Gale encyclopedia of medicine vol 4 (n s)

stenosis Acquired spinal stenosis usually begins with degeneration of the intervertebral disks or the surfaces of the vertebrae or both In trying to heal this degeneration, the body builds up the spinal column In the process, the spinal canal can become narrower Diagnosis The physician must determine that the symptoms are caused by spinal stenosis Conditions that can cause similar symptoms include a slipped (herniated) intervertebral disk, spinal tumors, and disorders of the blood flow (circulatory disorders) Spinal stenosis causes back and leg pain The leg pain is usually worse when the patient is standing or walking Some forms of spinal stenosis are less painful when the patient is riding an exercise bike because the forward tilt of the body changes the pressure in the spinal column Doppler scanning can trace the flow of blood to determine whether the pain is caused by circulatory problems X-ray images, computed tomography scans (CT scans), and magnetic resonance imaging (MRI) scans can reveal any narrowing of the spinal canal Electromyography, nerve conduction velocity, or evoked potential studies can locate problems in the muscles indicating areas of spinal cord compression Treatment Mild cases of spinal stenosis may be treated with rest, nonsteroidal anti-inflammatory drugs (such as aspirin), and muscle relaxants Spinal stenosis can be a progressive disease, however, and the source of pressure may have to be surgically removed (surgical decompresGALE ENCYCLOPEDIA OF MEDICINE Computed tomography (CT) scans—An imaging technique in which cross-sectional x rays of the body are compiled to create a three-dimensional image of the body’s internal structures Congenital—Present before birth The term is used to describe disorders that developed in the fetal stage Doppler scanning—A procedure in which ultrasound images are used to watch a moving structure such as the flow of blood or the beating of the heart Electromyography—A test that uses electrodes to record the electrical activity of muscle The information gathered is used to find disorders of the nerves that serve the muscles Evoked potential—A test of nerve response that uses electrodes placed on the scalp to measure brain reaction to a stimulus such as a touch Magnetic resonance imaging (MRI)—An imaging technique that uses a large circular magnet and radio waves to generate signals from atoms in the body These signals are used to construct images of internal structures Nerve conduction velocity test—A test that measures the time it takes a nerve impulse to travel a specific distance over the nerve after electronic stimulation Stenosis—The narrowing or constriction of a channel or opening sion) if the patient is losing control over bladder and bowel functions The surgical procedure removes bone and other tissues that have entered the spinal canal or put pressure on the spinal cord Two vertebrae may be fused, to eliminate improper alignment, such as that caused by spondylolisthesis For surgery, patients lie on their sides or in a modified kneeling position This position reduces bleeding and places the spine in proper alignment Alignment is especially important if vertebrae are to be fused Surgical decompression can eliminate leg pain and restore control of the legs, bladder, and bowels, but usually does not eliminate lower back pain Physical therapy and massage can help reduce the symptoms of spinal stenosis An exercise program should be developed to increase flexibility and mobility A brace or corset may be worn to improve posture Activities that place stress on the lower back muscles should be avoided GALE ENCYCLOPEDIA OF MEDICINE Surgical decompression does not stop the degenerative processes that cause spinal stenosis, and the condition can develop again Nevertheless, most patients achieve good results with surgical decompression The patient will probably continue to have lower back pain after the surgical procedure Resources BOOKS Berkow, Robert, ed Merck Manual of Medical Information Whitehouse Station, NJ: Merck Research Laboratories, 1997 Dee, Roger, et al Principles of Orthopaedic Practice New York: McGraw-Hill Health Professional Books, 1997 Larsen, D E., ed Mayo Clinic Family Health Book: New York William Morrow and Co., Inc., 1996 John T Lohr, PhD Spinal tap see Cerebrospinal fluid (CSF) analysis Spirometry see Pulmonary function test Spleen, enlarged see Hypersplenism Spleen removal see Splenectomy Splenectomy Definition Splenectomy is the surgical removal of the spleen, which is an organ that is part of the lymphatic system The spleen is a dark-purple, bean-shaped organ located in the upper left side of the abdomen, just behind the bottom of the rib cage In adults, the spleen is about 4.8 ϫ 2.8 ϫ 1.6 in (12 ϫ ϫ cm) in size, and weighs about 4–5 oz (113–142 g) Its functions include a role in the immune system; filtering foreign substances from the blood; removing worn-out blood cells from the blood; regulating blood flow to the liver; and sometimes storing blood cells The