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

    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

    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

    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

    CT Scan, Brain - Cranial CT Scan

    Overview & Description

    Computed tomography, also called CT, of the brain is a noninvasive imaging method that combines X-rays with computer technology. X-ray beams from several angles are used to create a series of detailed cross-sectional images of the brain.
    Who is a candidate for the test?
    CT is an excellent method for viewing the structures of the brain. It can provide detailed images of several types of tissue including bone, soft tissue, and blood vessels. For this reason, it can be used to:
  • provide feedback on brain and central nervous system diseases such as encephalitis and Treponema pallidum,\ the organism that causes syphilis. It is a tertiary, or third-stage, form of syphilis that affects the brain and spinal cord. ',CAPTION,'General Paresis');" onmouseout="return nd();">general paresis from Treponema pallidum\ bacteria. Less often, syphilis is transmitted from a pregnant woman to her baby. This form of syphilis is known as \congenital syphilis.\ ',CAPTION,'Syphilis');" onmouseout="return nd();">syphilis

  • diagnose brain tumors

  • gather data on head injuries

  • guide radiation therapy treatments
    A cranial CT scan can help a doctor diagnose and treat the following conditions:

  • brain tumors and other abnormal brain growths

  • skull fractures

  • brain damage after head injury

  • bleeding in the brain after a stroke

  • diseases of the inner ear such as Meniere disease

  • ruptured or leaking cerebral aneurysms
    How is the test performed?
    Before the test, the doctor will ask the person if he or she:

  • has any drug allergies or history of allergic reaction to medicines

  • is allergic to shellfish or to foods with added iodine such as table salt

  • has ever had claustrophobia, which is a fear of enclosed or small spaces. If this is a problem, mild sedating medicine may be given.
    A woman will be asked if she might be pregnant. Often, a urine pregnancy test will be done on females of childbearing age before the CT scan.
    The person having a CT scan will first need to remove items that can interfere with the images, such as wigs, hairpins, clips, and removable dental hardware. The person lies on a flat platform with his or her head on a special pillow. This pillow provides comfort, which helps to limit movement during the scan.
    Next, the table slowly moves into the donut-shaped machine. When the table is in the right position, the device delivers X-ray beams through the person's brain and skull from many angles.
    Often, a special substance called a contrast agent is used to enhance internal brain structures and improve the quality of the final images. Typically, the contrast agent is injected into a vein in the arm. Most CT tests take between 10 and 45 minutes. The scanning process is painless. To make sure the final images are clear, the person must lie still during the whole exam.
    The contrast agent may cause mild nausea in some people. Flushing, itching, and a metallic taste in the mouth are often described in patients who receive an injected contrast agent. Most of these feelings go away within a few minutes.
    After the test, the person will be asked to wait until the pictures are looked at to see if any more are needed. The person will be observed for any delayed reactions to the contrast agent. To help rid the body of the contrast agent, he or she may be asked to drink extra fluids.


  • Preparation & Expectations

    What is involved in preparation for the test?
    The person having a CT should not eat or drink for at least 4 hours before the test. The CT technologist will explain how the test is done. People who are prone to claustrophobia will receive a calming medicine before the exam.

    Results and Values

    What do the test results mean?
    A doctor specially trained in analyzing CT images, called a radiologist, will examine the results of the test. He or she will forward a report of the findings to the person's doctor.
    A cranial CT can reveal:
  • brain tumors

  • cerebral aneurysms

  • abnormalities in the structures of the brain

  • stroke from cardiogenic embolism, or a blood clot that has traveled to the brain

  • abscesses

  • intracerebral hemorrhage, or bleeding in the brain

  • multiple sclerosis


  • Attribution

    Author:Stephanie Slon, BA
    Date Written:
    Editor:Crist, Gayle P., MS, BA
    Edit Date:06/05/02
    Reviewer:Kathleen A. MacNaughton, RN, BSN
    Date Reviewed:10/10/02
    Sources
    Pagana, Kathleen D. and Timothy J. Pagana, Mosby's Manual of Diagnstic and Laboratory Tests, St. Louis, 1998.
    "Computed Tomography (CT) - Head," Radiological Society of North America (RSNA), 2000

    CT Scan, Chest - Chest CT Scan

    Overview & Description

    Computed tomography of the chest is a noninvasive imaging method that combines x-rays with computer technology. X-ray beams from a variety of angles are used to create a series of detailed cross sectional images.
    Who is a candidate for the test?
    Computed tomography can provide detailed views of several types of tissue including lung, bone, soft tissue and blood vessels. For this reason, this technique is an excellent method for determining the size and location of growths that are suspected to be cancer. It is also used to guide radiation therapy, biopsies, and other minimally invasive procedures. Conditions of the lungs and chest wall frequently diagnosed with chest CT include:
  • tumors and other abnormal growths, including lung cancer

  • broken ribs

  • abscesses, such as those caused by tuberculosis

  • enlarged lymph nodes

  • fluid around the lungs, or pleural effusion

  • abnormalities of the blood vessels supplying the lungs

  • conditions of the esophagus and stomach
    How is the test performed?
    Before the test the doctor will ask the person if he or she:

