Common Cornea Donation
Discussant: Anna Lisa Yu, M.D.
The cornea is dome-shaped tissue in front of the eye, which covers the iris, pupil, and lens. The cornea is composed of five layers. Damage to the cornea requires transplantation with donated corneal tissue coming from a recently deceased donor.
Reasons for corneal transplantation fall under the categories of: optical, to improve vision; tectonic, to preserve or reconstruct the damaged structure of the patient’s eye; and therapeutic, to remove infected corneas that are not responding to antibiotics.
Corneal transplant procedures may be for the entire cornea, partial, or tissue replacement.
Medical Forum No. 224
Discussant: Herminigildo Gan, M.D.
Headaches may be considered as warning signs of other illnesses. They can indicate systemic illness such as fever, persistent or progressive vomiting, stiff neck, pregnancy, cancer, immunocompromised state, and anticoagulated. Neurologic symtoms include altered mental state, focal neurologic symptoms, seizures, or papilledema. There are headaches that are new or have sudden onset especially in those age 40 or older; headaches subsequent to head trauma, awaken sufferers from sleep, or are worsened by maneuvers or movements.
Diagnostic tests to determine causes and conditions underlying headaches range from EEG, EMG, CT and/or MRI, to Cervical spne films and laboratory examination.
Tension brings about the most common headache syndrome and may either be episodic(less than 15 days per month) or chronic (more than 15 days per month). Tension-type headache is characterized by mild to moderate pain, with a pressing or tightening feeling. Location is variable but is often bilateral and can last for 30 minutes or even seven days. Nausea or vomiting is rare.
Migraine often strikes 17% of females and 6% of males. It can occur as a moderate to severe unilateral, pulsating pain and characterized by nausea, vomiting, photophobia or phonophobia. It can occur with or without aura. Among the factorsactors that trigger migraine include stress, menstruation, infection, trauma, use of vasodilators, intake of wine, and consumption of aged cheese.
Sinus headache or acute sinusitis may either be frontal (pain on the forehead) or maxillary. It is worsened with jarring, stooping, leaning forward and is usually a constant and dull ache.
Medical Forum No. 225
Discussant: Robert Chang, M.D.
Hemorrhoid is a complication resulting from overstretching of tissues. It can occur externally or internally, and symptoms include rectal bleeding during and after defecation, protrusion outside the anus during defecation, anal pain, discomfort, and itching.
Causes range from hereditary condition, chronic constipation, overuse of laxatives, weakening of connective tissues in the rectum and anus that comes with aging, to prolonged straining during bowel movement, sitting on the toilet for long periods of time, and pregnancy.
By degree, the condition is classified under Grade 1 (bleeding but no prolapse), Grade 2 (prolapsed upon defecation but spontaneously pushed in), Grade 3 (prolapsed upon defecation and must be manually pushed in), Grade 4 (permanently prolapsed outside the anus and cannot be pushed in). Treatment ranges from simple diet that includes dietary fiber and fluids, avoiding strain during bowel movement, to use of locally applied anti-inflammatory ointments such as Proctosedyl and Faktu. For the more serious condition in Grades 3 and 4, treatment options include Stapled Hemorrhoidopexy, Electrocautery excision, and Laser Hemorrhoidectomy.
Medical Forum 226
Obesity: Recommendation and Treatment
Discussant: Kim Shi Tan, M.D.
The direct consequence of overeating is being overweight and eventually obesity.
It is important to study obesity in order to recognize its types, determine appropriate treatment option, and identify causes and preventive measures.
Treatment includes an understanding of patient’s health status, proper diet, regular exercise, medical consultation, and bariatric surgery. A specialized team handles such cases and it includes Bariatric surgeons, endocrinologists, psychiatrists, internists, nutritionists, and exercise instructors.
Medical Forum No. 227
Discussant: Alvin Dela Cruz, M.D.
Heart arteries supply blood to the cardiac muscles. These can be blocked by atherosclerosis leading to chest discomfort, angina, or eventually heart attack. Treatment is either pharmacological, through angioplasty or coronary artery bypass surgery.
Coronary artery disease is the single most important cause of premature death and is manifested by any of the following: stable angina (ischemia due to fixed atheromatous stenosis); unstable angina (ischemia due to dynamic obstruction); myocardial infarction (occlusion of coronary artery); heart failure (myocardial dysfunction); arrhythmia (altered conduction); sudden death (asystole).
Coronary Artery Disease is addressed by beta-blockers, ACEI and ARB, non-pharmacologic inteevention, anti-platelets, control of hypertension and diabetes, lipid control, and education.