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Kawasaki Disease
Definition:
When Japanese doctor Tomisaku Kawasaki first described 50 children he had seen with prolonged fever, enlarged lymphatic glands and a strange looking rash in 1967, people thought it was a rare and self-limiting disease. Neither was true. Very soon epidemics appeared in Japan, Hawaii and North America. Fatalities were reported. The disease can involve the coronary arteries, resulting in "heart attacks" in babies. The disease has now surpassed rheumatic fever as the leading cause of acquired heart disease in small children. In untreated patients, up to 20% of survivors can have residual heart problems.
There is no single laboratory test that can define Kawasaki disease. Diagnosis depends on the presence of a milieu of clinical features, which take time to evolve, some of which notoriously subtle and fleeting. Common illnesses in childhood such as streptococcal infection, herpes simplex and other illness like toxic shock syndrome (Meaning: toxic substance produced by the Staph aureus bacteria, which induce bodily conditions of sudden high fever, vomiting, diarrhea, muscle aching, and in severe situation can lead to shock/ death) can mimic Kawasaki disease. Tests are often necessary to confirm that the child is not suffering from those conditions. The number of blood platelets tends to be increased in patients with Kawasaki disease, but this often happens only in the second to third week of the disease.
Who is at risk?
Kawasaki disease affects mainly children less than 5 years old, 50% being younger than 2 years old. Boys are more likely to be affected. The incidence is highest amongst Asians.
Symptoms:
The hallmark is profound inflammation of the medium size and small arteries discussed. It is a systemic disease, meaning that it can involve practically every organ. Inflammation of the coronary artery weakens its walls, so much so that they yield to the pressure inside and become dilated, what is known as aneurysms. When that happens, there is a risk of sudden rupture, and clots formed inside can block the blood supply to heart muscles.
What triggers the inflammation is still a mystery. Cases tend to cluster both in space and time. This suggests the presence of an infectious agent or some unidentified environmental factors. Whatever triggers it results in the patient's immune system going awry. Our body is not harmed by what started off the inflammation, but by the cascade of "friendly fire" it triggered-- also known as an "autoimmune phenomenon".
Dr. Kawasaki first called it "Mucocutaneous Lymph Node Syndrome". The term still describes the most common features that "ring the bell" in a child with prolonged fever. Typically, the patient is a previously healthy 18 to 24 months baby with high fever lasting for more than 5 days. The anxious parents might have brought him to see several doctors, who might have offered diagnosis such as influenza or throat infection, and have prescribed one antibiotics after another with no avail. As time goes on, the baby looks more miserable. His eyes turn red. His mouth sores. The lymph glands on the neck are swollen and painful. His fingers and hands appear swollen and red. A peculiar rash comes and goes, and raises the suspicion of drug allergy. It is the time when parents are told of the term "Kawasaki disease." A very characteristic peeling of the skin involving the finger tips appears in a later stage, usually one to two weeks after the onset of fever.
Treatment:
Since the late eighties, doctors have been using human gammaglobulins together with aspirin to treat Kawasaki disease. The drug combination is usually highly effective in shortening the course of the disease and can prevent cardiac complications, provided they are given early. Apart from the potential side effects of aspirin, the cost of gammaglobulins can be prohibitively expensive. Doctors also need to perform echocardiograms at regular intervals to find out if the coronary arteries are involved.
Prevention:
Since the etiology (occurrences, reasons and variables of diseases or pathologies) is largely unknown there is no way to prevent the disease. The emphasis should be to prevent cardiac complications in patients who have Kawasaki disease.
Kidney Stones
Definition:
Broadly speaking, kidney stones also include stones in other parts of the urinary system, since they all arise from the kidney. Our two kidneys are situated at the back of the abdomen. Their main function is to remove waste from the body in the form of urine. Blood is filtered as it is passed through the kidneys. The fluid containing the waste is drained into a space called the renal pelvis in the centre of the kidney, which leads to a tube called the ureter to connect with the bladder and urethra.
When the concentration of a particular mineral in the urine is too high, crystals may form and grow in size, resulting in stones. A stone can be dislodged and pass along the urine stream, until finally get this caught wherever the channel is too narrow to go through. The symptoms it causes depend on the stone's size and location, and it is also the size and location that determine the way a kidney stone should be managed.
Who is at risk?
Stone disease is two to three times more common in males than in females. A man has about 12 % lifetime risk of developing a kidney stone. It occurs more often in the middle aged than in the elderly. Kidneys stones can happen in children, though rarely so. Kidney stones are more frequently encountered in hot, arid areas.
Decreased fluid intake and consequent urine concentration are among the most important factors influencing stone formation. Certain occupations such as drivers are more prone to the disease. Some medications, such as anti-hypertensives and diuretics, can affect the mineral contents of urine, and increase the chance of stone formation.
Oxalate, a salt present in many vegetables, is a common component in kidney stones. Some kidney stones may consist of largely uric acid, a byproduct of nucleic acids we take from the diet. Patients suffering from certain metabolic diseases that result in high blood calcium or uric acid levels are in particular risk of kidney stones.
