TREAT WITH THE WHOLE-HEARTED

Otitis 3: Eksterna - Patofisiology

2014-09-07T17:27:00.000-07:00

Patofisiology
Trauma to the ear hole, the accumulation of keratin, or changes in pH can affect the occurrence of inflammation and infection. One study revealed that the bacteria have aerobe share of 91%, anaerobe four percent (4%), and also a mix of infection-four percent (4%). Organism is found most often among others have Pseudomonas aeruginosa (50%), Staphylococcus aureus (23%), anaerobe and gram negative organisms (12.5%), and yeast such as Aspergillus and Candida (12.5%). Increase of pH of pond water can be trusted to make infection may be more severe.

Predispositions Factors
Factors specific predisposes as follows:
a. Changes in skin pH is usually acid canalise be bass.
b. Changes in the environment, especially a combination of increased temperature and humidity.
c. A trauma is often mild or swim because of excessive ear cleaning.

Symptom and alert
Symptoms arising in otitis external diffuse, among others:
a. Redness on the outside of the ear (pinna) and ear hole that used to feel very sore.
b. Scaly skin that is good in and around the ear hole when flake.
c. Discharge from the ear and a little thin like pus.
d. Droop when the ear or jaw
e. At the time of ingest felt pain in the throat
f. Some people also lost their hearing

A diagnostic
a. Press painful tragus
b. Great pain
c. Most of the swelling wall canalise
d. Secret slightly
e. Hearing normal or slightly reduced
f. The absence of a fungus disease
g. There may be a painful adenopati regional press

Otitis external diffuse usually very painful
Stroma covering the bones in the third hole in the ear is very thin so that it allows only minimal swelling. So subjective interference experienced patients are often not comparable with that observed disease investigator.

Clinical manifestations
Eritema skin, secret a greenish skin edema and ear hole is a classical signs of otitis diffuse acute. Stench of secret not occur. Otitis external diffuses can be divided into 3 stages, namely:

a. Stadium "Pre inflammatory"
Stadium began with the loss of this layer of fat is normal and can be caused by the entry of water during the swim, wear clean cotton wool, and pry into your ear hole with the tools blunt. When the fat layer disappears at the time the weather is hot and humid air from the womb corneum increased stratum so that edema occurred intracellular. Edema is caused secret expenditure through orifisum apopilosebasea and layers of fat.
When exposed to hot and humid weather and long time the skin of the ear hole is not protected masers experience and reasonable ekfoliasi of cells epistle of the stratum corneum will not occur. This will cause a tickle, so try to minimize it with a paw or rub the cycle until there were: itching, Lucifer (itch scratch cycle). This will cause trauma to the stratum corneum, and there were predisposes for infection.

b. Stadium acute inflammation
Stadium this happens in 3 levels, namely: light, medium and heavy.
1. Lightweight
At the stadium, the patient experienced malaise when the light touches the tragus or concha moving. On examination the ear skin vagina will appear eritema and edema. When found a layer of clear secret not smell or accumulation of materials rekfoliasi or both. Ear drum looks less shiny.
2. Medium
Found itchiness and pain that are. Lumen ear hole partially closed by edema and exudate. Appear mass "debris" seropurulen cover the lumen and edema can also be seen there is currently little auricular, but does not have adenopati.
3. Heavy
On a more serious cases, patients complain of severe pain when chew and manipulated outside the ear. Although the helix does not seem involved, have found a clear edema periaurikuler and closing the lumen of the ear hole. Secret seropurulen a gray or green and exfoliated the visible mass in the lumen. Skin of the ear hole appear edema, and thick as can be seen papula, especially on top of the rear wall.
There is a decrease in the characteristics of the skin on the wall behind your ear hole (convex sagging), with a smooth and convex. This decrease extends membrane tympani. Otoskopi on using the enlargement, then can be seen papula white milk protruding from the surface and the surface, can also vesicle grayish organized by regions eritema.
Histopatologi showed the infected epidermis, and edema. Gram negative bacillus mainly pseudomonas species culture can almost 100% of your ear like this. When infected solved, it will appear papula small and pustule arising from secret purulent. In many circumstances this neutrofil complications can be obtained from the results secrete undelete it.

c. Stadium chronic infections (inflammation chronicles)
Besides the ear skin of leaves vary in degree, will thick (hiperkeratosis, acanthuses) and edema, which extends into the ear so that will orificium going refinement of the vagina and the ear hole of the ear, and abrasions on the laserasi lobe and conch. Dry mass and exfoliated often closed ear hole and can be found also secret colored gray or brown greenish and the smell fills recesses timpani.
Ear drum is not shiny and thick. Culture of the ear hole would result in the growth of gram negative bacillus (especially Proteus) and sometimes found fungi. Undelete will showed that the colored cells epistle basil and a very large amount.

Histopatology
In the acute otitis external diffuse the picture looks hiperkeratosis epidermis, parakeratosis, acanthuses, erosion, spingiosis, hiperplasia stratum corneum and stratum germinativum, edema, hiperemis, infiltration leukocyte, necrosis, necrosis focal followed in the dermis of healing fibroblast and apparatus gland decreased, the activities secretaries gland reduced.

Peritonsiler abscess (PTA / Quinsy) 9

2009-12-01T17:00:00.000-08:00

COMPLICATIONS
Complications that can arise in the abscess is peritonsiler (Fachruddin, 2002):
1. Spontaneous abscess rupture, causing hemorrhage, or pulmonary aspiration pyernia.
2. Spreading infection and abscess to the area, causing parafaring abscess parafaring.
3. If there is spreading to the region may lead to intracranial sinus thrombus Cavemosus, meningitis and brain abscess.
4. Nephritis, peritonitis, mediastinitis.

PROGNOSIS
Most of the patients treated with antibiotics and adequate drainage in the area will return abscces recover within a few days. A small percentage of complaints indicates a further abscess, and it is necessary tonsilektomi action. In addition, if the patient reported back pain throat complaints that persist after incision and drainage is appropriate, action may be indicated tonsilektomi (Gosselin, 2008).

CONCLUSION
1. Peritonsiler abscess (PTA) is an infection that occurred in the area - the area around tonsila Palatina caused by aerobic and anaerobic bacteria.
2. Pathophysiology of PTA is certainly not known, but one thing is widely agreed that the occurrence of an abscess is associated with inflammation of the tonsils previous events.
3. Management is done in cases of abscess peritonsiler with adequate antibiotics when the stadium infiltrates. Arise when the abscess is incision and should be followed by drainage tonsilektomi action.
4. Complications that can arise due to inadequate handling and complete. As if there is an appropriate treatment, the prognosis would be good then.

Peritonsiler abscess (PTA / Quinsy) 8

2009-12-01T16:55:00.000-08:00

Management
Handling peritonsiler abscess include hydration, pain, and antibiotics are effective to overcome Staphylococcus aureus and anaerobic bacteria. Fine needle aspiration is an effective treatment in 75% peritonsiler abscess in children and is recommended as primary therapy unless there is a history of recurrent tonsillitis, or abscess before it peritonsiler measure is immediately tonsilektomi (Bailey, 2005).
In the infiltration stage, given high doses of antibiotics, and symptomatic medications. Also need to gargle-gargle with warm water and cold compresses on the neck. Appropriate choice of antibiotic depends on the results of cultures of microorganisms in the needle aspiration. Penicillin is a "drug of choice" in peritonsilar abscesses and 98% effective in cases when the combicated with metronidazole. Dosage for penicillin in adults is 600 mg IV every 6 hours for 12-24 hours, and children 12500-25000 U / kg every 6 hours.
Initial dose metronidazole for adult maintenance dose of 15mg/kg and 6 hours after initial dose with intravenous 7.5 mg / kg for 1 hour was given for 6-8 hours and not exceed 4 grams / day (Fachruddin, 2002).
If formed abscess, requiring surgical drainage, either by needle aspiration technique or with incision and drainage techniques. Difficulties may arise in ascertaining whether associated with acute cellulitis or abscess formation which had actually been hesitant happen, needle size 17 can be inserted (after application with anesthetic spray) into the three locations that seemed most likely to produce pus aspirations. If pus is found by accident, this method may be sufficient for drainage followed by antibiotics. If the amount of pus were found, and insufficient drainage with this method, a further incision and drainage can be done (Adams, 1997).
Incision and drainage technique requires local anesthesia. First pharynx sprayed with topical anesthetic. Then 2 cc Xilocain with adrenaline 1 / 100, 000 injected. Knife tonsila no 12 or no 11 with tape to prevent deep penetration used to make the incision through the mucosa and submucosal polar near the tonsilaris fossa. Place of incision is the most prominent areas and soft or in the middle of the line joining the base of uvula with the last molar on the side of dull aching Hemostat is inserted through the incision and gently stretched. Tonsila suction should be provided to collect pus issued. In older children or young adults with severe trismus, surgical drainage for abscesses peritonsiler possible after the application of fluid cocaine 4% in the incision area and regional areas and the fossa ganglion sfenopalatina Nasalis. This is sometimes reduce pain and trismus. Children younger require general anesthesia. Tonsilektomi recommends immediate (tonsilektomi quinsy) feel that this is a safe procedure that helps perfect drainage of the abscess if tonsila removed (Adams, 1997).
When tonsilektomi performed with acts of abscesses drainage tonsilektomi it is called "a chaud", when tonsilektomi performed 3-4 days after darinase abscess tonsilektomi called "a tiede" and if tonsilektomi performed 4-6 weeks after the drainage of abscesses tonsilektomi called "a froid ". Tonsilektomi generally performed after the infection quiet, ie 2-3 weeks after the drainage of abscesses (Fachruddin, 2002).
If there is trismus, then to overcome the pain, given analgesia (local), with novocain injected xylocain or 1% of ganglion sfenopalatinum. This ganglion is located at the rear of the lateral from concha media. Sfenopalatinum ganglion nerve has branches Palatina anterior and posterior media that send branches to aferen nerve tonsil and palate molle on the tonsils. The most appropriate area for the incision got inervasi from Palatine branch m. trigeminal ganglion sfenopalatinum passing. Then the patients recommended for surgery tonsilektomi (Fachruddin, 2002).
Tonsilektomi an absolute indication to people who suffer from recurrent abscess or abscess peritonsilaris which extends to the surrounding tissue. Peritonsil abscess has a large tendency to relapse. Until now there has been no agreement on when tonsilektomi done peritonsil abscess. Some authors recommend 6-8 weeks later tonsilektomi considering the possibility of bleeding or sepsis, whereas others recommend immediate tonsilektomi (Adams, 1997).

Peritonsiler abscess (PTA / Quinsy) 7

2009-12-01T16:50:00.001-08:00

DIAGNOSIS
Information from patients is needed to make the diagnosis peritonsiler abscess. Patients had a history of pain in the esophagus is one that supports peritonsilar abscess. History of acute pharyngitis and tonsillitis accompanied by a lack of comfort in unilateral pharingeal (Steyer, 2007).
The diagnosis is rarely in doubt if the inspector saw a large swelling peritonsilaris, pushing past the midline uvula, with edema of the palate molle and protrusion of tissue from the midline. Palpation if possible to distinguish abscess from cellulitis (Adams, 1997).
In the investigation can be done:
1. Laboratory tests such as complete blood, electrolytes, and blood culture. Which is the "gold standard" for diagnosing abscess peritonsilar is by collecting pus from the abscess using a needle aspiration (Jevuska, 2007).
2. Radiological examination in anteroposterior position only shows "distortion" of the network but not useful for certain locations who abscess (Daley, 2007).
3. On CT scan can be seen on the tonsils hipodens areas that indicate the presence of fluid in the affected tonsils besides that it also can be seen in an asymmetrical enlargement of the tonsils. This examination can help to plan the operation (Daley, 2007).
4. Ultrasound, a technique is simple and noninvasive and can help in distinguishing between cellulitis and the beginning of the abscess. This examination can also determine a more focused selection before surgery and drainage for sure.

Peritonsiler abscess (PTA / Quinsy) 6

2009-12-01T16:48:00.000-08:00

Typically, complaints emerged in patients with a history of acute pharyngitis with acute tonsillitis (Gosselin, 2008). Classic symptoms begin 3-5 days time from onset of symptoms until the occurrence of abscesses around 2-8 days. Patients usually experience odinofagia complaints (pain swallowing) is good, so difficult to do tests because it is difficult to open his mouth and dehydration can also occur, vomiting (regurgitation), halitosis (foeter ex ore), "hot potato voice", a lot of saliva (hipersalivasi), nasal voice (rinolalia) and difficult to open the mouth (trismus), headache, weakness, fever, and swollen glands submandibula with tenderness. Patients also may experience pain when moving the neck (Fachruddin, 2002).
Some patients also have ipsilateral otalgia during swallowing. Trismus, which appears on all of the cases of several degrees of severity, suggesting an inflammation of the lateral wall of the pharynx and muscle pterigoid. Because inflammation of the muscles and cervical lymphadenopathy, sometimes patients also complain of neck pain and limited neck motion. The doctors should be more wary of the PTA, when seeing patients with symptoms of inflammation of the pharynx that persist despite antibiotics have been given adequate preparation (Gosselin, 2008).
On physical examination can be found in various conditions, from acute tonsillitis with unilateral asymmetric pharynx until the occurrence of dehydration and sepsis. Used by most patients experiencing tremendous pain. Oral examination will find eritem mucosa, palate, mole appeared swollen and prominent in the future, may be felt fluctuations. Uvula swollen and pushed to the contralateral side. Swollen tonsils, hiperemis, maybe a lot of detritus and pushed toward the center, front, and bottom (Fachruddin, 2002).

Peritonsiler abscess (PTA / Quinsy) 5

2009-12-01T16:44:00.001-08:00

Peritonsiler abscess is an infection that started from the outer surface that extends into the inner layer of soft tissue. Exactly pathophysiology of PTA is unknown. However, several theories attempt to explain the mechanism of the PTA, and the theory was widely accepted that the occurrence of an abscess peritonsiler tonsil inflammation spreading from there. Abscess formed between tonsila Palatina and the capsule, usually in the superior region. It is then believed that the abscesses originated from an acute episode include tonsilits growing soft tissue around the area (Mehta, 2007). Other Mecanisme happened is the emergence of necrosis and pus in the capsular area, which then clog the Weber glands, minor salivary glands found in the living and working peritonsiler help clean up debris from the tonsils, resulting in secretions and forming abscesses (Gosselin, 2008).
Superior and lateral regions tonsilaris fossa is loose connective tissue, the infiltration into the potential supurasi posters peritonsil occupy this area, so look swollen palate molle. In the early stage (stage infiltrates), in addition to swelling, the surface looks hiperemis. If the process continues, the area is more soft and yellowish color. Tonsils pushed to the middle, front and bottom, and swollen uvula pushed to the contralateral side. If the process continues, inflammation of the surrounding tissue will cause irritation of the m. Pterigoid internal, resulting in trismus. Abscesses may rupture spontaneously, may occur to the pulmonary aspiration (Fachruddin, 2002).

Peritonsiler abscess (PTA / Quinsy) 4

2009-12-01T16:42:00.000-08:00

Some microorganisms that can cause acute or chronic tonsillitis can also be a PTA-causing organisms. Aetiology peritonsiler abscess most frequently encountered is a species of aerobic and anaerobic gram-positive are usually found in the culture, usually bacterial beta-hemolytic Streptococcus group A. The next most common is from Staphilokokus groups, pneumococcal, and Haemophilus. And other microorganisms that can be found in the culture including Laktobasillus, groups such as filamentosa shaped Actinomyces sp., Mikrokokus, Neisseria sp., Diphtheria bacteria, Bacteroides sp., And some bacteria other non-sporulation (Gosselin, 2008). Sometimes the infection continues to be tonsila cellulitis difusa of the palate extends tonsila mole. Continuation of this process causes abscesses peritonsilaris. These disorders can occur quickly, with the beginning of tonsillitis, or the end of the course of the disease of acute tonsillitis. This can happen even if given penicillin. Usually unilateral and more frequently in children older and younger adults (Adams, 1997).

Peritonsiler abscess (PTA / Quinsy) 3

2009-12-01T16:38:00.000-08:00

Pharynx is divided into nasopharynx, orofaring and laringofaring. Nasopharynx is part of the pharynx that lies above pallatum molle, which is part orofaring located between palate molle and hyoid bone, while laringofaring part of the pharynx which extends from the hyoid bone to the lower boundary of cartilage crikoid (Ballenger, 1997). Orofaring open to the oral cavity in the anterior pharyngeal pillars. Pallatum molle (vellum palati) consists of muscle fibers are supported by fibrous tissue which is covered by mucosa. Protrusion on the median dividing it into two parts. Forms such as cones, located disentral called uvula. Two columns made up of tonsils tonsilar Palatina anterior and posterior. Glossoplatina and pharyngopalatina muscle is the largest muscle that make up the pillars of the anterior and posterior columns. Tonsils located between the basin palatoglossal and palatopharyngeal (Steyer, 2007).
Plika triangularis (tonsilaris) is a thin fold of mucosa, which covered the anterior pillar and some and some anterior surface of the tonsils. Plika semilunaris (supratonsil) is the upper folds of the mucosa which unites the two pillars. Supra tonsil fossa is the size of the gap varies over the tonsils, located between the anterior and posterior pillars. Tonsil consists of a protrusion of the circular or circular like cripte containing lymphoid tissue and surrounding connective tissue there. Amid the estuary there cripta mucous glands (Ballenger, 1997).
Tonsils and adenoid are the most important part of the Waldeyer ring lymphoid tissue surrounding the pharynx. Tonsils are located in the sinuses tonsilaris between the anterior and posterior pillars faussium. Faussium tonsils are one on each side is orofaring lymphoid tissue that is wrapped by a clear fibrous capsule. The inner surface of the membrane covered by stratified squamous epithelium which is attached. This epithelium extends into the open surface kripta tonsils. Kripta numbered 8-20 on the tonsils, usually tubular and is almost always extends from the tonsils to kekapsul the outer surface of the tonsils. The bound m.konstriktor faringeus superior, so depressed every time swallowing. m. palatoglusus and m. palatofaring also pressing the tonsils.
During the embryonic period, tonsils pharyngeal pouch formed from the second sebegai endodermal bud from the cell. Shortly after birth, tonsils are irregular and grow until it reaches the size and shape, depending on the number of network limphoid (Steyer, 2007).
Structure around tonsilla Palatina (Jevuska, 2007):
1. Anterior
In the anterior part is tonsilla Palatina palatoglossus Arcus, can extend for a short distance below it.
2. Posterior
There posteriorly palatopharyngeus Arcus.
3. Superior
In the superior near palate molle. Here tonsilla joined the lymphoid tissue on the lower surface of palate molle.
4. Inferior
In a third of the posterior inferior tongue. Here, together with tonsilla Palatina tonsilla lingualis.
5. Medial
In the medial part of the oropharynx space.
6. Lateral
There lateral capsula separated from the superior m.constristor pharyngis by loose areolar tissue. V. Palatina externa walked down from the palate molle in this loose connective tissue, to join the plexus venosus pharyngeus. Lateral to the superior pharynges there m.constrictor m. styloglossus and a.facialis arch. A. The internal carotid is located 2.5 cm behind and lateral tonsilla.
Palatina Tonsilla get vascularisasi from: tonsillaris ramus which is a branch of the facialis artery; the branches of a. Lingualis; a. Palatina ascendens; a. Pharyngea ascendens. While innervasinya, obtained from N. Palatinus Glossopharyngeus and minor nerve. Lymph vessels in the nl. Cervicales profundi. The most important node in this group are jugulodigastricus node, which lies below and belakangangulus mandibulae.

Peritonsiler abscess (PTA / Quinsy) 2

2009-12-01T16:33:00.000-08:00

Peritonsiler abscess (PTA) is the infectious disease most often occurs in the head and neck. A combination of aerobic and anaerobic bacteria in the peritonsilar area. Which could potentially place the abscess is a pillar area tonsils anteroposterior, inferior Piriform fossa, and superior palate (Mehta, 2007).
According to Gosselin (2008), peritonsiler abscess (PTA) is a pile of pus that is localized on the peritonsiler network formed as a continuation of supuratif tonsillitis. The alternative explanation that the PTA is an abscess that is formed from a group of salivary gland in supratonsiler fossa, known as the Weber glands. Because composed of loose connective tissue, severe infections in these areas can quickly lead to purulent material.
Peritonsil abscess formed due to the spread of infectious bacterial organisms to one's throat loose aereolar room around the pharynx causing abscess formation, where the infection has penetrated tonsil capsule but remains within the limits of pharyngeal constrictor muscle.

Epidemiology
Peritonsiler abscesses can occur at the age of 10-60 years, but most often occurs at the age of 20-40 years. In children is rare except in those who decreased immun system, but the infection can cause airway obstruction is significant in children (Mehta, 2007). These infections have the same proportion of men and women. Evidence indicates that chronic tonsillitis or multiple experiments using oral antibiotics for acute tonsillitis predispose people to develop peritonsiler abscess. In America sometimes incident -
sometimes approximately 30 cases per 100,000 people per year, are considered almost 45,000 cases each year (Gosselin, 2008).

