Medicine

Tuesday, July 26, 2011

Cryosurgery of the Cervix

Overview & Description

Cryosurgery of the cervix is the freezing of a section of the cervix. This is usually done to remove cells that show the types of changes that can lead to cancer in the future. Cells with these types of changes are called precancerous. The cervix is the lower portion of the uterus where it attaches to the vagina.

Who is a candidate for the procedure?

Cryosurgery may be used to treat a woman who has:

an inflamed cervix, called cervicitis

certain types of precancerous changes in the cervix. These changes are usually first detected from a Pap smear.

some forms of cervical ectropion, which may cause a chronic or long-standing whitish or yellowish discharge.

How is the procedure performed?

This procedure can often be done in the doctor's office. First, a tool called a speculum is used to hold the vaginal walls apart so that the cervix can be seen well. This tool is also used during a regular Pap smear. A bit of gel is then put on the cervix. This helps create a good seal for a tool called a cryoprobe. The cryoprobe delivers liquid nitrogen to the right spot on the cervix. A flow of liquid nitrogen, which is extremely cold, freezes the cervix cells for about 3 to 5 minutes. After a wait of 2 to 3 minutes to let the cells warm up, they are frozen again for 3 to 5 minutes. This repeated freezing destroys the cells.

Preparation & Expectations

What happens right after the procedure?

When cryosurgery has been used to treat precancerous cells in the cervix, a Pap smear should be done every 3 to 4 months after that for one year. During the second year, Pap smears should be done every 6 months. A Pap smear is done to test for cancer of the cervix. If a Pap smear is abnormal, a biopsy of the cervix may be needed to check the cells of the cervix more closely. A biopsy involves taking a small piece of tissue from the cervix with a special needle. The tissue can then be sent to the lab for analysis.

Home Care and Complications

What happens later at home?

A woman may go back to her normal activities after the procedure. Mild cramping may be treated with over-the-counter medicine, such as ibuprofen, naproxen, or acetaminophen.
During the next month, the cells that were frozen will be lost in the form of a clear discharge from the vagina. So that the tissues can heal, the woman should not put anything in her vagina for 4 to 6 weeks after the procedure. This means she must avoid using douches or tampons. And she should not have sexual intercourse during this time as well.

What are the potential complications after the procedure?

Rarely, complications can occur, such as:

bleeding from the cervix

infection of the cervix

narrowing of the cervix, which may cause more cramping than normal during menstruation if it blocks the menstrual flow

Attribution

Author:Eva Martin, MD
Date Written:
Editor:Crist, Gayle P., MS, BA
Edit Date:02/11/02
Reviewer:William M. Boggs, MD
Date Reviewed:02/11/02

Cryotherapy

Cryotherapy is the use of extreme cold to treat medical conditions by destroying abnormal or diseased cells.

What is the information for this topic?

Cryotherapy commonly uses liquid nitrogen as the source of cold. Nitrogen is a naturally occurring gas that can be artificially cooled into a liquid form. This requires very low temperatures. This type of treatment is used for a number of conditions, such as:

tumors or cancer, especially those of the skin, cervix, eye, and brain. This treatment is also being used for other cancers, such as prostate cancer and liver cancer.

certain early changes in the skin that might signal possible cancer. Actinic keratosis, a skin condition caused by sun exposure, can be treated with cryotherapy.

