Mesothelioma

Mesothelioma is a disease because of the growing and the divide abnormally and uncontrolled of mesothelium cells. The growth will invade and damage tissues and organs around it. Mesothelium is a membrane that covers and protects most of internal organs. The most of the abnormal growth is in Pleura, the membrane that cover the lung, most of because of asbestos.

There are three major histological type of mesothelioma: sarcomatous, epithelial and mixed. Pleural mesothelioma usually begins as discrete plaques and nodules that coalesce to produce a sheetlikeneoplasm. Tumor growth usually begins at the lower part of the chest. The tumor may invade the diaphragm and encase the surface of the lung and interlobar fissures.

The tumor may also grow along drainage and thoracotomy tracts. As the disease progresses, it often extends into the pulmonary parenchyma, chest wall, and mediastinum. Pleural mesothelioma may extend into the esophagus, ribs, vertebra, brachial plexus, and superior vena cava.

Asbestos, amphibole asbestos, asbestos-crocidolite, and amosite asbestos in particular, is the principal carcinogen implicated in the pathogenesis. Exposure to chrysotile asbestos is associated with a lower incidence of mesothelioma. The industries associated with asbestos exposure include mining, ship building involving the use of asbestos, asbestos cement manufacture, ceramics, paper milling, auto parts (asbestos brake lining), railroad repair, and insulation. In Turkey, the use of the fibrous substance erionite (similar to amphibole asbestos) in building construction has led to an epidemic of pulmonary mesothelioma. Environmental exposure to asbestos in areas polluted by the substance may increase the incidence of mesothelioma.

Most malignant mesotheliomas have complex karyotypes, with extensive aneuploidy and rearrangement of many chromosomes. A loss of a single copy on chromosome 22 is the most common abnormality.

Causes:

·          A substantial proportion of patients were exposed to asbestos in asbestos mills, shipping yards, mines, or their homes.

·          The crocidolite in asbestos is associated with mesothelioma in miners, manufacturers (using asbestos), and heating and construction workers. The rod-shaped amphiboles are more carcinogenic than the chrysotile.

·          Malignant mesothelioma has also been linked to therapeutic radiation using thorium dioxide and zeolite, a silicate in the soil.

·          An etiological role for simian virus 40 in malignant mesothelioma has also been suggested. Asbestos exposure alone was associated with malignant mesothelioma, but simian virus 40 alone was not; thus, some epidemiological evidence exists that simian virus 40 is a possible cocarcinogen. Its direct role at this point is still controversial.

·          Interleukin 8 has direct growth-potentiating activity in mesothelial cell lines.

·          Loss of one copy of chromosome 22 is the single most common karyotypic change in malignant mesothelioma. Other chromosomal changes commonly observed include 1p, 3p, 9p, and 6q. Several changes in the tumor suppressor gene p16 (CDKN2A) and p14 (ARF) and loss of function of neurofibromin 2 (NF2) or merlin are altered.

Symptoms of mesothelioma may not appear until 30 to 50 years after exposure to asbestos. Shortness of breath and pain in the chest due to an accumulation of fluid in the pleura are often symptoms of pleural mesothelioma. Symptoms of peritoneal mesothelioma include weight loss and abdominal pain and swelling due to a buildup of fluid in the abdomen. Other symptoms of peritonealmesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history, including any history of asbestos exposure. A complete physical examination may be performed, including x-rays of the chest or abdomen and lung function tests. A CT (or CAT) scan or an MRI may also be useful. A CT scan is a series of detailed pictures of areas inside the body created by a computer linked to an x-ray machine. In an MRI, a powerful magnet linked to a computer is used to make detailed pictures of areas inside the body. These pictures are viewed on a monitor and can also be printed.

A biopsy is needed to confirm a diagnosis of mesothelioma. In a biopsy, a surgeon or a medical oncologist (a doctor who specializes in diagnosing and treating cancer) removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform athoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. If the cancer is in the abdomen, the doctor may perform a peritoneoscopy. To obtain tissue for examination, the doctor makes a small opening in the abdomen and inserts a special instrument called a peritoneoscope into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.

