SELAMAT TINGGAL "SUNKEN CHEST"

Anak-anak umumnya suka bermain bola dan bersenang-senang di pantai. Tidak demikian dengan Jason (bukan nama sebenarnya). Dalam masa pertumbuhannya, ia sering merasa susah bernapas dan sering menghindarkan diri dari kegiatan olahraga. Jason sering terlihat hanya menonton di samping lapangan.

Jason sekarang berumur 18 tahun. Ia menderita kelainan kongenital (kelainan bawaan sejak lahir), pectus excavatum. Kelainan ini membuat rongga dadanya tampak seperti penyok ke dalam. Kelainan ini dikenal juga dengan sebutan funnel chest atau sunken chest. Kelainan ini ditandai dengan depresi yang dalam pada sternum atau tulang dada, yang biasanya di setengah atau dua per tiga bagian sternum, dengan area yang dalam pada perbatasan rongga dada dan rongga perut.

Hal ini disebabkan karena pertumbuhan yang berlebihan dari jaringan yang menghubungkan tulang rusuk ke rongga dada yang membuat perkembangan tulang dada masuk ke dalam.
Keparahan depresi dibedakan ringan sampai berat. Pada kasus yang ringan, gejala sesak napas baru dialami saat berolahraga. Sementara yang lebih berat, penderita sering bernapas pendek karena pertumbuhan tulang dada yang tidak normal ke dalam, mendesak paru-paru dan menekan jantung keluar dari posisi normalnya di rongga dada. Penderita ini membutuhkan tindakan bedah untuk memperbaiki kondisi tersebut.

Kondisi ini diketahui diderita 1 dari 1000 orang, dengan ratio laki-laki dibanding perempuan 3:1.
Sebelumnya teknik yang diketahui untuk memperbaiki kelainan ini adalah operasi melalui pembukaan rongga dada, membuang tulang iga yang tumbuh tidak normal, dan memotong sebagian tulang dada untuk dipindahkan ke posisi normal. Tulang dada kemudian dilindungi oleh otot sekitar atau batang logam pendek dan dijahit.
Saat ini terdapat teknik baru, dikenal dengan prosedur Nuss. Berbeda dengan teknik lama, pada prosedur ini dilakukan tindakan seminimal mungkin sehingga efek sampingnya juga minimal. Pada teknik ini hanya dibuat irisan kecil diantara kedua dinding rongga dada. Dibantu thorascope (sebuah kamera kecil untuk memandu ahli bedah) yang diletakkan dibawah sternum, sebuah batang dibengkokkan sesuai bentuk yang diinginkan. Batang tadi kemudian ditarik ke dada untuk mengangkat sternum keluar dan melonggarkan tulang rusuk sebisa mungkin. Batang tersebut dibiarkan ditempatnya sekitar 2 tahun setelah itu dilepas, yang hanya membutuhkan waktu selama 30 menit saja.

Metode lama menyebabkan banyak kehilangan darah dan meninggalkan jaringan parut yang besar pada dada, menurut dr James Wong, ahli bedah jantung, paru dan pembuluh darah di Singapura. Namun dengan prosedur baru, tidak perlu memotong sebagian tulang dada maupun tulang rawan, sehingga hasilnya akan lebih bagus secara kosmetik.
Dr Wong telah melakukan teknik Nuss pada 3 orang pasien dan sejauh ini tidak ada komplikasi. Ia menganjurkan prosedur ini dilakukan sekitar usia 8-15 tahun dimana dinding dada masih elastis. Biaya pembedahan sekitar SGD 15.000 - 20.000 termasuk honor dokter dan biaya RS sekitar 5 hari perawatan.

Setelah Jason menjalani operasi dengan teknik baru tersebut, dia disarankan untuk tidak melakukan olahraga angkat berat selama 2 bulan dan sekarang dia sudah bisa tersenyum lebar. Kepercayaan dirinya perlahan kembali.
(Summarised by MediCALL Clinic & Health Centre)

Nyeri pasca Operasi Hernia Inguinal

Hernia di daerah selangkangan sebagian besar (sekitar 96%) adalah jenis hernia inguinal. Hernia jenis ini terjadi karena adanya bagian yang terbuka di daerah saluran yang dinamakan kanal inguinal di daerah selangkangan. Akibatnya organ dalam rongga perut, seperti usus, bisa turun ke daerah selangkangan melalui jaringan yang terbuka tersebut dan menimbulkan Hernia Inguinal.

