidence showing that any other topical (applied directly to the scar) treatment works. In fact, Vitamin E applied directly to the skin may actually cause the wound to heal more slowly and may cause irritation.

When to have scar revision done is not always clear. Scars shrink and become less noticeable as they age. You may be able to wait for surgical revision until the scar lightens in color, which can be several months or even a year after the wound has healed. For some scars, however, it is best to have revision surgery 60-90 days after the scar matures.

There are several ways to improve the appearance of scars:

  • The scar may be removed completely and the new wound closed very carefully
  • Dermabrasion involves removing the upper layers of the skin with a special wire brush called a burr or fraise. New skin grows over this area. Dermabrasion can be used to soften the surface of the skin or reduce irregularities.
    • Massive injuries (such as burns) can cause loss of a large area of skin and may form hypertrophic scars. These types of scars can restrict movement of muscles, joints and tendons (contracture). Surgery removes extra scar tissue. It involves a series of small cuts (incisions) on both sides of the scar site, which create V-shaped skin flaps (Z-plasty). The result is a thin, less noticeable scar, because the way the wound closes after a Z-plasty more closely follows the natural skin folds.
  • Skin graftinginvolves taking a thin (partial, or "split thickness") layer of skin from another part of the body and placing it over the injured area. Skin flap surgery involves moving an entire, full thickness of skin, fat, nerves, blood vessels, and muscle from a healthy part of the body to the injured site. These techniques are used when a large amount of skin has been lost in the original injury, when a thin scar will not heal, and when the main concern is improved function (rather than improved appearance).
  • Tissue expansion is used for breast reconstruction, as well as for skin that has been damaged due to birth defects and injuries. A silicone balloon is inserted beneath the skin and gradually filled with salt water. This stretches the skin, which grows over time.
Why the Procedure Is Performed

Problems that may indicate a need for scar revision include:

  • A keloid, which is an abnormal scar that is thicker and of a different color and texture than the rest of the skin. Keloids extend beyond the edge of the wound and are likely to come back. They often create a thick, puckered effect that looks like a tumor. Keloids are removed at the place where they meet normal tissue.
  • A scar that is at an angle to the normal tension lines of the skin.
  • A scar that is thickened.
  • A scar that causes distortion of other features or causes problems with normal movement or function.
Risks

Risks for any anesthesia are:

  • Reactions to medications
  • Breathing problems

Risks for any surgery are:

  • Bleeding
  • Infection
  • Blood clots
  • Scar recurrence
  • Keloid formation (or recurrence)
  • Separation (dehiscence) of the wound

Exposing the scar to too much sun may cause it to darken, which could interfere with future revision.

After the Procedure

For keloid revision, a pressure or elastic dressing may be placed over the area after the operation to prevent the keloid from coming back.

For other types of scar revision, a light dressing is applied. Stitches are usually removed in 3 to 4 days for the facial area, and in 5 to 7 days for incisions on other parts of the body.

When you return to normal activities and work depends on the type, degree, and location of the surgery. Most people can resume normal activities soon after surgery. Doctors usually recommend that you avoid activities that stretch and may widen the new scar.

If you have long-term stiffening of the joint, you may need physical therapy in addition to surgery to restore full function.

Avoid exposure to the sun for several months after treatment. Use sunblock or a dressing (such as a Band-Aid) to keep the sun from permanently tanning the healing scar.

Outlook (Prognosis)

No scar can be removed completely. How much the scar improves will depend on the direction and size of the scar, the age of the person, the skin type and color, and hereditary factors that may affect the healing process.

References

Thomas JR, Mobley SR. Scar revision and camouflage. In: Cummings CW, Flint PW, Haughey BH, Robbins KT, Thomas JR, eds. Otolaryngology: Head & Neck Surgery. 4th ed. Philadelphia, Pa: Mosby Elsevier; 2005: chap 24.

Zurada JM, Kriegel D, Davis IC. Topical treatments for hypertrophic scars. J Am Acad Dermatol. 2006;55(6).