storage of blood cells is called sequestration In healthy adults, about 30% of blood platelets are sequestered in the spleen Purpose Splenectomies are performed for a variety of different reasons and with different degrees of urgency Most splenectomies are done after the patient has been diagnosed with hypersplenism Hypersplenism is not a specific disease but a group of symptoms, or syndrome, that can 3137 Splenectomy Prognosis KEY TERMS Splenectomy Spleen Splenic artery Stomach Retractor Splenectomy is the surgical removal of the spleen This procedure is performed as a last result in most diseases involving the spleen In some cases, however, splenectomy does not address the underlying causes of splenomegaly or other conditions affecting the spleen (Illustration by Electronic Illustrators Group.) be produced by a number of different disorders It is characterized by enlargement of the spleen (splenomegaly), defects in the blood cells, and an abnormally high turnover of blood cells It is almost always associated with splenomegaly caused by specific disorders such as cirrhosis of the liver or certain cancers The decision to perform a splenectomy depends on the severity and prognosis of the disease that is causing the hypersplenism Splenectomy always necessary There are two diseases for which splenectomy is the only treatment—primary cancers of the spleen and a blood disorder called hereditary spherocytosis (HS) In HS, the absence of a specific protein in the red blood cell membrane leads to the formation of relatively fragile cells that are easily damaged when they pass through the spleen The cell destruction does not occur elsewhere in the body and ends when the spleen is removed HS can appear at any age, even in newborns, although doctors prefer to put off removing the spleen until the child is five or six years old Splenectomy usually necessary There are some disorders in which splenectomy is usually recommended They include: 3138 • Immune (idiopathic) thrombocytopenic purpura (ITP) ITP is a disease involving platelet destruction Splenectomy is the definitive treatment for this disease and is effective in about 70% of chronic ITP cases • Trauma The spleen can be ruptured by blunt as well as penetrating injuries to the chest or abdomen Car accidents are the most common cause of blunt traumatic injury to the spleen • Abscesses in the spleen These are relatively uncommon but have a high mortality rate • Rupture of the splenic artery Rupture sometimes occurs as a complication of pregnancy • Hereditary elliptocytosis This is a relatively rare disorder It is similar to HS in that it is characterized by red blood cells with defective membranes that are destroyed by the spleen Splenectomy sometimes necessary In other disorders, the spleen may or may not be removed • Hodgkin’s disease, a serious form of cancer that causes lymph nodes to enlarge Splenectomy is often perGALE ENCYCLOPEDIA OF MEDICINE • Thrombotic thrombocytopenic purpura (TTP) TTP is a rare disorder marked by fever, kidney failure, and an abnormal decrease in the number of platelets Splenectomy is one part of treatment for TTP • Autoimmune hemolytic disorders These disorders may appear in patients of any age but are most common in patients over 50 The red blood cells are destroyed by antibodies produced by the patient’s own body (autoantibodies) • Myelofibrosis Myelofibrosis is a disorder in which bone marrow is replaced by fibrous tissue It produces severe and painful splenomegaly Splenectomy does not cure myelofibrosis but may be performed to relieve pain caused by the swollen spleen • Thalassemia Thalassemia is a hereditary form of anemia that is most common in people of Mediterranean origin Splenectomy is sometimes performed if the patient’s spleen has become painfully enlarged Precautions Patients should be carefully assessed regarding the need for a splenectomy Because of the spleen’s role in protecting people against infection, it should not be removed unless necessary The operation is relatively safe for young and middle-aged adults Older adults, especially those with cardiac or pulmonary disease, are more vulnerable to post-surgical infections Thromboembolism following splenectomy is another complication for this patient group, which has about 10% mortality following the surgery Splenectomies are performed in children only when the benefits outweigh the risks The most important part of the assessment is the measurement of splenomegaly The normal spleen cannot be felt when the doctor examines the patient’s abdomen A spleen that is large enough to be felt indicates splenomegaly In some cases the doctor will hear a dull sound when he or she thumps (percusses) the patient’s abdomen near the ribs on the left side Imaging studies that can be used to demonstrate splenomegaly include ultrasound tests, technetium-99m sulfur colloid imaging, and CT scans The rate of platelet or red blood cell destruction by the spleen can be measured by tagging blood cells with radioactive chromium or platelets with radioactive indium nique