Testified, Judged & Sentenced

Introduction : Narrowing of the spinal canal leading to compression(nerve pinching) onto the spinal cord, nerve roots and intervertebral foramina caused by bony growth. Mainly caused by spinal degeneration with ageing, herniation, osteoporosis or maybe even a tumour. Commonly located in the cervical or lumbar regions and patients above 50years are mostly at risk. The congenital variant of this condition is called Klippel-Feil Syndrome. Normally presents itself at an early age (30-40yrs).

General symptoms include pain, limb weakness, lower back pain, neurogenic claudication and also tingling sensations. (Constellation of symptoms)

4 major types of Spinal Stenosis – Central, Far Lateral, Foraminal and Cervical.

Diagnostics :
1. Attain medical history with special attention to trauma or conditions in the lumbar region.
2. Physical examination includes assessing patient’s hindered movements, pain threshold with  relation to flexing spine, loss of extremity reflexes with numbness and weakness.
3. Tests – MRI, CAT, Myelogram and Bone scans.

Treatment :

If conservative ( NSAIDS, Analgesics, PhysioTherapy, Rest, Support Devices) treatment methods are not effective, surgery is the way to go. We can opt for Decompressive Laminectomy, Laminotomy, Foraminotomy and Spinal Fusions.

The former 3 are aimed to remove stress on nerves by creating sufficient room between lamina and nerve roots whereas the bone fusion operation is targeted to minimize motion along the vertebra which in turn alleviate the symptoms.

Risk factors the mentioned procedures include death, hematoma, haemorrhage, infection, respiratory and cardiac problems (cervical) and urinary difficulties and decreased intestinal function/motility(lumbar).

Surgical procedures are targeted to improve the quality of life for the patient. Current technological advances in the field of neuro and spinal surgery has lead to the use of endoscopic methods and other minimally invasive techniques.

Lately, I’ve been told that I hardly keep up to my words. This particular trait of mine has never failed me my entire life but of late, it’s been plaguing me in ways I can’t imagine. As promised, I would like to post up a medically related article for every other post in this blog. To kick-off my case studies , lets look into : Mucous Retention Cyst.

Introduction : A mucous cyst is a benign, common, mucus-containing cystic lesion of the minor salivary glands in the oral cavity. Some authors prefer the term mucocele since most of these lesions are not true cysts in the absence of an epithelial lining. The lesions can be located :

1. Directly under the mucosa (superficial mucous cyst),
2. In the upper submucosa (classic mucous cyst),
3. or in the lower corium (deep mucous cyst).

Two types of mucous cysts occur based on the histologic features of the cyst wall:
- a mucous extravasation cyst formed by mucous pools surrounded by granulation tissue (92%),
- a mucous retention cyst with an epithelial lining (8%).

PathPhysiology

The mechanism of mucous cyst formation is unclear; however, a traumatic etiology rather than an obstructive phenomenon is considered more likely. The frequent location of the mucous cyst in the lateral aspect of the lower lip also supports the role of trauma as an etiologic factor. Although obstruction may play a role in the etiology of the mucous cyst, Lymphatic vessels may also contribute to the early stages of mucous cyst development. Specifically, the growing mucous cyst may induce a pressure gradient that causes lymphatics to swell with interstitial fluid, eventually rupturing and delivering this fluid back to the mucous cyst.

Mucous cyst is a benign condition and non-fatal. Frequent in young males.

Case Study #1/2010
(new reference #no. system to start logging my cases, damn the punters !)

Male, 28yrs. Presents with a palpable growth , painless, on left lower lip inside. Probably the size of a BB pellet(<5mm). No visible lesion or ulceration on growth. The surface of epithelia is rather smooth, shiny and dome shaped.

Patient complained of an ulcer located in the same area which didn’t heal after 2 months. Ulcer was continuous for the course of 2 months, unchanged diet and lack ulcer management did not help either. Bonjela damn it !

After initial observation, we can conclude that growth is benign and related to salivary ducts. Differentials would be lichen planus, Stomatitis, neoplasm, hemangioma and lipomas.