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Tenosynovitis?

Definition

Tenosynovitis is inflammation of the lining of the sheath that surrounds a tendon (the cord that joins muscle to bone).

Alternative Names

Inflammation of the tendon sheath

Causes, incidence, and risk factors

The synovium is a lining of the protective sheath that covers tendons. Tenosynovitis is inflammation of this sheath. The cause of the inflammation may be unknown, or it may result from:

The wrists, hands, and feet are commonly affected. However, the condition may occur with any tendon sheath.

Note: An infected cut to the hands or wrists that causes tenosynovitis may be an emergency requiring surgery.

Symptoms
  • Difficulty moving a joint
  • Joint swellingin the affected area
  • Pain and tenderness around a joint, especially the hand, wrist, foot, or ankle
  • Pain when moving a joint
  • Redness along the length of the tendon

Fever, swelling, and redness may indicate an infection, especially if a puncture or cut caused these symptoms.

Signs and tests

A physical examination shows swelling over the involved tendon. The health care provider may touch or stretch the tendon, or have you move the muscle where it is attached to see whether you experience pain.

Treatment

The goal of treatment is to relieve pain and reduce inflammation. Rest or keeping the affected tendons still is essential for recovery.

You may want to use a splint or a removable brace to help keep the tendons still. Applying heat or cold to the affected area should help reduce the pain and inflammation.

Nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen can relieve pain and reduce inflammation. Local injections of corticosteroids may be useful as well. Some patients need surgery to remove the inflammation surrounding the tendon, but this is not common.

For tenosynovitis caused by infection, your health care provider will prescribe antibiotics. In some severe cases, surgery may be needed to release the pus around the tendon.

If there is no infection, a steroid injection may be used to decrease inflammation along the tendon sheath.

After you have recovered, do strengthening exercises using the muscles around the affected tendon to help prevent the injury from coming back.

Expectations (prognosis)

Most people fully recover with treatment. However, if the condition is caused by overuse and the activity is not stopped, tenosynovitis is likely to come back. In chronic conditions, the tendon may be damaged and recovery may be slow or incomplete.

Complications

If tenosynovitis is not treated, the tendon may become permanently restricted or it may tear (rupture). The affected joint can become stiff.

Infection in the tendon may spread to other places in the body, which could be serious and threaten the affected limb.

Calling your health care provider

Call for an appointment with your health care provider if you have pain or difficulty straightening a joint or extremity. If you suspect infection, contact your health care provider immediately.

Prevention

Avoiding repetitive movements and overuse of tendons may help prevent tenosynovitis.

Use the appropriate wound care techniques to clean cuts to the hand, wrist, and feet.

References

Geiderman JM, Katz D. General principles of orthopedic injuries. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 46.

Schmidt MJ, Adams SL. Tendinopathy and bursitis. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 115.

Reviewed By

Review Date: 07/28/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Ovarian overproduction of androgens?

Definition

Ovarian overproduction of androgens is a condition in which the female ovaries make too much testosterone. This leads to the development of male characteristics in a woman. Other hormones, called androgens, from other parts of the body can also cause the development of male characteristics in women.

Causes, incidence, and risk factors

In healthy women, the ovaries and adrenal glands produce about 40 - 50% of the body's testosterone. Both tumors of the ovaries and polycystic ovary syndrome (PCOS) can cause excess androgen production.

Cushing's disease, an abnormality in the pituitary gland, causes excess amounts of corticosteroids, which cause masculine body changes in women. Also, tumors in the adrenal glands can cause overproduction of androgens and lead to male body characteristics in women.