is used to remove greatly enlarged spleens After the surgeon makes a cut (incision) in the abdomen, the artery to the spleen is tied to prevent blood loss and reduce the spleen’s size It also helps prevent further sequestration of blood cells The surgeon detaches the ligaments holding the spleen in place and removes it In many cases, tissue samples will be sent to a laboratory for analysis REMOVAL OF RUPTURED SPLEEN When the spleen has been ruptured by trauma, the surgeon approaches the organ from its underside and fastens the splenic artery Partial splenectomy In some cases the surgeon removes only part of the spleen This procedure is considered by some to be a useful compromise that reduces pain from an enlarged spleen while leaving the patient less vulnerable to infection Long-term follow-up of the results of partial splenectomies has not yet been done Laparoscopic splenectomy Laparoscopic splenectomy, or removal of the spleen through several small incisions, has been more frequently used in recent years Laparoscopic surgery involves the use of surgical instruments, with the assistance of a tiny camera and video monitor Laparoscopic procedures reduce the length of hospital stay, the level of post-operative pain, and the risk of infection They also leave smaller scars Laparoscopic splenectomy is not, however, the best option for many patients Splenic embolization Splenic embolization is an alternative to splenectomy that is used in some patients who are poor surgical risks Embolization involves plugging or blocking the splenic artery to shrink the size of the spleen The substances that are injected during this procedure include polyvinyl alcohol foam, polystyrene, and silicone Embolization is a technique that needs further study and refinement Preparation Preoperative preparation for nonemergency splenectomy includes: • Correction of abnormalities of blood clotting and the number of red blood cells • Treatment of any infections Description Complete splenectomy REMOVAL OF ENLARGED SPLEEN Splenectomy is performed under general anesthesia The most common tech- GALE ENCYCLOPEDIA OF MEDICINE • Control of immune reactions Patients are usually given protective vaccinations about a month before surgery The most common vaccines used are Pneumovax or PnuImune 23 (against pneumococcal infections) and Menomune-A/C/Y/W-135 (against meningococcal infections) 3139 Splenectomy formed in order to find out how far the disease has progressed Splenectomy KEY TERMS Embolization—An alternative to splenectomy that involves injecting silicone or similar substances into the splenic artery to shrink the size of the spleen Hereditary spherocytosis (HS)—A blood disorder in which the red blood cells are relatively fragile and are damaged or destroyed when they pass through the spleen Splenectomy is the only treatment for HS Hypersplenism—A syndrome marked by enlargement of the spleen, defects in one or more types of blood cells, and a high turnover of blood cells Immune or idiopathic thrombocytopenic purpura (ITP)—A blood disease that results in destruction of platelets, which are blood cells involved in clotting Laparoscope—An instrument used to view the abdominal cavity through a small incision and perform surgery on a small area, such as the spleen Aftercare Immediately following surgery, patients should follow instructions and take all medications intended to prevent infection Blood transfusions may be indicated for some patients to replace defective blood cells The most important part of aftercare, however, is long-term caution regarding vulnerability to infection Patients should see their doctor at once if they have a fever or any other sign of infection, and avoid travel to areas where exposure to malaria or similar diseases is likely Children with splenectomies may be kept on antibiotic therapy until they are 16 years old All patients can be given a booster dose of pneumococcal vaccine five to 10 years after splenectomy Risks The chief risk following splenectomy is overwhelming bacterial infection, or postsplenectomy sepsis This vulnerability results from the body’s decreased ability to clear bacteria from the blood, and lowered levels of a protein in blood plasma that helps to fight viruses (immunoglobulin M) The risk of dying from infection after splenectomy is highest in children, especially in the first two years after surgery The risk of postsplenectomy sepsis can be reduced by vaccinations before the operation Some doctors also recommend a two-year course of penicillin following splenectomy or long-term treatment with ampicillin Other risks following splenectomy include inflammation of the pancreas and collapse of the lungs In some 3140 Pneumovax—A vaccine that is given to splenectomy patients to protect them against bacterial infections Other vaccines include Pnu-Imune and Menomune Sepsis—A generalized infection of the body, most often caused by bacteria Sequestration—A process in which the spleen withdraws some normal blood cells from circulation and holds them in case the body needs