  • has any drug allergies, or history of allergic reaction to medications

  • is allergic to shellfish, or foods with added iodine such as table salt

  • has experienced claustrophobia, or anxiety in enclosed spaces. If this is a problem, mild sedating medication may be given.
    A woman will be asked if there is a possibility she might be pregnant. Frequently, a urine pregnancy test will be performed on females of child-bearing age before the CT scan.
    The person having the test will lie on a flat table. The CT technologist may use pillows or other devices to help support the individual's body in the proper position. As the test begins, the table will move slowly into a donut-shaped machine. This device delivers x-ray beams through the person's chest cavity from a variety of angles.
    Often, special substances called "contrast agents" are used to enhance internal structures and improve image quality on the final image.
    For a chest CT, contrast agents are most commonly injected into a vein or swallowed. If contrast is administered, the patient may experience mild nausea, flushing, itching or a metallic taste in the mouth. Most of these sensations disappear within a few minutes.
    A conventional chest CT test takes approximately 30 to 45 minutes. More advanced CT devices, known as helical or spiral CT machines, reduce the imaging time dramatically. To prevent distortion of the final images, the person must lie very still for the duration of the test.
    After the test, the person will be asked to wait until the pictures are examined to see if more images are needed. The person will be observed for any delayed allergic reactions to the medication used as the contrast agent. Also, the individual will be encouraged to drink extra fluids to help flush the contrast material from the body.


  • Preparation & Expectations

    What is involved in preparation for the test?
    The person having a CT will need to refrain from eating or drinking at least 4 hours prior to the test. The CT technologist will explain the procedure to the individual. People who are prone to claustrophobia will be administered a calming drug before the exam.

    Results and Values

    What do the test results mean?
    A doctor specially trained in analyzing CT images, called a radiologist, will examine the results of the test. The radiologist will forward a report of the findings to the individual's healthcare provider.
    Some of the conditions a chest CT can reveal include:
  • tumors of the lungs, chest wall, bone and soft-tissue, such as lung cancer

  • lung abscess

  • lung infections such as pneumonia and tuberculosis

  • chronic lung conditions such as emphysema

  • fluid or inflammation of the membranes around the heart, known as pericardial effusion

  • fluid or inflammation of the membranes around the lungs, known as pleural effusion

  • rib or spine fractures

  • stomach problems, such as hiatal hernia or conditions of the esophagus

  • enlarged lymph nodes

  • conditions of the aorta such as calcification, dilation, or tears


  • Attribution

    Author:Stephanie Slon, BA
    Date Written:
    Editor:Keefe, Sandy, RN, MSN
    Edit Date:06/13/00
    Reviewer:Lanita Dawon, MD
    Date Reviewed:09/04/01
    Sources
    Pagana, Kathleen D. and Timothy J. Pagana, Mosby's Manual of Diagnstic and Laboratory Tests, St. Louis, 1998.
    "Computed Tomography (CT) - Body," Radiological Society of North America (RSNA), 2000.

    CT Scan, Head - Cranial CT Scan

    Overview & Description

    Computed tomography, also called CT, of the brain is a noninvasive imaging method that combines X-rays with computer technology. X-ray beams from several angles are used to create a series of detailed cross-sectional images of the brain.
    Who is a candidate for the test?
    CT is an excellent method for viewing the structures of the brain. It can provide detailed images of several types of tissue including bone, soft tissue, and blood vessels. For this reason, it can be used to:
  • provide feedback on brain and central nervous system diseases such as encephalitis and Treponema pallidum,\ the organism that causes syphilis. It is a tertiary, or third-stage, form of syphilis that affects the brain and spinal cord. ',CAPTION,'General Paresis');" onmouseout="return nd();">general paresis from Treponema pallidum\ bacteria. Less often, syphilis is transmitted from a pregnant woman to her baby. This form of syphilis is known as \congenital syphilis.\ ',CAPTION,'Syphilis');" onmouseout="return nd();">syphilis

  • diagnose brain tumors

  • gather data on head injuries

  • guide radiation therapy treatments
    A cranial CT scan can help a doctor diagnose and treat the following conditions:

  • brain tumors and other abnormal brain growths

  • skull fractures

  • brain damage after head injury

  • bleeding in the brain after a stroke

  • diseases of the inner ear such as Meniere disease

  • ruptured or leaking cerebral aneurysms
    How is the test performed?
    Before the test, the doctor will ask the person if he or she:

  • has any drug allergies or history of allergic reaction to medicines

  • is allergic to shellfish or to foods with added iodine such as table salt

  • has ever had claustrophobia, which is a fear of enclosed or small spaces. If this is a problem, mild sedating medicine may be given.
    A woman will be asked if she might be pregnant. Often, a urine pregnancy test will be done on females of childbearing age before the CT scan.
    The person having a CT scan will first need to remove items that can interfere with the images, such as wigs, hairpins, clips, and removable dental hardware. The person lies on a flat platform with his or her head on a special pillow. This pillow provides comfort, which helps to limit movement during the scan.
    Next, the table slowly moves into the donut-shaped machine. When the table is in the right position, the device delivers X-ray beams through the person's brain and skull from many angles.
    Often, a special substance called a contrast agent is used to enhance internal brain structures and improve the quality of the final images. Typically, the contrast agent is injected into a vein in the arm. Most CT tests take between 10 and 45 minutes. The scanning process is painless. To make sure the final images are clear, the person must lie still during the whole exam.
    The contrast agent may cause mild nausea in some people. Flushing, itching, and a metallic taste in the mouth are often described in patients who receive an injected contrast agent. Most of these feelings go away within a few minutes.
    After the test, the person will be asked to wait until the pictures are looked at to see if any more are needed. The person will be observed for any delayed reactions to the contrast agent. To help rid the body of the contrast agent, he or she may be asked to drink extra fluids.


  • Preparation & Expectations

    What is involved in preparation for the test?
    The person having a CT should not eat or drink for at least 4 hours before the test. The CT technologist will explain how the test is done. People who are prone to claustrophobia will receive a calming medicine before the exam.

    Results and Values

    What do the test results mean?
    A doctor specially trained in analyzing CT images, called a radiologist, will examine the results of the test. He or she will forward a report of the findings to the person's doctor.
    A cranial CT can reveal:
  • brain tumors

  • cerebral aneurysms

  • abnormalities in the structures of the brain

  • stroke from cardiogenic embolism, or a blood clot that has traveled to the brain

  • abscesses

  • intracerebral hemorrhage, or bleeding in the brain

  • multiple sclerosis


  • Attribution

    Author:Stephanie Slon, BA
    Date Written:
    Editor:Crist, Gayle P., MS, BA
    Edit Date:06/05/02
    Reviewer:Kathleen A. MacNaughton, RN, BSN
    Date Reviewed:10/10/02
    Sources
    Pagana, Kathleen D. and Timothy J. Pagana, Mosby's Manual of Diagnstic and Laboratory Tests, St. Louis, 1998.
    "Computed Tomography (CT) - Head," Radiological Society of North America (RSNA), 2000.

    CTR - Carpal Tunnel Repair

    Overview & Description

    Carpal tunnel repair is a surgical procedure that helps to relieve the symptoms of carpal tunnel syndrome. In carpal tunnel syndrome, the median nerve in the wrist is compressed and often is irritated. This causes numbness and pain in the fingers and hand. Carpal tunnel repair relieves the compression of the median nerve.
    Who is a candidate for the procedure?
    Carpal tunnel repair is done when other treatments for carpal tunnel syndrome have failed to relieve symptoms. Other treatments include rest, splinting, and physical therapy. If a person has symptoms for more than 4 months, surgery is often considered.
    How is the procedure performed?
    Carpal tunnel release is usually done in a same-day surgery setting. A local anesthetic is used to numb an area on the palm of the hand. A 2-inch incision is made to free the carpal tunnel ligament from the median nerve. This relieves the pressure on the median nerve.
    An endoscopic release is a less-invasive form of surgery. This procedure uses an endoscope, a small fiber-optic camera. The surgeon uses it to look into the carpal tunnel through a small incision in the wrist. A small tube, or cannula, is placed alongside the median nerve. Through this cannula, a special knife is inserted to free the carpal tunnel ligament from the median nerve.


    Preparation & Expectations

    What happens right after the procedure?
    After the surgery, the person will be kept in the surgery recovery room for a few hours. He or she can expect the following:

  • The affected hand will be elevated to decrease swelling.



  • Anti-inflammatory medicine such as ibuprofen may be given to decrease swelling and discomfort.



  • A bulky gauze dressing will be applied.



  • He or she will be able to eat right after surgery.



  • He or she will be discharged from the same-day surgery center within a few hours.



  • Home Care and Complications

    What happens later at home?
    After discharge, the individual will be given instructions for ways to relieve pain and swelling. These include:

  • applying ice for 20 minutes every 2 hours during the first 48 hours



  • avoiding heavy lifting until given the OK by the healthcare provider



  • changing the dressing daily



  • doing finger and wrist exercises according to the surgeon's instructions



  • elevating the hand above the level of the heart for 48 hours to prevent swelling
    The pain of carpal tunnel syndrome should clear up within the first 2 weeks after surgery. Full recovery of function and sensation to affected areas may take several weeks or months.
    What are the potential complications after the procedure?
    Surgery can cause bleeding, infection, or allergic reaction to anesthesia. Specific complications of carpal tunnel release include nerve damage, scarring, and pain.



  • Attribution

    Author:Gail Hendrickson, RN, BS
    Date Written:
    Editor:Crist, Gayle P., MS, BA
    Edit Date:04/30/01
    Reviewer:Barbara Mallari, RN, BSN, PHN
    Date Reviewed:09/04/01
    Sources
    Professional Guide to Diseases, Sixth Edition. Springhouse: Springhouse Corporation, 1998.
    Griffith, H. Winter. Instructions for Patients. Philadelphia:W.B. Saunders Company,1994.