Symptoms

Hyperandrogenism:

  • Acne
  • Amenorrhea(absence of menstrual periods)
  • Changes in female body contours
  • Decrease in breast size
  • Increase in body hair in a male pattern (hirsutism) such as on the face, chin, and abdomen
  • Oily skin

Virilization:

  • Clitoromegaly (enlargement of the clitoris)
  • Deepening of the voice
  • Increase in muscle mass
  • Temporal balding (thinning hair and hair loss)
Signs and testsYour health care provider will perform a physical exam. Any blood and imaging tests ordered will depend on your specific symptoms, but may include:
  • 17-hydroxyprogesterone test
  • ACTH test
  • CT scan
  • DHEA blood test
  • Glucose test
  • Insulin test
  • Pelvic ultrasound
  • Prolactin (if periods are infrequent or absent) test
  • Testosterone test
  • Total cholesterol test
  • TSH test (if there is hair loss)
Treatment

Treatment depends on the problem that is causing the increased androgen production. Medications can be given to decrease hair production in patients who have excess body hair (hirsutism) or to regulate menstrual cycles. In some cases, surgery may be necessary to remove an ovarian or adrenal tumor.

Expectations (prognosis)

The success of the treatment depends on what caused the excess androgen production. If the condition is caused by an ovarian tumor, surgical removal of the tumor may correct the problem. Most ovarian tumors are not cancerous (benign), and will not come back after they've been removed.

In polycystic ovary syndrome, the following can reduce symptoms caused by increased androgen levels:

  • Careful monitoring
  • Dietary changes
  • Medications
  • Regular vigorous exercise
Complications

Infertility is a possible complication.

Women with polycystic ovary syndrome may be at increased risk for:

  • Diabetes
  • High blood pressure
  • High cholesterol
  • Obesity
  • Uterine cancer
Prevention

There is no known prevention. Maintaining a normal weight through healthy diet and regular exercise can reduce your chances of any long-term complications.

References

Lobo RA. Hyperandrogenism: physiology, etiology, differential diagnosis, management. In: Katz V, Lobo RA, Lentz G, Gershenson D, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 40.

Bulun SE, Adashi EY. The physiology and pathology of the female reproductive axis. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 16.

Reviewed By

Review Date: 06/07/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Canker sores?

Definition

A canker sore is a painful, open sore in the mouth. Canker sores are white or yellow and surrounded by a bright red area. They are benign (not cancer).

See also: Herpes, Fever blisters and Canker sores

Alternative Names

Aphthous ulcer; Ulcer - aphthous

Causes, incidence, and risk factors

Canker sores are a common form of mouth ulcer. They occur in women more often than men. They may occur at any age, but usually first appear between the ages of 10 and 40.

Canker sores usually appear on the inner surface of the cheeks and lips, tongue, soft palate, and the base of the gums.

Canker sores can run in families. They may also be linked to problems with the body's immune (defense) system. The sores may occur after a mouth injury due to dental work, aggressive tooth cleaning, or biting the tongue or cheek.

Canker sores can be triggered by emotional stress, dietary deficiencies (especially iron, folic acid, or vitamin B-12), menstrual periods, hormonal changes, food allergies, and similar situations. They occur most commonly with viral infections. In some cases, the cause can not be identified.

Symptoms

The first symptom is usually a tingling or burning sensation that you feel before other symptoms develop.

The following symptoms may then occur:

  • Painful, red spot or bump that develops into an open ulcer
    • Center is colored white or yellow
    • Usually small (under 1 cm) but occasionally larger
    • Single bump or group of bumps (crops)
  • Sore may turn gray just before starting to heal

Less common symptoms include:

Pain decreases in 7 to 10 days, with complete healing in 1 to 3 weeks. Particularly large ulcers (greater than 1 cm in diameter) often take longer to heal (2 to 4 weeks). Occasionally, a severe occurrence may be accompanied by nonspecific symptoms of illness, such as fever. Canker sores often return.

Signs and tests

Your health care provider can often make the diagnosis by looking at the sore. If canker sores persist or continue to return, tests should be done to rule out other causes, such as erythema multiforme, drug allergies, herpes infection, bullous lichen planus, and other disorders.

Canker sores are not cancer and do not cause cancer. There are types of cancer, however, that may first appear as a mouth ulcer that does not heal. See: Squamous cell carcinoma.

A biopsy may be used to distinguish a canker sore from other causes of mouth ulcers.

