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TREATMENT OF Ramsay Hunt syndrome
*Medical:
.Corticosteroids and oral acyclovir are commonly used .Recently,combined therapy using corticosteroids plus intravenous acyclovir did not show benefit over corticosteroids alone in promoting facial nerve recovery after 6 months. However, randomized clinical trials evaluating both therapies are required.
.Vestibular suppressants may be helpful if vestibular symptoms are severe.
.As with Bell palsy, care must be taken to prevent corneal irritation and injury.
.Temporary relief of otalgia may be achieved by applying a local anesthetic or cocaine to the trigger point, if in the external auditory canal.
.Carbamazepine may be helpful, especially in cases of idiopathic geniculate neuralgia.
*Surgical:
Surgical decompression of the facial nerve has no role in this syndrome.
INVESTIGATION OF Ramsay Hunt Syndrome
Laboratory Studies:
1.The diagnosis of Ramsay Hunt syndrome is usually made without difficulty when the clinical characteristics are present. If necessary, varicella zoster virus (VZV) may be isolated from vesicle fluid and inoculated into susceptible human or monkey cells for identification by serologic means.
2.WBC count, erythrocyte sedimentation rate (ESR), and serum electrolytes are helpful in distinguishing the infectious and inflammatory nature of this syndrome.
3.As CNS complications are suspected (eg, meningitis, meningoencephalitis, myelitis, arteritis [large and small vessel], and ventriculitis), spinal fluid analysis and CNS imaging studies are recommended.
4.Viral studies ,
.VZV isolation in conventional cell culture is considered the definite diagnostic test. However, growing VZV in cell culture can be difficult and is usually too slow to be clinically helpful.
The sensitivity of conventional cell culture is 30-40%, with a specificity of 100%.
.Other tests, including Tzanck test, electron microscopy, and polymerase chain reaction (PCR) are generally more rapid and sensitive. The sensitivity of conventional PCR technique is estimated to be 60%.
.VZV has been detected by PCR in the tear fluid of patients with Bell palsy (prevalence, 25-35%).
.VZV antigen detection by direct immunofluorescence assay (DFA) is also possible, with sensitivity of 90% and specificity close to 99%.5
.Antibody determinations on paired sera may be helpful in establishing the diagnosis by comparing titers at time of presentation and a few weeks later.
Imaging studies:
-Structural lesions can be ruled out by CT scan, MRI, or magnetic resonance (MR) angiography.
-Gadolinium enhancement of the vestibular and facial nerves on MRI has been described in Ramsay Hunt syndrome.
-Recent advances in clinical MRI images (eg, 3-Tesla MRI, multichannel phased array coil, 3-dimensional fluid-attenuated inversion recovery [FLAIR]) allow the evaluation of subtle alterations at the level of the blood-labyrinthine barrier.
Tests:
-Audiometry usually reveals sensorineural hearing loss.
-Unilateral caloric weakness may be present on electronystagmography (ENG).
-Electrodiagnostic methods, such as facial motor nerve conductions studies (electroneurography), electromyography of facial innervated muscles, the blink reflex, and nerve excitability testing, could add information regarding the extent of seventh cranial nerve (CN VII) involvement, as well as prognostic factors.
Procedures:
-In the setting of a peripheral facial palsy, cerebrospinal fluid (CSF) rarely is analyzed. Although lumbar puncture is not recommended in the diagnosis of this disease, CSF findings can be helpful in confirming the diagnosis. In one study, CSF findings were abnormal in 11% of 239 patients with idiopathic peripheral facial palsy, in 60% of 17 patients with Ramsay Hunt syndrome (abnormal finding was pleocytosis), in 25% of 8 patients with Lyme disease, and in all 8 patients with HIV infection. Thus, if the CSF is abnormal, a specific cause should be sought.
-Temporary relief of otalgia in geniculate neuralgia may be achieved by applying a local anesthetic or cocaine to the trigger point, if in the external auditory canal.
Histologic Findings:
-The affected ganglia of the cranial nerve roots are swollen and inflamed.
-The inflammatory reaction is chiefly of a lymphocytic nature, but a few polymorphonuclear leukocytes or plasma cells may also be present.
-Some of the cells of the ganglia are swollen and others degenerated.
1.The diagnosis of Ramsay Hunt syndrome is usually made without difficulty when the clinical characteristics are present. If necessary, varicella zoster virus (VZV) may be isolated from vesicle fluid and inoculated into susceptible human or monkey cells for identification by serologic means.
2.WBC count, erythrocyte sedimentation rate (ESR), and serum electrolytes are helpful in distinguishing the infectious and inflammatory nature of this syndrome.
3.As CNS complications are suspected (eg, meningitis, meningoencephalitis, myelitis, arteritis [large and small vessel], and ventriculitis), spinal fluid analysis and CNS imaging studies are recommended.
4.Viral studies ,
.VZV isolation in conventional cell culture is considered the definite diagnostic test. However, growing VZV in cell culture can be difficult and is usually too slow to be clinically helpful.
The sensitivity of conventional cell culture is 30-40%, with a specificity of 100%.
.Other tests, including Tzanck test, electron microscopy, and polymerase chain reaction (PCR) are generally more rapid and sensitive. The sensitivity of conventional PCR technique is estimated to be 60%.
.VZV has been detected by PCR in the tear fluid of patients with Bell palsy (prevalence, 25-35%).
.VZV antigen detection by direct immunofluorescence assay (DFA) is also possible, with sensitivity of 90% and specificity close to 99%.5
.Antibody determinations on paired sera may be helpful in establishing the diagnosis by comparing titers at time of presentation and a few weeks later.
Imaging studies:
-Structural lesions can be ruled out by CT scan, MRI, or magnetic resonance (MR) angiography.
