Medical Forum No. 193
»Prostate Diseases of Aging Men
Discussant: Aldrin Gamboa. M.D.
Prostate diseases generally refer to prostatitis (inflammation of prostate gland), benign prostatic hyperplasia(Non-cancerous enlargement of the prostate gland), and prostate cancer (growth of malignant/cancerous cells in the prostate gland).
Common symptoms of benign prostatic hyperplasia include frequent urination, strong and sudden urge to urinate, feeling of incomplete emptying of the bladder, difficulty in starting to urinate, stopping and restarting several times to urinate, progressive loss of force of urinary stream. Treatments are mainly surgery and medication.
For prostate cancer, available tests are digital rectal examination and serum prostate specific antigen. Treatment options include active surveillance, radiation therapy, surgery, hormonal and chemotherapy. Different types of surgery may also be utilized for prostate cancer such as open prostatectomy, laparoscopic prostatectomy, and robotic prostatectomy.
Prognosis for sufferers of prostate cancer depends largely on stage of cancer, Gleason’s score, age and general health.
Medical Forum No. 194
»Constipation and Diarrhea
Discussant: Peter Sy, M.D.
Constipation is a common clinical problem characterized by excessive straining, hard stools, lower abdominal fullness, and a sense of incomplete evacuation.
Chronic constipation result from inadequate fiber and water intake or from disordered colonic transit. It may also be due to systemic diseases, psychiatric disorders, or neurologic diseases. Medications may also cause constipation.
Remedies for mild constipation include intake of fiber and water, use of laxatives and enemas to aid fecal evacuation. Exercise is also recommended.
Irritable bowel syndrome, on the other hand, is a functional gastroinstestinal disorder characterized by abdominal pain, distention of abdomen, constipation, frequent feeling of incomplete evacuation, and presence of mucus in the stool. These symptoms, when coupled with progressive unexplained weight loss, decreased stool caliber, constipation, and blood in the stool may point to the possibility of colon cancer.
Diarrhea is defined as increased fluidity, frequency, and decreased consistency of stools. If the condition is present for less than four weeks, diarrhea is classified acute. If the duration is for more than four weeks, the condition is chronic.
Diarrhea may be caused by a number of reasons including infection, food poisoning, diet, medications, exposure to pets, swimming pool water, travel to developing countries.
Treatment range from correction of fluid and electrolyte deficits, symptomatic therapy to decrease frequency and abdominal pain, to specific treatment aimed at cause.
Diagnostic workup are also available to rule out cancer. These are complete blood count, CEA, fecalysis with occult blood, barium enema, sigmoidoscopy, colonoscopy.
Medical Forum No. 195
»Adult and Pediatric Urologic Scrotal Conditions
Discussant: Johnson Sy, M.D.
Adult and pediatric urologic scrotal conditions range from circumcision to tumors. The conditions and information related to them are as follow:
Circumcision is a surgical procedure that removes the foreskin in the male organ. The American Association of Pediatrics does not advocate routine circumcision. The procedure may carry complications such as bleeding, infection, cutting foreskin too short or too long, scarring that leads to narrowing of urine stream.
Hypospadias is a condition where urethral opening is located proximal to normal site; epispadias has the opening located anteriorly and proximal to normal site. Both conditions are caused by low levels of progesterone necessary for urethral development and result to problems of fertility, bent penis or chordee, and inability to direct urinary stream. Treatment is by operation as early as six months’ old.
Hernia has the intestines going through the open sac down the scrotum and seen externally as a bulge more prominent when crying, running but disappears when lying down. In children the cause is congenital, and in adults the cause is due to intraabdominal pressure. Once diagnosed, patient should undergo operation because complications include bowel perforation, sepsis, death.
Hydrocoele is a condition where there is a patent/open sac but the opening is small. In children, only fluid from the abdomen enters the sac. Among adults, the condition is usually due to imbalance between fluid production and absorption due to bacterial or parasitic infection. Course of treatment is through an operation called hydrocoelectomy.
Varicocoele are enlarged spermatic veins and pampiniform plexus along the apermatic cord releasing excessive heat that affects sperm count, motility, and morphology. Treatment is through an operation called varicocoelectomy or ligation of the enlarged veins.