Treatment

Treatment is usually not necessary. In most cases, the canker sores go away by themselves.

If you have a canker sore, you should not eat hot or spicy foods, which can cause pain. Mild, over-the-counter mouth washes or salt water may help. There are over-the-counter medicines that soothe the painful area. These medicines are applied directly to the sore area of the mouth.

The easiest home remedy is a mixture of half hydrogen peroxide and half water. Use a cotton swab to apply the mixture directly to the canker sore. Then, dab a small amount of Milk of Magnesia on the canker sore, three to four times a day. This is soothing and may also help it heal.

Another home remedy is to mix half Milk of Magnesia and half Benadryl liquid allergy medicine. Swish this mixture in your mouth for about 1 minutes, then spit it out.

Other treatments for more severe cases include applying fluocinonide gel (Lidex) or chlorhexidine gluconate mouthwash. Powerful anti-inflammatory medicines called corticosteroids are sometimes used.

To prevent bacterial infection, brush and floss your teeth regularly and visit the dentist for routine care.

Expectations (prognosis)

Canker sores usually heal on their own. The pain usually decreases in a few days. Other symptoms disappear in 10 to 14 days.

Complications

Antibiotic treatment for canker sores may lead to oral thrush (a type of mouth infection) or other Candida infections. Rarely, bacterial infections such as cellulitis and Ludwig's angina may occur.

Canker sores are not cancer and don't lead to cancer. But if you have a mouth ulcer lasts more that 2 weeks, you should see your doctor to rule out possible cancer.

Calling your health care provider

Apply home treatment and call your health care provider if symptoms of canker sores persist or worsen, or canker sores recur more often than 2 or 3 times per year.

Call your health care provider if symptoms are associated with other problems such as fever, diarrhea, headache, or skin rash.

References

Femiano F, Lanza A, Buonaiuto C, et al. Guidelines for diagnosis and management of aphthous stomatitis. Pediatr Infect Dis J. 2007;26:728-732.

Gonsalves WC, Chi AC, Neville BW. Common oral lesions: Part I. Superficial mucosal lesions. Am Fam Physician. 2007;75(4):501-507.

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Prednisone

Serum sickness?

Definition

Serum sickness is a reaction similar to an allergy. Specifically, it is an immune system reaction to certain medications, injected proteins used to treat immune conditions, or antiserum, the liquid part of blood that contains antibodies that help protect against infectious or poisonous substances.

See also: Immune response

Causes, incidence, and risk factors

Plasma is the clear fluid portion of blood. It does not contain blood cells, but it does contain many proteins, including antibodies, which are formed as part of the immune response to protect against infection.

Antiserum is produced from the plasma of a person or animal that has immunity against a particular infection or poisonous substance. Antiserum may be used to protect a person who has been exposed to a potentially dangerous microorganism against which the person has not been immunized. For example, you may receive a certain type of antiserum injection if you have been exposed to tetanus or rabies. This is called passive immunization. It gives you immediate, but temporary, protection while your body develops an active immune response against the toxin or microorganism.

During serum sickness, the immune system falsely identifies a protein in antiserum as a potentially harmful substance (antigen). The result is a faulty immune system response that attacks the antiserum. Immune system elements and the antiserum combine to form immune complexes, which cause inflammation and other symptoms.

Certain medications (such as penicillin, cefaclor, and sulfa) can cause a similar reaction. Unlike other drug allergies, which occur very soon after receiving the medication again, serum sickness develops 7 - 21 days after the first exposure to a medication.

Injected proteins such as antithymocyte globulin (used to treat organ transplant rejection) and rituximab (used to treat immune disorders and cancers) cause serum sickness reactions.

Blood products may also cause serum sickness.

Symptoms
  • Fever
  • General ill feeling
  • Hives
  • Itching
  • Joint pain
  • Rash
  • Swollen lymph nodes

Note: Symptoms usually do not develop until 7 - 21 days after the first dose of antiserum or exposure to the medication. However, some people may develop symptoms in 1 - 3 days if they have previously been exposed to the substance.