Dalam operasi hernia yang menggunakan jaringan prostetik (yang dinamakan mesh) untuk menutup daerah saluran yang terbuka, dimaksudkan untuk mencegah turunnya organ dalam rongga perut ke saluran di daerah selangkangan tersebut dan mencegah timbulnya hernia lagi. Dengan teknik operasi ini, pasien umumnya sudah bisa kembali beraktivitas normal dalam kurun waktu 10 hari setelah operasi. Kemungkinan untuk hernia timbul kembali relative kecil, sekitar 3% atau kurang.

Akan tetapi, juga dilaporkan adanya beberapa kejadian dimana nyeri paska operasi berlangsung lebih lama. Bahkan 3-5% kasus dilaporkan ada pasien mengalami rasa nyeri yang permanen.

Nyeri paska operasi hernia inguinal dalam bahasa latinnya dinamakan Ingunodynia. Hal ini dapat disebabkan oleh berbagai macam hal, seperti berikut ini:

o Infeksi (catatan: biasanya disertai dengan demam)

o Peradangan sebagai reaksi dari keberadaan barang asing (contoh: jahitan, mesh, dll)di jaringan tubuh pasien (catatan: bisa ditandai dengan adanya kulit / jaringan yang berwarna kemerahan karena meradang dan/atau nampak membengkak)

o Hernia yang timbul kembali (catatan: biasanya nampak benjolan hernia kendati sebelumnya sudah dioperasi)

o Kerusakan persarafan sebagai akibat prosedur pembedahan hernia tersebut.

o Saraf terjepit oleh jaringan skar, jaringan prostetik (mesh) yang dipasang waktu pembedahan atau jahitan di daerah bekas pembedahan.

o Tumor saraf jinak yang dinamakan Neuroma yang tumbuh setelah operasi

o Pergeseran letak jaringan prostetik(mesh)yang di tempatkan untuk mencegah timbulnya hernia.

o Pengerutan jaringan yang terluka dari prosedur operasi

Catatan: beberapa ketidaknormalan yang tersebut di atas, mungkin tidak nampak dari luar; tapi bisa ditentukan berdasarkan pemeriksaan lebih lanjut oleh dokter dan/atau dengan pemeriksaan imaging.

Penyebab pasti dari nyeri tersebut dan pengobatannya tidak bisa ditentukan secara pasti tanpa pemeriksaan fisik pasien. Kadang perlu didukung dengan pemeriksaan X-rays, MRI or CT scans untuk menentukan kemungkinan adanya penyebab nyeri lain yang tidak berkaitan dengan operasi hernia. Jadi bilamana setelah operasi hernia, pasien mengalami nyeri yang berkepanjangan, sebaiknya berkonsultasi dengan dokter yang merawat untuk menyingkirkan kemungkinan-kemungkinan penyebab nyeri yang seperti tersebut di atas.

Sleep Talking

Sleep talking is the act of talking, mumbling, laughing or conversing during sleep. It is also called by the name somniloquy.

It's an abnormal but very common behavior that takes place during sleep. It is not usually considered a medical problem. That condition is very common in childhood and does occur in some adults. Fifty percent of children and about five percent of adults suffer from the disorder. Girls talk in their sleep as much as boys.

In itself, the condition is rather harmless. And usually treatment is not needed. However, if sleep talking occurs frequently and becomes profane, dramatic or emotional, a medical professional’s opinion and evaluation should be sought. This is when the sleeping disorder can be considered alarming. A thorough diagnosis should be carried out and the proper treatment measures be employed.

Things that can cause sleep talking include but not limited to certain medications, emotional stress, fever, and substance abuse.

There is no known way to reduce sleep talking. Avoiding stress and getting plenty of sleep might help to lessen occurrence of sleep talking. Keeping a sleep diary for about 2 weeks can help identify your sleep patterns and help find out possible underlying causes. Note the times you go to bed, when you think you fell asleep, when you woke up, and write down the following:
· the medicines you take, and the time of day you take them
· what you drink each day and when, especially caffeinated drinks such as cola, tea, and coffee, as well as alcohol
· when you exercise

Leukoencephalopathy (brain white matter changes)

Leukoencephalopathy (brain white matter changes) is caused by the reactivation of a common virus in the central nervous system of individuals with lowered immune defenses, such as individuals with acquired immune deficiency syndrome (AIDS); people undergoing chronic corticosteroid or immunosuppressive therapy; and individuals with cancer. This disorder may be associated with neurofibromatosis type 1 that can also develop cancer. Other clinical studies eported that leucoencephalopathy can also be due to gene mutation.
The symptoms of leucoenecephalopathy are the result of loss of white matter (which is made up of myelin, a substance the surrounds and protects nerve fibers) in multiple areas of the brain. Without the protection of myelin, nerve signals can’t travel successfully from the brain to the rest of the body. The most prominent symptoms are clumsiness; progressive weakness; and visual, speech, and sometimes, personality changes. In general, the progression of deficits leads to life-threatening disability and death over weeks to months, although some survive till adult age left with severe neurological disabilities. People with this disorder are particularly vulnerable to stresses such as infection, mild head trauma or other injury, or even extreme fright. These stresses may trigger the first symptoms of the condition or worsen existing symptoms, and can cause affected individuals to become lethargic or comatose.