extra blood in an emergency In hypersplenism, the spleen sequesters too many blood cells Splenomegaly—Abnormal enlargement of the spleen Thromboembolism—A clot in the blood that forms and blocks a blood vessel It can lead to infarction, or death of the surrounding tissue due to lack of blood supply cases, splenectomy does not address the underlying causes of splenomegaly or other conditions Excessive bleeding after the operation is an additional possible complication, particularly for ITP patients Infection immediately following surgery may also occur Normal results Results depend on the reason for the operation In blood disorders, the splenectomy will remove the cause of the blood cell destruction Normal results for patients with an enlarged spleen are relief of pain and of the complications of splenomegaly It is not always possible, however, to predict which patients will respond well or to what degree Resources BOOKS Hohn, David C “Spleen.” In Current Surgical Diagnosis and Treatment 10th ed Ed Lawrence W Way Stamford: Appleton & Lange, 1994 Packman, Charles H “Autoimmune Hemolytic Anemia.” In Conn’s Current Therapy, 1996, ed Robert E Rakel Philadelphia: W B Saunders Co., 1996 Tanaka, Kouichi R “Nonimmune Hemolytic Anemia.” In Conn’s Current Therapy, 1996, ed Robert E Rakel Philadelphia: W B Saunders Co., 1996 PERIODICALS Tsoukas, Christos M., et al “Effect of Splenectomy on Slowing Human Immunodeficiency Virus Disease Progression.” Archives of Surgery 133 (Jan 1998): 25-31 GALE ENCYCLOPEDIA OF MEDICINE National Heart, Lung and Blood Institute P.O Box 30105, Bethesda, MD 20824-0105 (301) 251-1222 Leukaemia Research Fund 43 Great Ormond Street, London, WC1N 3JJ (020) 7405-0101 OTHER “Laparoscopic Splenectomy.” Foxhall Surgical Page Non-emergency Surgery Hotline (800) 638-6833 Teresa Norris, RN Splenic trauma Definition Splenic trauma is physical injury to the spleen, the lymphatic organ located in the upper left side of the abdomen Description The spleen is an organ that produces white blood cells, filters the blood, stores blood cells and destroys those that are aging It is located near the stomach on the left side of the abdomen A direct blow to the abdomen may bruise, tear or shatter the spleen Trauma to the spleen can cause varying degrees of damage, the major problem associated with internal bleeding Mild splenic subcapsular hematomas are injuries in which bleeding is limited to small areas on and immediately around the spleen Splenic contusions refer to bruising and bleeding on and around larger areas of the spleen Lacerations (tears) are the most common splenic trauma injuries Tears tend to occur on the areas between the three main blood vessels of the spleen Because of the abundant blood supply, splenic trauma may cause serious internal bleeding Most injuries to the spleen in children heal spontaneously Severe trauma can cause the spleen or its blood vessels to rupture or fragment Splenic trauma is more common in children than in adults In general, children are prone to abdominal injuries due to accidents and falls and because their abdominal organs are less protected by bone, muscle and fat Abdominal injuries including splenic trauma are the most common cause of preventable deaths in children Causes and symptoms The most common cause of injury to the spleen is blunt abdominal trauma Blunt trauma is often caused GALE ENCYCLOPEDIA OF MEDICINE by a direct blow to the belly, car and motorcycle accidents, falls, sports mishaps, and fights The spleen is the most commonly injured organ from blunt abdominal trauma Penetrating injuries such as those from stabbing, gunshot wounds, and accidental impaling also account for cases of splenic trauma, although far less frequently than blunt trauma In adults, ruptured spleens may have been preceded by conditions causing splenic enlargement, such as infections, cancer, immune system disorders, diseases of the spleen, or circulatory problems Damage to the spleen may cause localized or general abdominal pain, tenderness, and swelling Fractured ribs may be present Splenic trauma may cause mild or severe internal bleeding, leading to shock and for which symptoms include rapid heartbeat, shortness of breath, thirst, pale or clammy skin, weak pulse, low blood pressure, dizziness, fainting, sweating Vomiting blood, blood in the stools or urine, deterioration of vital signs, and loss of consciousness are other symptoms Diagnosis The goal of diagnosis of all abdominal traumas is to detect and treat life-threatening injuries as quickly as possible The physician will determine the extent of organ damage and whether surgery will be necessary while providing appropriate emergency care Initial diagnosis consists of detailing all circumstances of the injury from the patient and bystanders as well as the close physical examination of the patient and measurement of vital signs Blood tests, urinalysis, stool samples and x rays of the chest and abdomen are usually performed Plain x–rays may show abdominal air pockets that indicate internal ruptures, but