Signs and tests

The lymph nodes may be enlarged and tender to the touch. The urine may contain blood or protein. Blood tests may show immune complexes or signs of blood vessel inflammation.

Treatment

Corticosteroid creams or ointments or other soothing skin medications may relieve discomfort from itching and rash.

Antihistamines may shorten the length of illness and help ease rash and itching.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may relieve joint pain. Corticosteroids taken by mouth (such as prednisone) may be prescribed for severe cases.

Medications causing the problem should be stopped, and future use of the medication or antiserum should be avoided.

Expectations (prognosis)

The symptoms usually go away within a few days.

Complications

If the drug or antiserum that caused serum sickness is used again in the future, your risk of having another similar reaction is quite high.

Complications include:

  • Anaphylactic shock, an immediate, life-threatening reaction
  • Inflammation of the blood vessels
  • Swelling of the face, arms, and legs
Calling your health care provider

Call your health care provider if medication or antiserum has been given within the last 4 weeks and symptoms of serum sickness appear.

Prevention

There is no known way to prevent the development of serum sickness.

People who have experienced serum sickness, anaphylactic shock, or drug allergy should avoid future use of the antiserum or drug.

References

Salmon JE. Mechanisms of immune mediated tissue injury. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 44.

Reviewed By

Review Date: 05/02/2010

Stuart I. Henochowicz, MD, FACP, Associate Clinical Professor of Medicine, Division of Allergy, Immunology, and Rheumatology, Georgetown University Medical School; and David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Cranial mononeuropathy VI?

Definition

Cranial mononeuropathy VI is a nerve disorder. It prevents some of the muscles that control eye movements from working well. As a result, people may see two of the same image (double vision).

Alternative Names

Abducens palsy; Lateral rectus palsy; Vith nerve palsy; Cranial nerve VI palsy

Causes, incidence, and risk factors

Cranial mononeuropathy VI is damage to the sixth cranial (skull) nerve. This nerve, also called the abducens nerve, helps control eye movement to the left or right.

Disorders of this nerve can occur with:

In some people, there is no obvious cause.

Because there are common nerve pathways through the skull, the same disorder that damages the sixth cranial nerve may affect other cranial nerves (such as the third or fourth cranial nerve).

Symptoms

Symptoms may include:

  • Double visionwhen looking to one side
  • Headaches
  • Pain around the eye
Signs and tests

Tests typically show that one eye has trouble looking to the side, while the other eye moves normally. An examination shows the eyes do not line up -- either at rest, or when looking in the direction of the weak eye.

Your health care provider will do a complete examination to determine the possible effect on other parts of the nervous system. Depending on the suspected cause, you may need:

You may need to be referred to a doctor who specializes in visual problems related to the nervous system (neuro-ophthalmologist).

Treatment

If your health care provider diagnoses swelling or inflammation of, or around the nerve, medications called corticosteroids will be used.

Sometimes, the condition may disappear without treatment. People with diabetes may benefit from close control of blood sugar levels.

Until the nerve heals, wearing an eye patch will relieve double vision.

Expectations (prognosis)

Treating the cause may improve the condition. Most people in whom no cause is found recover completely.

Complications

Complications may include permanent vision changes.

Calling your health care provider

Call your health care provider if you have double vision.

Prevention

There is no way to prevent this condition. However, people with diabetes may reduce the risk by controlling their blood sugar.

References

Baloh RW. Neuro-ophthalmology. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 450.

Reviewed By

Review Date: 06/15/2010

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Daniel B. Hoch, PhD, MD, Assistant Professor of Neurology, Harvard Medical School, Department of Neurology, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Prednisone

Pneumocystis jiroveci pneumonia?

Definition

Pneumocystis jiroveci pneumonia is a fungal infection of the lungs. The disease used to be called Pneumocystis carinii.

Alternative Names

Pneumocystosis; PCP; Pneumocystis carinii

Causes, incidence, and risk factors

This type of pneumonia is caused by the fungus Pneumocystis jiroveci. This fungus is common in the environment and does not cause illness in healthy people.