    Monday, July 25, 2011

    Crush Injury

    Overview, Causes, & Risk Factors

    A crush injury occurs when a body part is caught between 2 objects.
    What are the causes and risks of the injury?
    Most crush injuries are the results of accidents. A minor crush injury is often not serious. An example of a minor crush injury is getting a finger caught in a door. A crush injury is more serious when it involves a large force, such as a foot being run over by a car. This type of crush injury may damage tissues below the skin, such as blood vessels, nerves, muscles, or bones. The force may cause the skin to crack or scrape off during the injury. A loss of function or blood flow may occur in the area. The tissue damaged by a crush injury is also at increased risk for infection. There may be permanent numbness or deformity of the injured body part. Amputation, or removal of a body part with surgery, may be needed in severe injuries.

    Symptoms & Signs

    What are the signs and symptoms of the injury?
    Signs and symptoms of a crush injury include:
  • swelling

  • bleeding

  • pain

  • damaged skin

  • numbness

  • a deformed or "mangled" body part


  • Diagnosis & Tests

    How is the injury recognized?
    A crush injury is recognized based on:
  • a history of trauma

  • swelling of the affected limb

  • bleeding

  • damage to surrounding tissues

  • pain

  • blood collecting under the skin

  • loss of sensation
    X-rays may be taken to help diagnose the injury.


  • Prevention & Expectations

    What can be done to prevent the injury?
    Some crush injuries can be avoided with careful use of tools and vehicles. People should not drive or use heavy equipment when they are tired or have been using alcohol or illegal drugs. The Occupational Safety and Health Administration (OSHA) is a government organization which works to create a safer environment in work places where many crush injuries occur.

    Treatment & Monitoring

    What are the treatments for the injury?
    Minor crush injuries can usually be treated at home. Medical treatment is needed for a more serious crush injury. This treatment is needed to prevent loss of function, restore circulation to the injured area, and prevent infection.
    The crush injury is cleansed with soap and water. If there is bleeding, pressure is applied to control the bleeding. Ice is applied. An x-ray is required to determine if the bone was damaged. A Clostridium tetani\ bacteria. ',CAPTION,'Tetanus Immunization');" onmouseout="return nd();">tetanus shot should be given if the person has not had one in the past 10 years. Antibiotics may be given to prevent infection. A severe injury may need surgery and even removal of the body part.
    What are the side effects of the treatments?
    A tetanus shot may cause pain at the site of the shot. Antibiotics may cause stomach upset, diarrhea, or an allergic reaction. Surgery has a risk of bleeding, infection, and reactions to the anesthesia medication.
    What happens after treatment for the injury?
    It is important to watch closely for swelling, which is a common problem after a crush injury. Severe swelling can lead to injury of underlying tissue. The affected area should be kept elevated above the level of the heart.

    Attribution

    Author:Gail Hendrickson, RN, BS
    Date Written:
    Editor:Planko, Christa, MA
    Edit Date:05/26/00
    Reviewer:Adam Brochert, MD
    Date Reviewed:08/09/01
    Sources
    Professional Guide to Disease, Sixth Edition, 1998 "OSHA's Mission " www.osha.gov/oshinfo/mission.html

    Crush Wound - Crush Injury

    Overview, Causes, & Risk Factors

    A crush injury occurs when a body part is caught between 2 objects.
    What are the causes and risks of the injury?
    Most crush injuries are the results of accidents. A minor crush injury is often not serious. An example of a minor crush injury is getting a finger caught in a door. A crush injury is more serious when it involves a large force, such as a foot being run over by a car. This type of crush injury may damage tissues below the skin, such as blood vessels, nerves, muscles, or bones. The force may cause the skin to crack or scrape off during the injury. A loss of function or blood flow may occur in the area. The tissue damaged by a crush injury is also at increased risk for infection. There may be permanent numbness or deformity of the injured body part. Amputation, or removal of a body part with surgery, may be needed in severe injuries.


    Symptoms & Signs

    What are the signs and symptoms of the injury?
    Signs and symptoms of a crush injury include:

  • swelling



  • bleeding



  • pain



  • damaged skin



  • numbness



  • a deformed or "mangled" body part



  • Diagnosis & Tests

    How is the injury recognized?
    A crush injury is recognized based on:

  • a history of trauma



  • swelling of the affected limb



  • bleeding



  • damage to surrounding tissues



  • pain



  • blood collecting under the skin



  • loss of sensation
    X-rays may be taken to help diagnose the injury.



  • Prevention & Expectations

    What can be done to prevent the injury?
    Some crush injuries can be avoided with careful use of tools and vehicles. People should not drive or use heavy equipment when they are tired or have been using alcohol or illegal drugs. The Occupational Safety and Health Administration (OSHA) is a government organization which works to create a safer environment in work places where many crush injuries occur.