cervical dysplasia, or abnormal precancerous cells in a woman's cervix that can lead to cancer of the cervix

warts, including genital warts from human papilloma virus, or HPV

acne

hemorrhoids, which are enlarged veins in the rectum

certain types of chronic pain or nerve irritation, such as a condition called trigeminal neuralgia

other common skin lesions, such as skin tags, hemangiomas, or seborrheic keratoses

a tear in the back part of the eye, called a retinal tear or retinal detachment

bleeding during standard surgery
For many lesions, liquid nitrogen is applied with a cotton-tipped applicator. A spraying device can also be used. The nitrogen is placed on the lesions until they are frozen and destroyed.
For internal tumors or cancer, liquid nitrogen is run through an instrument called a cryoprobe. This probe is placed in contact with the lesion. The doctor uses special imaging tests, such as ultrasound or a CT scan, to guide the probe. This helps prevent damage to nearby tissue. Some tumors or cancers may need a cycle of treatments. In these cases, the tumor is frozen, allowed to thaw, and then refrozen.
Cryotherapy offers some advantages over other methods of treatment. It is less invasive than regular surgery. It may eliminate the need for cuts in the skin. In other cases, only a small skin incision is needed so that a probe can be inserted into the body. Pain, bleeding, and other risks of surgery are reduced. It is often less expensive than other forms of surgery. The person often has a shorter recovery time.
For individuals with cancer, cryotherapy can be added to other standard treatments. This therapy may also be offered to a person whose cancer hasn't responded to normal treatments.
Cryotherapy, like almost all treatments, has side effects. However, they may be less severe than the side effects of regular surgery. The main risk is damage to surrounding healthy tissue. This can be quite serious, such as in brain surgery, when the healthy tissue is very important. Skin irritation, damage, and infection can occur when this therapy is used to treat skin conditions.

Cryotherapy of the Cervix - Cryosurgery of the Cervix

Overview & Description

Who is a candidate for the procedure?

Cryosurgery may be used to treat a woman who has:

an inflamed cervix, called cervicitis

certain types of precancerous changes in the cervix. These changes are usually first detected from a Pap smear.

some forms of cervical ectropion, which may cause a chronic or long-standing whitish or yellowish discharge.

How is the procedure performed?

Preparation & Expectations

What happens right after the procedure?

Home Care and Complications

What happens later at home?

What are the potential complications after the procedure?

Rarely, complications can occur, such as:

bleeding from the cervix

infection of the cervix

narrowing of the cervix, which may cause more cramping than normal during menstruation if it blocks the menstrual flow

Attribution

Author:Eva Martin, MD
Date Written:
Editor:Crist, Gayle P., MS, BA
Edit Date:02/11/02
Reviewer:William M. Boggs, MD
Date Reviewed:02/11/02

Cryptorchidism - Undescended Testicle

Overview, Causes, & Risk Factors

Undescended testicle, called cryptorchidism, refers to a testicle that fails to move into the scrotum. This is a condition that is present at birth.

What is going on in the body?

The testes move from inside the abdomen into the scrotum during a baby's development. The testicles are found in the scrotum in 97% of boys born at full term. The testicles may not move into the scrotum in up to one-third of premature infants. Some testicles continue moving and reach the scrotum during the first year of life. If the testicles have not moved into the scrotum by one year of age, it is unlikely that they will ever do so.

What are the causes and risks of the condition?

The exact causes of this condition are still a subject of debate. There appear to be both hormonal and mechanical factors at work. This condition is much more likely to occur in premature infants. The earlier a child is born, the more likely the child is to have this condition. Certain inherited conditions can also make this condition more likely to occur.

Symptoms & Signs

What are the signs and symptoms of the condition?

The testicles are noted to be absent in the scrotum by the parent or healthcare provider. In most cases, only one testicle is affected, but both can be involved. There are usually no other signs or symptoms. This condition sometimes occurs along with other physical defects.

Diagnosis & Tests

How is the condition diagnosed?

Careful and gentle physical examination of the child can usually diagnose this condition. A urologist, or doctor who specializes in treatment of conditions of the kidney, bladder and genitals, is usually consulted. If both testes are unable to be felt with the hand, hormone levels are checked to make sure the child has testicles. Other conditions that can cause an inability to feel the testicle must be ruled out. For example, some testicles occasionally move up into the abdomen but are usually in the normal location. X-ray tests are sometimes used to locate the testes. Currently, most urologists use laparoscopy to locate the testicles and guide further therapy. During this procedure, a narrow telescope is placed into the abdomen to search for the testicles.