However, it can cause a lung infection in people with a weakened immune system due to:

  • Cancer
  • Chronic use of corticosteroids or other medications that weaken the immune system
  • HIV/AIDS
  • Organ or bone marrow transplant

Pneumocystis jiroveci was a relatively rare infection before the AIDS epidemic. Before the use of preventive antibiotics for the condition, most people in the United States with advanced AIDS would develop it.

Symptoms

Pneumocystis pneumonia in those with AIDS usually develops slowly over days to weeks or even months, and is less severe. People with pneumocystis pneumonia who do not have AIDS usually get sick faster and are more acutely ill.

Symptoms include:

  • Cough -- often mild and dry
  • Fever
  • Rapid breathing
  • Shortness of breath -- especially with activity (exertion)
Signs and testsTreatment

Antibiotics can be given by mouth (orally) or through a vein (intravenously), depending on the severity of the illness.

People with low oxygen levels and moderate to severe disease are often prescribed corticosteroids as well.

Expectations (prognosis)

Pneumocystis pneumonia can be life threatening, causing respiratory failure that can lead to death. People with this condition need early and effective treatment. For moderate to severe pneumocystis pneumonia in people with AIDS, the short term use of corticosteroids has decreased death.

ComplicationsCalling your health care provider

If you have a weakened immune system due to AIDS, cancer, transplantation, or corticosteroid use, call your doctor if you develop a cough, fever, or shortness of breath.

Many infections can lead to similar symptoms. Your health care provider can help rule out opportunistic infections such as pneumocystis.

Prevention

Preventive therapy is recommended for:

  • Patients with AIDS who have CD4 counts below 200
  • Bone marrow transplant recipients
  • Organ transplant recipients
  • People who take long-term, high-dose corticosteroids
  • People who have had previous episodes of this infection
References

Feinberg JE. Pneumocystis pneumonia. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 362.

Reviewed By

Review Date: 12/01/2009

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Prednisone

Secondary aplastic anemia?

Definition

Secondary aplastic anemia is a failure of the bone marrow to make enough blood cells. All blood cell types are affected.

Alternative Names

Anemia - secondary aplastic; Acquired aplastic anemia

Causes, incidence, and risk factors

Secondary aplastic anemia is caused by injury to blood stem cells. Normal blood stem cells divide and turn into all blood cell types, mainly white blood cells, red blood cells, and platelets. When blood stem cells are injured, there is a reduction in all blood cell types.

This condition can be caused by:

  • Certain drugs
  • Chemotherapy
  • Disorders present at birth (congenital disorders)
  • Drug therapy to suppress the immune system
  • Pregnancy
  • Radiation therapy
  • Toxins such as benzene or arsenic

When the cause is unknown, it is referred to as idiopathic aplastic anemia. In about half of all cases, no cause can be found.

The disease may be acute or chronic.

Symptoms
  • Bleeding of the gums
  • Easy bruising
  • Fatigue
  • Frequent or severe infections
  • Nosebleeds
  • Rapid heart rate
  • Rash
  • Shortness of breath during physical activity
  • Weakness
Signs and tests

Signs include:

Tests may include:

Treatment

It is critical to find out whether secondary aplastic anemia is caused by a medication or exposure. In some cases, removing the exposure can lead to recovery.

Mild cases of aplastic anemia may be treated with supportive care, or may not need treatment. Blood and platelet transfusions will help correct the abnormal blood counts and relieve some symptoms in moderate cases.

Severe aplastic anemia, which causes a very low blood-cell count, is a life-threatening condition. Younger patients with a severe case of the disease will need a bone marrow transplant if a matching donor can be found. Older patients, or those who do not have a matched bone marrow donor, can be treated with medications that suppress the immune system. These medications include anti-thymocyte globulin (ATG), tacrolimus, or cyclosporine.