are rarely helpful because they not show splenic and intra-abdominal damage Several other diagnostic tests may be used for the non-invasive and accurate assessment of splenic damage: computed tomography scans (CT), magnetic resonance imaging (MRI), radionuclide scanning, and ultrasonography Ultrasonography has now become a standard bedside technique in many hospitals to check for bleeding in the abdomen Imaging tests allow doctors to determine the necessity and type of surgery required The CT scan has been shown to be the most available and accurate test for abdominal trauma MRI tests are accurate but costly and less available in some hospitals, while radionuclide scanning requires more time and patient stability Peritoneal lavage is another diagnostic technique in which the abdominal cavity is entered and flushed to check for bleeding When patients exhibit shock, infection, or prolonged internal bleeding, exploratory laparoscopy is used for emergency diagnosis 3141 Splenic trauma ORGANIZATIONS Sporotrichosis Treatment Not long ago nearly all cases of splenic trauma were treated by laparoscopy, opening the abdomen, and by splenectomy, the surgical removal of the spleen This approach resulted from the difficulty in assessing the severity of the injury, the potential dangers of shock and death, and the beliefs that the spleen healed poorly and that it was not an important organ Nowadays, improved techniques of diagnosis and monitoring, as well as understanding that removal of the spleen creates future risk of a lowered capacity to fight infection has modified treatment approaches Research over the past two decades has shown that the spleen has high healing potential, and confirmed that children are more susceptible to infection after splenectomy (post splenectomy sepsis, PSS) PSS has a mortality rate of over 50% and standard procedure now avoids splenectomy as much as possible Adult splenic trauma is treated by splenectomy more often than children’s; for unknown reasons, the adult spleen more frequently spontaneously ruptures after injury Adults are also less susceptible to PSS Nonoperative Treatment In nonoperative therapy, splenic trauma patients are monitored closely, often in intensive care units for several days Fluid and blood levels are observed and maintained by intravenous fluid and possible blood transfusions Follow-up scans may be used to observe the healing process Operative Treatment Splenic trauma patients require surgery when nonoperative treatment fails, when major or prolonged internal bleeding exists and for gunshot and many stab wounds Whenever possible, surgeons try to preserve at least part of the spleen and try to repair its blood vessels KEY TERMS Computed tomography (CT) scan—Computeraided x-ray exam that allows cross-sectional views of organs and tissues Laparoscope—An optical or fiberoptic instrument that is inserted by incision in the abdominal wall and is used to view the interior of the peritoneal cavity Laparoscopy—Procedure using a laparoscope to view organs, obtain tissue samples and perform surgery Magnetic resonance imaging (MRI)—Imaging technique using magnets and radio waves to provide internal pictures of the body Radionuclide scanning—Diagnostic test in which a radioactive dye is injected into the bloodstream and photographed to display internal vessels, organs and tissues Ultrasonography—Imaging test using sound waves to view internal organs and tissues Schwartz, George, MD Principles and Practice of Emergency Medicine Philadelphia: Lea & Febiger, 1992 ORGANIZATIONS American Trauma Society 8903 Presidential Pkwy Suite 512, Upper Marlboro, MD 20227 (800) 556-7890 OTHER American Association for the Surgery of Trauma home page Douglas Dupler Prognosis The ample blood supply to the spleen can promote rapid healing Studies have shown that intra-abdominal bleeding associated with splenic trauma stops without surgical intervention in up to two out of three cases in children When trauma patients stabilize during nonoperative therapy, chances are high that surgery will be avoided and that spleen injuries will heal themselves Splenic trauma patients undergoing diagnostic tests such as CT and MRI scans have improved chances of avoiding splenectomy and retaining whole or partial spleens Resources BOOKS Hohn, David C., “Spleen” In Current Surgical Diagnosis and Treatment Ed Lawrence W Way, Stamford, CT: Appleton & Lange, 1994 3142 Split personality see Multiple personality disorder Spontaneous abortion see Miscarriage Sporothrix schenckii infection see Sporotrichosis Sporotrichosis Definition Sporotrichosis is a chronic infection caused by the microscopic fungus Sporothrix schenckii The disease GALE ENCYCLOPEDIA OF MEDICINE Sporotrichosis causes ulcers on the skin that are painless but not heal, as well as nodules or knots in the lymph channels near the surface of the body Infrequently, sporotrichosis affects the lungs, joints, or central nervous system and can cause serious illness Description The fungus that causes sporotrichosis is found in spagnum