Most kidney stones contain calcium, but the role of dietary calcium is less clear. It has been shown that calcium restriction cannot prevent stone disease, and is no longer universally recommended. Some people are born with a tendency to have higher calcium levels in their urine, and are more prone to kidney stone formation. This tendency runs in families.
Repeated urinary tract infections can also precipitate stone formation. Kidney stones can develop in cancer patients undergoing chemotherapy, as the rapid breakdown of cells produces large amount of uric acid.
Symptoms:
The type of pain caused by stones is often called a colic-meaning that the pain comes as cramps, waxing and waning as if a woman in labour. The pain frequently begins on one side of the flank, radiating to the lower abdomen and the groin. Sometimes the site of pain migrates downwards as the stone is passed along the ureter. When the stone is approaching or is inside the bladder, the patient may feel pain and urgency in passing urine. Some patients may find with blood in their urine. This is especially common with uric acid stones.
Treatment:
The pain caused by kidney stones is notoriously severe. The presence of pain itself is not an ominous sign though, since pain is associated with the migration of the stone. The pain can be partly relieved with analgesics or drugs which relax the smooth muscles of the urinary tract.
If a kidney stone is suspected, doctors need to confirm its presence, size, location, and its effect on the kidney functions. That's why a number of urine and blood tests as well as radiological examinations are necessary. Most, but not all, stones show up on X rays. To locate a stone more accurately, doctors would order an IVP (intravenous pyelogram or intravenous urogram, IVU) where a drug, called a contrast, is injected into the blood to let the urinary tract show up in a series of X rays films. If you have a history of severe allergic reactions, you need to tell your doctor for alternative arrangements.
Stones less than 4 mm in the ureter have more than 80% chance of being passed out spontaneously. Drinking plenty of fluids (over 3 litres a day) would help. You should also look carefully into the urine and strain it to confirm the passage of stones. If found, save them up. Your doctors may take them to the laboratory for analysis. Follow up X rays may be ordered to check for the presence of residual stones.
The less fortunate patients may have stones too large or too tightly lodged. Doctors can use strong ultrasound to break them up - a procedure called extracorporeal shock wave lithotripsy. When that fails doctors may need to remove them surgically.
Prevention:
Doctors may collect fragments of the stone for analysis and recommend a special diet depending on the findings, taking into consideration of your dietary habits. Occasionally patients may need drugs to prevent stone formation. Approximately 50 percent of patients with kidney stones have a recurrence within 10 years.
To prevent kidney stones, you should:
- Drink plentifully and frequently - Avoiding dehydration is important in preventing kidney stones. A glass of water should be taken with each meal, between each meal, and before sleep for maximal effect.
- Decrease salt intake - A salty diet produces urinary conditions that promote kidney stones formation by increasing calcium content in the urine.
- Decrease animal protein intake - Red meat is a precursor of uric acid, a constituent of some kidney stones. Foods rich in uric acid also include organ meats, game meats, anchovies, sardines, herring, mussels and scallops.
- Decrease oxalate intake - Oxalate is another constituent of kidney stones found in certain plants and their products such as nuts, chocolate, tea, spinach, beans, dark leafy greens, soy, rhubarb, strawberries. Avoid them if you have had oxalate stones.
- Do not take excessive vitamin C.
- Increase your dietary fibre intake.
Kyphosis
Definition:
A deformity caused by excessive curvature of the spine, resulting in stooped back, humpback or hunchback.
"Postural kyphosis" is caused by slouching and poor posture. The condition is usually not progressive and can be readily corrected by conscious effort. A less common, but less correctable cause of kyphosis is "Scheuermann's Disease". For unknown reason, several vertebral bones in the patient wedge and fuse together. Both postural kyphosis and Scheuermann's Disease are more common in adolescents.
Kyphosis can also occur at birth if caused by congenital malformation of the vertebral bones.
In adults, kyphosis can be caused by trauma, infection, or tumor that involves the spinal column. Kyphosis can also occur as a result of systemic diseases such as rheumatoid arthritis, osteoporosis and rickets.
Who is at risk?
- Adolescents
- People with poor posture
- Survivors of major accidents who have suffered from fractures to the spine
- Patients with or tuberculosis or tumors that involves the spinal column
- Elderly with osteoporosis
- Patients with rheumatic disorders such as ankylosing spondylitis and rheumatoid arthritis
Symptoms:
In early stages, kyphosis may produce no noticeable signs or symptoms, but can only be picked up in a routine checkup. Late cases are readily noticeable when the hunchback deformity becomes obvious. Back pain or pain down the legs may occur in some patients.
Treatment:
Treatment for kyphosis depends on the cause and severity of the condition.
For patients with postural kyphosis, conservative treatments including exercises to strengthen back muscles, and training in using correct posture may all be necessary.
Other causes of kyphosis, if severe or progressive, may require bracing or even surgery. Therefore serial monitoring by specialists is important, especially in growing patients.
Prevention:
- To prevent postural kyphosis, mind your posture. Take frequent breaks to stretch yourself. Use chairs with good back support.
- Early diagnosis and treatment of Scheuermann's Disease can arrest its progress. Whenever spinal deformities are suspected, seek opinion from the doctor.
- Prevention and early treatment of osteoporosis can prevent kyphosis in the elderly