Treatment for mesothelioma depends on the location of the cancer, the stage of the disease, and the patient's age and general health. Standard treatment options include surgery, radiation therapy, andchemotherapy. Sometimes, these treatments are combined.

Surgery is a common treatment for mesothelioma. The doctor may remove part of the lining of the chest or abdomen and some of the tissue around it. For cancer of the pleura (pleural mesothelioma), a lung may be removed in an operation called a pneumonectomy. Sometimes part of the diaphragm, the muscle below the lungs that helps with breathing, is also removed.

Radiation therapy, also called radiotherapy, involves the use of high-energy rays to kill cancer cells and shrink tumors. Radiation therapy affects the cancer cells only in the treated area. The radiation may come from a machine (external radiation) or from putting materials that produce radiation through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).

Chemotherapy is the use of anticancer drugs to kill cancer cells throughout the body. Most drugs used to treat mesothelioma are given by injection into a vein (intravenous, or IV). Doctors are also studying the effectiveness of putting chemotherapy directly into the chest or abdomen (intracavitary chemotherapy).

To relieve symptoms and control pain, the doctor may use a needle or a thin tube to drain fluid that has built up in the chest or abdomen. The procedure for removing fluid from the chest is calledthoracentesis. Removal of fluid from the abdomen is called paracentesis. Drugs may be given through a tube in the chest to prevent more fluid from accumulating. Radiation therapy and surgery may also be helpful in relieving symptoms.

Assesment To Sprain And Strain

Sprains and strains are among the most common injuries in sports. A large percentage of musculoskeletal injuries observed in the outpatient setting involve the ankle. Sprains constitute 85% of all ankle injuries. Of these, 85% are inversion sprains. Up to one sixth of participation time lost from sports results from ankle sprains. Proper rehabilitation begins with accurate diagnosis, because up to 40% of patients with untreated or misdiagnosed ankle injuries develop chronic symptoms. Most injuries respond to treatment. Pain reduction is essential, but improvement of any loss of motion, strength, and/or proprioception is equally important. Proper treatment of a sprain or strain is of utmost importance. Without the best treatment, a sprain of a ligament or a strain of a muscle can be a long recovery. Proper treatment of this injury can get you back quickly.

What is Sprain and Strain?

A sprain is a stretch and/or tear of a ligament, the fibrous band of connective tissue that joins the end of one bone with another. Ligaments stabilize and support the body's joints.

A strain is an injury of a muscle and/or tendon. Tendons are fibrous cords of tissue that attach muscles to bone.

What cause Sprain and Strain?

A sprain is caused by direct or indirect trauma (a fall, a blow to the body, etc.) that knocks a joint out of position, and overstretches, and, in severe cases, ruptures the supporting ligaments. Typically, this injury occurs when an individual lands on an outstretched arm; slides into a base; jumps up and lands on the side of the foot; or runs on an uneven surface. 

Chronic strains are the result of overuse (prolonged, repetitive movement) of muscles and tendons. Inadequate rest breaks during intensive training precipitates a strain. Acute strains are caused by a direct blow to the body, overstretching, or excessive muscle contraction.

What are the signs of sprain?

While the intensity varies, pain, bruising, swelling, and inflammation are common to all three categories of sprains: mild, moderate, severe. The individual will usually feel a tear or pop in the joint. A severe sprain produces excruciating pain at the moment of injury, as ligaments tear completely, or separate from the bone. This loosening makes the joint nonfunctional. A moderate sprain partially tears the ligament, producing joint instability, and some swelling. A ligament is stretched in a mild sprain, but there is no joint loosening.

What are the signs of a strain?

Typical indications include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping. In severe strains, the muscle and/or tendon is partially or completely ruptured, often incapacitating the individual. Some muscle function will be lost with a moderate strain, where the muscle/tendon is overstretched and slightly torn. With a mild strain, the muscle/tendon is stretched or pulled, slightly.