Prevention & Expectations

What can be done to prevent the condition?

There are no known ways to prevent this condition.

What are the long-term effects of the condition?

This condition increases the risk for cancer of the testicle. It has been estimated that roughly 10% of men who developed this cancer had undescended testicles.
Torsion of the testicle is more common than in normal testicles. This condition is a twisting of the testicle around its blood supply that may cause the blood supply to be cut off. Testicles that have been repaired are much less likely to develop this problem.
Hernias in the groin area develop in most people with this condition.
Fertility, or the ability to father children, is reduced in men with an undescended testicle on one side. It is very poor in men that are affected on both sides.

What are the risks to others?

This condition cannot be passed from one person to another.

Treatment & Monitoring

What are the treatments for the condition?

The primary treatment for this condition is surgery. Often, a child is watched until the age of one to see if the testicle will move into the scrotum by itself. If not, affected testicles can be brought down into the scrotum using surgery. Surgery improves cosmetic appearance and makes examination of the testicles to check for cancer easier. Surgery may also improve the chance of future fertility in some cases.

What are the side effects of the treatments?

There is little discomfort after most procedures to repair this condition. The recovery time is usually short. Laparoscopy generally results in a faster recovery, but in young children, fast healing is the rule after any surgery. The primary risk of the procedure is failure. This may mean the testicle cannot be found or is damaged during the surgery. As with all surgeries, there is a chance of bleeding, infection and reactions to the medicine used for pain control.

What happens after treatment for the condition?

After a short recovery time, the child can return to normal activities.

How is the condition monitored?

After surgery, periodic physical exam of the testicles is required. Surgery to correct this condition does not reduce the risk of cancer of the testicle.

Attribution

Author:Stuart Wolf, MD
Date Written:
Editor:Keefe, Sandy, RN, MSN
Edit Date:05/13/00
Reviewer:Adam Brochert, MD
Date Reviewed:08/07/01

CSF Leak

Overview, Causes, & Risk Factors

Cerebrospinal fluid, also known as CSF, leak is an abnormal drainage of cerebrospinal fluid from the subarachnoid space in the brain. The fluid may leak out into the body, but more often it is seen leaking through the ears, nose, or an open wound.

What is going on in the body?

CSF is formed within the inner spaces of the brain called ventricles. The fluid travels through the ventricles and exits the brain beneath the cerebellum, which is at the base of the head. It then travels down the spine, around the spinal cord and nerves, and back up to the head. The final step is passing over the top of the brain where it is absorbed. The fluid is held between the arachnoid and dura membranes. These membranes enclose the brain and spinal cord. Leakage occurs when the arachnoid membrane is ruptured.

What are the causes and risks of the condition?

A CSF leak is caused by a rupture of the arachnoid membrane. This usually results from trauma, although it can occur spontaneously. Tissue destruction caused by tumors could lead to a CSF leak.

Symptoms & Signs

What are the signs and symptoms of the condition?

CSF is a clear, watery liquid that leaks out of the nose, ear, or a wound. Headache is common with a CSF leak. It may be relieved when the person sits upright from a lying position. However, changing to this position may cause the flow of fluid to increase. Coughing or sneezing can also cause an increased flow of CSF.

Diagnosis & Tests

How is the condition diagnosed?

Diagnosis is made through observation and by testing any suspicious watery fluid for glucose, which is present in cerebrospinal fluid. X-ray studies may be needed to find the exact place where the membrane has ruptured. Other studies may include CT scans.

Prevention & Expectations

What can be done to prevent the condition?

There is no way to prevent a CSF leak except by avoiding trauma. Sports safety guidelines for children, adolescents, and adults can help avoid head injury during sports.

What are the long-term effects of the condition?

