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Testicular Cancer
Definition:
Testicular cancer is a malignant tumor of the testicle. Most testicular cancers arise from sperm-forming cells, called germ cells.
Who is at risk?
The disease tends to affect infants and children from birth to below 10 years old, young adults from 15 to 34 years old and elderly men above 60 years of age. Testicular cancer is more common in Caucasians. The followings are high risk groups:
- The patient is born with a testicle high in the abdomen;
- Genetic or chromosome disorders that give rise to intersex states;
- Past history of testicular cancer in one side;
- Family members with testicular cancer.
Symptoms:
About half of the patients present with a painless mass in the scrotum, sometimes detected after minor trauma to the region. About a third of the patients have pain in the scrotum. As much as 20% of patients present with swellings in other parts of the body such as the neck, the abdomen, the groin or the brain, where the disease has spread.
Treatment:
Testicular cancers are often sensitive to radiation. Radiotherapy after radical surgery to remove the affected testicle and adjacent structure is curative in most early cases. Advanced disease also responds well to chemotherapy with anti-cancer drugs. Recent figures show that more than 95% of patients diagnosed early are still living after 5 years.
Prevention:
Those at risk of the disease should perform regular self-examination for testicular swellings. The testicles of all male infants should be examined by pediatricians. A missing testicle in the scrotum may be in the groin or in the abdomen, and should be corrected surgically at an early age if not coming down spontaneously. Patients with genetic or chromosomal disorders that result in intersex state may need to have their testes removed.
Thalassemia
Definition:
Thalassemis is a type of familial anaemia that is caused by an inherited disorder in the production of hemoglobin. The severity depends on the numbers and the type of defective gene a patient is carrying.
Who is at risk?
The disease is most prevalent in area round the Mediterranean Sea, hence it is also called Mediterranean Anaemia. About 5 to 10 percent of Southeast Asian people are carriers one or more defective genes of thalassemia. When both parents are carrying the same defective genes, the chance of giving birth to a severely affected child is 1 in 4.
Symptoms:
Children severely affected with thalassemia may not have any symptom at birth. It is often only after 2 to 4 months old that they are found to be pale, get tired and breathless easily, and are feeding and growing poorly. Their livers and spleens are enlarged, and parents may bring the child to see a doctor for a mass in the abdomen.
Treatment:
Severe anaemia would require monthly blood transfusions. This brings in a large amount of iron which can damage the child's organs in the long run. Most patients would therefore also need daily injections to remove the iron load. Treatment is painful and life-long. Bone marrow transplantation and stem cell transplantation have shown promising results in some centres in curing the disease once and for all.
Prevention:
Women should be tested for thalassemia as soon as pregnancy is confirmed. If she is a carrier of the gene, the father should also be tested. As early as 9 to 11 weeks of pregnancy, the condition of fetus can be tested for, so as to provide information for parents to decide whether to carry on with the pregnancy or not.
Tonsils, Disease of Tonsils
Definition:
Tonsils are masses of tissue that are similar to the lymph nodes or "glands" found in the neck, groin, and armpits. Tonsils and adenoids are near the entrance to the breathing passages where they can catch incoming germs and can become infected themselves. They work as part of the body's immune system by filtering germs that attempt to invade the body and help develop antibodies to germs. Acute tonsillitis refers to the inflammation of a tonsil. Abscesses refer to the collection of pus around the tonsils. Bacterial chronic tonsillitis and infectious mononucleosis can sometimes occur but tumors of tonsils are rare.
Who is at risk?
- Individuals with narrowing of the nasal or sinus passage;
- Individual with recurrent ear and throat infection.
Symptoms:
- Swollen, red tonsils (often coated with a yellow or white membrane)
- Blisters or painful ulcerated areas on the throat
- Sudden onset sore throat
- Pain with swallowing
- Headache
- Loss of appetite
- Malaise
- Chills & fever
- Swollen and tender lymph nodes in the neck or jaw area
Additional symptoms of tonsillitis in children include:
- Nausea
- Vomiting
- Abdominal pain
Treatment:
- Acute bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Chronic infection with abscess or tumor might require surgery. The two primary reasons for tonsil and/or adenoid removal are:
- Recurrent infection despite antibiotic therapy.
- Difficulty breathing due to enlarged tonsils and/or adenoids.
- Adenoidectomy may be a beneficial treatment for some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion).
- Infectious mononucleosis (glandular fever): Severe enlargement may obstruct the airway and treatment with steroids (e.g. cortisone) might sometimes be helpful.
Prevention:
The following suggestions may help to inhibit the spread of the contagious illnesses that are generally responsible for the spread of tonsillitis:
- Keep your (and your child's) distance from anyone with tonsillitis or a sore throat.
- Do not share utensils, drinking glasses, toothbrushes, etc., with anyone who has tonsillitis or a sore throat.
- Wash your (and your child's) hands frequently.
- Cover your mouth when you cough or sneeze, and teach your children to do the same.
- Avoid contact with people who have tonsillitis.
Trachoma
Definition:
Trachoma is a highly contagious disease of the eye caused by the bacteria Chlamydia trachomatis. The disease spreads by direct contact with eye, nose, and throat secretions from affected individuals. After years of repeated trachoma infections, the inside of the eyelids can become so scarred that they turn inward with the eyelashes rubbing on the eyeballs. If being left untreated, this scarring can lead to blindness.
Who is at risk?
Trachoma is most prevalent in poor rural countries, which have overcrowded living conditions with limited access to water and sanitation. It frequently affects children, hence repeated infections during childhood are common. However scarring and blindness may only appear in adulthood.
