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Nails in health and disease


NAILS IN HEALTH AND DISEASE.

Introduction:

The nails are present at the end of each finger tip on the dorsal surface.The main function of nail is protection and it also helps for a firm grip for holding articles.It consists of a strong relatively flexible keratinous nail plate originating from the nail matrix. Under the nail plate there is a soft tissue called nail bed.Between the skin and nail plate there is a nail fold or cuticle.Normal healthy nail is slight pink in colour and the surface is convex from side to side.Finger nails grow 1 cm in three months and toe nails take 24 months for the same.

Importance of nails in disease diagnosis:

The colour ,appearance,shape and nature of the nails give some information about the general health and hygiene of a person . Nails are examined as a routine by all doctors to get some clues about underlying diseases.Just looking at nails we can makeout the hygiene of a person.The abnormal nail may be congenital or due to some diseases.The cause for changes in the nail extend from simple reasons to life threatening diseases.Hence the examination by a doctor is essential for diagnosis .Some abnormal findings with probable causes are discussed here for general awareness.

1) Hygiene:-

We can make out an unhygienic nail very easily .Deposition of dirt under the distal end of nail plate can make a chance for ingestion of pathogens while eating.If nail cutting is not done properly it can result in worm troubles in children.When the worms crawl in the anal orifice children will scratch which lodges the ova of worms under the nails and will be taken in while eating.Prominent nail can also complicate a skin disease by habitual scratching.Sharp nails in small kids cause small wounds when they do feet kicking or hand waving.

2) Colour of the nails:-

a) Nails become pale in anaemia.

b) Opaque white discolouration(leuconychia) is seen in chronic renal failure and nephrotic syndrome.

c) Whitening is also seen in hypoalbuminaemia as in cirrhosis and kidney disorders.

d) Drugs like sulpha group,anti malarial and antibiotics ect can produce discolouration in the nails.

e) Fungal infection causes black discolouration.

f) In pseudomonas infection nails become black or green.

g) Nail bed infarction occures in vasculitis especially in SLE and polyarteritis.

h) Red dots are seen in nails due to splinter haemorrhages in subacute bacterial endo carditis, rheumatoid arthritis, trauma, collagen vascular diseases.

i) Blunt injury produces haemorrhage and causes blue/black discolouration.

j) Nails become brown in kidney diseases and in decreased adrenal activity.

k) In wilsons disease blue colour in semicircle appears in the nail.

l) When the blood supply decreases nail become yellow .In jaundice and psoriasis also nail become yellowish.

m) In yellow nail syndrome all nails become yellowish with pleural effusion.

3) Shape of nails:-

a) Clubbing: Here tissues at the base of nails are thickened and the angle between the nail base and the skin is obliterated. The nail becomes more convex and the finger tip becomes bulbous and looks like an end of a drumstick. When the condition becomes worse the nail looks like a parrot beak.

Causes of clubbing:-

Congenital Injuries

Severe chronic cyanosis

Lung diseases like empyema,bronchiactesis,carcinoma of bronchus and pulmonary tuberculosis.

Abdominal diseases like crohn's disease,polyposis of colon,ulcerative colitis,liver cirrhosis ect...

Heart diseases like fallot's tetralogy,subacute bacterial endocarditis and ect..

b) Koilonychia:-

Here the nails become concave like a spoon.This condition is seen in iron deficiency anaemia.In this condition the nails become thin,soft and brittle.The normal convexity will be replaced by concavity.

c) Longitudinal ridging is seen in raynaud's disease.

d) Cuticle becomes ragged in dermatomyositis.

e) Nail fold telangiectasia is a sign in dermatomyositis ,systemic sclerosis and SLE.

4) Structure and consistancy:-

a) Fungal infection of nail causes discolouration,deformity,hypertrophy and abnormal brittleness.

b) Thimble pitting of nail is charecteristic of psoriasis ,acute eczema and alopecia aereata.

c) The inflamation of cuticle or nail fold is called paronychia.

d) Onycholysis is the seperation of nail bed seen in psoriasis,infection and after taking tetracyclines.

e) Destruction of nail is seen in lichen planus,epidermolysis bullosa.

f) Missing nail is seen in nail patella syndrome.It is a hereditary disease.

g) Nails become brittle in raynauds disease and gangrene.

h) Falling of nail is seen in fungal infection,psoriasis and thyroid diseases.

5) Growth:-

Reduction in blood supply affects the growth of nails. Nail growth is also affected in severe ilness. when the disease disappears the growth starts again resulting in formation of transverse ridges.These lines are called Beau's lines and are healpful to date the onset of illness.

Prostate cancer


PROSTATE CANCER

Introduction:-

Prostate is a glandular organ present only in males. It surrounds the neck of bladder & the first part of urethra and condributes a secretion to the semen. The gland is conical in shape and measures 3 cm in vertical diameter and 4 cm in transverse diameter.It has got five lobes anterior,posterior,two lateral and a median lobe.Since the first part of the urethra pass through it any lesion in the prostate will produce difficulty in passing urine.