    Treatment & Monitoring

    What are the treatments for the injury?
    Minor crush injuries can usually be treated at home. Medical treatment is needed for a more serious crush injury. This treatment is needed to prevent loss of function, restore circulation to the injured area, and prevent infection.
    The crush injury is cleansed with soap and water. If there is bleeding, pressure is applied to control the bleeding. Ice is applied. An x-ray is required to determine if the bone was damaged. A Clostridium tetani\ bacteria. ',CAPTION,'Tetanus Immunization');" onmouseout="return nd();">tetanus shot should be given if the person has not had one in the past 10 years. Antibiotics may be given to prevent infection. A severe injury may need surgery and even removal of the body part.
    What are the side effects of the treatments?
    A tetanus shot may cause pain at the site of the shot. Antibiotics may cause stomach upset, diarrhea, or an allergic reaction. Surgery has a risk of bleeding, infection, and reactions to the anesthesia medication.
    What happens after treatment for the injury?
    It is important to watch closely for swelling, which is a common problem after a crush injury. Severe swelling can lead to injury of underlying tissue. The affected area should be kept elevated above the level of the heart.


    Attribution

    Author:Gail Hendrickson, RN, BS
    Date Written:
    Editor:Planko, Christa, MA
    Edit Date:05/26/00
    Reviewer:Adam Brochert, MD
    Date Reviewed:08/09/01
    Sources
    Professional Guide to Disease, Sixth Edition, 1998 "OSHA's Mission " www.osha.gov/oshinfo/mission.html

    Crush Wound - Crush Injury

    Overview, Causes, & Risk Factors

    A crush injury occurs when a body part is caught between 2 objects.
    What are the causes and risks of the injury?
    Most crush injuries are the results of accidents. A minor crush injury is often not serious. An example of a minor crush injury is getting a finger caught in a door. A crush injury is more serious when it involves a large force, such as a foot being run over by a car. This type of crush injury may damage tissues below the skin, such as blood vessels, nerves, muscles, or bones. The force may cause the skin to crack or scrape off during the injury. A loss of function or blood flow may occur in the area. The tissue damaged by a crush injury is also at increased risk for infection. There may be permanent numbness or deformity of the injured body part. Amputation, or removal of a body part with surgery, may be needed in severe injuries.

    Symptoms & Signs

    What are the signs and symptoms of the injury?
    Signs and symptoms of a crush injury include:
  • swelling

  • bleeding

  • pain

  • damaged skin

  • numbness

  • a deformed or "mangled" body part


  • Diagnosis & Tests

    How is the injury recognized?
    A crush injury is recognized based on:
  • a history of trauma

  • swelling of the affected limb

  • bleeding

  • damage to surrounding tissues

  • pain

  • blood collecting under the skin

  • loss of sensation
    X-rays may be taken to help diagnose the injury.


  • Prevention & Expectations

    What can be done to prevent the injury?
    Some crush injuries can be avoided with careful use of tools and vehicles. People should not drive or use heavy equipment when they are tired or have been using alcohol or illegal drugs. The Occupational Safety and Health Administration (OSHA) is a government organization which works to create a safer environment in work places where many crush injuries occur.

    Treatment & Monitoring

    What are the treatments for the injury?
    Minor crush injuries can usually be treated at home. Medical treatment is needed for a more serious crush injury. This treatment is needed to prevent loss of function, restore circulation to the injured area, and prevent infection.
    The crush injury is cleansed with soap and water. If there is bleeding, pressure is applied to control the bleeding. Ice is applied. An x-ray is required to determine if the bone was damaged. A Clostridium tetani\ bacteria. ',CAPTION,'Tetanus Immunization');" onmouseout="return nd();">tetanus shot should be given if the person has not had one in the past 10 years. Antibiotics may be given to prevent infection. A severe injury may need surgery and even removal of the body part.
    What are the side effects of the treatments?
    A tetanus shot may cause pain at the site of the shot. Antibiotics may cause stomach upset, diarrhea, or an allergic reaction. Surgery has a risk of bleeding, infection, and reactions to the anesthesia medication.
    What happens after treatment for the injury?
    It is important to watch closely for swelling, which is a common problem after a crush injury. Severe swelling can lead to injury of underlying tissue. The affected area should be kept elevated above the level of the heart.

    Attribution

    Author:Gail Hendrickson, RN, BS
    Date Written:
    Editor:Planko, Christa, MA
    Edit Date:05/26/00
    Reviewer:Adam Brochert, MD
    Date Reviewed:08/09/01
    Sources
    Professional Guide to Disease, Sixth Edition, 1998 "OSHA's Mission " www.osha.gov/oshinfo/mission.html

    Crushed Fingers - Smashed Fingers

    Overview, Causes, & Risk Factors

    Smashed fingers occur when fingers are caught between heavy objects. Damage may occur to one or more fingers, most often the thumb.
    What are the causes and risks of the injury?
    Fingers can be smashed doing almost any activity. For instance, fingers can get smashed when doing the following activities:
  • closing a car door

  • closing a desk drawer

  • playing baseball or other sports

  • working with a hammer

  • working with pieces of wood or concrete blocks


  • Symptoms & Signs

    What are the signs and symptoms of the injury?
    Following are some of the signs and symptoms of smashed fingers:
  • bleeding

  • bone fracture

  • bruising

  • change in color

  • deformity or loss of a finger

  • loss of a fingernail

  • pain

  • swelling


  • Diagnosis & Tests

    How is the injury recognized?
    Smashed fingers are usually self-diagnosed. The person shows and explains how the injury occurred. There may be some bleeding, bruising, swelling, or redness. If the healthcare professional thinks any of the fingers are broken, an X-ray may be taken.