-Gadolinium enhancement of the vestibular and facial nerves on MRI has been described in Ramsay Hunt syndrome.
-Recent advances in clinical MRI images (eg, 3-Tesla MRI, multichannel phased array coil, 3-dimensional fluid-attenuated inversion recovery [FLAIR]) allow the evaluation of subtle alterations at the level of the blood-labyrinthine barrier.
Tests:
-Audiometry usually reveals sensorineural hearing loss.
-Unilateral caloric weakness may be present on electronystagmography (ENG).
-Electrodiagnostic methods, such as facial motor nerve conductions studies (electroneurography), electromyography of facial innervated muscles, the blink reflex, and nerve excitability testing, could add information regarding the extent of seventh cranial nerve (CN VII) involvement, as well as prognostic factors.
Procedures:
-In the setting of a peripheral facial palsy, cerebrospinal fluid (CSF) rarely is analyzed. Although lumbar puncture is not recommended in the diagnosis of this disease, CSF findings can be helpful in confirming the diagnosis. In one study, CSF findings were abnormal in 11% of 239 patients with idiopathic peripheral facial palsy, in 60% of 17 patients with Ramsay Hunt syndrome (abnormal finding was pleocytosis), in 25% of 8 patients with Lyme disease, and in all 8 patients with HIV infection. Thus, if the CSF is abnormal, a specific cause should be sought.
-Temporary relief of otalgia in geniculate neuralgia may be achieved by applying a local anesthetic or cocaine to the trigger point, if in the external auditory canal.
Histologic Findings:
-The affected ganglia of the cranial nerve roots are swollen and inflamed.
-The inflammatory reaction is chiefly of a lymphocytic nature, but a few polymorphonuclear leukocytes or plasma cells may also be present.
-Some of the cells of the ganglia are swollen and others degenerated.
Chest Tube Placement
A chest tube insertion involves the surgical placement of a hollow, flexible drainage tube into the chest.
Chest tubes are inserted to drain blood, fluid, or air and to allow the lungs to fully expand. The tube is placed between the ribs and into the space between the inner lining and the outer lining of the lung (pleural space).
The area where the tube will be inserted is numbed (local anesthesia). Sometimes sedation is also used. The chest tube is inserted through an incision between the ribs into the chest and is connected to a bottle or canister that contains sterile water. Suction is attached to the system for drainage. A stitch (suture) and adhesive tape keep the tube in place.
The chest tube usually stays in place until the x-rays show that all the blood, fluid, or air has drained from the chest and the lung has fully re-expanded. When the chest tube is no longer needed, it can be easily removed. Most people don't need medications to sedate or numb them while the chest tube is removed. Antibiotics may be used to prevent or treat infection.
In certain people, the chest tube may be inserted using a minimally invasive technique guided by x-ray. Sometimes chest tubes are placed during major lung or heart surgery while the person is under general anesthesia.
Source: U.S. National Library of Medicine and the National Institutes of Health.
egyptian woman gives birth to 7 children
A 27-year-old Egyptian woman gave birth to septuplets early Saturday in the coastal city of Alexandria, family members and the hospital director said Ghazala Khamis was in good condition after having a blood transfusion during her Caesarean section due to bleeding, said Emad Darwish, director of the El-Shatbi Hospital where she gave birth.
This is a very rare pregnancy .Darwish decided to carry out the Caesarean section at the end of Khamis’ eighth month of pregnancy due to the pressure on her kidneys. He said Khamis, who already has three daughters, took fertility drugs in an effort to have a son.
Khamis, the wife of a farmer in the northern Egyptian province of Beheira, was admitted to the hospital two months earlier.“From the initial checkup, I say that none of the babies have any sort of deformities or incomplete organs,” Darwish said.
ULTRASOUND
What is an ultrasound?
Ultrasonography, which is sometimes called sonography, uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood blow through various vessels. Ultrasound procedures are often used to examine many parts of the body such as the abdomen, breasts, female pelvis, prostate, scrotum, thyroid and parathyroid, and the vascular system. During pregnancy, ultrasounds are performed to evaluate the development of the fetus.
How are ultrasounds performed?
Ultrasounds may be done on an outpatient basis, or as part of inpatient care. Although each hospital may have specific protocols in place, generally, an ultrasound procedure follows this process:
1.A gel-like substance is smeared on the area of the body to undergo the ultrasound (the gel acts as a conducer).
2.Using a transducer, a tool that sends ultrasound waves, the ultrasound is sent through the patient's body.
3.The sound from the transducer is reflected off structures inside the body, and the information from the sounds is analyzed by a computer.
4.The computer then creates a picture of these structures on a television screen. The moving pictures can be recorded on film videotape.
5.There are no confirmed adverse biological effects on patients or instrument operators caused by exposures to ultrasound
Ultrasonography, which is sometimes called sonography, uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood blow through various vessels. Ultrasound procedures are often used to examine many parts of the body such as the abdomen, breasts, female pelvis, prostate, scrotum, thyroid and parathyroid, and the vascular system. During pregnancy, ultrasounds are performed to evaluate the development of the fetus.
How are ultrasounds performed?
Ultrasounds may be done on an outpatient basis, or as part of inpatient care. Although each hospital may have specific protocols in place, generally, an ultrasound procedure follows this process:
1.A gel-like substance is smeared on the area of the body to undergo the ultrasound (the gel acts as a conducer).
2.Using a transducer, a tool that sends ultrasound waves, the ultrasound is sent through the patient's body.
3.The sound from the transducer is reflected off structures inside the body, and the information from the sounds is analyzed by a computer.
4.The computer then creates a picture of these structures on a television screen. The moving pictures can be recorded on film videotape.
5.There are no confirmed adverse biological effects on patients or instrument operators caused by exposures to ultrasound
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