Chronic Sinusitis

Chronic rhinosinusitis is a group of different diseases that affect nasal mucosa and paranasal sinuses. These diseases last 12 weeks or longer, in spite of medical treatment.

Chronic sinusitis is divided into 3 syndromes since treatments are different. The 3 syndromes are:

1. Chronic sinusitis without nasal polyps which accounts for about 65 percent of cases


2. Chronic sinusitis with nasal polyps which account for about 25 percent


3. Allergic fungal sinusitis which accounts for about 10 percent

Those who are inflicted with chronic sinusitis must have at least 2 of the following 4 symptoms:

1. Yellow or greenish runny nose
2. Facial pain or pressure
3. Stuffy nose or nasal obstruction
4. Diminished sense of smell

CT scans of sinuses are usually required to make an accurate diagnosis (see picture).

Treatment of chronic sinusitis usually involves multiple therapies, most of which have not been validated in randomized trials. In most cases, the goal of treatment is to alleviate symptoms since chronic sinusitis may not be cured.

Greenfield by The Brothers Four

Acute Sinusitis

Sinusitis, also known as rhinosinusitis, is commonly caused by viruses. Viruses initially infect nasal mucosa then spread to paranasal sinuses (see picture). Interestingly, nose blowing may propel infected nasal fluid into sinuses.

In 0.5 to 2 percent of viral sinusitis cases, bacteria impose more complicated infection. The most common bacteria are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. It may be difficult to tell viral from bacterial sinusitis, since existing clinical criteria are not reliable. Abnormal vision, swelling of eyes, or confusion are worrisome symptoms that require urgent referral to specialists.

Sinus CT scan is not helpful in differentiating between viral and bacterial sinusitis. CT may help exclude diagnosis of sinusitis if there are no evidence of edema or gaseous bubbles. Sinus CT should be done without contrast.

Antibiotics are indicated for bacterial sinusitis, but not recommended for viral cases.

Vivo Per Lei by Andrea Bocelli

Body Mass Index (BMI) and Obesity

Obesity has been associated with at least 15 well-known health problems and been documented in medical literature for at least 2000 years. The Framingham Study concluded that those who were obese at age 40 lived 6 to 7 years less than those who were not [Ann Intern Med 2003 Jan 7;138(1):24-32].

In Japan, people over 40 have to undergo waistline measurement to see if they are too fat or not. Those who are deemed too fat have to go through diet counseling. If chubby Japanese fail to get slender, they may be fined.

New Zealanders go even more extreme: Goverment can restrict those who are deemed "too fat" from immigrating to the country. It is unclear, however, which criteria New Zealand goverment uses to determine a "fat" individual from "non-fat" one .

In the U.S., obesity is a big public health problem. Data from the National Health and Nutrition Examination Survey 1999-2000 shows that the prevalence of overweight and obesity in adults is 64.5 percent and 30.5 percent, respectively. Even though there is no fine or immigration restriction policy yet in the U.S., life-style changes and weight-loss treatment are recommended for men and women whose waistlines are greater than 40 inches (102 cm) and 35 inches (89 cm), respectively.

The body mass index (BMI) is used to evaluate obesity. Overweight is defined as a BMI between 25 and 30; obesity between 30 and 35; morbid obesity greater than 35.

If you are curious about where you stand in the BMI spectrum, you may want to use the calculator located in the lower right-sided corner of vietshealth blog home page.

Passacaglia by Secret Garden

Pancreatic Cancer

Actor Patrick Swayze, a famous pancreatic cancer patient.

Pancreatic cancer is insidious, often dubbed as "silent killer." It is difficult to treat since a majority of patients have advanced tumors by the time they tell doctors symptoms. It is interesting to know that atypical diabetes mellitus, glucose intolerance occuring in a thin older adult, precedes pancreatic cancer in many cases [Gastroenterology 2005 Aug;129(2): 504-11].