Peritonsiler abscess (PTA / Quinsy) 1

2009-12-01T16:18:00.000-08:00

Recent years diagnosis and treatment of infection in the neck has been given the challenge to the experts to do more research. The complexity and depth of the location in this region makes difficult the diagnosis and treatment is established.
Neck abscess formed in the potential space between the fascia in the neck as a result of infection spreading from various sources, such as teeth, mouth, throat, paranasal sinuses, middle ear and neck which depends on space involved. Clinical signs and symptoms may include pain and swelling. Peritonsiler abscess (PTA / Quinsy) is one of the neck abscess in which besides the neck abscess abscess can also retrofaring, parafaring abscesses, abscesses and angina submandibula Louis (Ludwig angina) (Fachruddin, 2002).
Peritonsiler abscess is usually a complication of acute tonsillitis cases. The presence of inflammation in the form of edema can be a major cause of complaint difficult in swallowing. Dehydration often appear in advanced stage patients who refused to eat and drink because of the pain he felt. The expansion of these abscesses can cause inflammation that is felt until the entire face and neck, and the possibility it may cause airway obstruction (Gosselin, 2008).

how to choose baby's sex? conclusions

2009-10-22T10:18:00.000-07:00

In the present and future periods is the ideal small family and the good boys and girls alike. But we can still find a husband who left his wife because his wife could not born child of the desired gender, or still often we see a husband and wife will not stop reproducing, despite being the umpteenth child was born, because the gender of the coveted yet come. Eventually will make a great family.
Since ancient times many myths have emerged that indicate the existence of demand for some people to have children with a specific gender. Existing demand and speculation about what gender to be born. That's how myths are formed. Not to mention the myths about ways to get a boy or girl of that sounds reasonable until the no. For example, to get the girl, the mother should eat a lot of sweets. This is certainly contrary to the doctor ordered, since sweet foods may trigger the emergence of diseases such as diabetes and hypertension.

how to choose baby's sex? CHOOSING BUSINESS AS baby's sex date

2009-10-22T10:04:00.000-07:00

Some researchers such as Gordon, M., Bhattacharja, BC and Leiberman, E.J. try to separate the two populations of sperm and andro-sperm-sperm gino genuine. Then this pure seeds inserted into the uterine insemination by wives. Thus the certainty will be obtained by birth desired gender.
A. Electrophoresis methods
The rationale is that andro and gino-sperm have masses, sizes and different shapes. Will therefore contain an electrical load or different poles. So in this way are expected to andro-sperm will be attracted and gathered at one pole while gino-sperm into the other pole (Mochtar, 1998).
B. Centrifugation method (Pemusingan)
Since weight and mass are different, then after the two kinds of sperm sentrifuse each will form a layer in the tube, the layer containing the sperm and andro-containing layer gino-sperm (Mochtar, 1998).
C. Sedimentation methods (Sedimentation)
By the influence of gravity, gino greater sperm more quickly settles to the bottom of the tube deposits, while andro-more sperm live in the top layer (Mochtar, 1998).
D. Diaphragm method (Filter)
This method using a special diaphragm which just missed, such as andro-sperm and sperm contain-gino. The diaphragm is mounted close the cervix uteri of women like the only contraceptive diaphragm (Mochtar, 1998).
E. Pills Men and Women Pill
Researchers predict that within the next 2-3 decades advances in science in the field of biomedicine will produce a pill that can determine the sex. This pill will be swallowed by the husband prior to intercourse. If a woman wants a baby girl swallow pills. This was stated by Brich, CH. Director of Biology University of Sidney (Mochtar, 1998).
F. Reaction Tube Method
By using the tools that complicated and expensive researchers like Gardner, R., Edward, R., and Hafes, ESE. have been able to choose sperm and egg cells are guaranteed good quality. Similarly, through the micro operations, the embryo was able manipulated. Even they can separate the sex-chromatin found only in female cells only (Mochtar, 1998).
From developed countries reported that many are now available ready-made sperm, egg cells (ova), and even embryos stored in a sperm bank, the bank ova, and embryo banks.
The events of the amazing scientific disciplines of biology in humans has been much publicized. Among other things, the progress of science has been able to help many women who are naturally according to science content will not be able to have offspring because of the total damage to both the oviduct (fallopian tubes). How to help this woman popularly called "test-tube babies" which in principle is to perform the technique in vitro fertilization (IVF), fertilization is a technique in the tube containing food (tube nurseries), followed Embryo Transfer (ET), is the result seedbeds that implanted into the womb (Mochtar, 1998).
G. Cloning Method
Gender identification method days to be very amazing. But from a moral standpoint and spiritual will have broad impact.
The way is called cloning, which comes from the Greek word meaning a way / means of propagation without sexual relations. According to experts, not only allow cloning choose sex, but can also produce genetic clone (copy) which is identical to the original (Mochtar, 1998).
H. Method Preimplantation genetic diagnosis (PGD) by Leigh (2005), among others:
Is a technique fertiliasi in vitro (IVF) in which embryos created outside the womb and then tested gender and genetic disorders.
When PGD was introduced in 1989, this technique is only used to help couples or someone with a serious genetic disorder that reduces the risk of having offspring that suffer from the same disorder. PGD is now used for the same reasons but also used in women age 35 years or older and or have a history of abortion habitualis. Only the expert clinicians with this technique that can use this technique to select the sex without a medical reason. This technique has almost 100% effectiveness
During the IVF cycle, egg fertilized with sperm in a petri dish. Single cell or several cells into embryos and then moved 3 to 5 days and tested gender.
In normal IVF cycle, the researchers tried to distinguish between normal embryos by looking under the microscope. But with PGD, embryos are tested thoroughly genetic disorders and gender. By transferring only healthy embryos into the uterus, there would be little possibility of abortion or having children with genetic disorders. Prenatal tests such as amniocentesis or chorionic villus sampling (CVS) was recommended if a woman aged 35 years or more because of genetic abnormalities can be detected in the older age pregnancy.
In normal IVF cycle, doctors usually transfer two or more embryos into the uterus. The amount depends on maternal age, embryo quality, and reproductive history. But with PGD, doctors transfer only no more than two because the embryos implant or may not result in a healthy pregnancy is removed.
I. Microsort method
Dye technique is a technique that tries to separate the sperm women with male sperm. Sperm with the desired gender are inserted directly into the uterus, usually through artificial insemination (AI) (Leigh, 2005).
Based Microsort that female sperm carrying the X chromosome is larger than female sperm carrying Y chromosomes This procedure involves staining sperm samples dipped in fluorescent and then eliminate them with lasers. X chromosome absorbs more dye and shine brighter than the Y chromosomes Sperm are then selected with the desired sex are transferred to the uterus by using artificial insemination. In the same case, in vitro fertilization (IVF) can be used to increase the possibility of pregnancy but very invasive and expensive (Leigh, 2005).
J. Ericsson Method
Is a technique that aims to separate the male sperm with female sperm. Sperm with the desired gender is inserted directly into the uterus through artificial insemination (Leigh, 2005).
Technique Ericsson has the effectiveness of 78-85% for sex selection of men and 73 to 75% for female sex selection (Leigh 2005).
Whole sperm swim, but the male sperm swim faster and reach the bottom. Rapid sperm swimming with the slow and sperm separated by the desired gender inseminased (Leigh, 2005).

how to choose baby's sex? Procedures and guidelines which Wanting Men Babies

2009-10-22T09:39:00.000-07:00

1. Doing intercourse as close as possible to ovulation, or exactly 12 hours before and after ovulation.
2. Shortly before intercourse every time his wife washed his penis with a mixture vagina 1 liter + 2 tablespoons salt soda (sodium bicarbonate-soda)
3. If it can better achieve orgasm wife first, followed by orgasm husband.
4. The recommended position is the knee-chest position (genu-pectoral) where the husband approached her from behind.
5. In the second husband and ogasme achieve ejaculation do penis deep penetration.
6. Fasting or abstinence from intercourse is necessary starting from a dry period until the day of ovulation. It means that the volume and number of sperm per cc will be as much as possible.
Procedures and guidelines on the safe and simple, but the results are not guaranteed 100%. Shettles reported clinical results obtained 80% and if the couple really careful especially if you rinse and ovulation in time, then the success rate will reach 85-90%.

how to choose baby's sex? Gender CHOOSING UNDER ANY THEORY OF SCIENTIFIC RESEARCH

2009-10-22T09:30:00.000-07:00

Now, as medical science is more advanced and myths often proved wrong, it is wise if the desire choosing gender expert was consulted on (Hasuki, 2006).
Van Bear (1827), von Kolliker (1841) and Van Beneden (1883) is a pioneer scholars conception observations / conceptions / fertilsasi the merger between sperm cells (sperm) with the egg cell (ovum) in the oviduct (fallopian tubes) . They say that half of the number of chromosomes carrying the gene and gender comes from the mother and half from the father as the two seeds were immersed himself. Possibility there are two kinds of sperm cells sperm cells carrying the male chromosome. From the microscopic examination of sperm showed that in the core (nucleus) found a pair of chromosomes that are not the same form (Mochtar, 1998).
McClung (1902) The first researcher who said that the small chromosome called the Y chromosome and the larger X chromosome and this is what determines the sex (Mochtar, 1998).
Rock, J. and Shettels, L.B. (1940-1956) definitively establish that human beings have 46 chromosomes for each cell body and 23 for each sex cell. Now known that humans have 46 chromosomes, 22 pairs did not differ in men and women, called autosomes. A different pairs of chromosomes called the sex chromosomes (gonosom) which determine the sex. A man having sex chromosome X and Y that are genetically written 46XY, while women have similar sex chromosomes XX and written 46xx (Mochtar, 1998).
According to the British Medical Journal, in theory there are 2 methods of selecting the sex of the baby. First, choose the gender before conception in which only follow if the sperm cromosom X or Y cromosom reaching the ovum. The second method is selective pregnancy termination. Electoral gender is not realistic, although some people believe that the atmosphere of alkaline and continuous orgasms can be easier to get the boys because cromosom Y sperm move faster to reach the ovum first. Time when sexual intercourse is also an important factor. Intercourse during ovulation produced a daughter, but only 65% reability. The possibility that sex selection is by artificial insemination using semen (Anon, 1980).
According to Nugroho, other scientific theories that can be used in choosing the sex of the theory of Akihito. So called because it is said that finding was the Japanese emperor Hirohito. Then the crown prince, Akihito, to apply this theory and managed to get 2 sons and 1 daughter, according to his wish. In essence, this theory is based on the calculation of ovulation (egg expenditure) wife (Hasuki, 2006).
As is known, the man in this case there is a sperm cell has a type of sex chromosomes X and Y. While women have 2 same sex chromosomes are X and X. When the sex, X sperm fertilize the egg cell occurs meeting with X chromosome X, thus obtained is a girl (XX). Conversely if Y sperm that fertilize the egg, the Y chromosome X chromosome will meet that will have a baby boy (XY). So basically, the boy can be obtained if the Y sperm first fertilized egg. As for getting the girls to the X sperm first fertilized egg cell (Hasuki, 2006).
The results also show each chromosome has its own character. Y sperm round, smaller, or about a third of the X chromosome, bright, way faster, and he was shorter and less resistant in the acidic atmosphere. While X sperm was bigger, walking slowly, its shape longer, and can survive much longer and more resistant to acid atmosphere (Hasuki, 2006).
From the data it can be inferred if they want to get the boys the sex must be coincident or immediately after ovulation (when an egg cell exit from the ovary or of fertility). That way, the Y sperm into the uterus can directly fertilize the egg. As for getting a girl, intercourse should be done before ovulation occurs. For example, ovulation could have occurred on the 10th. Therefore, sex should be done 3 days earlier, so that at the time of ovulation occurs live X sperm are still alive and an egg (Hasuki, 2006).
This method is not practical because the couple had to know the exact duration of ovulation. And to know that a woman should measure basal body temperature for 3 consecutive months. Measurement process was not allowed one, namely by putting a special thermometer in the mouth every morning before getting out of bed. There are several other conditions, such as room temperature should be normal and not a woman in ill health. Then, the measurement was recorded in a table. If one day, showed an increase in body temperature compared to the basal temperature, meaning that's when ovulation is happening.
Unfortunately, for women with irregular menstrual cycles, it is certainly hard to do. The accuracy of this method is also low because no matter what we do not know whether X or Y sperm that successfully fertilize the egg.
Shettles was a physician and international experts in the field of human reproductive physiology. He has amazing knowledge about the world of IVF or test tube conception and is also known in terms of research and discovery about how to choose the sex of the baby. Here are the results of his findings:
1. Medical science has long known that the men who determine the sex of offspring.
2. The husband who deserts his wife or divorce her because they do not produce male children is deceiving and fooling himself.
3. Sperm in the semen consists of the size and shape:
- Smaller sperm with round heads called andro-sperm containing the Y chromosome that produce male sex.
- Sperm larger size with an oval head (oval) called gino-sperm containing the X chromosome that produces the female sex.
4. Gino-sperm has an endurance and greater vitality and longer than the andro-sperm.
5. Situations and conditions around the vagina, the factors that influence:
- Conditions that copulation burrows will inhibit both acid gino-andro-sperm or sperm, but it will hit and weaken andro-sperm early and in large quantities,
- Whereas the situation is alkaline vagina, whether the two kinds of sperm. That's why the chemical makeup of a woman's body becomes more alkaline at the approach of ovulation seconds so the chances of conception (fertilization) is more optimal. Moreover, if intercourse is done to reach orgasm.
6. In non-acidic environments, andro-sperm able to move more agile and faster than gino-sperm.
7. Timing intercourse during ovulation and is supporting factor in choosing the sex of the baby:
- Intercourse is conducted at close to ovulation time and when the slime pit is very alkaline intercourse, so most likely to produce a baby boy
- Intercourse is performed 2-3 days before ovulation, when mucus acidic vagina, the possibility of daughters produced
8. The number of sperm per cubic centimeter can also affect the sex of the baby. If the sperm count 20 million or less (oligospermi) the possibility of offspring varies inversely with the amount. It could be argued that if the sperm count of one million or less in case of pregnancy, it will only produce a baby girl.
Shettles finally make two procedures and guidelines for each of you who wanted a baby girl or a boy.
Procedures and Guidelines For Women Wanting Babies
1. Do sex 3 days before ovulation and then stop 2 days before ovulation. Intercourse can be repeated again 2 days after ovulation.
2. Close before couples make intercourse, genital pit several times rinsed with a mixture of 1 liter of water + 2 tablespoons white table salt.
3. The wife should try to avoid orgasm because it would remove alkaline secretion which will neutralize the acid environment.
4. Choose the face position, face to face, husband and wife on the bottom, so that the sperm directly into the skin way cervix.
5. Should occur when the husband orgasm and ejaculation, do not do penetration of the penis is experienced in, remove the part.
6. Sexual conduct after a period every 2 days on a regular basis until 2-3 days before ovulation will be better. Because the number of relatively small sperm may increase the likelihood of getting a baby girl.

how to choose baby's sex? CHOOSE BY Gender Pseudo SCIENTIFIC THEORY

2009-10-22T09:19:00.000-07:00

Dawson, E.R. is a member of the Royal Society of Medicine has advanced the theory that only the women who are responsible for the sex of their children. If the egg from the right ovary and a pregnancy, the baby the men who will be born; vice versa when the left ovary obtained a baby girl. According to the report will be egg matures every month alternately in the right ovary and then on the left (Mochtar, 1998).
Dawson proposed the idea that there are "moon man" and "moon girl" is useful to set the time of intercourse in order to obtain the sex of children wanted. One way is derived from traditional Chinese records mention the existence of correlative relationship between maternal age and the moon at the time of the last period with a baby's sex (Mochtar, 1998).

how to choose baby's sex? Gender CHOOSE BY ANCIENT THEORY

2009-10-22T09:05:00.000-07:00

Since ancient times the records have shown the existence of human effort to choose the sex of the child by way of surrender to the superstitious ceremony. There are even selling life to the spirits in order to get a boy or a girl (Mochtar, 1998).
Community groups who hold matrilineal descent (matrilineal) expect the presence of girls, while groups of people who hold the line of the father (patrilineal) longed for the presence of boys in the offspring (Mochtar, 1998).
A. Left Right Theory
According Mochtar (1998), left-right theory advanced by famous philosophers, among others:
Parmenides (540 BC), a Greek philosopher said that she has two half-breed, one on the right and one on the left. Boys grow in the right half-breed, and a baby girl on the left half-breed. If a girl wants, at the time of intercourse wife should lie on his left side. Conversely, if you want a boy so she should lay on his right side so that the seed flow at half-breed husband right.
Anaxagoras (500-428 BC), suggested the hypothesis that what determines the sex of the testicles (testes) husband. The resulting right testicle is the seed of men, while the left testis female seeds.
According to Hipocrates (460-377SM) is not enough just lying on your right side, even right testicle should be tied with a rope strong during intercourse if you want a baby boy.
According to Democritus (460-360 BC) both men and women produce seeds and that determines the sex of the child and the character is a mosaic that forms on mixing the two seed. If the dominant is the seed of the woman, the offspring is female, whereas if a male role, will be born baby boy.
Can be considered that Democritus was the ancient forerunner of the modern chromosome theory.
Aristotle (384-322 BC) believed that the seeds of a stronger flow during sexual intercourse will determine the baby in the womb. He added that this strength is influenced by natural circumstances such as gusts of wind around, and others. He said, that would be a lot of boys when intercourse man born done at the time the north wind blows, than when the wind blows south. The reason is moist south winds, and this predispose girls.
B. According to the theory Advice Old Men
In the Middle Ages existing advice elders to their grandchildren who want a male offspring. How is the wife supposed to drink wine and mixed blood lion a physician according to a particular measure. As he prayed a progenitor, they have intercourse at the time recommended the full moon (Mochtar, 1998).
If pregnancy occurs, and children born of women remained; when asked, the advisers are not running out of the dictionary answer. Misfortune occurred in the seconds that determine sudden cloud had covered the full moon light beam that would give sex is male (Mochtar, 1998).
C. Traditional Theory of the People
Ossets tribes in the Caucasus, an Eskimo tribe, and the Maori tribes are selecting the sex of the baby in a way that somewhat less human. Mothers who are pregnant should be left in place separate from her husband's birth. When they gave birth to a baby girl, this child left behind. With the pitch and they returned empty handed to their husbands without any problems. But otherwise, if that was born a man, so they happily brought back not only with children even more prizes to be presented to their husbands and successful males (Mochtar, 1998).
On the island Pelew wives dressed man before intercourse, because they believe that way will have male offspring. In Sweden the night before the wedding the bride slept with a boy to hit induction and later will give birth to a baby boy (Mochtar, 1998).
Japanese people also have similar beliefs. They like to believe that child sex can be born chilling forecast of the previous child. If the back of her neck feathers spread, then the next child must be male. But if the previous child chilling together, then the next child women (Hasuki, 2006).
In the Spessart mountains (Germany), if you want boys, the husband always carried an ax on the bed and while holding intercourse hummed the song: "Ruck, Ruck, roy berkommst du ein Bub" (ask for boys). If the number of boys had enough, of course axes removed and sung: "Ruck, Ruck, raid du ein berkommst Maid" (ask for girls) (Mochtar, 1998).
In the area of Austria some farmers believe that in a year when the harvest abundant, the baby will be born male species. In Slavic countries the wife during intercourse required massaging her husband's right testicle; in provinces Madena (Italy) the husband bit into his right ear and on the plains wife husband hung the pants Pensylvania (outside in) the right of the bed. Overall it is believed that they have children boys (Mochtar, 1998).
It is undeniable that in the Indonesian culture sex factors in the family is an important issue. This is clearly reflected by the wayang stories or saga-long saga that has been widespread in our society (Mochtar, 1998).
We also developed in the community right-left theory has traditionally handed down by old people. Female patients who had surgery for cysts ovarii often bartanya: "Will I still be able to give birth a baby girl, who was appointed when the left half-breed?" On the contrary: "What can baby boy, when the hybrid operation right?" ( Mochtar, 1998).
Condition of pregnant women who had entrusted a reflection of fetal gender. If the mother's face was pale but diligent dress then her stomach like an egg shape and tilted downward believed female fetus. However, if the mother's face looks dull, lazy to dress up, full of pimples, looks cool, and form protruding belly up then the baby is a boy (Hasuki, 2006).
Popular theories is that the conception of boys going on the full moon; that the tide could affect a baby's sex; that sweet food is a factor that produced a daughter, and salty foods, sour or bitter produce sons (Mochtar , 1998)

how to choose baby's sex? Fetal growth of genital

2009-10-22T08:51:00.000-07:00

According Bagazi, fetal sex was already formed in week 3 or 21 days after conception. Then the fetus genitals will continue to grow, and generally at week 21 was perfect sex (Majidi, 2005).
Along with the formation of fetal sex, nature has been accompanied. When the male genitals, then the component nature of his manhood was equal to men in general. Although at the time of birth, looks normal, as no different from a baby girl. Baby boy newly born, is already having sex hormones male, although the activation of a new hormone will occur in adolescents. Similarly, the baby girl (Majidi, 2005).
At first, the same gonadal development in both sexes. The earliest signs of the gonads is something that appears on the ventral surface of the embryonic kidney on the side of the thoracal segments and lumbar 8 to 4 at the age of about 4 weeks gestation. Coelomic epithelial thickening, and cell groups appear to form a bud mesenchyme beneath. Coelomic epithelial region of strict limits to this are often called the germinal epithelium. However, at the gestation age 4 to 6 weeks, there are many large ameboid cells in this region who have migrated from the yolk sac into the body of the embryo; these cells have been seen in the area as early as 3 weeks of gestation. Primordial germ cells are distinguished by looking at the large size and morphology and sitokimia description given. These cells react strongly to the alkaline phosphatase test, and still be recognized even after repeated division (Cunningham, 2005).

