Introduction to Mumps

 Pediatrics  Comments Off
May 312011
 

Also known as infectious or epidemic parotitis, mumps is an acute viral disease caused by a paramyxovirus. It’s most prevalent in unvaccinated children between ages 2 and 12, but it can occur in other age-groups. Infants younger than age 1 seldom get this disease because of passive immunity from maternal antibodies. Peak incidence occurs during late winter and early spring.

The prognosis for complete recovery is good, although mumps sometimes causes complications.

Causes

The mumps paramyxovirus is found in the saliva of an infected person and is transmitted by droplets or by direct contact. The virus is present in the saliva 6 days before to 9 days after onset of parotid gland swelling; the 48-hour period immediately preceding onset of swelling is probably the time of highest communicability.

The incubation period ranges from 14 to 25 days (the average is 18 days). One attack of mumps (even if unilateral) almost always confers lifelong immunity.

Signs and symptoms

Signs and symptoms of mumps vary widely. An estimated 30% of susceptible people have subclinical illness. Mumps usually begins with prodromal signs and symptoms that last for 24 hours; these include myalgia, anorexia, malaise, headache, and low-grade fever, followed by an Continue reading »

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Traumatic Amputation

 General Surgery  Comments Off
May 302011
 
Traumatic amputation involves the accidental loss of a body part, usually a finger, a toe, an arm, or a leg. In complete amputation, the member is totally severed; in partial amputation, some soft-tissue connection remains.
The prognosis has improved as a result of early improved emergency and critical care management, new surgical techniques, early rehabilitation, prosthesis fitting, and new prosthesis design. New limb reimplantation techniques have been moderately successful, but incomplete nerve regeneration remains a major limiting factor.

Causes

Traumatic amputations usually result directly from accidents at a factory or farm, or from power tools or motor vehicle accidents.
Diagnosis
Any patient with a traumatic amputation requires careful monitoring of vital signs as well as assessment for other traumatic injuries. If amputation involves more than just a finger or a toe, assessment of airway, breathing, and circulation is also required. Because profuse bleeding is Continue reading »
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Urticaria and angioedema

 General Medicine  1 Response »
May 192011
 
Urticaria, commonly known as hives, is an episodic, usually self-limited skin reaction characterized by local dermal wheals surrounded by an erythematous flare. Angioedema, which can present either subcutaneously or dermally, produces deeper, larger wheals (usually on the hands, feet, lips, genitals, and eyelids) and a more diffuse swelling of loose subcutaneous tissue. Urticaria and angioedema can occur simultaneously, but angioedema may last longer.
Causes
Urticaria and angioedema are common allergic reactions. Causes include allergy to drugs, foods, insect stings and, occasionally, inhalants, such as animal dander and cosmetics, that provoke an immunoglobulin (Ig) E-mediated response to protein allergens. However, certain drugs may cause urticaria without an IgE response.
When urticaria and angioedema are part of an anaphylactic reaction, they almost always persist long after the systemic response has subsided. This occurs because circulation to the skin is inhibited after an allergic reaction, which results in slow histamine reabsorption at the reaction site. Nonallergic urticaria and angioedema are probably also related to histamine release.
External physical stimuli, such as cold (usually in young adults), heat, water, or sunlight, may provoke urticaria and angioedema. Dermographism urticaria develops with varying pressure, usually under tight clothing, and is aggravated by scratching.
Several different mechanisms and underlying disorders may provoke urticaria and angioedema. These include IgE-induced release of mediators from cutaneous mast cells; binding of IgG or IgM, resulting in complement activation; localized or secondary infections such as respiratory infection; neoplastic diseases such as Hodgkin’s disease; connective tissue diseases such as systemic lupus erythematosus; collagen vascular diseases; and psychogenic diseases.
Signs and symptoms
The characteristic features of urticaria are distinct, raised, evanescent dermal wheals surrounded by an erythematous flare. These lesions may vary in size. In cholinergic urticaria, the wheals may be tiny and blanched, surrounded by erythematous flares.
Angioedema characteristically produces nonpitted swelling of deep subcutaneous tissue, usually on the eyelids, lips, genitalia, and mucous membranes. These swellings don’t usually itch but may burn and tingle.
Diagnosis
An accurate patient history can help determine the cause of urticaria. Such a history should Continue reading »
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