Common symptoms of pancreatic cancer are poor appetite, weight loss, bloating abdomen or abdominal pain, jaundice (yellow skin), change in color of stool.

When a patient presents with suspicious symptoms, a doctor may recommend a variety of diagnostic studies such as ultrasound, CT scan, ERCP, MRCP, endoscopic ultrasound (EUS), serum tumor marker CA 19-9. Staging laparascopy is also used to determine whether a tumor is resectable.

When a suspicious pancreatic tumor is seen on scan or ultrasound, doctors may recommend resection before an absolute diagnosis of cancer is established. However, some resected tumors may turn out benign, as in the case of U.S. Supreme Court Justice Ginsburg.

Surgical resection is the only curative treatment. However, only 15 to 20 percent of patients are candidates for surgery. The prognosis is poor even in patients with resectable cancer: the 5-year survival following surgery is about 10 to 30 percent. The use of adjuvant chemotherapy and radiotherapy may help some patients live longer after tumors are resected.

This Is What I Call Romance

Happy Valentine's Day!

Screening for Coronary Heart Disease (CHD)

Coronary Heart Disease (CHD) refers to a spectrum of heart diseases that result from damaged arteries of the heart. Angina pectoris (a.k.a. cardiac chest pain), unstable angina, ischemic heart disease, ischemic cardiomyopthy, and myocardial infarction (a.k.a. heart attack) are common variants of CHD. Atherosclerosis is a main cause of CHD.

CHD remains the leading cause of death in adults; many patient had sudden death as very first clinical symptom. A Framingham Heart Study concluded that lifetime risk of CHD for men and women aged 40 was 49% and 32% respectively. These men and women did not have any CHD at the beginning of this study [Lancet 1999 Jan 9;353(9147):89-92].

Since CHD may already exist in many individuals who do not have any symptoms, there is great interest in detecting this disease at its early stages, a.k.a. screening. There are various recommendations from different groups of experts with regard to CHD screening. Even though there is no unanimous consensus on it, asymptomatic people with high risks of CHD will benefit from screening. High risks of CHD are:

• Cigarette smoking


• Diabetes mellitus


• Cholesterol > 250mg/dl


• Systolic blood pressure > 140mmHg or diastolic blood pressure > 90 mmHg


• Family members who have heart attacks or die of sudden cardiac death under age 60
  

There exist several screening tests, none of which is perfect. Considering cost and easy accessibility, exercise ECG test is likely the best one.

Prelude in E Minor by Chopin

Lay back.
Close your eyes.
Imagine a person you love dearly.





How do you feel?

Atherosclerosis

Atherosclerosis is a medical term that describes the hardening of arterial wall, which is normally distensible and elastic. In other words, the wall of arteries become thicker and harder as atherosclerosis goes on. Atherosclerosis may eventually cause complete blockage of arteries, resulting in lack of blood supply to human organs. If the blockage affects the arteries of heart and brain, it will cause heart attacks and stroke, respectively.

Atherosclerosis begins in childhood and advances with aging. Atherosclerosis starts with the damage of the innermost lining of artery, also known as endothelial dysfunction. Then fat is deposited and accumulated at the damaged site, resulting in thickening of arterial wall. Bad fat, also known as low density lipid (LDL), accelerates thickening process to form a fibrous plaque. Fibrous plaque is a chunk of fat, tiny smooth muscle cells, and tiny fragile blood vessels. At some point in time, this plaque ruptures, causing blood clots that clog up the artery. Heart attacks or stroke will ensue.

There is convincing evidence that family history of coronary heart disease and cigarette smoking accelerate atherosclerosis.

In short, atherosclerosis is more severe if a person:

• has a family history of coronary heart disease
• eats bad fat such as saturated fat, trans-fat
• smokes cigarette

Wild Child by Enya

Mitral Stenosis (MS)

Mitral valve stenosis (MS) occurs when the leaflets of the mitral valve become thick and obstruct blood flow from the left atrium to the left ventricle of the heart. MS mostly results from rheumatic fever. MS may stay silent for 15 to 40 years after rheumatic fever until the onset of heart symptoms.