And genital system Urinary system in embryos grown in the area right and left dorsal, lateral from the midline. Start week 4 was a thickening of the mesoderm, called protrusion urigenital (urogenital ridge). Not long after the cells migrate from germinativum primordial yolk sac wall near the diverticulum allantois and arrive at the urogenital ridge and mesenchyme with cells derived from mesoderm to form the gonad (Wiknjosastro, 1999).
Growth of the external genitalia begins in the gastrula growing part of the mesoderm between the ectoderm and entoderm in the surrounding membrane cloaca. This is caused protrusion in the midline is called the genital tubercle. In men, genital tubercle becomes the penis, while in women the clitoris (Wiknjosastro, 1999).
Kaudal and left-right are the folds of genital tubercle, which closed in behind and around vestibulum. This folds into labium minus, and in the vestibulum urethra and vagina. Labium laterally right and left have become penojolan the labium mayus. In labium there mayus glands, glands that lead to Bartholini medially. Right and left orifice there uethra eksternum small glands, glands paraurethralis (Wiknjosastro, 1999).

how to choose baby's sex? 1

2009-10-22T08:38:00.000-07:00

As a newborn, the first question most asked is: 'baby is a boy or a girl? "Genital appearance to answer what the baby gender. The term 'sex' refers to biological differences between men and women; the term 'gender' refers to the social status that distinguishes men and women. Generally assumed the position of gender in social behavior (Stewart, 1999).
A thousand years ago, has noted that the man had tried and wanted to choose the sex of the child. Efforts are made through traditional ceremonies, mostly superstitious and magical practices, and others mask shallow knowledge.
Likewise feeling anxious to failure because not getting the sex of the child who is expected to be the problem since time immemorial.
Medically, selecting the sex of the baby is very possible. Even with knowing the nature of sperm, a more practical effort can be done individually by the husband-wife (Hasuki, 2006).

hypertension crisis 8 CONCLUSION

2009-09-30T18:33:00.000-07:00

1. Hypertensive crisis occurs when there is increased blood pressure suddenly, where TD diastole above 120-130 mmHg.
2. Interference in the target organs in acute or hypertension attack en route to emergency associated with hypertension, and should receive treatment as soon as possible in matter of minutes or hours to avoid complications - complications that can occur.
3. Increased high blood pressure without a disruption in the target organ is known as a hypertensive urgency (hypertensive urgency), where treatment can be done in a few hours to 48 hours but remain in close supervision.
4. handling and proper management can reduce the risk of complications there, so patients can perform activities as usual.

hypertension crisis 7 Management AND THERAPY

2009-09-30T18:28:00.000-07:00

Management of inpatients
Patients with hypertension  genuine emergency requiring the careful IV therapy to control both blood pressure and decrease slowly but steadily.
 strict monitoring is needed. Treated in the ICU is appropriate.
 Another issue or another broadcaster needs to be acknowledged and addressed (for example, surgery for aortic dissection)
Management on an outpatient
 Hypertension is a chronic problem. The main thing to reduce the risk of disability and death of patients is long-term treatment.
 If the patient is known with high BP examination in the emergency room but did not show any interference with the target organ, the patient does not need to get treatment as soon as possible. Patients only need difollow-ups regularly.
 JNC recommendation from high blood pressure for routine follow-up in patients without target organ disorders:
 Prehypertension (TDS 120-139, TDD 80-89)  BP should be checked again in 1 year.
 Hypertension degree I (TDS 140-159, TDD 90-99)  TD should be checked again in 2 months.
 Hypertension degrees II (TDS> 160 or TDD> 100)  need treatment at a health center within 1 month.
 If TDnya> 180/110, the patient should be examined and given within 1 week of therapy.
Referral of patients can be done with consideration of the existing condition of the broadcaster. If known there are other disorders that accompany, such as aortic dissection or subarachnoid hemorrhage, it is necessary to be referred to health centers higher.
COMPLICATIONS, PREVENSI, and Prognosis
Complications that may arise from the crisis of hypertension or side effects of treatment given:
Congestive heart failure 
Myocardial miokardial 
Renal 
 retinopathy
Injury  brain blood vessels
Disturbance due to a decrease   TD cerebral blood perfusion and heart inadekuat, so it can towards stroke or ischemic infarction.
Some things that need to be considered in patients with high BP to prevent an attack or hypertensive crisis reactivation:
Examination  good in the long run for hypertension is the best way to prevent a sudden attack of hypertension crisis.
 Educate patients and follow-up routine in patients with essential hypertension crisis as to prevent re-attack emergency hypertension.
 Use appropriate antihypertensive drugs by doctors is the main thing to avoid the development of hypertensive emergency.
Prognosis
 The death rate within 1 year more than 90% in patients with hypertension who did not handle the emergency.
 life expectancy of about 144 months for all patients with hypertensive emergency encountered in the emergency room.
Life expectancy  5 years in all patients with hypertensive crises around 74%.

hypertension crisis 6 Management AND THERAPY

2009-09-30T18:24:00.000-07:00

If a case of hypertensive crisis, which first had to do is do not panic. Things - things you can do before bringing the patient into the ER, among others:
 Know all signs - there are clinical signs of hypertensive crisis, such as chest pain or heart failure. Actions to lower blood pressure is not indicated before the patient was taken to hospital.
 Oxygen, a strong diuretic (furosemide), and nitrate, all of which may be given.
 In most cases, action to deal with hypertension before being taken to the hospital was not wise. In certain circumstances, reduction in blood pressure which can drastically reduce the target organ perfusion significantly.
Subsequent handling in the ER for patients with hypertension in principle is to determine the presence or absence of interference with the target organ.
 initial action (if the patient is not in a state of distress)
 Put in patients who are not depressed in a quiet room and checked again after initial examination. In one study, 27% of patients with early diastole blood pressure> 130 mmHg can decrease significantly after relaxation without special handling.
 Consider whether there are other reasons that cause increased blood pressure (such as severe pain which sometimes causes a rise in blood pressure).
Looking for the presence or absence  interference with target organ of patients  know history, physical examination, laboratory tests, other investigations.
 Patients without interference with the target organ can be moved without the provision of therapy as soon as possible, but still difollow - up in the hope that lowering blood pressure in stages. (JNC recommendations)
 misconception is that patients should not be moved from the emergency room with blood pressure is still high. So that the patients were given oral medication, such as nifedipin, with the hope to decrease blood pressure before it moved. This is not indicated and may be dangerous.
 The work done in this way may be difficult in improving blood pressure "drop". If this happens, then the target organ will experience hipoperfusi.
 Some patients may have a talent for an increase in blood pressure and takes a long time to control it but he was not familiar with the blood pressure drops rapidly, although it was the normal number.
 Patients with target organ disorders usually requires immediate action to lower blood pressure through the line quickly. Drug therapy is given depends on the organ - the organ.
 In the case of hypertensive crisis, blood pressure should not be lowered to the normal rate.
 The decrease of blood pressure can quickly lead to decrease blood flow to the brain, kidney, and / or coronary blood vessels, which allows the emergence of ischemic and infarction.
 In general, MAP should not be lowered more than 20 - 25% in the first hours of therapy. If the patient is stable, then further blood pressure can be lowered to 160/100-110 the next 2-6 hours.
 For the best results are expected, can be obtained by continuing the infusion of working quickly, can be titrated from parenteral antihypertensive medications with a continual monitoring of patients - sustained and intensive.
 blood pressure drop rapidly as indicated in the following circumstances:
 Ischemic acute myocardial
 Nitroglycerin IV
  - blockers IV
 congestive heart failure with pulmonary edema
 Nitroglycerin IV
 Lasix IV
 Nitroprusside IV
  acute aortic dissection in this situation, if possible systole blood pressure should be lowered quickly to 100 to 110 mm Hg or more lower.
 Labetalol IV
 Alternative IV with nitroprusside   - blockers (esmolol cont.)
 Injury  brain blood vessels using antihypertensive drugs are not always recommended for stroke patients with hypertension.
 Controlling blood pressure is influenced by the use of thrombolytic drugs in ischemic stroke. TD systole> 185 mmHg or diastole TD> 110 mm Hg is a contraindication to the use of tissue plasminogen activator (TPA) in the first 3 hours of ischemic stroke patients.
 latest recommendations from the American Stroke Association explains that patients with ischemic stroke and sistolenya TD> 220 mmHg or diastolenya TD> 120-140 can be lowered blood pressure approximately 10-15% (with IV nitroprusside or labetalol IV), if the patient is always monitored closely to decrease the status neurologist associated with blood pressure lower.
Intracranial hemorrhage   there is no evidence to support that hypertension trigger further bleeding in patients with intracranial hemorrhage.
Drastic reduction  systole blood pressure can reduce perfusion in the brain and increase the risk of death.
 Control to lower blood pressure by giving IV nitroprusside or labetalol IV (there are no bradikardi) is recommended when the systole TD> 200mmHg or diastole TD> 110mmHg.
 Interaction monoamine oksidade - tiramin with acute hypertension  phentolamin IV
 Pheokromositoma
 Phentolamin IV
 Labetalol IV
 Hypertension enselopati
 Nitroprusside IV
 Labetalol IV
IV Fenoldopam 
 Acute renal failure
IV Fenoldopam 
 Nicardipin IV
  - blockers IV
 Eklamsia
 Hydralazin IV
 Labetalol IV
IV Magnesium 
 blood pressure drop quickly in the ER in addition to the above conditions is controversial and should be avoided.
 In patients who initiated because of the use of drugs - illegal drugs can be given a combination of nitroprusside with α and  - adrenergic blockers.

hypertension crisis 5 DIAGNOSIS

2009-09-30T17:50:00.000-07:00

Knowing the previous history and clinical findings are very important to distinguish between hypertension and hypertensive emergency urgency. Information about previous history of hypertension should include that have been diagnosed, the duration, degree, and control of blood pressure taken. Also find information about the previous history should take precedence in the discovery of the organ - the target organ affected, the situation during hypertension, and findings - that there are other findings.
Some other things that can be asked related to the occurrence of hypertensive crisis:
 Drugs - drugs
- Antihypertensive therapy previously obtained.
- The use of substances - substances "over - the - counter", as an example of a drug - a drug simpatomimetik.
- The use of drugs - drugs such as cocaine.
 Date of last menstrual
 other health problems (ex: hipertens earlier, thyroid disease, Cushing's syndrome, systemic lupus, and kidney disease).
 assessment of complaints that lead to hypertension crisis clinical findings:
-  chest pain of ischemic heart muscle or myocardium
- Back pain  aortic dissection
- Difficulty in breathing  pulmonary edema or congestive heart failure
- Symptoms - anxiety symptoms  neurologist, vision problems, level of chaos that changes - change (hypertension enselopati)
Physical examination should be given priority on things - things that can explain the crisis of hypertension in the emergency situation.
 Alerts - vital signs
 blood pressure should be measured in standing and sitting position (if possible  assess whether or not the volume depletion
 blood pressure should also be measured on both arms  significant differences leading to the aortic dissection.
Funduskopi examination may include changes that are consistent from chronic hypertension. Acute changes include arterial spasm (focal or diffus), retinal edema, bleeding in the retina (surface and shape as a tongue of fire, or deep and wide), exudate in the retina (hard or like cotton wool), or papiledema.
Examination focused on the cardiovascular whether there is a sign - a sign of heart failure (such as the lungs ronkhi voice, increased jugular venous pressure, askultasi emergence of S3 in the heart, and peripheral edema) or aortic dissection. Results further possibility of compensation can occur from an artery that is usually caused by a decrease in pulse rate, and this may result in ischemic brain, muscles, or digestive tract. Additional sound new murmur or mitral insufficiency penigkatan than may sound as a result of increased left ventricular afterload.
With the heart - the heart, neurological examination can directly explain the sign - a sign that will soon happen / is happening. Symptoms often arise as a result of hypertension among other enselopati, disorientation, decreased level of consciousness, and in some cases focal neurological deficit or seizures comprehensive or specific focal only. Enselopati hypertension is a stand-alone diagnosis, where the existence of other lesions (cont: stroke, subarachnoid hemorrhage, mass lesions) could be set aside. This is possible because of cerebral edema caused by the loss of autoregulation of cerebral blood vessels that appear because of hypertension weight.
The laboratory should be done immediately upon discovery of clinical symptoms and explain the important results for the ongoing situation. Routine blood tests can determine the presence or absence of mikroangiopati hemolytic anemia. Examination of urine can also indicate a hematuri, proteinuri or sediment on the state azotermia or kidney failure. Urine examination to determine the levels metanefrin can also be done to eliminate the possibility of pheokromositoma. Increased levels of serum urea and creatinine, metabolic acidosis, and hypokalemia can be seen on the blood chemistry tests which can indicate a decrease in kidney function. Aldosterone levels and plasma rennin can also be examined to rule out the existence of primary hiperaldosteronism in patients with significant hypokalemia previously not received diuretic drugs at the time of attack .. Hypokalemia which is the description of secondary aldosteronism, is at approximately 50% of patients with hypertensive crisis. In patients with elevated blood pressure due to natriuresis, serum sodium levels are usually lower than the state of primary aldosteronism. This happens because the increase in hydrostatic pressure peritubuler kidney-related increase in arterial pressure. This Natriuresis causes a secondary decrease in sodium reabsorbsi. Laboratory tests that can be done as an alternative to support the diagnosis of hypertensive crisis, among others, toxicology tests, pregnancy testing, and endocrine examinations.
Hipertropi the left ventricle and changes associated with ischemia or infarction can be seen on electrocardiography examination. Photo roentgens thoracic show evidence of heart enlargement, pulmonary edema, or a widened mediastinum, where it all can lead to aortic dissection. In addition, to further strengthen the suspicion of aortic dissection, can be performed chest CT examination, transesofageal ekhokardiografi, or with aortic arteriogram. Ekhokardiografi two dimensions can be used to distinguish pure diastole dysfunction of the heart during systole dysfunction sign - a sign of heart failure appear. All this may help in determining the therapy given and the provision of long-term therapy.
Head CT scan can be performed on patients with symptoms of neurological disorders. Sign - a sign that may arise from this investigation, among others, brain hemorrhage, brain edema, or ischemia in the brain.
In the end, it is important to determine the cause of secondary hypertension (eg hypertension renovaskular) which may cause the crisis. Test with a single dose of captopril may be given, especially in patients who did not receive drug therapy for hypertension before. Aktvitas levels of plasma rennin known in advance and then the patients were given 25 to 50 mg of captopril, 60 minutes and then re-examined rennin levels. The sensitivity value is a good test, but for very low spesifisitasnya. For further examination, such as Doppler ultrasound, MRI renal angiography, angiography with contrast, may be done to better diagnosis.
Using Skrening captopril test for secondary causes of the crisis of hypertension:
METHOD
o Patients receive adequate intake of salt and not getting a diuretic drug.
o Stop all hypertension medications three weeks before the test, if possible.
o The patient is seated at least 30 minutes, take blood samples and determined aktvitas levels of plasma rennin.
o captopril 50 mg diluted in 10 ml of water, the patient should immediately take the solution.
o After 60 minutes, take back the blood sample and measured re-elevated levels of plasma rennin.
INTERPRETATION
Expressed a positive test if:
 There was elevated levels of plasma rennin or more 12 ng/ml/jam.
and
 absolute increase in plasma rennin levels of 10 ng / ml / hour or more.
and
 Increased levels of plasma rennin > 150 % or > 400 % if the lower threshold value of plasma rennin levels were < 3 ng / ml / days.

hypertension crisis 4 Pathophysiology

2009-09-30T17:38:00.000-07:00

Pathophysiology for sure about the development of hypertensive crisis is unknown. Progressive malignant hypertension may be a nonspecific process that causes increased blood pressure is extreme. Humoral factors (especially the renin-angiotensin axis) and local products produced by blood vessels (eg prostaglandins and free radicals) may also be involved in increasing blood pressure very quickly.
However, the progressive increase in blood pressure is an important first step. There are three major organ systems are affected by high blood pressure is the central nervous system, cardiovascular system, renal system.

Central Nervous System 
Cerebral autoregulation is an important ability of the cerebral blood vessels to maintain cerebral blood flow remained constant in addition to changes in blood pressure. When the average arterial pressure - mean (MAP) increased, disturbed and endhotelium cerebral brain barrier can become loose. Fibrinoid material deposited in the brain blood vessels and cause lumen narrowed. Then the blood vessels of the brain trying to vasodilatation in the lumen was narrowed. This could be the beginning of cerebral udem and mikrohemoragik. Patients with chronic hypertension may tolerate a high MAP before an interruption in autoregulasi system.
Enselopati Hypertension is one of the clinical manifestations of cerebral edema and mikrohemoragi, which occur dysfunction of cerebral autoregulation. Without immediate treatment, enselopati hypertension can lead to cerebral hemorrhage, coma and eventually died.
Cardiovascular system 
Hypertension affects the structure and function of coronary arteries and left ventricle. Hypertension also activate the renin-angiotensin system, aldosterone, which causes systemic vasokonstriktif. This resulted in increased oxygen demand of the heart muscle because of increased left ventricular wall stress that can lead to hipertropi left ventricle and compression of the coronary blood vessels. When hypertension emergency occurs, the left ventricle can not compensate for systemic vascular resistance. This will ultimately lead to left ventricular failure and pulmonary edema, or ischemic heart muscle.
 renal system
Chronic hypertension causes pathological changes in small arteries of kidney. This continued on endothelial dysfunction and a weak vasodilatation, which will affect renal autoregulation. When disturbed renal autoregulation, intraglomerular pressure is directly related to systemic arterial pressure, this makes the lack of protection of renal changes in fluctuating blood pressure. When the crisis of hypertension, such interference can cause ischemia in acute renal.

hypertension crisis 3

2009-09-30T17:33:00.000-07:00

CAUSES AND RISK FACTORS
Although the causes of the crisis relatively low blood pressure, but hypertension is a disorder of pervasive and highly significant effect for men. Most of hypertension is essential or primary (no other cause), and hypertensive crisis appears more frequently in patients who have a history of previous hypertension. Hypertensive crisis may also arise because the disease that causes hypertension or any other cause:
  kidney disease parenkhim chronic pyelonephritis, preimer glomerulonephritis, tubulointerstitial nephritis (approximately 80% of all secondary causes).
 systemic disorders involving the kidney erimatosus  systemic lupus, systemic sclerosis, vasculitides.
Renovascular disease   atherosklerotik disease, displasi fibromuskuler, poliartritis nodosa.
Endocrine   pheokromositoma, Cushing syndrome, primary hiperaldosteronism.
  drugs cocaine, amphetamines, cyclosporin, dismissal klonidin, phensiklidin, diet pills, oral contraceptive pill.
  drug interactions Monoamine oxidase inhibitors with Tricyclic antidepressants, antihistamines, or tyramine-containing foods.
  central nervous system CNS trauma or spinal disorders, for example Guillain-Barré syndrome.
Aortic Koarktasio 
 Preeclampsia - eklamsia
Hypertension  post-surgery.
Hypertensive crisis can occur at any time. Hypertensive crisis may occur in neonates with congenital renal artery hipoplasi, children with acute glomerulonephritis, a young pregnant woman with eklamsia, or parents with atherosclerosis and renal artery stenosis. Some individuals may not be used to increase blood pressure significantly, and the symptoms and clinical manifestations of hypertensive crises arise in blood pressure are lower than those with chronic hypertension. However, treatment must be provided.
In the United States, approximately 50 million people stricken with hypertension. Prevalence increases with age. More than half of people aged between 60-69 years and about three-quarters of people aged 70 years or older who attacked hypertension. According to Mc Cowan, 2006, the crisis of hypertension attacked about 500,000 U.S. residents, or about 1% of adults who suffer from hypertension. And approximately one billion people worldwide suffer from hypertension.
Death due to ischemic heart disease and stroke increases with increasing blood pressure. For every increase in blood pressure 20 mmHg 10 mmHg systole and diastole, the risk of death due to ischemic heart disease and stroke would double.
When compared to existing inter-racial, African-American race is a race that has the greatest risk factor for hypertension crisis stricken. Hypertensive crisis appears more frequently in patients with advanced age. And overall, the prevalence and incidence of hypertension incidence is greater in men than women. The frequency of occurrence of hypertension crisis also two times more in men than women.
From a research note that blood pressure control is less effective in terms of systole blood pressure measurement is an independent risk factor for hypertension crisis cases that appeared in the ER.
But instead of that, mobilities and mortality due to hypertensive crisis, depending on the number of infected target organs and the extent of blood pressure can be controlled.

hypertension crisis 2

2009-09-30T17:26:00.000-07:00

DEFINITIONS
Hypertensive crisis can be defined as an increase in blood pressure arrived - arrived and meaningful, which diastolic pressure above 120 mm Hg - 130 mm Hg. Increased blood pressure is reached - arrived this may cause damage to several organs and can trigger a stroke occurs. Where in the incident, the heart can not function as well as function.

CLASSIFICATION
Mostly the crisis of hypertension is divided into two, namely hypertensive emergency (emergency hypertension) and hypertensive urgency (urgency hypertension).
Hypertension  emergency (emergency hypertension) which occurs  increased blood pressure is very high and there are abnormalities / target organ damage is progressive, so that in these circumstances blood pressure should be taken down immediately (within minutes to hours) in order to prevent / reduce damage to the target organ occurred.
Hypertension  urgent (urgency hypertension)  where there are blood pressure is very high but it is not accompanied by abnormalities / progressive organ damage, thus lowering blood pressure can be implemented more slowly, within hours to days.
The term for the progressive hypertension (accelerated hypertension) and malignant hypertension (malignant hypertension) is used in explaining the high blood pressure associated with clinical findings in retina. Accelerated hypertension is associated with bleeding of the retina and the presence of exudate (group 3 Keith-Wagener-Barker retinopathy). And
Malignant hypertension associated with the papiledema (group 4 Keith-Wagener-Barker retinopathy). Current clinical findings are not much different in funduscopy examination. And the situation can be described as a progressive malignant hypertension (accelerated-malignant hypertension).

SYMPTOMS AND clinical manifestations
The crisis is a symptom hypertension target organ affected, including chest pain and shortness of breath on cardiac and aortic dissection; eyes blurred in the eye papilla edema; severe headaches, disturbance of consciousness and brain disorders lateralisasi; acute renal failure in renal impairment; in addition to headache and neck pain on the increase in blood pressure in general.

hypertension crisis 1

2009-09-30T16:52:00.000-07:00

Community lifestyle today is a luxury lifestyle and sometimes far away from health considerations. So many health problems that arise as a result of it. One of them is hypertension.
Until now hypertension still remains a problem for several reasons, among others, increasing prevalence, is still the number of hypertension patients who had received treatment or been treated, but her blood pressure has not reached the target, as well as the accompanying diseases and complications that can increase morbidity and mortality.
Epidemiological data show that with the increasing elderly population, the number of patients with hypertension will likely increase, in which both systolic hypertension or a combination of systolic and diastolic hypertension often occurs in more than half of people aged> 65 years. In addition, blood pressure control rate of the former continue to increase, in the last decade shows no progress anymore (horizontal curve pattern), and blood pressure control was achieved only 34% of all hypertensive patients. Until now, data are incomplete hypertension most come from countries - countries that have been developed.
Hypertension of unknown cause was defined as essential hypertension, or by some doctors prefer the term primary hypertension. This is to distinguish with other hypertension secondary cause - for the unknown. Essential hypertension itself is 95% of the total cases of hypertension.

According to The Seventh Report of the Jonit National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), the classification of blood pressure in adults are divided into:
Classification TDS (mmHg) TDD (mmHg)
Normal <120> 160 or> 100

Hypertension can cause organ damage, either directly or indirectly. Disturbances in the organ - a common target organ in patients with hypertension found among others:
 Heart
 left ventricular hypertrophy
 angina or myocardial infarction
 Heart failure
 Brain
 stroke or transient ischemic attack
 Dementia
 chronic kidney disease
Peripheral arterial disease 
 retinopathy
The evaluation of hypertension in patients aims to:
1. assess and identify lifestyle factors - other cardiovascular risk factors or to assess the existence of an accompanying disorder that affects the prognosis and determine treatment.
2. find the cause of an increase in blood pressure.
3. determine the presence or absence of target organ disorders and cardiovascular disease.
Of all of the above, there is a situation where an increase in blood pressure is very high with the possibility of occurrence or interference / damage to the target organ. The situation is called hypertensive crisis. In general, hypertensive crisis occurs in patients with hypertension who do not or neglects to take antihypertensive drugs. Such conditions can cause disability or even death to the person who attacked them.
Problems that often occur during the handling of this crisis of hypertension patients are not quite right. Often, patients with blood pressure high blood pressure-lowering drugs are given directly by large doses in the hope that lowering blood pressure immediately. This is tantamount to overcome a problem but it adds another problem, as it can possible happen hipoperfusi organs - organs that targets can lead to occurrence of ischemic and infarction.

cancer lungs: 14 PREVENTION

2009-09-11T22:57:00.000-07:00

The most important prevention is not smoking from an early age. Quitting smoking can reduce the risk of lung cancer. Research from the group of smokers trying to quit smoking, only 30% were successful.

Lately a lot of preventive chemopreventif done. Aims to intervene Chemopreventif carcinogenic process, using natural or pharmacological drugs. Kemoprevensi agents are widely used micronutrients or antioxidants, retinoids, carotenoids, vitamin C, selenium, hormone therapy. Chemopreventif agents must be accompanied by experimental or epidemiological data showing efficacy, the mechanistic basis for the activity and same granting chemopreventif the long term.

Conclusion:
1. In men, lung cancer and the leading cause of death in women, lung cancer the third leading cause of death.
2. Practical division for medicinal purposes: a). small cell lung cancer (SCLC), b). NSCLC (non small cell lung cancer / squamous carcinoma, adenocarcinoma, large cell carcinoma).
3. Treatment for lung cancer depends on the type, the SCLC is chemotherapy treatment, radiotherapy for NSCLC, while surgery is the best option.

cancer lungs: 13 THERAPY

2009-09-11T22:40:00.000-07:00

Treatment of lung cancer, depending on the type and stage of cancer, in addition to the overall health of patients. If the patient has emphysema, for example, the poor pulmonary function inhibits the operation on patients, even if the patients have tumors that can be surgically removed. Other factors may also play a role, no matter what type of cancer patients. There was a time where, for example, when the side effects of treatment greater than the benefits gained. If that happens, patients can be given supportive therapy. This means, treat symptoms of cancer, causing pain and difficulty in breathing, but does not cure the cancer itself.