ATG consists of antibodies made in horses or rabbits against a type of white blood cell in humans called T cells. It is used to suppress the body's immune system. ATG allows the bone marrow to start generating blood cells again, because many causes of aplastic anemia are thought to be due to the body's own T-cells attacking the stem cells.

Other medications to suppress the immune system, such as cyclosporine, tacrolimus, and cyclophosphamide (Cytoxan) also may be used. Corticosteroids and androgens have been used as well.

Expectations (prognosis)

The condition usually gets worse unless the cause is removed or the disease is treated.

Untreated severe aplastic anemia usually gets worse, eventually leading to death. Mild and moderate forms of the disease can be slower.

Bone marrow transplant has been successful in young patients. It has a long-term survival rate of approximately 80%. Older patients have a survival rate of 40 - 70% after a transplant.

Complications
  • Bleeding in the brain
  • Death caused by bleeding, infections or other complications of a bone marrow transplant, rejection of a bone marrow graft, or severe reactions to ATG
  • Infection
Calling your health care provider

Call your health care provider if:

  • You have signs of infection, such as fever
  • You bleed for no reason
  • You are feeling extremely tired or short of breath with activity
Prevention

Secondary aplastic anemia may be an unavoidable consequence of treatments such as chemotherapy. Avoid toxins such as benzene and arsenic, if possible.

References

Castro-Malaspina H, O'Reilly RJ. Aplastic anemia and related disorders. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 171.

Young NS, Maciejewski JP. Aplastic anemia. In: Hoffman R, Benz EJ, Shattil SS, et al., eds. Hematology: Basic Principles and Practice. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 29.

Reviewed By

Review Date: 01/31/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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Prednisone

Chemical pneumonitis?

Definition

Chemical pneumonitis is inflammation of the lungs or breathing difficulty due to inhaling chemical fumes or breathing in and choking on certain chemicals.

Causes, incidence, and risk factors

Many household and industrial chemicals are capable of producing both an acute and a chronic form of inflammation in the lungs.

Some of the most common dangerous, inhaled substances include:

  • Chlorine gas (during use of cleaning materials such as chlorine bleach, in industrial accidents, or near swimming pools)
  • Grain and fertilizer dust
  • Noxious fumes from pesticides
  • Smoke (from house fires and wildfires)

Chronic chemical pneumonitis can occur after only low levels of exposure to the irritant over extended periods of time. This causes inflammation and may lead to stiffness of the lungs, which decreases the ability of the lungs to get oxygen to the body. Unchecked, this condition may ultimately lead to respiratory failure and death.

Chronic aspiration of acid from the stomach can also lead to chemical pneumonitis.

Symptoms

Acute:

  • Air hunger (feeling that you cannot get enough air)
  • Cough
  • Difficulty breathing
  • Possibly wet or gurgle sounding breathing (abnormal lung sounds)
  • Unusual sensation (possibly burning feeling) in the chest

Chronic:

Signs and tests

The following tests help determine how severely the lungs are affected:

Treatment

Treatment is focused on reversing the cause of inflammation and reducing symptoms. Corticosteroids may be given to reduce inflammation.

Antibiotics are usually not helpful or needed. Oxygen therapy may be helpful.

In cases of swallowing and stomach problems, eating small meals in the upright position can help.

Expectations (prognosis)

The outcome depends on the chemical agent involved, the severity of exposure, and whether the problem is acute or chronic.

Complications

Respiratory failure and death can occur.

Calling your health care provider

Call your health care provider if you have trouble breathing after inhaling (or possibly inhaling) any substance.

Prevention

Household chemicals should be used only as directed and always in well-ventilated areas. Never mix ammonia and bleach together.

Work rules regarding breathing masks should be followed and the appropriate breathing mask should be worn. People who work near fire should take care to limit exposure to smoke or gases.

Be careful about giving mineral oil to anyone who might choke on it (children or the elderly).

Don't siphon gas or kerosene.

References

Christiani DC. Physical and chemical injuries of the lungs. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 94.

Reviewed By

Review Date: 09/15/2010

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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