Spermatocoele is the accumulation of sperms over the head of the epididymis caused by distal blockage in the sperm passageway. Epididymal cysts contain clear fluid and are usually benign. An operation is done only if the symptoms are bothersome.
Testicular Torsion is the twisting of the testis upon itself cutting off blood supply to the testis. This is caused by genetic factor and is common in puberty/adolescent age ten to eighteen years. Symptoms include vomiting, fever, loss of cremasteric reflex, and high lying testis. In a true urological emergency, the testis has to be saved in six hours through an operation called orchidopexy or in non-salvageable cases through an orchiectomy.
Undescended Testis or Crytorchidism is a condition where the testis fails to descend down the scrotum at birth. Those who suffer from this condition have ten to forty times risk of having testicular cancer.
Type A or true distal type takes the inguinal path and hormonal therapy has virilizing side effect. Ectopic is perineum, femoral or down the thigh.
Risk factors include low birth weight, multiple gestation, preterm babies; and causes include shortened gubernaculums testis, hormonal and environmental factors. 80% of cases descend during the first six months of life. Treatment is through surgery which is done during the first six to eighteen months of life.
Testicular Tumors are painless lumps in the testis and are usually detected within the age range of 25 to 35 years old. Self-examination is recommended as well as testicular ultrasound, blood tests, liver ulrasound among others. Mode of treatment is via an operation and it is suggested that before the procedure, sperm banking is to be done or other options for sperm banking.
Medical Forum No. 196
Discussant: Melissa Co Sia, M.D.
Hypertension is a condition where the blood pressure is elevated to more than the 130/80 level. There are several types of hypertension which include Essential hypertension and secondary hypertension under which are conditions of hyperaldosteronism, renal artery stenosis, hyperthyroidism, and pheochromocytoma.
Hypertension may be asymptomatic or may be defined by signs and symptoms such as headache, flushing, and dizziness. Complications include coronary artery disease, cardiomyopathy and heart failure, cerebrovascular accident, renal impairment, and cardiac arrhythmia.
Treatment range from diet to medications, with the latter including channel blockers, beta blockers, diuretics, ACE inhibitors, ARB, or central-acting agents.
Prevention includes diet and lifestyle modification as well as exercise.
Medical Forum No. 197
»Low Back Pain
Discussant Arlene Lim Vitug, M.D.
Low back pain is caused by muscle spasms, apinal cord compressions, infections, masses, and disc herniations/slipped discs.
Signs and symptoms include arthritis, oral ulcers, skin ulcers, reddening of face on sun exposure, skin rashes, eye pain, redness of eyes, blurring of vision, two to three times incidents of miscarriage, patchy loss of scalp hair, bluish discoloration of fingertips on exposure to cold.
When low back pain occurs, use warm packs, take proper posture, take medicines like paracetamol, and consult a doctor.
Avoiding low back pain range from taking a standing position when bathing, dressing up, standing straight, sitting erect, and lying in a posture of maximum relief. Regular exercise, wearing of lat shoes or shoes with only one-inch heels, and using pain killers only when pain becomes tolerable are also recommended.
Medical Forum No. 198
Discussant: Solidad Balete, M.D.
Swine Influenza is a highly contagious respiratory disease common in pigs. The current AH1N1 virus is a new subtype that had not been previously detected in swine and humans and is spread through human-to-human contact.
Symptoms or clinical presentation of AH1Ni include acute respiratory illness with rhinorrhea or nasal congestion, cough and sore throat, fever as well as othertypical influenza symptoms of body aches, headache, chills, fatigue, and possibly diarrhwa and vomiting.
Most at risk for AH1N1 are patients with fever and respiratory symptoms who live in areas where there are confirmed cases; in contact with persons who have been exposed; who have acute respiratory illness with a recent history of contact with animals with confirmed swine influenza.
Range of severity may be mild or even symptomatic but cases of severe nature have been identified in certain areas. Diagnosis is done through obtaining respiratory specimen for analysis, with the best samples obtained via nasal pharyngeal aspirate or nasal wash aspirate.
Treatment is done with a course of five-day medications of zanamivir and oseltamivir within 48 hours of diagnosis. AH1N1 is resistant to amantadine and rimantadine.
Persons afflicted with AH1N1 are infectious for 1 day before the illness to 7 days after the onset.