The purpose of lung cancer treatment are:
 Curative: cure or prolong disease-free period and increase the life expectancy of patients.
 Palliative: reducing the impact of cancer, improve the quality of life.
 Treat home (Hospice Care) in the case of terminals; reduce physical and psychological impact of cancer both in patients and families.
 Supportive: supporting palliative and curative treatment such as terminal nutrition, blood transfusion and blood components, growth factor anti-pain medication and anti-infective drugs.

There is a fundamental difference of biological temperament Small Cell Lung Cancer in Non-Small Cell Lung Cancer, so the treatment must be distinguished:

Small Cell Lung Cancer (SCLC)

Because most small cell lung cancer has spread outside the lungs when found, surgery is usually not an option. The most effective treatment is chemotherapy, either as monotherapy or in combination with radiation therapy.

SCLC is divided into two, namely:
1. Limited stage disease who were treated with curative purposes (the combination of chemotherapy and radiation) and treatment success rates of 20 %.
2. Extensive-stage disease treated with chemotherapy and initial treatment response rates of 60-70% and complete treatment response rates for 20 - 30 %. Median survival time for limited disease state is for 18 months and extensive disease state is 9 months.

Radiotherapy. In some cases inoperable, radio therapy performed as curative and can pengobatab as adjuvant therapy / palliative in tumors with complications are like reducing the effects of obstruction / suppression of blood vessels / bronchus.

This therapy uses X-rays to kill cancer cells. In some cases, radiation may come from outside the body (external radiation). On the other hand, radioactive compounds can be placed on the needle, using a catheter inserted into or near the lung (internal radiation). How radiation given depending on the type and stage of cancer is handled. Radiation therapy can be administered before, during, or after chemotherapy. In all cases, the goal of treatment is to destroy cancer cells with as little as possible interfere with the normal tissue.

Medication side effects may include redness and swelling of the skin, where the radiation enters the body, shortness of breath, fatique, and sometimes hard to swallow. Dysphagia due to post radiation esophagitis often occurs while the post radiation pneumonitis are rare ( <> 50 % tumor measured 50 or more than 5 the number of detected lesions disappeared; c). stable disease 50 % reduction or <> 25 % bigger; e). lokoprogresif: tumors growing within a radius of the tumor (local).

Side effects of chemotherapy is the most disturbing aspect of the treatment of cancer cells with rapid growth. As contained in the digestive tract, bone marrow and hair, is part of the most influential of these drugs. Although many side effects occurred, severity of cancer depends on these drugs. Sometimes patients have several reactions. On the other hand, patients may experience symptoms such as nausea and vomiting, dizziness, feeling very tired and the risk of infection increases.

Non-Small Cell Carcinoma
Surgical therapy is the first choice in stage I or II in patients with adequate reserves remaining lung. In stage IIIA there is still controversy about the success of the operation if the ipsilateral mediastinal lymph or there thorax wall metastases. Tumor removal technique performed a variety of techniques. Thoracotomy or the opening of the chest wall for surgical procedures and operations sternotony median or do by cutting through the breastbone is the standard method for lung cancer surgery.

Operation to treat lung cancer include:
 Wedge resection. In this operation carried out removal of the lung tumors, along with the soft tissue margin.
 Lobectomy. Operation of lung cancer most often committed. Lobectomy is the appointment of the entire lobe of one lung.
 Pneumonectomy. In this operation, the entire lung removed. Because pneumonectomy would reduce lung function, and cause other complications, this action is only done when necessary and if the patient is able to breathe with one lung.

Operating procedures will also have side effects that can cause lymphocytopenia or low number of lymphocytes (white blood cells) in the blood that causes the short survival time in patients with advanced-stage cancer.

The use of chemotherapy in NSCLC patients in the last two decades has been investigated. Curative chemotherapy for the treatment of combined integrated with other cancer treatment modalities in patients with advanced disease lokoregional.

Chemotherapy is used as standard therapy for patients ranging from stage IIIA and for palliative treatment. Sitostatika drugs have good activity in NSCLC with response rates between 15 - 35 %, however the use of a single drug did not achieve complete remission.

Combination has been investigated sitostatika to increase response rates that will have an impact on life expectancy. According to the Food and Drug Administration (FDA), the use of Avastin with paclitaxel and carboplatin can be used for initial systemic therapy in patients who can not do surgery. For patients with metastatic lung tumors in the colon and rectum, Avastin can be used as sitostatika combined with intravenous 5 - fluorouracil.

cancer lungs: 12 STAGING

2009-09-11T21:58:00.000-07:00

Staging is a system of classifying information about cancer, including location and how far the cancer has spread. TNM system is often used in establishing the stages of lung cancer, especially for Non-Small Cell Lung Cancer. Lung tumors are classified according to tumor size (T), the level of lymph node involvement (N), and how far the cancer has spread (M). Staging Non-Small Cell Lung Cancer include:
 Stage 0. At this stage, limited cancer of the lining of the airways and lung tissue had invaded. 0 cancer, is often found during bronchoscopy performed, which may be done to see the X-ray abnormalities in the chest. When found and treated as soon as possible, of cancer at this stage can be eliminated.
 Stage I. Cancer at this stage has invaded lung tissue, but has not spread to the lymph node.
 Stage II. At this stage the cancer has spread to surrounding lymph nodes and invade the chest wall
 Stage IIIA. At this stage, the cancer has spread from the lungs to the lymph node in the center of the chest.
 Stage IIIB. The cancer has spread to areas such as the heart, blood vessels, trachea and esophagus or to the lymph nodules in the collarbone area.
 Stage IV. The cancer has spread to other parts of the body such as the liver, bones or brain.

Staging for Small Cell Lung Cancer is different from Non-Small Cell is divided into limited and extensive:
 Limited. Cancer of the lungs and nearby lymph nodes.

 Extensive. The cancer has spread outside the lung and surrounding lymph nodes, and may have attacked the lungs or other organs.

Staging test used to determine how far the cancer has spread is important in planning treatment. In addition to CT scan, this test includes:
 Magnetic Resonance Imaging (MRI). In addition to radiation, this test uses radio waves and powerful magnets to produce images of body parts. This is very good for detecting tumors that have spread to the brain or spinal cord.
 Positron Emission Tomography (PET) scans. Unlike other imaging techniques, PET scans do not produce images clear organ structure. Even this way of producing color images of the area with more or less intense to provide information about chemical activity within certain organs and tissues. This chemical activity may indicate whether the cancer cells have spread to nearby lymph node, even before the enlarged lymph node. However, PET scans should be interpreted carefully, because sometimes benign conditions can mimic cancer.

cancer lungs: 11 Prognosis

2009-09-11T21:54:00.000-07:00

A. Small Cell Lung Cancer (SCLC):
 With a change therapy in the past 15 - 20 years the possibility of life on average (median survival time) who had < 3 months increased to 1 year.
 The possibility Disease Limited group average life up to 1-2 years, while 20% of it remained alive in 2 years.
 30 % died because of local complications of the tumor.
 70 % died of carsinomatosis.
 50 % metastasize to the brain (autopsy)

B. Non-Small Cell Lung Cancer (NSCLC):
 Most important in the prognosis of lung cancer is to determine the stage of the disease.
 Compared with other types of NSCLC, karsinomaskuamosa not as bad as others. In patients who performed surgery, the possibility of life after 5 years was 30 % surgey.  Survival after surgery, 70 % on Occult carcinoma; 35 - 40 % in stage 1; 10 - 15% in stage II and less than 10 % at stage III.
 75 % of squamous carcinoma died of complications torakal, 25 % because of the extra torakal, 2 % of them died because of the central nervous system disorders.
 40 % of adenocarcinoma and large cell carcinoma died of complications torakal, 5 for 55 extra torakal.
 15 % of adenocarcinoma and large cell carcinoma metastatic to the brain and 8 - 9 % die from central nervous system disorders.
 The possibility of life on average tumor metastases patients varies from 6 months to 1 year, where it is highly dependent on performance status (Karnofsky scale), extent of disease, the weight loss in the last 6 months.

cancer lungs: 10 DIAGNOSTIC PROCEDURES

2009-09-11T21:37:00.000-07:00

A. Photo chest roentgens in Posterior-anterior (PA) and lateral

Simple initial examinations that can detect lung cancer. Mayo Clinic Study of the USA, found 61 % of lung tumors were detected in routine examination with normal chest roentgens images, whereas sputum cytologic examination can detect only 19 % . In lung cancer, breast examination roentgens photo also necessary to re-evaluate its doubling time. Reported that most lung cancer has a doubling time of 37 - 465 days. When the doubling time> 18 months, mean tumor benign. The signs of other tumors are benign lesions, concentric spherical, solid and calcification of the firm.

Inspection photos chest roentgens tomography more accurate ways to support the possibility of lung tumors, when the usual way breast images can not confirm the presence of tumors. Investigations another radiologist who sometimes is also necessary bronkografi, fluoroscopy, superior vena cavografi, ventilation / perfusion scanning, ultrasound sonography.

In photos roentgens primary lung cancer can be seen as a solitary round shadow or cause the collapse of a lobe due to bronchial tumor block. Early cancer can be very small and irregular shape, but usually will be fine when growing up. While the picture radiologist for secondary lung tumors does not indicate where the location of the primary tumor.

B. Examination Computed Tomography and Magnetic Resonance Imaging

CT scan at thorax, more sensitive than normal chest image examination, because it can detect abnormalities or nodules with a minimum diameter of 3 mm, although false positives for abnormalities of this magnitude can reach 25 - 60 %. If this facility possible, a CT scan could be a second screening examination after normal chest images. Magnetic Resonance Imaging examination (MRI) is not routinely done, because he is limited to assessing the invading tumor abnormalities in the vertebrae, spinal medulla, the mediastinum, in addition to cost is also quite expensive.

MR examination thorax not superior to CT scan thorax. We are developing a technique that is more accurate imaging of Positron Emission Tomography (PET) can distinguish benign and malignant tumors based on differences in metabolism of biochemical substances case of glucose, oxygen, proteins, nucleic acids. Examples of substances used methionine 11 C and F - 18 fluorodeoxyglucose (FD6).

Tumors less than 1 cm, somewhat difficult to detect because of the small size is less resolusion by PET Scanner. Sensitivity and specificity reported how PET is 83-93% 60-90% sensitive and specific.

Some false positives to be found also a sign of malignant lesions such as inflammation and infection and tuberculosis aspergilosis. Although it is known from several studies PET examination has better accuracy values than CT scans.

C. Inspection of Bone Scanning

This examination is required if the expected signs of metastases to the bone. Tumor incidence of non small cell lung cancer (NSCLC) to bone was reported by 15 %.

D. Sputum cytology examination

Sputum cytology examination is done routinely, especially when patients have complaints such as cough. Cytologic examination does not always give positive results because it depends on:
 Location of tumors of the bronchus
 Type of tumor
 Engineering issued a sputum
 The number of sputum examination. Examination is recommended 3 - 5 days in a row
 When sputum examination (sputum must be fresh)

In lung cancer, which is central to good sputum examination can give positive results up to 67 - 85 % in squamous cell carcinoma. Sputum cytology examination is recommended as a routine examination and screening for early diagnosis of lung cancer, and they are developing early diagnosis using sputum examination staining with immune MAB with antigen antibody 624 H 12 for SCLC (small cell lung cancer) and 703 D4 antibodies to antigens NSCLC (non small cell lung carcinoma). Reports from the National Cancer Institute USA this technique gives results 91 %, 88 % sensitive and specific.

Other cytologic examination for lung cancer diagnostics can be performed on pleural fluid, aspiration of cervical lymph nodes, supraklavikula, rinse and bronchus on bronchoscopy sweep.

E. Histopathology examination

Histopathologic examination is the gold standard for diagnosis of lung cancer to obtain biopsy specimens in a way through:

Bronchoscopy. Modification of fiber-optic bronchoscopy may include:
 Trans bronchial lung biopsy (TBLB) with the demands of fluoroscopy or ultrasound.
 Recently fuorescence examination was developed by using fluorescence bronchoscopy exchanging agent such as Hp D (hemato porphyrin derivate) gave fluorescence concentrates in cancer tissue. The newer technique is to auto fluorescence bronchoscopy. The results of this examination showed 50% more sensitive than white light bronchoscopy for detection of carcinoma in situ and severe dysplasia.
 Ultrasound bronchoscopy, also developed at this time to detect peripheral tumors, endobronkial tumors, lymph node lesions of the mediastinum and hilar regions.
 positive result with bronchoscopy can be reached: 95 % for centrally located tumors and 70-80% for tumors of peripheral location.
 Trans-bronchial-Needle Aspiration (TBNA). Working against lymph nodules in the hilar or mediastinal. The result will be better when guided by CT scan.

How to examination by bronchoscopy is to insert a tube pipe flexible bronchoscope into the airways. In this way doctors can look inside the lungs and lung tissue samples taken for laboratory examination.

Trans Torakal biopsy (TTB)
If the patient has cavities fluid in the lungs, the doctor may take a sample by inserting a thin needle into the chest between the ribs. Fluid is then examined in the laboratory, to see whether or not cancer cells. Raised a number of liquids with a biopsy or torasentesis can also improve breathing.

Biopsy with TTB especially for lesions located peripheral to the size of < 2 cm sensitivity reached 90 - 95 %. Complications pneumothorak can reach 20 - 25 % and haemoptysis up to 20 %. With better preparation, these complications can be minimized. Examination results will be better if there is demand for CT scans, ultrasound, or fluoroscopy. Biopsy of lymph nodes palpable, can be done in Daniel's biopsy of the lymph-nodes scalaneus supraklavikular. Torakoskopi. Biopsy of the tumor in the pleura give better results than by way torakoskopi blind (blind). For tumors located on the surface of the pleural biopsy with the way visceralis Video Assisted Thoracoscopy has a sensitivity and specificity to 100 %, whereas complications occur is very small. Mediatinoskopi. More than 20 % of lung cancers metastasize to the mediastinum, especially Small Cell and Large Cell Ca Ca. to obtain tumor metastases or lymph nodes involved can be done by mediastinoskopi where mediastinoskopi inserted through the supra-sternal incision. This can help assess how far the cancer has spread and whether the operation is wise choice to remove the tumor. Biopsy results positive value 40 %. From other studies on the false negative values obtained mediastinoskopi of 8 - 12 (followed by Thoracotomy).

Thoracotomy for lung cancer diagnostic procedures done when non-invasive and invasive previously failed to find tumor cells.

cancer lungs: 9 Early Detection

2009-09-11T21:34:00.000-07:00

Complete anamnesis and thorough physical examination is the key to proper diagnosis. In addition to clinical symptoms mentioned above, several factors need to be considered in patients with suspected lung cancer, including: factors of age, smoking habits, a history of cancer in the family, exposure to carcinogenic substances or exposed to the fungus, and infections that can cause solitary pulmonary nodule. Finding lung cancer at an early stage is very difficult because at this stage there are no complaints or symptoms. The size of tumors at early stages is relatively small (<1cm)> 40 years, smoking> 1 pack per day and / or working in polluted environment that allows happens lung cancer (factory paint, plastic, asbestos, etc.) . Research conducted by the NCI on cancer research center 3 for> 20 years of more than 30,000 volunteers male heavy smokers, where half undergo intensive screening with sputum cytologic examination every 4 months and chest roentgens images (PA and lateral) of each year and a half other as the control group. The results of this study showed a positive early-stage tumors in the first group of 45% and 15% in the control group. Patients with lung cancer has a 5-year rate of survival by 35% compared to the control group 13%. In this study, examination of malignant cells by cytologic examination of sputum more easily find squamous cell carcinoma, while the image more chest roentgens found adenocarcinoma and squamous cell carcinoma. Small cell carcinoma rare detected in early stages. Overall the study concluded that there is a positive value (benefits) in the early detection of lung cancer.

cancer lungs: 8

2009-09-11T21:21:00.000-07:00

Lung cancer can also spread through the bloodstream to the liver, brain, adrenal glands and bone. This can happen at an early stage, especially in small cell carcinoma. Symptoms of liver failure, confusion, seizures, and bone pain; that could arise before the occurrence of various lung disorders, so that early diagnosis difficult to enforce.

Some lung cancer effect in a place far away from the lungs, such as metabolic disorders, neurological disorders and muscle disorders (paraneoplastik syndrome). This syndrome is not related to the size and location of the cancer and does not necessarily indicate that the cancer has spread outside the chest; syndrome is caused by substances released by cancer. The symptoms can be an early sign of cancer or a preliminary indication that the cancer had returned, after such treatment. One example of the syndrome is paraneoplastik Eaton-Lambert syndrome, characterized by muscle weakness extraordinary. Another example is the muscle weakness and pain due to inflammation (polimiositis), which may be accompanied by inflammation of the skin (dermatomiositis).

Some lung cancer hormone or hormone-like substances, resulting in high levels of the hormone.
Small cell carcinoma producing corticotropin (causing Cushing's syndrome) or antidiuretic hormone (causing fluid retention and low sodium levels in the blood). The formation of excessive hormones can also cause carcinoid syndrome, namely redness, wheezing breath sounds, diarrhea and heart valve abnormalities. Squamous cell carcinoma releasing hormone-like substances that cause blood calcium levels are very high.

Other hormonal syndrome associated with lung cancer are:
- Breast enlargement in men (gynecomastia)
- Excess thyroid hormone (hyperthyroidism)
- Changes in the skin (skin in the armpit become darker).
Lung cancer can also cause changes in the form of fingers and toes and change at the end of long bones, which can be seen on x-rays.

cancer lungs: 7

2009-09-11T21:17:00.000-07:00

The symptoms of lung cancer depends on the type, location and how its spread:

Usually the main symptoms are persistent cough. Patients who suffer from chronic bronchitis, lung cancer often realize that the cough gets worse.

Sputum may contain blood. If the cancer grows into the blood vessels underneath, can cause bleeding.

Cancer can cause wheezing sound due to a narrowing of the airways in or around the growth of cancer. Bronchial obstruction can cause the collapse of the lung which is the branching of the bronchi, a condition called atelectasis. Another result is a form of pneumonia with symptoms of cough, fever, chest pain and shortness of breath.

If the tumor grows into the chest wall, can cause persistent chest pain.

Symptoms that occur later are loss of appetite, weight loss and weakness. Lung cancer often leads to accumulation of fluid around the lungs (pleural effusion), so that the patient experienced shortness of breath. If the cancer spreads in the lungs, shortness of breath can occur great, blood oxygen levels are low and heart failure.

Cancer can grow into certain nerves in the neck, results in Horner syndrome, which consists of:
- Eyelid closure
- Small pupils
- Eyes sunken
- Reduced perspiration on one side of the face.

Cancer at the top of the lungs can grow into the nerves to the arms so that the arm pain, numbness and weakness. Damage can also occur in the nerve cords so that the patient's voice becomes hoarse.

Cancer can grow directly into the esophagus, or grew up in near his throat and squeezed, resulting in swallowing disorders. Sometimes formed abnormal channels (fistulas) between the esophagus and bronchi, causing great cough during swallowing process took place, because food and liquid into the lungs.

Lung cancer may grow into the heart and causes:
- An abnormal heart rhythm
- Enlargement of the heart
- Accumulation of fluid in the pericardial sack.

Cancer also can grow around the superior vena cava. This venous obstruction causes blood to flow back to the top, the other into the veins of the upper body:
 vein in the chest wall will enlarge
 face, neck and upper chest wall (including breast) will swell and look dark purple.

This condition also causes shortness of breath, headache, vision disturbances, dizziness and drowsiness. Symptoms usually get worse if the patient bend forward or lie down.

cancer lungs: 6

2009-09-11T21:14:00.000-07:00

Only a small proportion of lung cancer (about 10% -15% in men and 5% in women) are caused by substances that met or inhaled in the workplace. Working with asbestos, radiation, arsenic, chromate, nickel, klorometil ethers, mustard gas and coke oven emission can cause lung cancer, although usually only occurs in workers who also smoked.

The role of air pollution as a cause of lung cancer is still unclear. in more lung cancer patients in many urban areas air pollution than many who live in rural areas.

Lung cancer can also be associated with genetic where there is a change / mutation of several genes that play a role in lung cancer, namely: Proto oncogen, tumor supressor gene, Gene encoding enzyme. The occurrence of lung cancer based on the appearance of tumor suppressor genes in the genome (oncogene). The existence of the initiator of tumor suppressor genes changed by removing (deletions / del) or insertion (insertion / INS) some basa acid composition, appearance and / or erbB1 gene neu/rbB2 role in the anti-apoptosis (a mechanism for cells to die naturally programmed cell death). Change the look of this case gene causes the target cells in this case lung cells turn into cancer cells with the growth nature of the autonomic.

Cigarettes as well as an initiator and promoter known progresor and cigarettes are related (the largest) with the occurrence of lung cancer. Thus cancer is a genetic disease at the outset limited to target cells and then become aggressive in the surrounding tissue and even of other organs.

Diet. Several studies have reported that the low consumption of betakarotene, selenium and vitamin A causes high risk of lung cancer.

Sometimes lung cancer (particularly adenocarcinoma and alveolar cell carcinoma) occur in people who have lung scarring due to a lung disease, such as tuberculosis and fibrosis.

cancer lungs: 5

2009-09-11T21:10:00.000-07:00

Like most other cancers than the exact cause of lung cancer are unknown, but prolonged exposure or inhalation of a carcinogenic substance which is the main causative factor in addition to other factors such as immune, genetic, and others.

From some literature has reported that the etiology of lung cancer is related to smoking. Lombard and Doering (1928) have reported high incidence of lung cancer in smokers compared with nonsmokers.

Layer formed from the respiratory tract cells to the surface of a rectangular shape (columnar epithelium) and the glands that produce mucus and other fluids. In the lungs of healthy, these cells divide in a controlled and orderly arrangement. However, when a cell becomes cancerous, the cells continued to divide even when new cells are not needed. Although it took years to develop lung cancer, lung tissue changes may occur as soon as possible after exposure with lung cancer causing compounds (carcinogens) in cigarette smoke. When exposed continuously, normal cells are damaged and eventually become cancerous. Because of easy access to the bloodstream and lymph vessels, cancer cells can spread to other parts of the body before the patient develops symptoms.

Smoking is the main cause of approximately 90% of cases of lung cancer in men and about 70% in women. The more cigarettes smoked, the greater the risk for suffering from lung cancer.