    Prevention & Expectations

    What can be done to prevent the injury?
    Some measures to prevent smashed fingers include the following:
  • Follow sports safety guidelines for children, adolescents, and adults.

  • Pay attention when getting in and out of the car.

  • Teach young children about safety techniques.

  • Use care when working with heavy materials.

  • Use safety devices when appropriate.


  • Treatment & Monitoring

    What are the treatments for the injury?
    In the case of some types of fractures, a healthcare professional may recommend a splint for broken fingers. In other cases, it may be better to just tape the finger to another finger.
    If blood accumulates under the fingernail, the following measures may be helpful.
  • Apply ice to decrease swelling and relieve pressure.

  • Elevate the hand above the level of the heart.

  • Use over-the-counter medications, such as acetaminophen or ibuprofen, to help relieve the pain.
    If the pressure under the bloody fingernail becomes too painful, try taking the following steps. If there are any concerns about doing these steps, seek medical assistance immediately.
    1. Clean the finger with some alcohol or wash it with warm, soapy water.
    2. Use a pair of pliers to hold a needle or safety pin over an open flame until it is very hot.
    3. Touch the very hot needle or safety pin to the injured fingernail.
    4. Push the end of the needle or safety pin into the fingernail, creating a small hole. Push the needle or safety pin into the nail until blood comes out. This will relieve the pressure. Oozing and bleeding from this hole may last 2 to 3 days.
    5. Soak the finger in warm, soapy water for 20 minutes, 4 times a day until the oozing stops.
    6. Repeat the procedure if the hole closes up and the pressure comes back.
    What are the side effects of the treatments?
    Pain medications may cause stomach upset or allergic reactions. If the hot needle or safety pin is pushed too far, it can go into the nail bed. This causes a lot of pain but no permanent damage. Although the risk is small, the hot needle or safety pin may cause an infection.
    What happens after treatment for the injury?
    After treatment, the fingernail usually comes off. This can happen quickly or it may take a few weeks. If the fingernail starts to loosen, protect it so that it does not catch on anything. The pain may persist for awhile after treatment. Any new or worsening symptoms should be reported to the healthcare provider.


  • Attribution

    Author:James Broomfield, MD
    Date Written:
    Editor:Ballenberg, Sally, BS
    Edit Date:04/30/01
    Reviewer:William M. Boggs, MD
    Date Reviewed:08/09/01

    Crying in Childhood

    Crying in Childhood

    Children may cry for many reasons ranging from serious health problems to being hungry.
    Information
    Humans have developed many different ways to communicate with each other. Some of these include facial expressions, hand gestures, body posturing, and the use of sound. Many species, including fish, reptiles, insects, birds, and mammals, use these same techniques. Humans, however, use sound to communicate much more than other species do. The use of language is the principle factor that separates man from the rest of the animal world.
    Why do children cry?
    Crying is one way that humans express their emotions. It is one of the most effective ways a child who cannot speak communicates with others. Infants and young children cry for many reasons. As children mature into adults, crying occurs less often, and the reasons for crying become more specific.
    It is often not clear why children are crying. It is a caregiver's job to figure out why a child is crying and to relieve the underlying distress, if possible. Here are a few broad reasons why children who are past infancy cry:
    The first reason is physical illness.
    Children cry when they are in pain from an injury or illness. Injuries are usually obvious. But the source of pain may not be so apparent in a child who cannot talk, or one who is younger than 2 or 3 years old. Ear infections are a common cause of pain in young children. These occur more often in the winter months and if a child has a nose or throat infection. Frequent crying at night that disrupts a child's sleep is a common sign of ear infection. A caregiver should call the child's healthcare provider if the child is crying and has at least one of these symptoms:
  • a temperature above 100.5 degrees F (38 degrees C)