Chronic leakage may occur at times. The leak most commonly comes from the nose. A long-term result may result in the loss of the sense of smell.

What are the risks to others?

There are no risks to others.

Treatment & Monitoring

What are the treatments for the condition?

Leakage through the nose or ears following trauma usually gets better with rest. Antibiotics are given if an infection is present. If the leakage persists, the doctor may place catheters in the lumbar spine to reroute the CSF. Surgical closure of the ruptured membrane is rarely needed. If leakage is caused by erosion due to tumor or infection, the underlying cause must be treated.

What are the side effects of the treatments?

Infection of the trauma site and failure of the rupture to close spontaneously may sometimes occur. In cases of a skull fracture, swelling may damage a cranial nerve, leading to weakness or paralysis on the side of the face. These injuries commonly result in hearing loss on the affected side.

What happens after treatment for the condition?

Treatment is usually successful, although complications such as infection can occur.

How is the condition monitored?

A person should be monitored for infection and recurrence of CSF leakage. A change of therapy may be needed if infection or recurrence takes place. Any new or worsening symptoms should be reported to the doctor.

Attribution

Author:James Warson, MD
Date Written:
Editor:Crist, Gayle P., MS, BA
Edit Date:10/16/02
Reviewer:Kathleen A. MacNaughton, RN, BSN
Date Reviewed:10/16/02

Sources

Current Medical Diagnosis & Treatment, 39th edition.

CST - Craniosacral Therapy

Overview & Description

Craniosacral therapy (CST) is a type of therapy used in an attempt to improve health. CST involves using gentle hand and finger touch, movements, and pressure to move parts of the body. The word comes from the terms cranium and sacrum. Cranium refers to the head and sacrum refers to a bone in the lower spine above the tailbone.

What is the information for this topic?

CST focuses on the nervous system, especially the membranes and fluid that surround the brain and spinal cord. This fluid is called cerebrospinal fluid (CSF). CSF is always moving and circulating around the spinal cord and brain.
CST therapists claim that CSF moves in a smooth, rhythmic motion. As the fluid moves, expanding and contracting movements occur in other parts of the body. CST therapists claim that there are roughly 10 to 14 cycles of this movement per minute. People trained to perform CST use their hands to feel these movements. They claim to be able to feel abnormalities or blockages in these movements. CST therapists use a very small amount of pressure with their fingertips and hands to correct abnormal or blocked movements. They claim that the pressure applied can help CSF circulate better.
CST has been used to treat many conditions, including:

headaches, neck pain, spinal or back pain

temporal mandibular joint disorder, called TMJ

ear pain, ear and sinus congestion, and chronic bronchitis

dizziness and vertigo

joint pain or problems

depression

learning disabilities

injuries from trauma, such as head injury or neck injury

colic in infants

problems related to nerve damage or injuries, such as sciatica
To begin the therapy, a person usually lies down on a massage table. The therapist monitors the rhythmic motions described above. The therapist feels the body motions and applies gentle pressure to areas that do not seem to be flowing correctly. The pressure is usually applied to the bones of the head, spine, chest, rib cage, and arms and legs. This is believed to help CSF flow smoothly. The amount of pressure applied is very gentle.
CST therapists believe if there is a problem with the craniosacral motions or CSF, the body cannot stay healthy. This is because the body must focus on the abnormal flow. This means the body does not have enough remaining energy to stay healthy.
A second aspect of CST is called somatoemotional response. In this part of CST, the therapist uses talking and imagery techniques. These help release painful emotions that may come with the hands-on therapy. The CST therapist will guide a person through his or her emotions. The therapist will try to help the person resolve any inner concerns or conflict.
Each session lasts anywhere from 30 minutes to 1 hour. The number of sessions will depend on what type of condition is being treated. Sessions may continue as long as a person feels they are helpful.
Most medical professionals do not believe CST is a valid treatment for any condition. There has been no scientific proof of any of the claims made by CST therapists. There is question as to the ability to move bones of the skull, since they are fused together. Scientists who study the nervous system have been unable to find or measure any rhythmic movements talked about in the CST theories.
Anyone with CSF problems, blood clots, or cerebral aneurysms, which are abnormally widened blood vessels, should avoid this therapy. Those who have been advised to avoid things that affect the CSF should also not have this therapy. Parents are strongly advised to speak with a medical doctor before letting an infant or child have this therapy.
Side effects are reported to be rare. However, little scientific data is available to evaluate the true risk of side effects. Possible reported side effects include diarrhea, headaches, and angry outbursts. Because physical manipulation is used, injury is a possibility.
Anyone who desires CST therapy should first consult his or her healthcare provider. Any unusual symptoms, such as shortness of breath, headaches, chest pain, or back pain should be reported to the healthcare provider.