There is a relationship between the average number of cigarettes smoked per day with a high incidence of lung cancer. It is said that, 1 of 9 heavy smokers will suffer from lung cancer. Later the report several studies suggest that passive smokers would be at risk for lung cancer. Children who are exposed to smoke for 25 years in adulthood will be subject to the risk of lung cancer doubled compared with the not exposed, and women living with husband / partner is also affected smokers lung cancer risk 2-3 fold. An estimated 25% of lung cancer than non-smokers is derived from passive smokers. Lung cancer incidence in women in the USA in the last 10 years also increased to 5% per year, partly because of the increasing number of women smokers or passive smokers.

Effect of cigarettes not only lead to lung cancer, but can also cause cancer in other organs such as the mouth, larynx and esophagus.

Report of the NCI (National Cancer Institute) in the USA in 1992 declared cancer in other organs such as kidneys, urinary vesika, ovary, uterus, colon, rectum, liver, penis and others higher in patients who smoke than non-smoking.

cancer lungs: 4 Mesotelioma Malignant

2009-09-11T21:03:00.000-07:00

Bronchial adenoma is a small group of malignant neoplasms of low the agresifitas. Occur in the lower trachea or main bronchi. Two of the most important forms are bronchial carcinoid and rare silindroma. Bronchial carcinoid as small cell carcinoma, derived from cells of bronchial mucosa Kulchitsky. These tumors develop nearly 4% of all bronchial tumors. Can become real in adolescence until middle age (average age at diagnosis, 45 years), where the number of men and women are affected about the same lot. Signs and symptoms of bronchial obstruction such as chronic cough, haemoptysis, or pneumonitis are common. Bronchial carcinoid tumors like carcinoid of the small intestine. Some tumors secrete serotonin, 5-hydroxy tryptophan, and other biologic substances which generate a complex of symptoms known as carcinoid syndrome. The symptoms include a red face, bronchoconstriction, and wheezing, and diarrhea. Carcinoid tumors follow the course of the disease is relatively benign, and surgical resection is usually quite useful, given the survival rate 5 years, exceeding 90% of typical carcinoid.

Mesotelioma malignant tumor that is generally not of the pleura, where the majority of cases associated with exposure to an abscess. This exposure may be brief but usually the time between the exposure and clinical awitan is 25 years old. Malignant Mesotelioma very fierce and the survival of less than 1 year from the time of diagnosis.

Both primary sarcoma of lung and primary malignant melanoma both lungs are rare, but it is a form of lung cancer are very fierce. Usually the type of lung cancer is more of a metastasis from the primary tumor was diagnosed rather than a locus of primary tumors.

Finally, it must be remembered that the lung is more often a place as metastasis cancer than the location of primary malignant neoplasms. The lungs are often the place deposits of cancer cells from the secondary other organs, because microscopic tumor emboli are carried by the blood is usually caught in the capillary network of the lungs. Tumors carried by the lymph from the lower half of the body and the abdominal cavity can be detained while walking through the duct torasikus. Neoplasms that often lead to lung metastases, respectively from the most common carcinoma of the breast, gastrointestinal tract, female genital tract and kidney, melanoma and male genital cancers.

cancer lungs: 3

2009-09-11T20:59:00.000-07:00

Type of carcinoma is distinguished from the histological cell type:
Squamous cell carcinoma histological type of carcinoma is the most common bronkogenik found. Cancer is derived from the surface of bronchial epithelium. Epithelial changes including metaplasia or dysplasia due to long-term smoking, typically precedes the emergence of tumors. Squamous cell carcinoma usually located around the central hilum, and protruding into the major bronchi. The diameter of the tumor rarely exceeds a few centimeters, and tends to spread directly to the hilar lymph nodes, chest wall and mediastinum. Squamous cell carcinoma is often accompanied by cough and haemoptysis due to irritation or ulceration, pneumonia and abscess formation due to obstruction and secondary infection. Because these tumors tend to be somewhat slow to metastasize, so early treatment can improve prognosis.

Adenocarcinoma, as the name shows such as the cellular composition of bronchial glands and may contain mucus. Frequency increases and as a variant of carcinoma is the most widely bronkogenik. Most of these tumors arise in the peripheral segment bronchus and sometimes can be associated with local scarring of the lungs and chronic interstitial fibrosis. Lesions often extends through blood and lymph vessels in the early stages, and is still not showing clinical symptoms until the distant metastasis occurred.

Cell carcinoma, bronchial alveolar carcinoma is a subtype Adeno rarely found, and that comes from alveolar or bronchial epithelium of the terminal. general cause not real, accompanied by signs that resemble pneumonia. These neoplasms are macroscopic in some cases of pneumonia-like consolidation lobaris uniform. In microscopic look alveolar groups are limited by clear cells produce mucus and sputum are many mukoid. The prognosis is poor unless the affected lobe disposal during early disease. Adenocarcinoma is the only type of histology of lung cancer that have no obvious connection with smoking.

Large cell carcinoma is a malignant cells are large and very poorly differentiated with large cytoplasm and nucleus sizes vary. These cells tend to occur in lung tissue of peripheral, grew rapidly with extensive and rapid spread to places far away.

Small cell carcinoma, such as squamous cell type, usually located in the center around the main branching bronchi. Unlike lung cancer, the other, this type of tumor arising from Kulschitsky cells, the normal component of the bronchial epithelium. In microscopic, this tumor is made up of small cells (about twice the size of lymphocytes) with the nucleus and cytoplasm hiperkromatik slightly thick. These cells often resemble oat seeds, so named oat cell carcinoma. Carcinoma cellule have time fastest division worst prognosis compared all carcinoma bronkogenik. Early metastasis to the mediastinal and hilar lymph nodes, as well as with haematogenous spread to the distal organs, often encountered. Approximately 70% of patients had evidence of extensive disease (metastasis to distal) at the time of diagnosis, and number 5-year survival of less than 5%.

In addition bronkogenik carcinoma, another form of lung cancer include primary adenoma, sarcoma, and mesotelioma bronchus. Although rare, these tumors is important because it may mimic carcinoma bronkogenik and life-threatening.

cancer lungs: 2

2009-09-11T20:53:00.000-07:00

Lung cancer is usually classified according to primary histology types and all have a natural history and response to treatment varies. Although there are more than a dozen types of lung cancer primary, but bronkogenik cancer, including four first types of cells is 95% of all lung cancers.

Practical division for medicinal purposes: a). small cell lung cancer (SCLC), b). NSCLC (non small cell lung cancer / squamous carcinoma, adenocarcinoma, large cell carcinoma).
1999 WHO histological classification for tumors and pleural tumors: (2)
Epithelial tumors:
1. Benign: papilloma, adenoma
2. Preinvasive lesion: squamous dysplasia / carcinoma in situ, atypical adenomatous hyperplasia, diffuse idiopathic pulmonary neuroendocrine cell hyperplasia.
3. Malignant:
1. Squamous cell carcinoma: papillary, clear cell, basaloid.
2. Small cell carcinoma: combined small cell carcinoma
3. Adenocarcinoma:
• Acinar
• Papillary
• bronchoalveolar: nonmusinous, musinous, musinous and nonmucinous mixed or indeterminate cell type

• Solid carcinoma with mucin formation
• Adenocarcinoma with mixed subtypes
4. Large cell carcinoma: neurondocrine Large cell carcinoma, Basaloid carcinoma, Lymphoepitelioma-like carcinoma, Clear cell carcinoma, Large cell carcinoma with rhabdoid phenotype
5. Adenosquamous carcinoma
6. Carcinoma with pleomorphic sarcomatoid or sarcomatous elements
7. Carcicoid tumors: typical carcinoid, atypical carcinoid
8. Salicary gland carcinomas of type: mucoepidermoid carcinoma, adenoid cystic carcinoma
4. Others: soft tissue tumors
5. Mesothelial tumors: Benign, Malignant mesothelioma
6. Miscellaneous tumors
7. Lymphoproliferative diseases
8. Secondary tumors
9. Unclassified tumors
10. Tumor like lesions

cancer lungs: 1

2009-09-11T20:36:00.000-07:00

Currently, cancer is a major cause of death in the productive age. It is estimated that, at least there are 150 new cancer patients each year per 100,000 people in Indonesia. This means, of the 200 million population is estimated there will be 300,000 cancer patients each year.

The prevalence of lung cancer in developed countries is very high, in the USA in 2002 there were 169,400 reported new cases (of which 13% of all new cancers are diagnosed) with 154,900 deaths (of which 28% of all cancer deaths), the prevalence of events in the UK reached 40,000 / year, while in Indonesia was ranked 4th largest cancer, the cancer hospital Dharmais occupied Jakarta in 1998 ranked third after breast cancer and cervix. The death rate from lung cancer worldwide reach approximately one million residents each year. Because of our recording system that prevalence was not good but certainly not yet known, and pulmonary tumor clinic at the hospital felt the true increase. In other developing countries reported the incident quickly rising partly because of excessive tobacco consumption in China is like 30% of cigarettes consumed the world. Most of the male lung cancer (65%) life-time risk in women 1:13 and 1:20.

Lung cancer is one of the biggest causes of death worldwide, with incidence rates increasing from time to time. Among all the diseases of cancer in men, lung cancer is the most common cause of death in the world. In women although the number
low incidence of lung cancer but it is the third leading cause of death due to cancer.

More than 1.3 million new cases of lung and bronchial cancer worldwide, causing 1.1 million deaths each year. Based on the number of incidents and the prevalence in the world, Asia, Australia, and Far East are at the first level with an estimated number of cases more than 670 thousand with a mortality rate of more than 580 thousand people. In Indonesia, lung cancer became the main cause of death of men and more than 70% of new cancers were diagnosed at an advanced stage (stage IIIB or IV). Therefore, only 5% of patients can survive for up to 5 years after being found positive.

According to Ahmad Hudoyo from Friendship Hospital, in Indonesia, lung cancer is the most cancers. This is mainly because the number of smokers, particularly smokers is very much a beginner. In the United States and European anti-cigarette programs are running and can hit smokers from 70% to 20%, lung cancer rates are still too many.

Until now, lung cancer is still a major problem in medicine. Difficult to detect lung cancer. In the early stages, this cancer has no symptoms, so that when the patient had been diagnosed at an advanced stage. Cancer cells that are not controlled in the lung tissue, making wild production causing that inhibits tumor growth and stop the lung function as they should. The large size of the lungs, causing cancer to grow for years undetected and without symptoms. The disease is only detected after the cancer reaches an advanced stage.

skin; verruca 8 destructive therapy

2009-09-05T01:40:00.000-07:00

Method Virusidal
A. Formaldehyde
Formasidal is virusidal agent and is in packaging gel 0.7% or 3% solusio. By cooling will accelerate the eradication of the virus verruca. Two hundred children with plantar verruca treated with 3% formaldehyde for 6 - 8 weeks to produce 80% verruca eradication. A control study comparing the use of formaldehyde with the soaking liquid and the second with saccharose showed no difference in eradication rates between the three groups.

B. Glutaraldehyde
Glutaraldehyde in solusio packaging or 10% formaldehyde gel and the like, this hardened skin and cause peeling easier. In studies without control by the use solusio 20% once a day at verruca eliminate 72% of 25 patients in three months. The disadvantage is that your skin is brown and there are reports of skin necrosis after the use of glutaraldehyde 20%.

Antimitotik Therapy
A. Podofillin / Podofillotoksin
Podofillotoksin, an active ingredient in a mixture of raw podofillin which acts as a binding coil antimitotik during mitosis. Inhibited cell division. This agent is used in therapy veruka anogenital, but weak in the penetration into the thick stratum corneum and podofillin more effective for treatment of skin verruca. Cessation of use after peeling verruca, may be effective, but there is a risk of inflammation, the formation of sterile pustules, and secondary infections.

B. Bleomisin
Bleomisin (blenoksan) is a kemoterapeutik agent that inhibits DNA synthesis in cells and viruses. Bleomisin is verruca alternative therapies that do not respond to other therapies or difficult verruca removed by surgery. Bleomisin in 1 - 5 unit vial diluted with 30 mL of physiological salt and 0.3 mL ( 0.15 units) injected into the verruca. Additional injections can be given every three or four weeks until resolution is reached. The pain is the biggest factor for therapy. Potential side effects is the formation of scar tissue, changes in pigmentation, nail damage, and Raynaud's phenomenon. Bleomisin recorded against pregnancy in category D, potentially absorbed after injection. One study reported that bleomisin used for the naughty verruca therapy. After the use of topical anesthetic, is injected into the bleomisin needle verruca. Resolution level reached 92%.
Although a number of RCT (randomized control trial) who reported that the level of effectiveness is low bleomisin, one article has been concluded that there was no consistent evidence on the effectiveness of therapy bleomisin intralesi in verruca nongenital and the data is not meant entirely for analysis. Another article based on RCT and a series of four different cases that present evidence of the effectiveness bleomisin, advocated its use as a third-line therapy for verruca vulgaris and plantar verruca.

C. Retinoids
Systemic retinoids have been used in the management of verruca for its ability to alter and accelerate the eradication keratinisasi way verruca induces irritant dermatitis. Small study reported etretinat effectiveness in children with a wide veruka. Etreninat not used widely in the United States, asitretin (soriatan) is now used. Etretinat dose of 1 mg / KgBB / day given no more than three months. In the 20 children who were included in this study, 16 of which showed complete resolution of verruca and without recurrence. Verruca relapse in four other patients after regression part.
One article found evidence supporting the use of topical retinoids based on one cohort study that examined the effectiveness of retinoids using a number of case reports and a number of experiments using systemic retinoids. Other articles from several case studies suggest the use of oral and topical retinoids as second-line therapy as a treatment verruca Plana.

Immune stimulation
A. Topical sensitization
Slow induction of hypersensitivity reactions have been used as verruca therapy. Dinitroklorobenzen and squarit dibutilester acid has been used, but many studies have seen difensipron effects. Two open studies have shown the difensipron great results. In one study, difensipron used every week for 8 weeks in 134 patients and provides approximately 60% response (complete resolution occurred in 44% of patients within 4 months). In another retrospective study, 48 patients were treated every 3 weeks, 88% of patients in verruca net 14 weeks. Return to this therapy that some patients can not sensitisation, while others have dermatitis reaction.

B. Cimetidin
Cimetidin have imunomodulator effects that are not clear and are used for therapies that have been advanced verruca. Open trial reported some effectiveness, but studies with controls showed no benefit compared with placebo.

C. Immunotherapy Intralesi
Intralesi Immunotherapy uses the immune system's ability to recognize viral antigens and certain fungi. Antigens for Candida skin test commonly used. It is believed that the slow type hypersensitivity reaction induced by this antigen improve the immune system's ability to identify and eradicate HPV. One study showed complete resolution of verruca participants and 47% ,75 - 99% resolution in 13% of participants. In the 34% who enrolled in this study had documented complete resolution of all verruca remote from the injection site. In 22% of participants, the level of 75 - 99% verruca resolution remote from the injection site has also been noted. Regression verruca remote from the injection site was not found on other therapies. Although some recent RCT has been published, an article states that intralesi Immunotherapy as second-line therapy for plantar verruca and third-line therapy for verruca vulgaris and verruca Plana.

Other Therapies
Many other therapies have been used to therapy verruca, although few are receiving these types of therapy. Traditional medicines are still used but without evaluation. Homeopathy uses a variety of drugs that contain calcium, netrium, and sulfur which showed the advantage over placebo. Hypnosis has been evaluated with a double-blind placebo-controlled trial of 40 individuals who were treated for more than 6 weeks. The group that got hypnosis lost more than verruca groups received topical salicylic acid or placebo. Local warming therapy has been tested on 13 patients. At 29 verruca who were treated, 86% net, while 41% of the placebo group, verruca regresses. Intralesi interferon has shown some effect on the experiment verruca open. Imiquimod 5% cream for 9-11 weeks has been used by a minority of patients with great results. Irradiation, one of the most commonly used, now no longer used for treatment of benign.

skin; verruca 7 destructive therapy

2009-09-05T00:46:00.000-07:00

Destructive Therapy

A. Salicylic acid
Salicylic acid is a slow acting keralolitik epidermis infected. Results with mild irritation may stimulate an immune response. Salicylic acid itself has shown the results of a resolution on 67% of patients with verruca in hand and 84% in patients with plantar verruca within 12 weeks.
There are many patented products salicylic acid, but no recent information to compare these products:
1. 11-17% salicylic acid in kolodio and gels such as kolodio lactic acid, copper
2. 26% salicylic acid in the basic poliakrilik designed to mix their own
3. salicylic acid with 25% podofilin in oinment, used for plantar verruca
4. 50% salicylic acid is used to ointment plantar verruca.
Before applying ointment verruca, keratin layer must first exfoliated or removed with sandpaper or a polished and smooth the surface by soaking in warm water. Kolodio products to form a layer of exfoliated before re-application. Product occlusion has been shown to increase the level of plantar verruca cleansing.
The comparison between the content of salicylic acid ointment and a single treatment with glutaraldehyde, folouroasil, podifilin, benzalklonium, cryotherapy with liquid nitrogen, does not prove more effective than salicylic acid.

B. Cryotherapy (Surgical Frozen)
Liquid nitrogen (LN2, 2196 8C) is the agent most frequently used. Mixture of dimethyl ether / propane (257 8C) is used as pleased with this product, but the effectiveness in making a sufficient temperature to necrotic cells was low. Cryotherapy have any effect on either resolution verruca necrosis by simple destruction keratinocytes infected with HPV and local condition inflammatory response to induce cell-mediated immune effective.
Different techniques between physicians with a variety of freezing time, the way the distance between the application and therapy. Many doctors use a cotton stick spray, but still widely used and better used in children or verruca close to the eye. Generally done freezing until halo around verruca lost and the time between 5-30 seconds depending on the location and size verruca. When an application re-LN2 with cotton sticks, to note that HPV and other viruses like HIV can survive in liquid nitrogen.
Verruca with surgical destruction of frozen every three weeks can give resolution results in 69% of patients with verruca in hand within 12 weeks. This study used liquid nitrogen with a cotton bud to disappear from the surrounding halo verruca (about 5-30 seconds). Cleanup levels increased when cryotherapy combined with salicylic acid ointment, although not significant.
Two cycles of freeze-liquid has been shown to improve resolution in plantar verruca but not in palmar verruca. The ideal interval between surgery frozen with the next one is not clear. Bunney study showed that the interval of more than three weeks, reducing the rate at 12 weeks of treatment, other studies show that the resolution depends on the amount of therapy, so that weekly therapy produces a more rapid resolution.
Patients should be reminded that the frozen surgical pain and heat. Need to be careful when passing tendon surgery and frozen in patients with little circulation. Can occur hypo and hyperpigmentation, especially in blacks. Therapy can be followed by onikodistrofi on verruca periungual.

C. Termokauter or Kuretase and cautery
Verruca surgery has been practiced mainly with a blunt kuretase or surgery followed by cautery. This method is particularly used in verruca filiformis on the face and extremities. In an open study, the success rate of patients reported an average of 65-85%. This procedure usually leaves scar tissue and recurrence occurs more than 30%. The growth of scar tissue on the soles of the feet is a relative contraindication in this surgical method.
A study conducted in India, which compare the effectiveness of 5-flouroasil (pyrimidin fluorine which cuts the viral DNA synthesis) with electrosurgery performed on 50 patients who were divided into two groups, showed 52% of patients showed good response to 5-flourourasil, whereas 72 patients showed good response to electrosurgery. 5-flouroasil give a better effect on verruca Plana, verruca plantar, and condyloma akuminata, whereas electrosurgery provides a better response to the verruca vulgaris especially in the case verruca filiformis. Electrosurgery side effect of pain, secondary infection, the growth of scars, and hipopigmentasi, while 5-flouroasil have side effects of eritem, photosensitive, and hiperpigmentasi.8

D. Chemical cautery: Batang Silver Nitrate
Chemical cautery with daily re-use silver nitrate sticks can cause destruction to effect adequate resolution verruca, but sometimes hyperpigmented scars formed. In a placebo control study in 70 patients, three silver nitrate application all verruca resolution at more than 9 days at 43% and 26% probandus improvement verruca one month after treatment compared to 11% and 14% in the placebo group.

E. Carbon dioxide laser
Destruction produced by CO2 laser has been used to therapy virus verruca. Periungual and subungual lesions are difficult resolusition with other treatment methods, appropriate when using this method. The level of recovery was reported in two cases of 64-71% after 12 months, but pain can occur after an operation scar tissue growth.

F. Pulsed Dye Laser
Therapy with vascular lesion laser, also known as pulsed dye laser therapy that can selectively target a hemoglobin contained in verruca. When hemoglobin heat, thermal energy dissipated into the surrounding tissue, causing the blood vessels cautery. The result is a frequent necrosis verruca peeling. The use of pulsed dye laser absorption of energy depending on the capillary matting in verruca and local tissue necrosis. Pain and less scarring than the laser occurs CO2.1 Many studies have studied the effectiveness of pulsed dye laser therapy after about two or three times a therapy reported cure rates of about 48-93% verruca at various locations. One study showed a resolution rate of about 72%. Highest resolution level of 85.7% in periungual and verruca lowest level in 50% verruca plantar.
In a separate study comparing the pulsed dye laser therapy with cryotherapy and cantaridin. In patients treated with cryotherapy and cantaridin, 70% showed the cleaning, while 66% of patients showed eradication after pulsed dye laser therapy. The researchers conclude that pulsed dye laser therapy effective as conventional therapy. Pulsed dye laser therapy is recommended as second-line therapy in verruca and third-line therapy for verruca vulgaris and verruca Plana. However, another article found EBM weak to support the use of pulsed dye laser as sole therapy for this study method can only be used for therapy verruca located on the hands and feet.

G. Fotodinamik Therapy
This therapy depends on the chemical capture by abnormal cells, usually an amino acid-levulinat (AAL) was involved in track and photograph porphyrin oxidation by irradiation using laser or non laser that affect the network. Comparison of responses in 45 patients who received three laser therapy with wavelengths of 589-700 nm after the AAL 20% cream or placebo cream showed that active treatment resulted in an increase or reduction of the size of the resolution after 4 months verruca with AAL and irradiation.

skin; verruca 6 Management

2009-08-30T20:25:00.001-07:00

Management
There is no single therapy is one hundred percent effective, and various kinds of therapy should be combined. Research on the effectiveness of therapy should take into account the possibility of spontaneous regression. Any decision taken therapy which must be made case by case basis based on the physician experience, patient selection, and implementation of evidence-based medicine. Immunocompromised patients may experience with verruca incomplete cleaning and verruca become resistant to therapy. Verruca left without treatment is a valid management option if the patient is acceptable, but plantar verruca cause pain and verruca the invisible hand and less influence on school activities or led to difficulties at work. Verruca in adults with a long duration of infection and in immunosuppressed patients have little chance to heal spontaneously and more difficult to be treated.
Verruca with different types and different locations require different therapies. Verruca on the face should not be treated with ointment verruca severe irritation because of the risk. Verruca Plana with Koebner phenomena with any destructive techniques can aggravate the disease. Most verruca can be treated by general practitioners and even by the nursing staff.
The main goal is verruca management:
(1) to eliminate verruca without recurrence
(2) without cicatrix's
(3) create a long-term immunity.
General principles of management verruca must see things as follows:
1. not all be eliminated verruca
2. indication to be removed are: pain, interfere with the activity, cosmetic factors, and the risk of malignancy
3. there is no treatment success rate is very high (about 60-70% net in three months)
4. immune response is an important factor in the net verruca. Immunocompromised individuals may not show the net verruca
5. the highest level of cleanliness for the management of a variety usually the younger people who have a short duration of infection.

skin; verruca 5 Veruka and Malignancy

2009-08-30T20:17:00.001-07:00

Diagnosis Banding
Verruca plantar must be distinguished from regions where lesions callositis waxy, thick, yellowish and there are no capillaries in the peel. Cron occur in places affected by pressure and are usually smaller and pain with blockage in the middle.
Veruka Plana should be distinguished liken Planus which shows a purplish and diskolorasi Wickham stria. Planus liken lesions usually associated with itching and certain mucosal lesions.
Nevus epidermal similar verruca digitata or verruca filiformis. Molluscum contagiosum lesions are white with papul seen umbilikasi or in the middle of the curve.

