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Genital warts (condylomata acuminate)
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????????? Genital warts are caused by infection with human papilloma virus and are sexually transmitted. Ordinary skin warts can occur on the genitals by direct contact with a finger lesion but they are less moist, soft and less often pedunculated than the genital variety. The lesions most commonly occur under the prepuce in the coronal sulcus. But may be found elsewhere, including inside the urinary meatus. IN women genital warts are most commonly found in the vulva but they may line the vagina and occur on the cervix. Perianal warts are common. Genital warts may complicate HIV infection.
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Treatment is by chemical and physical means:
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????????? Podophyllotoxin 25% in spirit is often effective as a topical application. It is applied to the wart with great care to avoid the surrounding skin and washed off after six hours or so.
If chemical method fails, the wart can be excised or tey can be ablated with cryosurgery, electrosurgery or laser. Circumcision is sometimes advised if there are florid lesions under the foreskin.
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????????? Idiopathic-hypertrophy of the male breast may be unilateral or bilateral. Te breast enlarges at puberty and sometimes presents the characteristics of female breasts.
??????????? Hormonal-enlargement of the breasts of an accoplanied stilboestrol therapy for prostate cancer. It may also occur as a result of teratoma of the testis. In anarchism and after castration. Rarely it may be feature of ectopic hormonal production in bronchial carcinoma and in adrenal and pituitary disease.
??????????? Associated with leprosy – Gynaecomastia is very common in men suffering from leprosy. This possibly because of bilateral testicular atrophy, which is a frequent accompaniment of leprosy.
??????????? Associated with liver failure – Gynaecomastia sometimes occurs in patients with cirrhosis due to failure of the liver to metabolize oestrogen.
??????????? In Klinefelter’s syndrome, a sex chromosome anomaly having XXY tisomy. It is also seen with certain drugs such as cimetidine, digitalis and spironolactone.
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Treatment Provided the patient is healthy and comparatively young reassurance may be sufficient. If not mastectomy with preservation of areola and nipple can be performed
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????????? Galactorrhoea, or “inappropriate lactation?, is a continuous secretion of milk in the absence of recent pregnancy.
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Physiological factors: In nearly all women who have lactated it is possible to express a little milk or allied secretion from the breasts for years afterwards especially premenstrually.
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Suckling: Other causes of prolactin release via hypothalamic reduction of PIF by stimulation
of the afferent sensory neural arc include thoracotomy scars, cervical spinal lesion and herpes zoster.
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Psychological factors: Chronic emotional stress and psychiatric disorders.
Hypothalamic and pituitary condition: Tumors of pituitary glands and midbrain, basal meningitis, encephalitis and functional disturbances.
Chiari – Frommel Syndrome characterized by lactation, amenorrhoea and super involution of the uterus dating from pregnancy.
Del Castillo Syndrome
Forbes Albright Syndrome.
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????????? All these condition represent different phases of the same disorder with progression from hyperplasia to micro adenoma, with hyperprolactinaemia as the common factor as a consequence of hypothalamic pituitary dysfunction.
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Drugs – Reserpine, Phenothiazine derivatives, Amphetamines, Opiates, diazepam, butyrophenones, alpha-methyl-dopa and tricyclic antidepressants. Estrogen-progestogen oral contraceptives.
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Other conditions: Hypothyroidism (thyroid releasing hormone is produced in excess and acts as a prolactin releasing factor) and renal failure
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-????????? Enquiry about the taking of drugs and handling of the breasts.
-????????? If galactorrhoea has been present for over 6 months and there is no obvious cause apart from hyperprolactinaemia, then the possibility of pituitary tumor must be considered.
-???????? Raised prolactin level and a countdown view of the sella turcica and magnetic resonance imaging (MRI) of the pituitary fossa, clinches the diagnosis of intrasellar pathology.
-????????? Withholding drugs (if the drugs cannot be withdrawn, then the use of bromocriptine in addition is given)
-????????? If the TSH level is elevated, treatment for hypothyroidism should be started
-????????? If the countdown view of sella turcica is abnormal or the prolactin level is greater than 100 ng per ml and MRI should be done.
-????????? In the absence of a demonstrable tumor, hyperprolacitnaemia and galactorrhoea will be cured by bromocriptine therapy continued for at least 3 months. Most patient responds to 5 to 7.5 mg daily in divided doses. Bromocriptine brings about shrinkage of macrodenomas too, the main response occurring in the first 3 months. Subsequently, the dose is tapered to as low as 0.625 mg. Daily, depending on the prolactin level.
Trans-spehnoidal surgery is a viable option. This may need to be combined with radiotherapy.
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???????? Graves disease is characterized by hyperthyroidism diffuse enlargement of thyroid, ophthalmopathy with exophthalmos, dermopathy in the form of pretibial myxoedema. Graves disease is more common in females with peak incidence between 30-50 years. It is an autoimmune disorder produced by autoantibodies to the TSH receptors, thyroglobulins. Serum thyroid hormone levels are elevated.
Clinical features include heat intolerance, sweating palpitation, fatigue, weakness, weight loss with increased appetite, diarrhoea, oligomenorrhea, loss of libido, tremors, lid retraction, lid bag etc.,
??????????? Management is by antithyroid drugs, subtotal thyroidectomy and radioactive iodine.
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???????? Gangrene is death with putrefaction of portions of tissue. It is commonly seen affecting the distal part of a limb, the appendix a loop of small intestine and sometimes organs such as the gall bladder, the pancreas or the testis.
The causes of gangrene are arterial obstruction due to thrombosis of an atherosclerotic artery, embolus from heart, arteritis with neuropathy in diabetes, buerger’s disease, drugs like ergot, infections, trauma, burns scolds, frost bite and various causes like deep vein thrombosis.
??????????? Management includes care of the affected part protection of local pressure area, surgical toilet, and general measures to improve tissue oxygenation. Sometimes amputation of the affected organ may be required to some life.
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Acute Demyelinating Polyneuropahy
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Cause: Acute an subactue polyradiculaneuropathy
Following: Viral injections; Campylobacter jejinum infection, Caccination, Surgical procedures
Symptoms: Weakness progressive proximal legs ascending type, involving the arms and force, Sensory symptoms less conspicuous, Normal Bladder + Bowel function
Asbury’s Criteria for diagnosis for excluding porphyria, diphtheria, botulison
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Treatment:
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