Diseases of the prostate gland:-

1) Prostatitis:-

This is the inflamation of the prostate gland due to bacterial infection.

2) Benign enlargement of the prostate:-

This is a non cancerous tumour of the prostate seen after the age of 50. 3,Cancer of the prostate:-This is the 4th most common cause of death from malignant diseases in males.

Cancer of the prostate.

Cancer of the prostate is directly linked with the male sex hormones(androgens).If the levels of sex hormone increases the growth rate of cancer also increases.It is found that after the removel of testes there is marked reduction in the size of tumour.

Site of tumour:-

Prostate cancer is seen mainly in the posterior lobe.Non cancerous enlargement is seen in other lobes.

Changes in the gland in cancer:-

The gland becomes hard with irregular surface with loss of normal lobulation .Histologically prostate cancer is an adeno carcinoma(cancer of the epithelial cells in the gland)

Growth :-

Growth rate is very fast in prostate cancer .The tumour compresses the urethra and produce difficulty in urination.

Spread of tumour:-

Metastasis in cancer of prostate is very early.

1) Local spread:-

From the posterior lobe the cancer cells go to the lateral lobes and seminal vesicles.Tumour cells also move to the neck and base of the urinary bladder.

2) Lymphatic spread:-

Through the lymph vessels cancer cells reach the internal and external illiac group of lymph nodes.From there cells move to retroperitonial(Behind the peritonium) and mediastinal lymph nodes(in the chest)

3) Spread through the blood:-

Spread of cancer cells takeplace through the periprostatic venous plexus and reaches the vertebral veins while coughing and sneezing and finally enders the vertebral bodies of the lumbar vertebrae.

Signs and symptoms of prostate cancer:--

Signs and symptoms depend upon the stage of the cancer. The following symptoms may be seen.

1) No symptoms:-

Tumour is small and only in the posterior lobe. This is diagnosed accidentely.

2) Slight difficulty in urination:-

Here the tumour is enlarged and urethra is slightly compressed.Shortly there will be frequent urge for urination with difficult urination.

3) When the tumour spread to all nearby areas including neck of bladder and urethra there will be painful urination with bleeding.Urine comes drop by drop.

4) Retention of urine:-

When the urethra is completely compressed there will be retention of urine.This can lead to hydronephrosis, renal failure ect.In this condition patient may get convulsions due to renal failure and finally coma.

5) Signs of metastasis:-

Some patients come with the signs and symptoms of metastasis.

a) Lumbo sacral pain due to spread of cancer cells to lumbar and sacral vertebrae.

b) Fracture of spine due to cancerous growth in the spine.

c) Swelling, pain and fluid collection in the abdomen due to lesion in the abdomen.

d) Respiratory complaints due to cancer of mediastinal lymphnodes and lungs.

e) General weakness due to spread of cancer to different parts of the body.

f) Anaemia due to involment of bone marrow and increased destruction of RBCs.

Clinical examination :-

Includes per rectal examination to feel the prostate gland,palpation of abdomen to feel the swelling in kidneys and any tumours.Patient is examined from head to foot to find out any lesions.

Investigations:-

1) Complete blood investigations;-

RBC,WBC,Platlets,ESR,bleeding time ,clotting time ect.

2) Urine analysis:-

Microscopic examination to detect pus cells,occult blood,casts,Crystals ect.

3) Renal function tests:-

Blood urea level,serum creatinine level,electrolyte level ect.

4) Serum acid phosphatase:-

Increased in cancer of prostate.

5) x-ray of the spine:-

To detect any tumour or fracture.

6) Ultra sonography;-

Gives idea about prostate,bladder,kidney ect.

7) C T scan:-

More detailed information about organs and tumour.

8) MRI of the spine:-

Gives detailed information about spine ,disc and nearby soft tissues.

9) Lymphangiography:-

Gives idea about lymphatic spread of cancer.

10) Biopsy to confirm cancer:-

Biopsy is taken from the tumour and is send for histopathological examination under the microscope.This will detect the presence of cancer cells.

Treatment:-

1) If there is retention of urine catheterisation is needed.

2) Dialysis if kidney failure.

3) If there is coma monitoring of all vital functions along with parentral nutrition and electolyte supply.

4) Specific treatment is prostatectomy(removal of prostate)

Partial prostatectomy :-

Here only the affected lobe is removed.

Radical prostatectomy :-

Total removal of prostate along with nearby lymphnodes.

5, Hormone therapy :-

Stilbestrol is given to reduce tumour growth.Since this treatement increases the chance for cardiovascular disease phosphorylated diethyle stilbesterol is used nowadays.

6) Chemotherapy:-Drugs like cyclophosphamide, cisoplatim ect are given.

7) Radiotherapy is also done for some cases.

8) Homoeopathy:-

Homoeopathic drugs like carcinocin, conium, sabal, crotalus, thuja, iodum, selinium, staphysagria, sulphur ect can be given according to symptoms.Constitutional homoeopathic medicine will give great relief and can increase the life span.

9) Yoga and meditation is also healpful.

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