Neurofibromatosis Type 1

Neurofibromatosis type 1 (NF1) is a progressive disorder, which means most symptoms will worsen over time. In general, most people with NF1 will develop mild to moderate symptoms, and have a normal life expectancy.

The condition is caused by mutation of gene that could result in overactive cell growth, learning impairments, and skeletal defects. Clinical manifestations of neurofibromatosis type 1 may vary greatly in range and severity from case to case, Some findings are as follows:
· flat patches on the skin that are darker than the surrounding area. These spots increase in size and number as the individual grows older.
· noncancerous (benign) tumors, named neurofibromas that are usually located on or just under the skin. These tumors may also occur in nerves near the spinal cord or along nerves elsewhere in the body. Some (3-5%) develop cancerous tumors that grow along nerves, and/or develop other cancers, including brain tumors and cancer of blood-forming tissue (leukemia).
· episodes of seizures, learning disabilities (50% of children with the condition), speech difficulties, attention deficit hyperactive disorders, and skeletal malformations, including progressive curvature of the spine (scoliosis), and bowing of the lower legs.
· high blood pressure

Treatments for the condition are aimed at controlling or relieving symptoms. Headache and seizures are treated with medications. Benign tumours may be removed surgically. Cancerous tumours may be treated with surgery, chemotherapy, and/or radiotherapy.

Small Bowel Obstructions

Small bowel obstruction, a mechanical bowel blockage arising from a structural abnormality, presents a physical barrier to the progression of gut contents. Patient of such a condition may then experience abdominal pain, bloating, and vomiting. Small-bowel obstructions can result from a variety of causes. Peritoneal adhesions are the most common cause of Small Bowel Obstruction (SBO) accounting for approximately 65% to 75% of cases. It is estimated that the risk of SBO is 1% to 10% after appendectomy, 6.4% after open cholecystectomy, and 10% to 25% after intestinal surgery. It is also estimated that 93% to 100% of patients who undergo transperitoneal surgery will develop postoperative adhesions. Most patients with adhesions do not experience any overt clinical symptoms. However, clinical symptoms may manifest when complication resulting from the adhesions are eventually developed.

Bowel obstruction may take many years to develop after abdominal/transperitoneal surgery. A clinical study reported that 21% of bowel obstructions caused by adhesions occur within the first month after surgery, 18% of bowel obstructions caused by postoperative adhesions occur between 1 month and 1 year after surgery, 21% occur between 1 and 5 years and 28% occur after 5 years.

About peritoneal adhesions, they are scar tissues forming abnormal attachments between organs or tissues or both in the abdominal cavity that are normally separated. Most are acquired as a result of peritoneal injury, the most common cause of which is abdomino-pelvic surgery.4 Less commonly, adhesions may form as the result of inflammatory conditions, intraperitoneal infection or abdominal trauma. The extent of adhesion formation varies but is most dependent on the type and magnitude of surgery performed, as well as whether any postoperative complications develop.

Myoma or Uterine Fibroid

Myoma or Uterine Fibroids are noncancerous tumours that grow slowly within the muscular wall of the womb (also known as uterus in medical term). It is estimated that 25% of women over the age of 35 have fibroids at some time during their life. One clinical study using pelvic ultrasound in women in the U.S. ,with no symptom aged 35-49, found that over 50% of women did have fibroids on pelvic ultrasound exam. Small fibroids may not cause problems, but larger ones may cause prolonged/heavy menstrual bleeding, abdominal pain during menstruations, infertility or recurrent miscarriages. Fibroids may also press on the bladder, causing a need to pass urine often, or on the rectum, causing low back pain. Generally fibroids do not need treatment when they are not symptomatic. However, they should be checked regularly by your doctor to make sure that they have not grown. If treatment is necessary, fibroids may be removed surgically. Some fibroids are treated using an injection of a substance that blocks the blood vessels supplying them, causing the fibroids to shrink.