Back strain. When the muscles that support the spine are twisted, pulled, or torn, the result is a back strain. Athletes who engage in excessive jumping (during basketball, volleyball, etc.) are vulnerable to this injury.

Hamstring muscle strain. A hamstring muscle strain is a tear or stretch of a major muscle in the back of the thigh. The injury can sideline a person for up to six months. The likely cause is muscle strength imbalance between the hamstrings and the muscles in the front of the thigh, the quadriceps. Kicking a football, running, or leaping to make a basket can pull a hamstring. Hamstring injuries tend to recur.

What is The symptom of sprain?

The symptoms of a sprain are almost exactly the same as that of a broken bone. When in doubt, sprains should be treated the same as broken bones. The most common symptoms are: pain

· swelling

· bruising

· inability to move

· inability to bear weight on the joint

· pain

· swelling

· bruising

· inability to move

· inability to bear weight on the joint

It is not necessary to have all of the symptoms of a sprain in order for the joint to be injured.

Sprain Severity

· Grade I Sprain: A grade I (mild) sprain causes overstretching or slight tearing of the ligaments with no joint instability. A person with a mild sprain usually experiences minimal pain, swelling, and little or no loss of functional ability. Bruising is absent or slight, and the person is usually able to put weight on the affected joint.

· Grade II Sprain: A grade II (moderate) sprain causes partial tearing of the ligament and is characterized by bruising, moderate pain, and swelling. A person with a moderate sprain usually has some difficulty putting weight on the affected joint and experiences some loss of function. An x-ray or MRI may be needed.

· Grade III Sprain: A grade III (severe) sprain results in a complete tear or rupture a ligament. Pain, swelling, and bruising are usually severe, and the patient is unable to put weight on the joint. An x-ray is usually taken to rule out a broken bone. This type of a muscle sprain often requires immobilization and possibly surgery. It can also increase the risk of an athlete having future muscles sprains in that area.

Strain Severity

Strains are categorized in a similar manner to sprains:

· Grade I Strain: This is a mild strain and only some muscle fibers have been damaged. Healing occurs within two to three weeks.

· Grade II Strain: This is a moderate strain with more extensive damage to muscle fibers, but the muscle is not completely ruptured. Healing occurs within three to six weeks.

· Grade III Strain: This is a severe injury with a complete rupture of a muscle. This typically requires a surgical repair of the muscle; the healing period can be up to three months.

First Aid

Use the RICE method to treat the sprain.

1. Rest the sprained joint by not placing weight on it. Use a cane or crutch on the uninjured side to lean away from the injury.

2. Ice the sprain with an ice pack.

3. Compress the sprain with a compression bandage. Ask a healthcare provider to show you how to properly apply a compression bandage.

4. Elevate the sprain above the level of the heart as often as possible during the first 48 hours.

Rest, ice, compression, and elevation usually will help minimize the damage. It is important in all but mild cases for a medical doctor to evaluate the injury and establish a treatment and rehabilitation plan. A severe sprain or strain may require surgery or immobilization followed by months of therapy. Mild sprains and strains may require rehabilitation exercises and activity modification during recovery.

Prevention Tips

No one is immune to sprains and strains, but here are some tips developed by the American Academy of Orthopaedic Surgeons to help reduce your injury risk:

· Participate in a conditioning program to build muscle strength

· Do stretching exercises daily

· Always wear properly fitting shoes

· Nourish your muscles by eating a well-balanced diet

· Warm up before any sports activity, including practice

· Use or wear protective equipment appropriate for that sport

When To See a Doctor for a Sprain or Strain

· You have severe pain and cannot put any weight on the injured joint.

· The area over the injured joint or next to it is very tender when you touch it.

· The injured area looks crooked or has lumps and bumps that you do not see on the uninjured joint.

· You cannot move the injured joint.

· You cannot walk more than four steps without significant pain.

· Your limb buckles or gives way when you try to use the joint.

· You have numbness in any part of the injured area.

· You see redness or red streaks spreading out from the injury.

· You injure an area that has been injured several times before.

· You have pain, swelling, or redness over a bony part of your foot.