  • sore throat

  • stiff neck

  • drowsiness

  • severe headache

  • vomiting
    The second reason for frequent crying is toddlerhood.
    Toddlerhood, the time when children are between the ages of 12 and 36 months old, can be very frustrating for many young children. Toddlers have a strong need to assert their independence. This is the way they learn the rules of the family and society. This need to be independent, along with being stubborn and having a shortage of other options, lead toddlers into conflict with their parents. This can result in the toddler being frustrated at not having his or her way. This frustration is expressed through crying and temper tantrums. Slowly, the toddler learns the family rules, becomes more independent, and develops his or her use of language. As his or her needs and feelings come to be expressed verbally, the young child uses crying less often to communicate.
    Although it can be difficult, caregivers should be patient with toddlers. Adults should expect to have to repeat and reinforce the rules for toddlers many times. It helps to keep rules simple so that the toddler can easily understand them. Spending time with a toddler doing what he or she wants to do gives the child some control. If a toddler is crying out of frustration, he or she should be soothed. Toddlers should not necessarily get their way if what they want is not appropriate. Crying that does not respond to soothing can be handled by putting the toddler in a brief time out. The rules should then be restated when the child has quieted himself or herself and is allowed to return to activities.
    The third reason is attention-getting.
    Children sometimes use crying as a way to get an adult's attention. A child learns this if an adult attends to him or her every time he or she cries. After infancy, or the first year of life, children can learn to comfort and quiet themselves when they go to bed and when they are not ill.
    At bedtime, it helps to put children in their own cribs while they are still awake. This prevents them from thinking that they cannot go to sleep without an adult being with them. Sometimes children wake in the night for a diaper change or feeding. These should be done gently but quickly, with just enough light to accomplish the task. Talking and touching should be kept to a minimum.
    Nighttime is not the time for an adult to be an entertainer. That should be saved for daytime. Brief periods of crying will not harm a child. Young children should get enough affection, approval, and attention during the daytime to meet their needs for feeling loved and accepted. They do not need reassurance of this in the middle of the night.
    Adults can learn not to respond to daytime crying that is directed at getting their attention. The adult should not respond in anger or with punishment to the crying. This type of negative attention accomplishes the child's goal. Rather, the adult can say, "Crying is not a good way to get my attention. If you want me to spend time with you, please ask me in your normal voice." If the child does not quickly respond, the adult should then ignore the child and do something else.
    When the child has quieted himself or herself, the adult should say something like, "I'm proud that you were able to quiet yourself. It is much more fun to be with you when you are not crying. Now, what is it you wanted to do with me?"
    It is very helpful for the adult to acknowledge when the child seeks attention without crying. The adult might say to the child something like, "I'd love to do that, and I love it when you ask without crying."
    The fourth reason for crying is irritability.
    Children cry more if they are irritable. However irritability, like crying, is merely a symptom of a problem. There are many reasons why a child may be irritable. He or she may be sleep deprived if he or she has trouble sleeping. Persistent mouth breathing and difficulty breathing through the nose when the child does not have a cold may indicate breathing problems while sleeping.
    Many children have television sets, phones and personal computers in their bedrooms. Children can become sleep deprived and irritable because they are up late entertaining themselves or talking to their friends. This is especially true of school-aged children.
    School-aged children, especially those in middle school and high school, can be involved in so many activities that they can be irritable from lack of adequate sleep. A child can also be irritable if he or she is having problems at school, trouble with friends, or if there is a lot of stress and tension in the home. Some children who live with a chronically irritable parent can learn irritability as a way of life.
    Sometimes a child is irritable in most settings. Sometimes he or she is involved with "the wrong crowd," is abusing drugs or alcohol, is sexually promiscuous, or is involved in antisocial behavior. In these cases, the parent should not hesitate to seek help from a mental health professional.
    The fifth reason is adolescence.
    In many ways, young adolescence is like a return of toddlerhood. As with the toddler, the young adolescent is struggling to become independent from his or her parents. This is often expressed at home by the young teen being irritable, short tempered and by crying after only minor provocation. The situation is made worse by the physical and hormonal changes the child is experiencing. An adolescent is trying to figure out who he or she is, how the world works, and who is boss. The struggle for independence, along with the physical and hormonal changes, can make a child very emotional. Parents can be reassured if they hear that their child is happy and well mannered at school, in activities, and at the homes of friends. These are places where the adolescent is with peers and is there by choice.
    The sixth reason for crying is depression.
    Children often do not exhibit the classic adult symptoms of depression. These include sadness, difficulty sleeping, appetite change, or loss of motivation. Children who are depressed will be irritable, angry, or fearful. They may cry or act out a lot. Younger children usually become depressed in response to significant, adverse changes in their social environment.
    Older adolescents may begin to show more classic signs of depression. This is most common in children who have family members, especially within the immediate family, who suffer from depression. Parents with children showing these symptoms should talk to the healthcare provider. They can also seek a referral to a mental health counselor who works with children and adolescents.
    Almost all children who are healthy and live in nurturing environments are happy and content most of the time. Chronic crying and irritability are not normal for a healthy child. A child who cries or is irritable most of the time should be seen by a healthcare provider. If the cause seems to be clearly related to issues in the child's social environment, attempts should be made to get to the root of these issues and correct them.