The area of the opening of a normal mitral valve is 4 to 6 cm2. Shortness of breath during physical activities usually occurs when the valve area is at least less than 2.5 cm2. Shortness of breath at rest occurs when the valve area is less than 1.5 cm2.

MS may cause several major complications as follows:

• Atrial fibrillation: an irregularly irregular heart rhythm in about 45 percent of cases


• Thromboembolism: blood clots thrown into other organs such as brain and lungs


• Bacterial endocarditis: an infection of mitral valve by bacteria traveling from other organs

Pregnant women with MS may have more severe symptoms and complications, especially heart failure.

Doctors may offer to treat MS with medications or surgical intervention when indicated. The 2006 American College of Cardiology/American Heart Association (ACC/AHA) and the 2007 European Society of Cardiology (ESC) guidelines concluded that main indications for intervention were moderate-to-severe MS and the presence of symptoms. Surgical options are percutaneous mitral balloon valvotomy (PMBV), commissurotomy, and mitral valve replacement.

The 2007 AHA guidelines did not recommend antibiotic prophylaxis for patients with MS before dental or invasive procedures.

Caravan by Kitaro

Aortic Stenosis (AS)

Aortic valve is a heart valve that controls the blood flow between left ventricle and aorta. Aortic stenosis occurs when valve leaflets become deformed, thus obstructing blood flow to other organs including the heart itself. Rheumatic heart disease is the most common cause of aortic stenosis (AS) in developing countries. In developed countries, an old aortic valve with built-up calcification is the most common cause of AS.

Aortic stenosis is severe when the calculated area of the valve is less than 1cm2. The measurment of the valve area is performed indirectly by measuring the blood flow and pressure gradient across the valve. Doctors usually recommend either echocardiography or cardiac catheterization to measure the area of valve, depending on whether the pumping power of left ventricle is normal or weak.

Patients with severe AS are considered candidates for valve replacement operation if they develop chest pain, pass-out, or heart failure. However, the 2006 American Heart Association (AHA) guidelines concluded that valve replacement should not be performed routinely in patients without aforementioned symptoms. There are exceptions when surgery is still recommended in patients without symptoms.

The 2007 AHA guidelines no longer recommended routine antibiotic prophylaxis before dental or invasive procedures for patients with AS.

Toccata by Paul Mariat & Orchestra

Diet and Your Heart

The following food and supplements are proven effective in preserving health of your heart.

1. Fruits and vegetables: green leafy vegetables, citrus fruits




2. High-fiber food




3. Unsaturated fat: olive and canola oil




4. Folate: 400 micrograms a day

Deliver Me by Sarah Brightman

Aortic Regurgitation (AR)

Aortic regurgitation (AR) occurs when aortic valve leaflets do not close adequately. As a result, blood flow leaks back to left ventricle (LV) which is one of the four heart chambers (see picture).

In developed countries, the most common causes of AR are aortic root dilation and congenital bicuspid aortic valve. In developing countries, the most common cause is rheumatic heart disease.

Since the size and function of left ventricle (LV) is critical in determining the timing and need for surgery, doctors may recommend serial echocardiography ranging from every 6 months to every 3 years.

The American Heart Association recommended aortic valve replacement or repair in asymptomatic patients with left ventricle pumping power (LVEF) <50>

With regard to medications, ACE inhibitor shows greatest benefit in patients with shortness of breath and significant dilation of left ventricle.

Women have a poorer outcome following aortic valve replacement when compared to men; post-operative 10-year survival rate for women and men was 39 and 72 percent respectively [Circulation 1996 Nov 15;94(10):2472-8].

The 2007 American Heart Association guidelines did not recommend antibiotic prophylaxis for patients with (AR) when they had dental or surgical procedures.