Verruca and Malignancy
Verruca benign in individuals imunokompeten almost never become malignant. There are a few reports of lesions that begin as verruca and later became squamous cell carcinoma is invasive. The combination of verruca periungual with genital HPV disease should be special attention.
Verukous many lesions occur in individuals with immunosuppression and in patients who receive organ transplants is about 50% of patients with renal transplants develop into verruca, five years after transplantation. Exposure to sunlight increases the incidence of lesions verruca and act as kokarsinogen. Changes displasi almost certainly happen and very little relationship between the clinical symptoms with the histological picture. The lesions are a particular form of the virus verruca, Keratosis Bowenoid or diesel or keratoakantoma or squamous karsinomata. Some types of HPV have been found in benign squamous lesions and malignant in patients with immunocompromise and a role in the initiation and progression of malignant processes.

skin; verruca 4 diagnosis

2009-08-30T20:02:00.000-07:00

Special forms

Epidermodysplasia verruciformis
Epidermodysplasia verruciformis is inherited disorder in which there are subtle defect-mediated immunity by cells and is an area of HPV infection and persistent. Lesion is very diverse forms, can be flat, resembling verruca lesions, macular hyperpigmentation, red, or atrophy, or plaque-like Pityriasis versicolor. Flat form and which resemble lesions frequently located in verruca extremities and face and a thicker plaque can mimic seboroik Keratosis. Lesions found to contain many types of HPV that cause verruca including Plana, but some types that do not cause disease in normal individuals. There is a risk of developing into squamous cell carcinoma of the skin exposed to the sun (sun-exposed).

Bowenoid papulosis
Also known as intraepitelial neoplasms of the vulva, penis, and anal (NIV, NIP, NIA). Bowenoid papulosis appears as a small papul, usually multiple, sometimes located on the surface of pigmented mucosa and skin in the anogenital region of both sexes. Usually found in young adults but no association of age and there is a strong relationship with HPV type 16 infection.

Focal epithelial hyperplasia
Also known as Heck's disease, is a rare benign lesions, which reduced noise without gender predisposition. Lesions characteristic of multiple noduler firmly bounded on the oral mucosa. The disease is usually found in native Americans and the Inuit in Greenland, is reported rarely found in other countries. HPV types 13 and 32 as an agent cause in patients with genetic predisposition.

Epithelioma carcinoma cuniculatum and verukosa
Epitelioma kunikulatum a squamous cell carcinoma appears as mass with a smooth consistency bulbus software on your feet. Multiple sinus open to the surface and when pressed, the lesions become like a giant plantar verruca, but the difference between rapid growth and local invasion.
Verukosa carcinoma developed in the cavum of oral and genital mucosal lesions, and look like cauliflower.

Diagnosis
Verruca diagnosis is established based on clinical examination but can also be supported by the histological picture of epidermal acanthuses with papillomatosis, hiperkeratosis, and parakeratosis with a protrusion and grooves in the middle of verruca. Dermis capillaries protruding and blood clot blockage. There are a wide keratinocytes with eccentric piknosis cell nucleus surrounded by a halo perinuklear (koilosit is characteristic of papilloma associated with HPV). HPV-infected cells had few granules and a lump of eosinophils keratohialin basofilik granules. Verruca Plana acanthuses only slightly and does not occur hiperkeratosis and parakeratosis or papillomatosis.
Characterization of HPV is very little done, but useful in some cases of genital verruca in children with suspected sexual abuse. Knowledge of the genotype of HPV in benign verruca therapy does not affect the election.

skin; verruca 3 aetiology, histopatology, and classification

2009-08-30T19:21:00.000-07:00

Aetiology
The virus causes fall into papilloma virus (group papova) diameter of 45 nm. Is a DNA virus replication occurs internuclear characteristics.
Histopathology
Verruca is-epithelial hyperplastic lesions. Happened here acanthuses irregulars and hiperkeratosis. Focal sections of cells that have the irregulars through vakuolisasi stratum granulosum and caused protrusion parakeratotik in Stratum corneum, which consists of material basofilik inclusions in the nucleus. Tues lower stratum spinosum and stratum basalis is not affected.

Classification and Clinical Symptoms
The disease has verruca clinical forms:
1. verruca vulgaris with variant verruca filiformis
2. verruca Plana juvenilis
3. verruca plantar
4. verruca akuminatum (Condyloma acuminatum)
5. special form
Verruca vulgaris (warts)
This form is most common in children, but also in adults and the elderly. Predileksi place mainly in the extensor extremities, although this could spread to other parts of the body including the mouth and nasal mucosa. These warts round, gray, or if lentikuler size confluention shaped plaque, rough surfaces (verukosa). With a stroke can occur throughout the scratch autoinokulasi (Koebner phenomenon).

Parent is also known wart at some point will cause warts children in large numbers. There are opinions that characterize the disease recover without treatment
Verruca vulgaris variant found in the face, eyelids, nostrils, and skin heads are shaped as a protrusion perpendicular to the surface of the skin and surface verukosa called verruca filiformis. The lesions are usually single, soft, thin, like yarn. Lesions in the scalp rather difficult to be eliminated because it can grow new lesions due to scratching or because the use of a comb.

Verruca Plana juvenilis
This verrruca size milier or lentikuler. Smooth or flat surface, same color of skin color or slightly brownish. Spread especially in the face and neck area, dorsum manus and pedis, wrists, and knees. There is also a Koebner phenomenon and includes diseases that can heal itself without treatment. The number of lesions can be very many. Mainly occurs in children and young people, although can also be found in the elderly.

Verruca plantar
These forms are in the soles of the feet, especially in areas experiencing stress. The form of the hard ring in the middle of a bit soft and yellowish color. Slippery surface due to friction and leading to pain during walking, which caused the suppression by the masses is in the middle of the ring.
There are two types of plantar Verruca:
• Solitary verruca a single verruca. Verruca its size is often increased and even multiply, forming satellite verruca.
• Verruca mosaic is a group of several small verruca that confluen in one place. Mosaic Verruca more difficult to treat than solitary verruca.

Condyloma akuminatum
Condyloma akuminatum is shaped skin disorder with surface-stemmed vegetation in the genital area predilection place. The disease is discussed separately.

skin; verruca 2 definition and epidemiology

2009-08-30T19:08:00.000-07:00

Definition
Hiperplasi epidermal Verruca is caused by human papilloma virus (HPV) a particular type. HPV genotypes are divided into separate based on DNA content. Different types of HPV that can infect both the stratum corneum squamous epithelium or mucous membrane layer that has no horns. Appearance of lesions is not only influenced by the type of virus but also by environmental factors and the host.
More than 100 types of HPV that infektion skin and mucous membranes have been identified. Types of HPV that infect the skin will develop into verruca vulgaris. Specific type of high-risk HPV that infect the mucosa tissue in the genital area has a carcinogenic effect. High-risk HPV is also found in the head and neck cancer that develops in the tonsils.
There is also a low-risk types of HPV that cause benign lesions in the genital area, such as genital verruca. Some types of HPV infect the skin and cause verruca at various locations in the body. HPV types cause benign growth, or papilloma on the vocal cords.

Epidemiology
Verruca the spread of cosmopolitan and transmission through skin contact or autoinokulasi. Higher risk of infection if the skin is not infected with HPV had an injury or in wet conditions (eg in the pool or in the general cleaning) and contact with the skin on verruca.
This virus can also spread to other parts of the body. For example, it can spread to verruca around nails, lips, and surrounding skin if we verruca often bite on the finger or the nail, or if we like to suck fingers with verruca. If you have the immune system bad, it can develop into a much verruca and difficult to remove (eg in AIDS patients, in patients undergoing chemotherapy, etc.).

skin; verruca 1

2009-08-30T19:00:00.000-07:00

A lot of people who have experienced infection Human Papilloma Virus (HPV) in their lives. One manifestation of this virus infection is a verruca / verruca or often referred to as warts or warts cuplak or in English.
Warts appear on the layer of the epidermis with a variety of forms. Verruca vulgaris, verruca plantar, verruca Plana, and Condyloma akuminuta are some clinical manifestation of HPV infection.
Prevalence of viral warts in the United States in children and adults was recorded between 3.9% to 4.9%. Another survey said the prevalence of this virus in the state located in the northern United States ranged from 3% in children, 20% in adolescents, 3.5% in adults aged 25-34 years.1 greatest incidence occurs at age 12-16 years and more attacking women than men.
Actually verruca warts or harmless, but sometimes not visible. Verruca that arise on the sole of the foot sometimes causes a sense sick.3 In one study says, verruca will recover spontaneously within two years without treatment in children 40% of patients.

skin : scabies 10 conclusion

2009-08-25T08:21:00.000-07:00

1. Scabies a contagious skin disease caused by infestation and sensitization to mites Sarcoptes scabiei hominis and product variants.
2. Scabies transmission can occur either directly or indirectly.
3. Scabies is the great imitator, where there are clinical symptoms which resemble to some other skin diseases. And lesions typical of this disease form, which papul itching or vesicle, and the presence of the tunnel (Burrow).
4. Scabies diagnosis can be established by a careful anamnesis (history of contact with other patients, pruritus nocturna), physical examination (lesions of the typical predileksi Glan  penis and scrotum in males and mammary areola in women), and also with laboratory tests appropriate (microscopic examination, the ink test, or biopsy tissue).
5. Permethrin 5% is still the treatment of choice of scabies current treatment.
6. The success of therapy and prognosis of healing depends on patient compliance in therapy, the patient's ability to maintain personal hygiene and environment, as well as extensive treatment in the family and the people who frequent contact with patients.

skin : scabies 9 treat

2009-08-25T08:12:00.000-07:00

Several types of treatment have been conducted since scabies first, but research on the ideal therapy scabies still do. According to Rikyanto (2001), the ideal skabisid is: 1. Should be effective against all stages of mites; 2. Should not cause irritation, hypersensitivity, and non-toxic; 3. No smelly or dirty, and no damage or color of clothing; 4. Easy to obtain and use (can be used by all ages), and also economical.
1. Sulfur presipitatum
This is a drug dosage longest antiskabies used. Celsus uses sulfur mixed in a special fluid for the treatment of early scabies in 25 AD Sulfur ointment is used in the preparation (2% - 10%) and is usually recommended to use ointment recommended 6%. It's easy: after a shower, sulfur ointment applied to the skin evenly throughout the body for two or three days - helped (Karthikeyan, 2005).
Sulfur ointment messy, rank, leaving marks on clothes, as well as in the situation is hot and humid, can stimulate the occurrence of irritant contact dermatitis. And the benefits of this preparation because it is cheap and is a major option in place - a place that requires treatment in a large scabies or economic reasons. Sulfur is recommended as an alternative therapy is relatively safe scabies in infants, children - children, and pregnant women.
2. Benzyl benzoate
Benzyl benzoate is a derivative of benzoic acid and benzyl alcohol are found in Peru and balsam of Tolu. These preparations are neurotoksik on mites. Dosage used in the form of emulsion concentration of 25% with 24-hour contact time without interspersed bath. In younger patients or in children - children, the dose can be reduced to 12.5%. Benzyl benzoate is very effective when used appropriately. Benzyl benzoate can cause irritant contact dermatitis on the face and scrotum. And the repeated use - dematitis repeated contact may cause allergies. Prohibited use of this preparation in pregnant and lactating women, infants and children less than 2 years. In developing countries with limited resources, benzyl benzoate can be used as an economical alternative in the treatment of scabies (Karthikeyan, 2005).
3. Krotamiton
Krotamiton (crotonyl-N-ethyl-o-toluidine) is used in the preparation or lotion kren 10%. Average - the average treatment success with krotamiton between 50% - 70%. Obtained best results when used twice daily for five days - joined after a bath and change clothes. This medication is not recommended in children - children. And its use in pregnant women who do not have enough information (Category C) (Karthikeyan, 2005).
4. Gamma benzene heksakloride (Lindane)
Gamma benzene hekaskloride is an insecticide. Wooldridge was first used to treat scabies in 1948. These drugs work on the CNS (central nervous system) mites and cause an increase eksitabilitas, convulsions, and death. Lindane 1% cream in the form of an effective dosage in the treatment skabies. Applied to use with dry skin and after 6 hours washed with soap, then be repeated again 1 week later.
Lindane became famous for not irritating and easy to use. But the side effects of this drug can not be excluded. On the use of excess (repetitive use - again and laundering more than 6 hours) can cause increased absorption of the drug, as well as use in neonates and infants as well as use in conjunction with the use of hair oil. This resulted in toxicity that causes such symptoms in the CNS, headache, dizziness, nausea, termor, disorientation, muscle weakness, convulsions, breathing failure, even death. Some who had reportedly also be abnormalities in the blood, such as AZ anemia, thrombocytopenia, and pansitopeni (Karthikeyan, 2005). Because the resulting side effects, so that this group can become the drug of choice in the second or third scabies treatment.

5. Permethrin
Permethrin is a synthetic of pirethoid and potent insecticide. Permethrin is very effective against mites with a low toxic effect on mammals. These drugs work by disrupting the exchange of Na + that regulate nerve cell membrane polarization mites. So that will happen inhibition of repolarisasi and resulting in paralysis of the nerve cells mites (Rikyanto, 2001). Permethrin is absorbed in small quantities only through the cutaneous layer, rapidly metabolized by enzymes in the skin, and is excreted through the urine. 5% permethrin cream in the preparation, applied to the entire body once a week for 2 weeks. Left pengolesannya effective in 8 to 12 hours, then washed to clean. This drug is the latest and most effective for the treatment skabies, so that the drug of choice. Permethrin is safe to use on infants over 2 months and in nursing mothers. According to Karthikeyan (2005), from several studies indicate that permethrin has a high cure rates than lindane and krotamiton. Permethrin did not cause side effects of allergies, and in cosmetics can be accepted. Mild burning sensation or smell may arise dreadful, sometimes also causes skin redness, and itching, but it was only temporary (Cordoro, 2008). And the factors that limit the use of this drug, that the price in terms of permethrin is the most expensive compared to other topical medications scabies.
6. Ivermectin
Ivermectin, a derivative of avermectin B, is almost equal to the macrolides, but without the antimicrobial action. How it works through the suppression of nerve impulse conduction in nerve-muscle synapse in the mites with stimulation of gamma amino butyric acid (GABA) from nerve endings and presinaps bind to receptors on postsinaps. Preparations ivermectin in capsule form at a dose of 3 mg or 6 mg. Feeding at a dose of 0.2 mg / kg single dose. When are repeated, preferably 7 - 14 days after the first delivery. The effectiveness of these drugs quite well with good healing and reduced the former - former pruritus. The drug is rapidly absorbed, metabolized in the liver and excreted through feces. Absorption can be improved if ivermectin eaten with fatty foods (Chosidow, 2006). Ivermectin is safe with side effects of a single dose was not significant. According to research conducted Meinking, et al (1995), giving a single dose of ivermectin is effective in treating patients who skabies on "healthy" and in some patients with HIV infection. Giving dikontrandikasikan in patients ivermectin sensitive and allergic to these drugs, patients with CNS disorders. Also this drug is not indicated in pregnant and lactating women, children under 5 years old or weighing less than 15 kg.
Ivermectin therapeutic potential of scabies choice. To further topical ivermectin began to be used in the skabies therapy.
In patients skabies krustosa and also patients with HIV, treatment is needed for a long time. Giving peroral sufficient ivermectin to treat scabies effective, but require multiple doses and in combination with the drug and can be added topical to keratolitik existing hiperkeratosis (Karthikeyan, 2005).
Some problems that can arise in therapy. According to Karthikeyan (2005), among other problems that remain itch feels post-therapy, and treatment failure. Persistent itch can be reduced by giving antihistamines or topical steroids delivery / oral (Cordoro, 2008). And treatment failure can occur because of: providing an inappropriate, inadequate provision, reinfestasi, and reinfection.

Prognosis
With proper diagnosis and appropriate treatment and adequate, the prognosis of recovery from scabies infection quite well. In imunokompromise patients can increase the risk of scabies krustosa, where it will affect the prognosis.

skin : scabies 8 Management

2009-08-25T08:07:00.000-07:00

Management
Generally divided into antiskabies drug topical medications and oral medications. Scabies treatment as important in making the right diagnosis. The main therapy is a drug - skabisidal topical medications. Some of the things considered in patients handling, among others (Karthikeyan, 2005):
• definite diagnosis
• Medical treatment is appropriate
• Provide drug evenly throughout the body.
National guidelines recommend that treatment be done in the whole body's skin, without exception. Give more attention to areas where there are tunnels or mites that often arise (Anon, 2007).
• Treat all people close or frequent contact with patients.
• Provide medical explanations given verbally and in writing to the patient.
• Treat secondary infection exist.
• Do control over one and four weeks after treatment
• Wash clothes and bedding after treatment is completed.
In addition patients should also be informed about how the use of drugs skabisid. Some things that need to be informed and advised in patients (Karthikeyan, 2005):
• Starting with a regular shower and dried to perfection later.
According to Webster (2007), bath with warm water may increase the systemic absorption of most drugs can trigger scabies and irritation reactions.
• Topical treatment given to certain lubricated the entire skin.
In the areas under the fingernails, can be assisted by lubricate nail brush or a small toothbrush (Webster, 2007).
When will wash their hands or other body parts during treatment, then afterward must re lubricated in the area (Anon, 2007).
• Treatment is best done at night before bed.
• Better for people with children - children remain at home until treatment is complete. And the baby needs more attention so as not to lick the drug spread (Anon 2007).
• Avoid touching the mouth and eyes with his hand directly.
• In women who are breastfeeding, before feeding the nipple should be cleaned from the existing topical medications, to then return after feeding lubricated (Anon, 2007).
• Change underwear, clothes, sheets, and pillowcases and washed the next day.
Clothing, towels and bed linen should be washed with a washing machine at a temperature of 50o C or above after starting treatment. It is expected to kill the mites that may exist. For clothes that had not been washed, should be stored in a plastic bag for 72 hours to accommodate these mites to death. Another alternative is to kill mites on clothing or sheets with iron with a high temperature, dry cleaning, or put in dryer with a high temperature for 10 - 30 minutes (Anon, 2007)
• The itching will still feel in a few days, but do not need to repeat the treatment performed.
• Each person in the house or close and frequent contact with patients should be treated in the same time.
• Control back to the treating doctor in a week.

skin : scabies 7 Examination Support

2009-08-25T07:59:00.000-07:00

1. Laboratory
On microscopic examination, expected to be found in the mites, either in the form of adults, larvae, or eggs through the skin scrape. The procedure of the microscopic examination through the skin is scrape (Cordoro, 2008):
- Mineral oil dripping on the glass object. Then with a scalpel blade no. Spoon curette 15 or 7 mm, after it is applied to the oil, carried out at scrape skin lesions found, mainly primary lesions, such as vesicles, papul, and tunnels. Avoid the occurrence of bleeding.
- Results scrape was then placed on an object glass and covered with glass for the deck and then examined on a microscope with magnification 400 x.
scrape skin can be done over and over again for more help in finding scabies (in various stages) or product (skibala, broken eggs). In scabies krustosa patients, may be added potassium hydroxide (KOH) to dissolve the keratin that is the skuama, but required a more thorough examination.
To find the existence of the tunnel (Burrow) on the skin, can be known by the following test (Cordoro, 2008):
- Test the ink; tip ink pen / ink dripped on the suspected area of the tunnel there. The ink is then going to fill the tunnel, unlike the surrounding area. The ink is cleaned out with alcohol. This method is useful in children - children and patients with a very small tunnel.
- Alternative ink tests (using tetracycline ointment) is an alternative topical tetracycline in ink testing. After smeared with tetracycline and cleaned with alcohol, the suspected area was examined under Wood's lamp. Tetracycline is left in the tunnel would cause flourensi yellowish color. This method is preferred because it is colorless and tetracycline skin area can be examined more widely.
Other laboratory tests can help diagnose include scabies (Binder, 2006):
- Increased levels of IgE and eosinophils in the blood.
- The health center can do a complete examination videodermatoskopi, epiluminens microscopy, and DNA amplification by PCR (polymerase chain reaction) using the ELISA method (enzyme-linked assay Immunosrbent).
2. Histopathology
Histological examination of scabies enough to determine a diagnosis, although there are a variety of arthropods reaction. If found in a tunnel, then the mites, larvae, eggs, and can be identified in skibala stratum korneum. Infiltrates of the superficial skin layer and a deeper, composed of lymphocytes, histiosit, mast cells, and eosinophils. Sometimes also obtained spongiosis and vesicle eksositosis composed of eosinophils and neurofil.
In scabies krustosa indicates massive hiperkeratosis stratum korneum with mites in large numbers and in various stages. Sometimes psoriasiform hyperplasia was also found under a layer of the epidermis with focal epidermal spongiotik and mikroabses. Dermis layer, chronic inflammatory infiltrates seem superficial and deep with some interstitial eosinophils (Cordoro, 2008).