Attribution

Author:Eileen McLaughlin, RN, BSN
Date Written:
Editor:Smith, Elizabeth, BA
Edit Date:09/14/00
Reviewer:Adam Brochert, MD
Date Reviewed:08/09/01

CT Scan

Overview & Description

Computed tomography (CT) is a computer-aided x-ray technique. X-rays consist of electromagnetic waves of energy. They penetrate the body to varying extents depending upon the density of the structures being viewed. The result is black and white images of interior portions of the body. A CT scan produces detailed cross-sectional views of the body, similar to slices of bread.
The technology behind CT scans has advanced rapidly in recent years. Older machinery used to take minutes to obtain enough information for a single "slice." Now, the same image can be produced in seconds. Newer scanners called spiral or helical scanners are so fast that they can scan the entire chest during one held breath. These devices can also produce three-dimensional scans.

Who is a candidate for the test?

CT scans are performed to evaluate:

abnormalities that showed up on other other types of x-rays.

injuries.

tumors related to cancer. CT scans can indicate the progress of some cancers if the cancers spread or metastasize and the effectivness of treatment.

bony abnormalities.

brain abnormalities.

abdominal symptoms. Use of CT scans in these cases can often prevent exploratory surgery.

suspicious chest abnormalities.
CT scans are also used to guide needles when taking tissue samples. In addition, the technique is useful in gauging a person's recovery after an operation. CT scans can also be used to guide instruments for surgery deep in the brain.

How is the test performed?

A person having a CT scan will need to undress and put on an exam gown. Next, the person will lie on a narrow table. The table will slide through a machine that looks like a doughnut. This is called the gantry. While in the gantry, an x-ray tube travels around the individual creating computer-generated x-ray images.
Some types of exams require the individual to receive an intravenous injection of iodinated contrast, which is a dye that makes some tissues show up better. Scans of the intestines sometimes call for the person to drink diluted iodinated contrast solution prior to the exam. After the exam, the technologist will view the pictures. If they are adequate, the person is free to leave.

Preparation & Expectations

What is involved in preparation for the test?

A person having the test will be asked to refrain from eating or drinking for 4 hours before the scan. All jewelry and metal objects that may interfere with the exam need to be removed beforehand, as well. Women will be asked if they are pregnant. Individuals should check with their healthcare provider or hospital x-ray department to see if any other preparation is needed.

Results and Values

What do the test results mean?

A CT scan provides a direct image of soft tissue structures such as the, liver, lung, spleen, pancreas, lymph nodes and fatty tissues. CT is also good for identifying and tracking large abnormalities such as tumors. CT of the head can be used to evaluate strokes, tumors, bleeding and injuries. It can also be used to examine most brain structures. CT performs well in providing images of bony structures. These include the spine, facial bones, sinuses and skull. It also works well in viewing long bones for fractures, tumors or infection.

Attribution

Author:James Compton, MD
Date Written:
Editor:Keefe, Sandy, RN, MSN
Edit Date:05/22/00
Reviewer:William M. Boggs, MD
Date Reviewed:09/04/01