moss, soil, and rotting vegetation Anyone can get sporotrichosis, but it is most common among nursery workers, farm laborers, and gardeners handling spagnum moss, roses, or barberry bushes Cases have also been reported in workers whose jobs took them under houses into crawl spaces contaminated with the fungus Children who played on baled hay have also gotten the disease Sporotrichosis is sometimes called spagnum moss disease or alcoholic rose gardener’s disease Causes and symptoms The fungus causing sporotrichosis enters the body through scratches or cuts in the skin Therefore, people who handle plants with sharp thorns or needles, like roses, barberry, or pines, are more likely to get sporotrichosis Sporotrichosis is not passed directly from person to person, so it is not possible to catch sporotrichosis from another person who has it The first signs of sporotrichosis are painless pink, red, or purple bumps usually on the finger, hand, or arm where the fungus entered the body These bumps may appear anywhere from one to 12 weeks after infection, but usually appear within three weeks Unlike many other fungal infections sporotrichosis does not cause fever or any feelings of general ill health The reddish bumps eventually expand and fester, creating skin ulcers that not heal In addition, the infection often moves to nearby lymph nodes Although most cases of sporotrichosis are limited to the skin and lymph channels, occasionally the joints, lungs, and central nervous system become infected In rare cases, death may result People who have weakened immune systems, either from a disease such as acquired immune deficiency Syndrome (AIDS) or leukemia, or as the result of medications they take (corticosteroids, chemotherapy drugs), are more likely to get sporotrichosis and are more at risk for the disease to spread to the internal organs Alcoholics and people with diabetes mellitus or a pre-existing lung disease are also more likely to become infected Although sporotrichosis is painless, it is important for people with symptoms to see a doctor and receive treatment GALE ENCYCLOPEDIA OF MEDICINE Sporotrichosis is a chronic infection caused by the microscopic fungus Sporothrix schenckii It produces ulcers on the skin that are painless but not heal, and nodules or knots in the lymph channels near the surface of the body (Illustration by Electronic Illustrators Group.) Diagnosis The preferred way to diagnose sporotrichosis is for a doctor to obtain a sample of fluid from a freshly opened sore and send it to a laboratory to be cultured The procedure is fast and painless It is possible to confirm the presence of advanced sporotrichosis through a blood test or a biopsy Doctors may also take a blood sample to perform tests that rule out other fungal infections or diseases such as tuberculosis or bacterial osteomyelitis Dermatologists and doctors who work with AIDS patients are more likely to have experience in diagnosing sporotrichosis In at least one state, New York, the laboratory test to confirm this disease is provided free through the state health department In other cases, diagnosis should be covered by health insurance at the same level as other diagnostic laboratory tests Treatment When sporotrichosis is limited to the skin and lymph system, it is usually treated with a saturated solution of potassium iodine that the patient dilutes with water or juice and drinks several times a day The iodine solution can only be prescribed by a physician This treatment must be continued for many weeks Skin ulcers should be treated like any open wound and covered with a clean bandage to prevent a secondary bacterial infection The drug itraconazol (Sporanox), taken orally, is also available to treat sporotrichosis In serious cases of sporotrichosis, when the internal organs are infected, the preferred treatment is the drug 3143 Sports injuries Prevention KEY TERMS Acidophilus—The bacteria Lactobacillus acidophilus, usually found in yogurt Bacterial osteomyelitis—An infection of the bone or bone marrow that is caused by a bacterium Bifidobacteria—A group of bacteria normally present in the intestine Commercial supplements are available Corticosteroids—A group of hormones produced naturally by the adrenal gland or manufactured synthetically They are often used to treat inflammation Examples include cortisone and prednisone Lymph channels—The vessels that transport lymph throughout the body Lymph is a clear fluid that contains cells important in forming antibodies that fight infection amphotericin B Amphotericin B is a strong anti-fungal drug with potentially severe toxic side effects It is given intravenously, so hospitalization is required for treatment The patient may also receive other drugs to minimize the side effects of the amphotericin B Alternative treatment Alternative treatment for fungal infections focuses on maintaining general good health and eating a diet low in dairy products, sugars, including honey and fruit juice, and foods, such as beer, that contain yeast This is complemented by a diet high