skin : scabies 6 diagnosis

2009-08-25T07:52:00.000-07:00

According to Handoko (2007), the diagnosis can be established if scabies found 2 of the 4 cardinal signs as follows:
• Proritus nokturna, means itching at night. This is caused by mites that activity was higher in the more humid conditions and higher temperatures, and it happened at night.
• Attacking a group of human beings. Where scabies not only suffered by the patient, but also about the entire family or transmitted to people - the closest.
• The discovery of the tunnel (kunikulus) in place predileksi lesions. Tunnels are usually white or gray - gray, straight line or curved - curved, with the average length - average 1 cm, and at the end of the tunnel is often found in vesicles, papules, or pustules.
• The discovery of mites, both in the form of eggs, larvae, or adults. This is the most diagnostic points.
From the clinical manifestations described above, which includes the classic scabies, still there are many forms - a special form of which can be found skabies (Rikyanto, 2001):
1. Scabies on the net (clean scabies)
Usually very hard to find the tunnel. Lice are usually lost due to bathe regularly.
2. Scabies in infants and children
Scabies lesions in children can be about the entire body, including the entire head, neck, palms, soles of the feet, and often secondary infection of impetigo, so that the tunnel ektima rare.
3. Scabies which is transmitted by animals
Sarcoptes scabiei canis variants can infect humans who work closely with these animals, such as farmers and pastoralists. Mild symptoms and will heal themselves when away from the animals - these animals and bathe with clean (Maskur, 2000).
4. Scabies nodular
Nodules due hipersensivitas reaction. The place is often subject to male genitalia, groin and axilla. Lesions that arise can stay a few weeks to several months, even up to a year despite having received anti scabies (Maskur, 2000).
5. Scabies incognito
Topical medication or systemic steroids may mask the symptoms and signs while scabies infestations remain. In contrast, treatment with topical steroids which can also cause long lesions intensified. This may be caused by the decline in cellular immune responses.
6. Scabies lying in bed (bed-ridden)
Patients with chronic diseases and elderly people who are forced to stay in bed may suffer a lesi limited scabies.
7. Scabies krustosa (Norwegian Scabies)
Eritrodermi picture Lesi form, accompanied skuama generalized, erythema, and nail dystrophy. There are many Krusta, this form easily transmitted because the population is very high Sarcoptes scabiei and itching is not prominent. Often occurs in older people and people who suffer from mental retardation (Down's syndrome), low skin sensation (leprosy, and tabes dorsalis syringomelia.

skin : scabies 5 Clinical Symptoms

2009-08-25T07:45:00.000-07:00

Clinical Symptoms
Diagnosis of scabies be enforced from history (anamnesis) and physical examination on patients, especially the history of infestations of scabies, family history, and contact with previous patients. Classic manifestations of itching scabies includes a comprehensive and extraordinary and increasingly intense itching at night.
Scabies different distribution of lesions in children and adults. In adults, lesions are usually found on the flexor of the arm, between - between fingers, back of legs, armpits, elbows, hips, back and genital area. Papul the itching and vesicles can be found on Glan scrotum and penis in males and breast (areola) in women is a characteristic of the lesion scabies. Lesions in infants and children - children grow more in the head, face, neck, palms, though it may also spread in other regions (Cordoro, 2008).
Presence of nodules and the tunnel (in the armpits or genital area) is a typical picture of scabies, but can also not be found. Secondary lesions that are not specific, such as excoriate, eczema, or impegtinasi, may be found in patients (Chosidow, 2006).

skin : scabies 4 pathogenesis

2009-08-25T07:39:00.000-07:00

Pathogenesis
Skin disorder that occurs from scabies was not only due to mites, but also by patients themselves, which is due to do scratching.
Mites (Committee) to move into the top layer of skin by removing the protease enzyme that can be thinned stratum korneum. They live from damaged tissue rather than blood sucking. Skibala (feces) are left behind when he passed the epidermis, forming lesions clinically shaped tunnel liner. Skibala causes sensitization of the skin, causing itching complaints (Cordoro, 2008).
The incubation period varies skabies, there are a couple of weeks and even months - months without showing symptoms. Sensitization of the mites will take approximately 4 to 6 weeks after the first mite infestations. Infestations of this first hipersentivitas reaction type IV, which is a reaction to the mites, eggs or skibala of these mites (Maskur, 2000). At this moment arises that resembles the skin disorder dermatitis with the finding papul, vesicles, hives, etc., which can occur with erosion scratching, ekskoriasi, krusta, even a secondary infection (Rikyanto, 2001).
At the time of this onset, the patient can infect at least within one month before being diagnosed with skabies. This means that transmission can occur in anyone who had contact with patients.
Scabies mites can not fly or jump away, but they can travel with average speed - average 2.5 cm / min in the warm skin. At room temperature with sufficient humidity, mites can survive 36 to 48 hours and still have the ability to infect and make a tunnel lesions (Chodisow, 2006). Was at a temperature of 20o C, the mites become immobile, but still can survive for a longer time (Cordoro, 2008).
Scabies transmission can occur either directly or indirectly. Direct transmission is due to skin contact with the skin (skin to skin contact). Because it did, it can be classified in scabies sexually transmitted diseases. According Chodisow (2006), from studies ever of the risk factors scabies transmission through sexual intercourse, that people at high risk for infection scabies on people - people who often relate the same sex (homosexual) or who frequently change - change partners. But there is no evidence that can be transmitted scabies with HIV.
Indirect transmission usually occurs through objects - objects related to the patient as the bedding, clothes, towels, pillows, and so forth.

skin : scabies 3 etiology

2009-08-25T07:35:00.000-07:00

Etiology
Scabies caused by Sarcoptes scabiei. Sarcoptes scabiei including the phylum Arthropoda, class Arachnida, order Ackarima, Sarcoptes super family. Sarcoptes scabiei derived from the Greek, which means that sarx koptein meat and that means cutting, and also from the Latin word meaning scratched scabere (Cordoro, 2008). Scabies who attack people of Sarcoptes scabiei variety hominis. In addition there is S. scabiei others, such as the goats and pigs. Sarcoptes scabiei var hominis was found by Italian biologist named Diaconti Cestoni in the 18th century (Handoko, 2007).
In morphologies S. Mites Scabiei is small, oval, convex back and abdomen flat. Mites are translucent, white, dirty, and no eyes. Female mites have a larger size than males, it ranges from 0.3 to 0.4 mm, where the male mites only about half the size of it. Form of adult mites have four pairs of legs, two pairs of front legs as a means to stick, and two pairs of legs on females both ends with hair, was on the third leg of male couples end up with hair and a fourth as a adhesive (Handoko, 2007).
Movement of mites in the skin causing a very itchy feeling and led to similar reactions with allergic reactions. Produced eggs produce allergic response that causes itching feeling better (Morgellons, 2007).
Skabies only occurs when there is S. scabiei males and females into the skin. After a copulation, S. scabiei males will die and the females will continue to live. Then the female mites enter the skin and create a tunnel (tunnel) in the stratum korneum speed from 1 to 5 mm / day. In these tunnels female mites will lay eggs 3 to 4 eggs a day until you reach number 40 or 50 grains. Fertilized female forms can live a month. Eggs will hatch, usually within 3 - 5 days. And the larvae have three pairs of legs. After 2 - 3 days, the larvae become nymphs with 4 pairs of legs. Life cycle from egg to adult form takes between 8 to 12 days. Adult mites will come out of the tunnel to find his partner (the event usually occurs at night). If mites are not in the skin, so he can live in clothing, sheets, or towels for 2 or 3 days, so in this period that may arise reinfection (Rikyanto, 2001).

skin : scabies 2

2009-08-25T07:31:00.000-07:00

Definition
Scabies is a skin disease due to mite infestations and sensitization Sarcoptes scabiei hominis and product variants on the body (Siregar, 2005).

Synonym
Human Skabies often also called scabies (gudikan), Ampera disease, itching Agogo, budukan, the Itch, Seven-Year Itch, intense pruritus, nocturnal pruritus (cakmoki, 2007).

Epidemiology
It is estimated that an epidemic or pandemic of scabies occurred in 30-year cycle. However, because scabies not a disease that routine in the recording, and the information there is also wide - types, making it difficult to ensure the incidence of scabies. Several years epidemic ever reported 1919-1925, 1936-1949, and 1964-1979. Scabies also is a disease found in tropical and subtropical regions. High prevalence figures in the Aborigines in Australia, in South America, and in some developing countries around the world (Binder, 2006). And in developing countries, can appear as scabies epidemic cases in the hospital, nursing home, or at primary health facilities (Karthikeyan, 2005).
Although scabies often occurs in a younger population, but actually scabies can attack all ages, all races, all socioeconomic levels, and with equal probability between men and women. The spread scabies not directly related to one's hygiene, but more related to poverty and population density (Binder, 2006).

skin : scabies 1

2009-08-25T07:15:00.000-07:00

For ordinary people, the term zoonoses is still a foreign thing. But basically, have a sense as zoonotic animal diseases that can be transmitted to humans. One of them who is still an issue in the scabies skin health. Scabies is not a disease in animals, but a disease affecting humans caused by animal parasites. Scabies in humans is an infestation of disease is very itchy skin caused by parasitic infection, in this case of mites (committee).
Scabies cases spread throughout the world is estimated at 300 million cases per year. Scabies can appear in men or women, at all ages, all ethnicities, and also at all levels of socio-economic life (Chosidow, 2006). More than 2500 years ago, has become scabies skin problems in humans. At first, the Romans used to indicate the limits scabies the itchy skin disease. Aristotle discussed the "lice in the flesh" contained in a vesicle. In the 17th century, precisely in 1687, Giovanni Cosimo Bonomo explain the disease caused by mites (Committee) is. This is a disease in humans for the first time unknown causes due to the typical (Binder, 2006).
Currently, scabies restriction leads to skin lesions caused by mites (committee) this. Enforcement scabies early diagnosis is still difficult, inadequate treatment of the patient, and the environment suspected as the main cause of this disease developing. Clinical scabies closely resembles the other skin diseases, so often associated with other skin diseases it. This often led to late diagnosis.

Scabies is widespread health problems, can strike all ages, and socioeconomic groups. Delay in diagnosis and treatment and low education about a very important role to scabies prevalence of these scabies. Worldwide prevalence estimated 300 million cases per year. Average - the average prevalence was higher in children - children and individuals with an active sexual activity than other groups. According Chosidow (2006), from a study in the UK, scabies show a high prevalence in the population of these cities and are women and children - children. Scabies This is more common in the rainy season than the summer. Patients with such a weak condition in leprosy, and patients with immune low condition (immunocompromissed) as in the case of post-transplant, HIV disease, and elderly patients are at high risk of this disease.

treat melasma : 10 Conclusion

2009-08-18T05:23:00.000-07:00

Hiperpigmentasi skin is a problem that many patients found the therapy to look for cosmetic reasons. Hiperpigmentasi interference that often complaint patients hiperpigmentasi is melasma and post-inflamasi. Melasma is hipermelanosis which usually occurs in areas affected by the sun.
The cause of melasma is ultraviolet rays, hormonal, drug, genetic, race, cosmetics, pregnancy and idiopathic. Pathogenesis melasma associated with many different fields of science, such as biology, biochemistry, pathology, and patofisiologi process pigmentasi skin, both at the cellular level, biomolekular, skin and tissue. In addition, knowledge of the pathogenesis is very important to establish the diagnosis and treatment
Melasma diagnosed only with clinical examination. To determine the type of melasma, Wood-ray examination is done. While the examination histopatologik only done in some cases.
Hiperpigmentasi treatment in general and in particular melasma, usually because of cosmetics, for their own lesi never give subjective complaints.
In addition to the curtain and use the sun to prevent melasma, the use of cream containing tretinoin, kojik acid and acid azeleat has showed improvement of melasma. Sometimes recommended for chemical peels or use a steroid cream topical. In the case of a heavy, laser treatment can be used to eliminate hiperpigmentasi.

treat melasma : 9 handling

2009-08-18T04:32:00.000-07:00

Handling
Melasma is an aberration in a difficult therapy. Pigment in melasma increased gradually, and it also requires a long time. Cases and chronicles recurrent and may often occur in people who are often exposed to sunlight exposure. All light waves from the sun, including visible spectrum can cause the occurrence of melasma.
Hiperpigmentasi treatment in general and in particular melasma, usually because of cosmetics, for never giving lesi subjective complaints.
Some of the actions of prevention are:

a. Avoid the sun. This is usually done with conventional ways, such as wearing a hat with a wide or paying or using screen sun (sunscreen)

b. Stop the use of contraceptives.
In addition to the curtain and use the sun to prevent melasma, the use of cream containing tretinoin, kojik acid and acid azeleat has showed improvement of melasma. Sometimes recommended for chemical peels or use a steroid cream topical. In the case of a heavy, laser treatment can be used to eliminate hiperpigmentasi.
Pandhi research conducted to evaluate the comparative treatment topikal in melasma treatment. Melasma from 50 patients taken at random, divided into 5 group (10 people per group). Evaluation of drug treatment of clobetasol propionate 0.05%, 0.025% tretinoin, hydroquinone 2%, benzoil peroxide 5% and glycolic acid 10% show the effectiveness of each drug. Effectiveness of drugs is highest clobetasol (80%).
Research other states that have the alpha hydroxyl acid is the right choice in the treatment of melasma suitable for Asian and Latin skin. Research that is conducted Satiti success kojik acid cream 2% can be used as alternative therapy melasma. Melasma can be difficult cured, melasma pigment form slowly and it is slowly.
Topikal range of treatment for melasma, including:

a. Hidroquinon
Hidroquinon is a chemical that impedes hydroxyphenolic so tyrosinase conversion decreased DOPA into melanin. Hidroquinon can be applied in the form of a cream or mixed with a solvent solution. Concentration allowed in the United States is 2%, without a prescription that is used for concentration of 4% or higher again. Hidroquinon related to the effectiveness of the degree of concentration but the side effects that occur along the increased concentration increased.
Other mechanisms that may be the way destructs, melanosit, melanosom degradation, and prevent DNA and RNA synthesis.
Hidroquinon used in the form of a cream-colored with a concentration of 2-50%. Cream is used at night, with the curtain in the afternoon sun. Generally appear to improvements in 6-8 weeks and followed up to 6 months.
Concentration that causes excessive skin irritation, reaction phototoksik with hiperpigmentasi post inflamasi and okronosis eksogen irreversible. Monobenzil ether causes vitiligo-like leukoderma a good lokalisata and general.Selain that, in hipopigmentasi can occur around the treated area. After the termination of the use hidroquinon, often relapse.

b. Retinoat acid (retinoic acid / tretinoin)
Acid retinoat 0.1% mainly used as additional therapy or a combination. Cream is also used at night, because during the day can occur fotodegradasi. Now retinoat acid is used as monoterapi and obtained a clinical improvement, although it take a while.
Retinoid trusted to work by increasing the turnover limit keratinosit and delivery melanosom to keratinosit. Major side effects of tretinoin is skin irritation, deskuamasi, photosensitive temporary and hiperpigmentasi paradoksikal. Combination with or without tretinoin corticosteroid topical has been promoted.
0,05-0,1% tretinoin pigmentasi with the transcript tirosinase hamper the functioning sintesis melanin. Tretinoin melasma can be effective in reducing the duration of 24 weeks. Tretinoin have any side effects, namely hiperpigmentasi secondary, and eritema irritation. Retinoid that can be used, among other adaphalen, tazarotene and isotretinoin topikal.

c. Azeleat acid (azeleic acid)
Azeleat acid is a drug that is safe to use. Azeleat acid treatment with 20% for 6 months to give good results. Side effects that can happen is feeling hot and itchy. There are no reports fototoksik reaction and fotoalergik on the use of acid azeleat.
Azeleat acid mechanism of action is not fully understood. Reduction DNA synthesis and cellular energy production mitokondria is the resistor in melanosit. Unlike hidroquinon, acid azeleat only work on melanosit the hiperaktif skin and does not affect the normal function melanositnya.
In a research report azeleat acid is as effective as with the hidroquinon 4% and without side effects. Acid azeleat combination with tretinoin or 0:05% 15-20% glikolat acid can accelerate the skin bleaching. Side effects that can happen is pruritus, eritema lightweight, and taste burnt.

d. Acid kojik
Kojik acid produced by fungus Aspergillus oryzae, and can prevent tirosinase. In the research found that a combination of acid kojik 2% with hidroquinon 2% more effective than the acid glikolat combined with hidroquinon 2%. Other research comparing glikolat acid 5% with 4% or hidroquinon acid kojik 4% for 3 months. -Combination before the combination is effective to reduce the hiperpigmentasi in 51% patients. Acid kojik can help patients hiperpigmentasi that does not fit with the other therapy.

e. Agent depigmentasi other
Depigmentasi other agents that have been examined in the treatment melasma is a 4-N-butylresorcinol, phenolic-thioeter, 4-isopropylcatechol and acid askorbat.

f. Combination therapy
Combination therapy is more effective than the use of one type of product. The cause of melasma is not fully known, so that combination therapy can be more effective for different degrees of therapy hiperpigmentasi one kind of product that is only effective on one hiperpigmentasi degrees.
The addition of tretinoin can increase the pigmentasi and keratinosit proliferation by preventing the oxidation of hidroquinon and improve epidermal penetration. Furthermore, the addition kortikosteroid topikal can reduce irritation and prevent melanin synthesis because cell metabolism will decrease. Combination hidroquinon 5%, tretinoin 0.1% and 0.1% had dexamethason known since 1975, with the name and formula Kligman. This formula is often used as combination therapy for melasma in the world.
Of a multicenter study, using random and double blind control trial showed that a combination of new hidroquinon 4%, tertinoin 0.05% and fluosinolon asetonid 0.01% (Tri-Luma, Galderma) that the result is better than other combinations with 2 or more products / agencies where 77% patients showed total recovery. The clinical, indicated a significant increase in the minimum and maximum of 4 weeks for 8 weeks. Side effects that is common is a mild local irritation, eritem.

g. Specific therapy in pregnancy
Melasma therapy in pregnant women should be done after the birth. This is because, melasma to be more resistant to treatment because of factors such as spark hormones during pregnancy is still high. Then, therapy is also beneficial because it does not become predileksi occurrence melasma also increased after birth and the most important therapy for melasma is kontraindikasi pregnancy.

In addition to the treatment used topikal, the systemic treatment can also be done include:

a. Askorbat acid (vitamin C)
Vitamin C has the effect of oxidation of melanin into the form of a reduction of melanin color is bright and prevent the formation of melanin to alter DOPA into DOPA quinon.

b. Glutation
Glutation form of reduction is sulfhidril compound (SH) that can potentially prevent the formation of melanin to the road to joining Cuprum (Cu) from tirosinase.

Special measures for melasma therapy can also be used as therapy options, among others:

a. Peel chemical
Peel chemical treatment can help hiperpigmentasi aberration. peel chemical smear done with acid glikolat 50-70% for 4-6 minutes should be done every 3 weeks for 6 times. Before the chemical peel, first given sour cream glikolat 10% for 14 days.

b. Surgical laser
Surgery using the laser Q-switched Ruby laser and Argon. relaps can occur. Hiper-treatment techniques pigmentasi with laser Qight amplification by stilulated emition of radiation) is a development of the current. Laser work monokromik emit high intensity, coherent source of energy that diabsorpsi by water, hemoglobin and melanin in the skin, to the kromophor. Absorpsi energy kromophor damage. Wavelength laser and set the lead in penetration and target kromophor.
Based on the spectrum absorpsi melanin, laser Q-switched ruby (694 nm) laser is an appropriate treatment for lesi hiperpigmentasi. Side effects of laser treatment including not feeling comfortable, redness, swelling, and hiperpigmentasi post-inflamasi. Patients should always be a spot test before treatment is done in full.

c. Intense Pulse Light (IPL)
Derivat of treat laser is Intense Pulsed Light (IPL), in pulsasi berintensitas with high wavelength (515 -1200 nm), which emanated by the light energy delivered to the skin. IPL energy is released to the dermis and diabsorpsi by kromophor. IPL has shown that work well for medical treatment for lentigines but melasma is not yet appropriate expectations. IPL treatment side effects are pain, local irritation and hiperpigmentasi post-inflamasi.

Prognosis
Melasma often disappear after a few months termination contraceptives, hormonal replacement therapy or after the birth. Melasma may relapse again if pregnant or use drugs that can spur melasma.
Melasma type dermis may take longer than the type of repair for epidermis because there is no effective treatment for the pigment in the dermis. Source of pigment from the epidermis is the dermis. Therefore, if the melanogenesis epidermis can blocked for some time, not pigment dermis and fill will slowly peter out. resisten cases and relapse often occurs and has been the prevention of contact with the clear sunlight to total no more needed.

treat melasma : 8 diagnosis

2009-08-18T04:25:00.000-07:00

Melasma Diagnosis
Melasma diagnosed only with clinical examination. To determine the type of melasma, Wood-ray examination is done. While the examination histopatologik only done in some cases.

Melasma Diagnosis Letter
a. Addison Disease
Addison disease is a disease caused insufiensi adrenal, where the increase occurred between kortikotropin and MSH, which is marked by symptoms that are often not typical, such as stiff-stiff, weak, anoreksia, Nausea, stomach aches, Gastroenteritis, diarrhea and emotions that are not stable. Insufiensi adrenal is triggered by infection or destructs autoimmune nonspecific on the adrenal gland. Diseases that often cause infection of Addison disease is tuberculosis. There is destructs cortex adrenal cause feedback inhibition hypothalamus gland and anterior pituitary lost, the consequences kortikotropin sekresi ongoing. Kortikotropin MSH and progenitor of both components is the same hormone. When kortikotropin parsed from prohormon, together with the MSH released. Consequences arising hiperpigmentasi crimson / bronze (Bronze hyperpigmentation) that way.
b. Drug induced photosensitivity is kutaneus disease as a result of the combination of chemical reaction and light, where the actual exposure of one of them does not cause disease. This disease is usually because of drugs or chemicals or systemic topical.
c. Discoid lupus eritematous (LED) is a disease that attacks the system connective and vascular caused autoimmune process and the interaction between genetic factors and immunologic, virus infection and hormonal. LED going on which The speck in the skin eritematosa and atrophy without ulserasi. Deviation localise usually symmetrical in the face, ears or neck.
d. Hiperpigmentasi post-infection occurs after inflammation of the skin. Aberration is very common and tend to settle on the dark skin. The clinical hiperpigmentasi can be found following the pattern and distribution of skin disease.
e. Efelid aberration is a form of skin The speck-The speck of black or brown in areas exposed to sunlight. It was revealed that familial factors are autosomal dominant, and usually occurs in the summer. Localization on the face, neck, shoulder, back and hands.
f. Ookronosis the pigment in the dermis hill that often occur because the stack metabolite hidrokuinon in the dermis.

treat melasma : 7 Laboratory examination

2009-08-18T03:38:00.000-07:00

Melanin can be seen in the epidermis or dermis using Wood rays (wavelength 340-400 nm). Epidermal pigment will changed when examined with Wood rays are not in the dermal pigment. In the dermal, will melanin appear black blue. On someone with dark brown skin-black, with checks ray lesi Wood does not appear on the patient so that this referred to as type intermediet.
Usually there is no specific laboratory examination for melasma. Tiroid inspection functions can be done if there are indications. Examination with the Wood-ray can help in determining the location of pigment in the epidermis or dermis. In the case of some pigment found in both locations.