After consults with dermatologists and surgeons, we conclude that a conservative treatment method should be used to the painless nature of the cyst. Fortunately the cyst is not lying on a nerve ending or irritating pain fibres. With time, the cyst may dissolve itself or daily salt water gargle should help speed up the process. In the event the cyst grows or the pain factor has kicked in, we should look into surgical excision. This, I would gladly do with a scalpel, vodka(or whiskey) and loads of sterile gauze.

Surgical Care

For definitive management,

- The treatment of choice for a deep mucous cyst and the classic form is surgical excision, which should include the immediate adjacent glandular tissue.

- Cryosurgery with liquid nitrogen spray or cryoprobe is an alternative therapeutic modality. After day 4 to week 1, a necrotic surface is observed in the treated area.

- The latter separates from the surrounding mucosa in 1-2 weeks, exposing a new epithelialized surface. The advantages of the procedure include a simple application, minor discomfort during the procedure, and a low incidence of complications (eg, secondary infection, hemorrhage); however, the possibility of recurrence exists.

The patient has no further complaints. It didn’t occur to him that a lump in his mouth wasn’t abnormal, what more could I ask of him. In fact that useless bum doesn’t even want to get it checked when referred to the 2nd coolest doctor around, Dr.M. (sadly, he happens to be the father of our dearest Anuisafag, I sympathize him at times.)

With references to a couple of online medical sites and journals, I was able to conjure up the above. I seriously got to broaden my horizons after this because not everything in this field is always related to the heart, lungs, kidney or brain. Russian Doctors truly have it easy, having every Tatyana, Dmitri and Elena come in with either a heart problem, pulmo-infection, stroke, hepato-renal failure or even some cheap STD.

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I spent the last few hours going through my entire blog entries for the past 3 years and I realized that my medical input into here is a bare minimum. Note to self: blogs are meant to be cool and serve some sort of purpose in the interwebs. So I’m going to try something new, for every post I write up here, it should be accompanied with something medically related.

I’m sure HypoGXII and Abz will have a good laugh with this.

After an awesome evening with Aimi yesterday, we’re going to double-up with the guys later at night. Easwar and Srishti might prove to be comic fun at the moment. Apparently those girls have taken interest in poker, another excuse for me to pwn em’ downside up.

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(edited hyperlink)

After completing the volley of exams this June, we’ve finally completed our 5th academic year here in M2. Upon seeing the faces of our graduating seniors, year after year we yearn to be in their shoes. 1 more year, just 1 more year.

First and foremost, I would like to congratulate the graduating batch of 2010, to all my friends and all the best in your future endeavors. M2 would be proud to have this batch to graduate on top of the batch of 08’. I foresee good practicing doctors amongst them to help improve the stigma on RSMU students. 

Weather here in Malaysia is still really hot. I’m planning to take these few days off to update on current affairs and also acclimatize myself to the weather and food. On top of that, plan my entire summer here. Golf, parties and everything in between. The challenge is top off last summer’s awesomeness.

On the day prior to our departure from Moscow, my roommate and I had the opportunity to spend an entire day with Layla T  and her picture-taking abilities. Destination, Tsaritsino Park. It was an awesome day out really. Check the pics out at facebook to let the beauty of nature enchant you.

Been clocking in Quality time with the folks, tubbs especially. The elder one busy with his career and sister just being her evasive self.

The World Cup has been rather interesting here. Top dogs crashing out, minor teams with quality players outshining the field and also putting out a world class display of football. England has yet to make me proud since 98 and my pick, the Argentinians have lived up to my expectations. As much as the tabloids claims a 1 man show by Messi, it really isn’t. Being marked by 2-3 players at any 1 time prohibits him from doing much on his own, hence the dependence on his teammates to play his game.

Alright, I’m off to catch the 3 Lions against their arch enemies, the jerries. Let’s see how this game goes.

All in all, Le Albinoceleste will take the cup home.

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The Old man has always said that you can never bring anything with you to the grave other than your name. Your possessions, fortune and wealth will be distributed amongst family members (or to those indicated in your will) accordingly and the only thing left is your name.

When I say Name, I mean it in it’s broadest sense possible.

The truth is, I got nothing worthy to write here but felt necessary to post up my newly acquired forum signature, credits to HypoGXII.

Ulquiorra and his nihilistic view on life makes more sense than anything right now.

The above quote was Ulquiorra’s final words to Ichigo before revealing his Resurrección: Segunda Etapa(2nd stage resurrection).

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