  • Crying in Infancy

    Crying in Infancy

    Infants may cry for many reasons ranging from serious health problems to being hungry.
    What is the information for this topic?
    Why do babies cry?
    Crying is one of the few ways an infant has to signal to caretakers that he or she has unmet needs. Almost every parent finds it very difficult to not attend to a crying baby. This has probably evolved as a mechanism to protect the helpless infant. The task is for parents to decide just what the baby is saying through his or her crying.
    A baby might cry if he or she:
  • is hungry

  • is tired

  • needs holding and comforting

  • is cold, hot, or uncomfortable

  • needs a diaper change

  • has a condition known as colic. This is when a baby has intense crying and fussing for no obvious reason.

  • is in pain

  • is sick or has another medical problem
    Finding the reason for crying can be a stressful process for parents. But over time, parents usually learn to interpret what their infant's crying means. Infants vary in the amount of crying that they do. Some only cry when something is wrong. Others cry for no apparent reason for several hours each day.
    What are some medical conditions that can cause a baby to cry?
    There are some serious health conditions that can cause an infant to cry. These conditions usually have other symptoms associated with them. For instance, if a baby's bowels are obstructed, he or she may vomit or become dehydrated. These clues tell a parent that something is wrong and that a healthcare provider should examine the baby.
    For some infants, eating or drinking cow's milk can lead to pain in the belly, which causes the infant to cry. This can occur even in breast-fed infants whose mothers consume milk products. If there is a strong history of allergy in the immediate family, an infant should not be given foods containing cow's milk until after his or her first birthday. Breast-feeding may help protect some infants from developing food sensitivities.
    Infections of the ears, nose, lungs, and throat might cause a baby to cry. These infections are more common in children who:

  • are not breast-fed

  • have school-aged siblings

  • are in day care

  • have parents that smoke
    Symptoms of infection can include fever, runny nose, tugging on the ear, and cough. More serious infections such as meningitis, an infection around the brain, may also cause crying. Meningitis causes the child to vomit, lose his or her appetite, and become lethargic or "out of it."
    There are other conditions that can make a child cry. The key is for parents to watch for symptoms or signs, along with the crying, that indicate that a child is not feeling well.
    What are some other reasons a baby cries?
    Sometimes an infant cries a lot when he or she is handled. It may be that the infant has an injury or broken bone that is not obvious. This might be caused by a birth injury or by child abuse. Large babies delivered naturally through the vagina are more likely to have birth injuries. A baby is more likely to be abused if he or she:

  • is born early

  • has a teenage mother

  • has a mother who is poor

  • is born into a family with a history of child or sexual abuse

  • has a parent who uses drugs and/or alcohol excessively
    Babies who are overstimulated by their surroundings can cry a lot. This is especially true for infants who are highly sensitive to the environment. Some babies will cry excessively if there is a lot of tension in the family or if the baby's primary caregiver is under a lot of stress.
    What can a parent or caregiver do for an infant's crying?

    Parents and caregivers should keep in mind that infant crying, even if it is excessive, is not known to cause any adverse, long-term effects.
    The first thing to do when a baby cries is to see if there is a simple reason why he or she is upset. Parents and caregivers may be able to soothe a crying infant by:

  • changing his or her diaper

  • feeding him or her

  • dressing him or her warmly in soft clothing

  • rocking him or her gently and soothingly

  • playing soft music

  • giving him or her a pacifier

  • putting him or her in a wind-up baby swing
    Babies up to about 5 months old will not become spoiled if their parents or caregivers hold them a lot. Some infants need frequent holding in order to feel comfortable and secure. If a young infant cries when alone and comforts readily when picked up, he or she may be one who needs a lot of holding. Parents and caregivers may find this easier to do if they wear soft, fabric infant carriers. This way the baby can be held close as the parent or caregiver performs their daily routines.
    To determine if food sensitivity is causing crying, a soy formula can be substituted for cow's milk formula. For the breast-fed infant, the mother should eliminate milk and milk products from her diet. If this seems to relieve the problem, the baby or nursing mother should be started again on milk products to be sure that that was the cause of the crying.
    If a healthcare provider is consulted, he or she will want to know when and where the crying takes place. He or she will also want to examine the infant.
    What are some things parents can do to handle the stress of a crying baby?
    Living with a fussy, crying baby can be a challenge to one's patience and self-control. This is especially true when the parent is depressed, addicted, or alone. Parents in these cases should try to arrange some sort of support system. That way, if the crying is too much to handle, they can get someone to take the baby for a while. Not doing this may lead to child abuse.
    Even in functional, intact families, crying babies can be stressful to the caregivers. This can also be hard on a marriage. Parents of young infants should try to find time for an evening out together, without the baby. The primary caregiver should also have a babysitter available, even if it's just for a few hours. This allows for a little rest or recreation.
    Most parents gradually learn whether or not their baby's crying is something to worry about. If the baby's crying seems to be out of the ordinary, the parents should contact the child's healthcare provider to discuss it. The healthcare provider can usually tell from the history of the crying and an examination of the baby whether there is anything to be concerned about. They may want to do further testing or just offer reassurance that the child seems well.

  • Cryo - Cryotherapy

    Cryo

    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.

  • Cryosurgery - Cryotherapy

    Cryosurgery

    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.

  • 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

    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

    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