According Supardiman (2007) support the examination can be done on people with melasma are: 6
1. Histopatologik examination. With histopatologik examination, can be 2 types hipermelanosis, namely:
a. Epidermal Type: increase the amount of melanin found mainly in the suprabasal layer of basalt and, sometimes in the stratum spinosum to stratum korneum. Cells that contain melanin is concentrated melanosit, cell-cell layer and suprabasal basalt, keratinosit cells and stratum korneum. In most cases, a number of melanosit not increased. Nevertheless, melanosit appear larger, more dendritic and more active.
b. Dermal type: there is makrofag bermelanin around the blood vessel in the dermis and the top down. At the top of the dermis there is a focus infiltrat.
2. Electron microscope examination. Electron microscope examination provides a description ultrastruktur melanosit in the basalt layer increases.
3. Examination with the Wood-ray (wavelength 340-400 nm). Examination with the Wood-ray can be divided into 4 types, namely:
a. Epidermal type: lesi see more color contrast
b. Dermal type: lesi color contrast does not increase
c. Type mix: lesi have increased the contrast, there is not
d. Type not clear: the Wood-ray, lesi not become clear, whereas with the usual ray clearly visible. Usually occurs in people with dark brown skin color, where the Wood lamp examination does not localise pigment.

treat melasma : 6 Clinical symptoms

2009-08-18T03:31:00.000-07:00

Melasma does not cause symptoms in addition to changes in skin color but the big problem may be cosmetic.
Melasma usually attack the women, only 1 out of 20 suffered by men. Melasma generally occur between ages 30 to 40 years. Melasma occurs in many people with darker skin.
Lesi melasma be a young makula brown or dark brown, with a boundary edge is not strictly regular. Lesi on dermal type melasma colored grayish or bluish. Predileksi often on the cheek and nose, called the fact pattern. Pattern found in the mandibular chin. While the pattern sentrofasial about the temple, forehead, eyebrow and top lip. A pattern that is rarely found on the border with arms which looks down on women who use progesterone and native American Indian.

treat melasma : 5 Classification

2009-08-18T03:20:00.000-07:00

According Supardiman (2007), melasma classified based on the clinical picture, the examination with Wood-ray examination and histopatologis.
1. Based on the clinical picture:
a. Form sentrofasial areas include the forehead, nose, the medial cheek, nose and chin down (63%)
b. Continuous forms of covering the nose and cheek lateral (21%)
c. Mandibular form covering mandibular region (16%).
2. Based on the examination with the Wood-ray
a. Epidermal type. On the type of melasma is more clearly visible with the Wood-ray diffraction compared with normal.
b. Dermal type. Type dermal rays Wood with no visible color contrast compared with the normal ray.
c. Type mixture. On the type of mixture, it appears some locations more clearly, while the other is not clear.
d. Type considered difficult because of dark skin color. This type of radiotherapy Wood, lesi become unclear. Differences in types this is the means of therapy. Dermal type more difficult than treated epidermal type.
3. Based on the examination histopatologis
a. Melasma type epidermal. Type of brown epidermal generally. Melanin mainly found in the basalt layer and supra basal. Sometimes there is melanin in the stratum corneum and stratum spinosum.
b. Melasma type dermal. Dermal type blue brown. In the dermal type macrophage melanin found around blood vessel in the dermis and the top down. In addition, at the top of the dermis there is a focus infiltrate.

treat melasma : 4 Etiology and Patogenesis

2009-08-18T03:09:00.000-07:00

Etiology melasma until now has not been definitely known. According Supardiman (2007), factors that are considered causative role in the occurrence of melasma is patogenesis:

1. Ultraviolet rays.
Spectrum sun damage this cluster sulfhidril in the epidermis which is the enzyme tirosinase resistor with the binding of the enzyme Cu ion is. Ultraviolet rays cause the enzyme tirosinase not dihambat again, so that drive the process of melanogenesis.
Other mechanisms that cause sun exposure can cause melasma is the ultraviolet ray radiation can cause cell membrane lipid peroksidasi so that the generated free radicals stimulate melanosit to release melanin. Curtain especially to block the solar UV-B radiation (290-320 nm) is not satisfactory because there is a wavelength that is longer on the UV-A rays and visible radiation (320-700 nm) have the nature melanosit stimulated to produce melanin.

2. Hormonal
Hormone estrogen, progesteron and MSH can stimulate the formation of melasma.
Hormones have an important role in the human body. On the mask of pregnancy is known in terms obstetrik. Certain mechanisms of melasma because of the pregnancy has not been known. Estrogen level, progesterone, and Melanosit Stimulating hormone (MSH) generally increased in the third trimester. However, in nulipara with melasma, and MSH estrogen level does not increase. Then, the occurrence of melasma because the use of oral contraceptives and diethylstilbestrol used for prostate cancer therapy has also been reported. In the research, women who get menopause will progesteron experiencing melasma, while women who got estrogen not only suffering from melasma, so that it can be proved that progesterone a role in the occurrence of melasma.
One study found that patients with the disease tiroid suffering from melasma. A report of cases also reported that melasma can occur in patients who have experienced emotional stress because of increased MSH produki by hipotalamus.

3. Drugs
For example difenilhidantoin, mesantoin, klorpromasin, sitostatik and minosiklin can cause the occurrence of melasma. Drugs in this collectedthe top of the dermis layer and can stimulate cumulative melanonogenesis.

4. Genetic
Reported cases of family around 20-70%. Genetic factors is a major occurrence of melasma. This occurred mainly in women than men. A person with brown skin and the young sun exposure will increase the excess occurrence of melasma. More than 30% of patients have melasma history of the family who suffered the same aberration. Identical twin trends have also been reported suffering from melasma.

5. Race
Melasma many found in the Hispanic and the dark skin color.

6. Cosmetics
Use of cosmetics that contain perfume, coloring matter or materials that can cause fotosensitivitas which can lead to the emergence hiperpigmentasi in the face if exposed sun.

7. Certain conditions, such as pregnancy and hormone replacement therapy during menopause.

8. Idiopatik.

Pathogenesis melasma is not yet clear, many factors that are considered causative role in pathogenesis melasma.
According Supardiman (2007), pathogenesis the occurrence of melasma involves many factors, such as:

1. Increased production of hormones or because melanosom because ultraviolet rays. Melanosom this increase can also be caused pharmacology materials such as silver and psoralen.

2. Retardation in Malphigian cell turnover. This condition can occur because drugs sitostatika.
Pathogenesis melasma associated with many different fields of science, such as biology, biochemistry, pathology, and patofisiologi process pigmentasi skin, both at the cellular level, biomolekular, skin and tissue. In addition, knowledge of the pathogenesis is very important to establish the diagnosis and treatment.

treat melasma : 3 Epidemiology

2009-08-18T03:05:00.000-07:00

In the case of melasma comparison between women and men is 24: 1, especially visible in the fertile with age women Exposure history directly affected the sun. Highest incidence at age 30-44 years, whereas according to Montemaro in 2001, 90% of cases occurred in melasma women, if any clinical symptoms in men and histologisnya same.
Research conducted by Goh and Dlova 1999 in Singapore, the ratio of melasma among women and men of 21: 1.
Melasma is a big problem for the East Asia, with skin type III or IV that is equal to 90%. Although the exact number of incidents in some countries is not known, but in East Asia is reported that the patient came to the clinic every year by the skin of 0.25 -40%.

treat melasma : 2 Definition

2009-08-18T03:00:00.000-07:00

Melasma is hipermelanosis which usually occurs in areas affected by the sun. Melasma derived from the Greek, which means the weld while cloasma black comes from the word cloazin, which means to be green, so that melasma more appropriate terminology is used to hiperpigmentasi in the face.
Melasma or khloasma is often called a hiperpigmentasi The speck that is often found in the region face the second cheeks, forehead, chin, mouth up, and can be extended up to the neck. Color can vary from brown to black youth and does not regularly shaped. Size also varies. Lesi usually symmetric, especially when the cheek, while spreading like a mask.
Synonyms of melasma is chloasma which sometimes used to describe the occurrence of melasma during pregnancy. On pigmentasi pregnancy can also occur in general, and often arise in the linea alba becomes a linea nigra, the areola mammae, and on the genitalia area eksterna. Hiperpigmentasi this is happening because of the increased level in the blood so that MSH stimulation occurred melanosit activity, is also estimated to increase estrogen and progesteron role in this interference pigmentasi.

treat melasma : 1

2009-08-18T02:50:00.000-07:00

Human skin color is a combination of several kromofor, the melanin that gives color brown, which gives oksihemoglobin red, which gives deoksihemoglobin blue carotene and the color orange-yellow. Melanin is the component that contributes most dominant color in the skin, so that interference is caused mainly by pigmentasi not have melanin pigment.
Melanin produced by cells melanosit located in the stratum basalis epidermis. Production of melanin occurs in the melanosit and then distributed to keratinosit around melanosit it. Main function of melanin is to absorb ultraviolet radiation. Differences in skin color of different races is not determined by the number of melanosit but depend on the metabolic activity melanosit, the size and shape melanosomnya the organela forming melanin.
Hiperpigmentasi skin is a problem that many patients found the therapy to look for cosmetic reasons. Hiperpigmentasi this is the result of deposisi melanin in the skin caused by increased synthesis or increased the number of melanosit. The many changes color depending on the location of melanin in deposisi. Hiperpigmentasi interference that often complain from patients hiperpigmentasi is melasma and post-inflamasi. These conditions have a major impact because the changes will affect the color of the face someone in the psychological, social life, and confidence.
Hiperpigmentasi determine the cause is very important in the approach to therapy. Based on history and clinical findings of patients, causes hiperpigmentasi likely due to post-inflamasi factors, drugs,
photosensitive agents, ultraviolet rays or systemic disease (eg, Addison disease, liver disease, pregnancy, tumor pituitari). So that the treatment interruption pigmentasi this can succeed, the agent must be determined and it is managed well.
Beauty is not only seen from the outside, but beauty is in support of the creation of a person to appear beautiful. Beauty also need to be outside, because of the line with the age, beauty could be someone outside the pale. One difference that can change the skin of someone's appearance is melasma.
To date, the melasma is still a problem in both the cosmetics and the skin disease in the clinic, this is because handling a difficult and requires a long time.

surgical epidural hematom: 9 conclusion

2009-08-11T23:11:00.001-07:00

Hematoma epidural is one of the cases emergency the need to obtain strict control because it can cause permanent disability and life threatening if not get the handling of the operation. Hematoma occurred in the space between the dura mater and the bottom tabulation of the skull bones.
Typical symptoms of hematoma epidural, namely the existence of lucid interval, where there is conscious phase between phases is not aware. And enforcement of the diagnosis based on clinical findings and of the scanning head to this day is still the gold standard for diagnosis support HED.
Action surgical evacuation can be done after the volume and location based on the results of head CT scan.
When you get the handling right and appropriate, the prognosis of patients with hematoma epidural is very good and can recover as usual.

surgical epidural hematom: 8 Complications & Prognosis

2009-08-11T23:06:00.000-07:00

Complications
Many complications may arise from the case of HED. When the brain herniasi, arterial - arterial anterior and posterior brain can be stopped, for the next infark can cause the brain (Ullman, 2006).
In some cases, patients with HED behavior changes can occur after several hours to days after injury. In addition, when handling and do not get adequate, then patients with HED may vegetative status or even death (Price, 2006).

Prognosis
After the blood clot is taken, for the next patient is treated in the ICU room, in which control more secure. Sometimes necessary to use ventilator patients are conscious and able to breathe by itself. Rating neurology the frequent important to determine the degree of awareness. Particular treatment may be given to reduce interference and maintain brain pressure remained stable intrakranial (Anonymous, 2004).
Mortality figures for patients who do not have a comma before surgical action is 0 and about 10% for patients with disabilities and 20% for patients in a coma in (Price, 2006).
Although the results obtained up to 0% for mortality figures and 100% for the outcome with good function, but the overall number of patient mortality with HED around 9.4% - 33%, average about 10%. In general, the motor examination before the operation, GCS score, pupil reaction, and closely associated with its outcome in patients with acute HED when they can be saved (Ullman, 2006).
As important to remind that the healing of the injury is very long and gradual. It is important also to get enough rest and adequate nutrition while waiting for the process of healing.

surgical epidural hematom: 7 conduct operation

2009-08-11T22:59:00.000-07:00

Most of the hematoma epidural is a surgical emergency and must be evacuate as soon as possible. Because brain hematoma epidural under generally quite normal, every effort made to reduce the pressure as soon as possible to prevent brain damage. Outcome of surgery for the hematoma epidural is very dependent on the patient's clinical condition prior to evacuation operative. When clot large, or there is doubt on the extent of brain damage underneath, it is recommended to make craniotomy flap wide standard. In the case where the hematoma epidural clearly limited to one Regio and where there is not accompanied by subdural bleeding on the CT scan appears, flap craniotomi a small modification can be used (Saanin, 2007).
HED with volume of 30 ml, 15 mm thickness and require surgical evacuation action because almost most of the patients with the HED of this kind shows that the level of awareness and poor showing signs - signs lateralisasi (Ullman, 2006).
Location is also an important factor in determining the operative. Hematoma in the Temporal, if the size or spread, can cause herniasi and cause disorients more quickly. HED in the posterior fossa, which is sometimes associated with the dissolution lateral sinus venosus, which requires surgery take action - the heart because the available space is very limited (Ullman, 2006).
In the period before the CT scan, the exploration drill often do, especially if the patient has shown symptoms lateralisasi or deorientasi quickly. Now, with a fast scanning techniques, such as how this is rarely done (Ullman, 2006).
Some circumstances be indicative actions Explore the drill hole (Price, 2006):
 intrakranial Hypertension instability with a heavy hemodinamik
 Alerts - sign herniasi start to appear
Not available  nerve surgeon for immediate consultation
 Trepanasi (or laying of the drill) should be done after consultation with the surgeon nerve, if possible, after residing in the central health.
 land or air transport is too long
Procedure in taking action to make the drill hole according to Price (2006) include:
 Make a deep hole, but not exceed, the broken bones in the skull or from the area indicated CT scan.
 If no CT scan, wimble placed on the side where the pupil is more dilatasi, 2 fingers to the anterior to the ear tragus and 3 finger over it.
In research conducted by Liu, et al in 2006, explained that with the evacuation drill holes and drainage with negative pressure is safe and effective for handling emergency the HED because trauma.

surgical epidural hematom: 6 handling and therapy

2009-08-11T22:35:00.000-07:00

Handling of HED depending on various factors. Side effects that may occur in the brain due to the mass by, among others, structural distortion, herniasi that threatens life, and increased pressure intrakranial (Ullman, 2006).
Two options in the handling of patients, namely 1. operative action immediately, and 2. initial observations, a conservative, and strict clinical supervision. HED notes that the speed has to be knowledgeable more quickly disbanding hematoma subdural, and patients have a very strict control, if steps taken conservative will (Ullman, 2006).
Not all cases get HED acute surgical action immediately. If lesi existing small and patients neurologist in good condition, with the supervision of the patient examination neurological the frequent be reasonable. Scanning the development can be done to assess the size of hematoma enlargement in the deorientasi. When it was found that increasing the size very quickly, then further surgical action is indicated (Ullman, 2006).

handling prehospital
According to Price (2006), actions taken prior to reaching the health center immediately control the situation - the situation can quickly threaten the lives and provide therapy suportif early. ABC control is the cornerstone that must be remembered. Then needs to be done vena access, the provision of oxygen, and strict supervision. Kristaloid per the provision of IV fluids to maintain blood pressure remains adequate. In addition, can also be done intubasi and sedative drugs, drugs neuromuskular appropriate resistor protocol.
- Use lidokain 1 mg / kg IV BB premedikasi as to prevent increased pressure intrakranial done intubasi time (Argyle, 1996).
- There are several responses about the increased mortality in patients with head injury Moderate to heavy intubasi done before in the hospital compared with patients in diintubasi Emergency Installation (IGD).
- Heating Ventilation mask the face with a good technique can be more beneficial for the brain injury compared with intubasi pre-hospital

handling in emergency intalasi
According to Price (2006), handling up to when the Installation of Emergency Access vena others, giving oxygen, strict supervision, and the liquid kristaloid important to maintain blood pressure remains adequate. This is the first step in handling the patient until after the health center.
Intubasi using Rapid Sequence Induction (RSI), which generally includes the use of lidokain, brain protective agent sedation (eg, etomidate), and agents neuromuskular resistor as premedikasi. Lidokain have a limited effect on the situation like this, even to this day can be spelled without the risk. Premedikasi using fentanyl may also be able to increase the pressure intrakranial. Intubasi should be done after the examination neurologik basis to facilitate oksigenisasi, to protect the roads of breath, and when necessary can be done hiperventilasi.
30o elevate the head of the bed is put back after, or with the reverse Trendelenburg's position to reduce pressure and increase the flow of intrakranial back vena.
Giving manitol 0.25 - 1 g / kg IV BB after consultation with the surgeon if the nerves of the average arterial pressure - average (MAP) greater than 90 mmHg with a sign - a clinical sign of increased pressure intrakranial ongoing. Manitol can decrease the pressure intrakranial (with a decrease in brain edema in osmotik) and viskositas blood, where it can improve blood flow to the brain circulation and oxygen. Fluid must be replaced and should be avoided hipovolemia (urin monitor output produced, it is better when using a down Catheter).
Hiperventilasi to the partial pressure of CO2 ( PCO2 ) 30 - 35 mmHg can alleviate signs - signs herniasi or increased pressure intrakranial, nevertheless, it is still controversial. A decrease in PCO2 should be - the heart that is not too far ( < 25 mmHg). Hiperventilasi given if it appears a sign - a sign of increasing pressure intrakranial progress and continue on sedation, paralisis, diuresis osmotik, and if possible serebrospinal fluid drainage. How to reduce pressure intrakranial with vasokonstriksi hipokarbi and decrease the risk of hipoperfusi cell death and the injury.
Phenytoin may decrease the incidence of spastic post-trauma, although it does not mean a strain on the go or a persistent disturbance.

medication
Some classes of drugs that can be given as a therapy or to prevent further occurrence of side effects (Price, 2006):

Group Diuretik Osmotik
Manitol (Osmitrol) given to maintain serum osmolalitas < 320 mOsm so that it can prevent the occurrence of kidney failure. Dose in adults is 0.25 to 1 gr / kgBB IV, and the dose for children in accordance with the calculation of body weight on the adult dose. Contraindicate of the drug among other drugs of this history hipersensitif before, anuria, the heavy congestion tuberculosis, dehydration weight, bleeding intrakranial of the active, progressive damage to the kidneys, sistolik blood pressure < 90 mmHg. The drug is given to the safe in pregnant women.

Group Antiepilepsi
Phenytoin (Dilantin) therapy is an option to profilaksi strain. Dose pemberiannya in adults is 17 mg / kgBB IV are mixed in with the NS infus no faster than 50 mg / min, and dose to the child - the child in accordance with the calculation of body weight of adult dose. This class can not be given to patients who have a history hipersensitif before, there is sinoatrial block, sinus bradikardi, AV block 2 and 3 degrees, or in patients with Adam-Stokes syndrome. The drug is not safe when given to women in situations that are pregnant.

surgical epidural hematom: 5 Diagnosis

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All that after the injury may not be able to understand the whole, they all can be supported with a thorough medical examination and diagnostic tests. Diagnosis of head injury based on physical examination and diagnostic tests. In the examination, a doctor can get more information from patients or their families and can ask how the injury occurred. Trauma to the head can cause interference neurologist and may be obtained after a medical check-up (Anonymous, 2004).
Diagnostic tests that can be done include:

1. Laboratory examination (Ullman, 2006).
Hematokrit rate, blood chemistry, coagulate factors (including number trombosit) is very important in the assessment of patients with HED, either spontaneously or because of trauma.
Head injury can cause a heavy deliverance tromboplastin network, which it can continue on the occurrence of DIC (Disseminated Intravascular Coagulation). Coagulate previous knowledge about the action required when surgery will be done. If necessary, factors - factors that are associated can be included before the operation & in the operations.
In the adult patients, the occurrence of HED rarely cause a decrease hematokrit a significant degree because the skull bones that have been set. In the baby, where blood volume is still limited, with the epidural bleeding skull bones who ekspansil with the suture still open can lead to loss of blood, which means. Because bleeding can cause instability hemodinamik, so that the necessary degree of monitoring hematokrit regularly and carefully.

2. Vetting radiologist
- Radiography (Ullman, 2006).
skull bones show a picture fracture drift shadow vascular branch of a. meningea media. picture fracture occipital, frontal or vertex is also sometimes found.
There is no guarantee fracture indicate the existence of HED. However, 90% of the cases related to the HED skull bones fracture. In the child - children, the number is smaller because the skull bones deformabilitas greater.
- CT - Scan head (Ullman, 2006).
CT scan method is the most accurate and sensitive in HED diagnose acute. Found a very unique. Space formed by HED layer is limited by dura to the bottom of the tabulation of the skull bones, especially in the suture line, shape description lentikuler or bikonveks. Hidrocephalus sometimes appear in patients with large posterior fossa.
Liquid serebrospinal not mixed with epidural bleeding, where bleeding is more homogeneous and visible dens. Quantity of hemoglobin in the hematoma also determine the number of rays of radiation absorbed.
picture density of hematoma in the brain compared with parenkhim change depending on the time after injury. In the acute phase picture hiperdens (picture bright in CT scan). Then the hematoma became isodens in 2 - 4 weeks, and subsequently became hipodens (dark picture). Many acute bleeding can be seen as a isodens or areas with low density, which shows the possibility of bleeding is in progress or the rate of low serum hemoglobin.
The picture on the air show HED acute fracture in the sinus or the mastoid space cavity.
About 10 - 50% of cases associated with the HED other lesi intrakranial. Lesi include hematoma subdural, contusion cerebral, and hematoma intraserebral.
At the time of surgery or the next otopsi, 20% of patients HED found blood on the epidural and subdural space. (Price, 2006)
- Magnetic resonance Imaging (MRI) (Ullman, 2006).
Acute bleeding in the MRI appears as a isodens, making it less suitable to detect the existence of bleeding due to acute trauma.
- Electroencephalogram (EEG) (Anonymous, 2004).

surgical epidural hematom: 4 clinical manifestations

2009-08-10T08:57:00.000-07:00

Most of the cases of HED was trauma, sometimes the form of blunt trauma to the head. Patients can prove the existence of previous head injury, such as the scalp laserasi, cephalohematoma, or contusion. Systemic diseases sometimes appear in the examination. Based on the severity of impact, the patient sometimes does not appear lost consciousness, lost consciousness in a short period of time, or lost the awareness that prolonged (Ullman, 2006).
Sign and symptoms of HED include heavy headache, nausea, vomiting, and enlargement of the size of one or both pupil (ipsilateral or bilateral) in accordance with the direction of head trauma or a sudden weakness of arm or leg. The sign of a more dangerous HED is increasing degrees nervous, like croon, confused, or the inability to wake up from the situation does not realize that in the (comma). Because the brain controls all functions of the body, changes the pattern of breath can occur. Short of breath - a short, gasping breathing, or a very slow breath is a sign warning that someone needs help (Anonymous, 2007).
Alerts appear in the lucid intervals of 20 - 50% of patients with HED. Originally the head injury that occurred the decrease in awareness. Once again improved awareness, HED continues to cause mass bleeding is increased pressure intrakranial, decrease the level of awareness of, and may cause the emergence herniasi syndrome (Ullman, 2006).
In the patients with hypertension intrakranial a heavy, a sign - a sign Cushing response may appear. Trias Cushing include the classic systemic hypertension, bradikardi, and respiratory depression. The response was usually start to appear when the brain perfused decrease because of the increased pressure intrakranial (Ullman, 2006).