in raw food Supplements of and vitamins C, E, and A, B complex, and pantothenic acid may also be added to the diet, as may Lactobacillus acidophilus, bifidobacteria, and garlic capsules Fungicidal herbs such as myrrh (Commiphora molmol), tea tree oil (Melaleuca spp.), citrus seed extract, pau d’arco tea, and garlic (Allium sativum) may also be applied directly to the infected skin Prognosis Most cases of sporotrichosis are confined to the skin and lymph system With treatment, skin sores begin healing in one to two months, but complete recovery often takes six months or more People who have AIDS are also more likely to have the fungus spread throughout the body, causing a life-threatening infection In people whose bones and joints are infected or who have pulmonary lesions, surgery may be necessary 3144 Since an opening in the skin is necessary for the sporotrichosis fungus to enter the body, the best way to prevent the disease is to avoid accidental scrapes and cuts on the hands and arms by wearing gloves and long sleeves while gardening Washing hands and arms well after working with roses, barberry, spagnum moss, and other potential sources of the fungus may also provide some protection Resources BOOKS Griffith, H Winter Complete Guide to Symptoms, Illness & Surgery Putnam Berkley Group 1995 PERIODICALS Dillon, Gary P., et al “Handyperson’s Hazard: Crawl Space Sporotrichosis.” The Journal of the American Medical Association 274 (6 Dec 1995): 1673+ Tish Davidson Sports injuries Definition Sports injuries result from acute trauma or repetitive stress associated with athletic activities Sports injuries can affect bones or soft tissue (ligaments, muscles, tendons) Description Adults are less likely to suffer sports injuries than children, whose vulnerability is heightened by: • immature reflexes • inability to recognize and evaluate risks • underdeveloped coordination Each year, about 3.2 million children between the ages of five and 14 are injured while participating in athletic activities, and account for 40% of all sports injuries As many as 20% of children who play sports get hurt, and about 25% of their injuries are classified as serious More than 775,000 boys and girls under age 14 are treated in hospital emergency rooms for sports-related injuries Injury rates are highest for athletes who participate in contact sports, but the most serious injuries are associated with individual activities Between one-half and two-thirds of childhood sports injuries occur during practice, or in the course of unorganized athletic activity GALE ENCYCLOPEDIA OF MEDICINE Sports injuries Chauncy Billups, a guard for the Denver Nuggets, grimaces after spraining his ankle during a game (AP/Wide World Photos Reproduced by permission.) Types of sports injuries About 95% of sports injuries are minor soft tissue traumas The most common sports injury is a bruise (contusion) It is caused when blood collects at the site of an injury and discolors the skin Sprains account for one-third of all sports injuries A sprain is a partial or complete tear of a ligament, a strong band of tissue that connects bones to one another and stabilizes joints A strain is a partial or complete tear of: • muscle (tissue composed of cells that enable the body to move) • tendon (strong connective tissue that links muscles to bones) Inflammation of a tendon (tendinitis) and inflammation of one of the fluid-filled sacs that allow tendons GALE ENCYCLOPEDIA OF MEDICINE to move easily over bones (bursitis) usually result from minor stresses that repeatedly aggravate the same part of the body These conditions often occur at the same time SKELETAL INJURIES Fractures account for 5–6% of all sports injuries The bones of the arms and legs are most apt to be broken Sports activities rarely involve fractures of the spine or skull The bones of the legs and feet are most susceptible to stress fractures, which occur when muscle strains or contractions make bones bend Stress fractures are especially common in ballet dancers, longdistance runners, and in people whose bones are thin Shin splints are characterized by soreness and slight swelling of the front, inside, and back of the lower leg, and by sharp pain that develops while exercising and gradually intensifies Shin splints are caused by overuse or by stress fractures that result from the repeated foot pounding associated with activities like aerobics, longdistance running, basketball, and volleyball 3145 ... joint 3 148 Description Based on the clinical condition of the patient, the physician determines what group of microorganism is GALE ENCYCLOPEDIA OF MEDICINE Bacterial culture A portion of the... a week after surgery GALE ENCYCLOPEDIA OF MEDICINE Incus—The middle of the three bones of the middle ear It is also known as the “anvil.” Malleus—One of the three bones of the middle ear It is... pockets of infection and pus under the skin (carbuncles) • tissue inflammation that spreads below the skin, causing pain and swelling (cellulitis) GALE ENCYCLOPEDIA OF MEDICINE A close-up of a woman’s