Symptoms:
In the early stages, symptoms such as itchiness, swelling, redness and discharge from the eyes may be confused with other conditions such as conjunctivitis. Those more severely affected would have swollen eyelids with turned-in eyelashes. Examination by eye doctor may reveal scarring in the upper eye lid with new blood vessels growing into the cornea.
Treatment:
Laboratory tests are needed to accurately identify and detect the bacteria in order to diagnose trachoma. Antibiotics can prevent long-term complications if used early in the infection. Those diagnosed late with scarring in the eyelid may need surgery in order to prevent irritation to the cornea, which can result in blindness.
Prevention:
Trachoma is a preventable cause of blindness. Improved sanitation and not sharing personal items such as towels are important measures to limit the spread of trachoma. Globally speaking, the challenge is to provide basic healthcare and medicine to developing countries where the disease is most prevalent.
Tuberculous Meningitis
Definition:
Tuberculous meningitis refers to a type of meningitis (inflammation of the covering of the brain, usually caused by infections) caused by tuberculosis. This is a serious disease resulting in severe neurological deficit or death in more than half of the cases.
The meninges are the membranous layers that cover the brain and spinal cord that serve as a barrier for protection. They are richly supplied with blood vessels and are important sources of nutrients for brain cells. No wonder any infection involving the meninges is potentially life-threatening.
Tuberculosis is primarily an illness of the respiratory system spread by coughing and sneezing. The bacteria enter the host by droplet inhalation. The bacilli establish a focus within the lung, and disseminate to nearby lymphatic glands forming a so-called primary complex. The patient may not have any symptoms at this stage. The body's resistance may be successful in walling off the bacteria with scar tissue. But in some patients, bacilli escape into the blood stream and find their way to settle in the meninges, establishing a focus of infection in the nervous system.
The inflammatory tissue enlarges into a swelling to wall off the bacilli, called a tubercle. The tubercle may keep on growing until it ruptures into the space between the meninges and the brain cells. There the bacilli would provoke more inflammation. The blood vessels supplying nutrients to the brain cells are affected and may even be obliterated. Scar tissue can block the flow of the fluids surrounding the brain. The pressure built up can block off the supply of nutrients and oxygen. The inflammation can cause damage to the large nerves coming out from the base of the brain.
Who is at risk?
In developing countries where tuberculosis is common, tuberculous meningitis is more common in children. Locally, the disease can happen to young adults in perfect health prior to the illness. Recent immigrants and those with family history of tuberculosis are at higher risk. People who are not immunized with BCG (name of a vaccine against tuberculosis) are more susceptible to tuberculosis, as well as smokers, alcoholics and people living in overcrowded condition.
Symptoms:
Tuberculois meningitis often begins slowly and quietly with a gradual fluctuating fever, fatigue, weight loss, behaviour changes, headache, and vomiting. If the disease is diagnosed at this early stage, patients do have a good chance of full recovery. Signs of infections in the upper respiratory tract commonly coexist, and may mislead the physician. This early phase is followed by a second phase marked by increasing neurologic deficits, loss of consciousness, or convulsions. The sixth nerve (one of the nerves coming from the brain) is the most commonly affected cranial nerve, and the patient would develop a squint. Thereafter the patient goes downhill to a final comatose stage, when the prognosis is grim.
Treatment:
To diagnose tuberculous meningitis, doctors need to perform a lumbar puncture. A small needle is pushed from the lower back into a space in the spinal canal. A few drops of the fluid is withdrawn for examination. Typically the sugar content would be low and the protein level high, the number of white blood cells increased, indicating active inflammation. The final proof would come from looking for the bacilli under the microscope and isolating the bacilli in a culture. The disease needs to be treated with a prolonged course of a combination of antibiotics. If the flow of brain fluids has been blocked by the inflammatory process, it may be necessary to perform a surgical procedure to put in a small tube connecting the ventricles (cavities inside the brain, normally filled with fluid) of the brain and the peritoneal cavity (the cavity inside the abdomen) of the abdomen (ventriculoperitoneal shunt) in order to release the pressure.
Prevention:
In Hong Kong, all newborn babies are immunized with the BCG vaccine, and this may be helpful in preventing tuberculous meningitis. Check the immunization record of you and your family members if you are a migrant to Hong Kong.
Untreated patients with dormant tuberculosis infection often are sources of infection. If your family members or colleagues have a chronic cough, advise them to see a doctor and have a chest X-ray.
Turbinate Dysfunction (Pathological Abnormalities of Nasal Septum)
Definition:
In the back of our nose are the turbinate bones. They are thin sheets of bony fragments protruding from the sides of the nasal wall of the skull. Covered by a wet membrane which is richly supplied with blood, the structure increases the surface area of the nose and functions as an "air conditioner" and "air-filter". Swelling of either the membranous structure or bones can lead to blockage of nasal breathing. Apart from causing symptoms, patients would breathe through their mouths, resulting in the loss of the structure's function as an air-filter.
Who is at risk?
Patients suffering from allergic or infectious conditions in the nose, such as allergic rhinitis and sinusitis, would be prone to turbinate dysfunction when the membranes are swollen. Patients with deviated nasal septum, the small piece of bone in the midline of the skull separating the nose into two sides, may have large turbinate bones or narrow passages that affect air flow.
Symptoms:
A patient with turbinate dysfunction would complain of nasal blockage and congestion. The excessive mucous tends to drain to the back of the mouth rather than in the front of the nose. Some patients may experience headaches and facial pains.
Treatment:
Several types of oral drugs are effective in controlling symptoms of nasal congestion and discharge. "Decongestants" work by shrinking blood vessels and "antihistamines" by blocking the action of "histamine", a chemical secreted in our body to mediate immune functions.
Steroid nasal sprays are also useful for treating turbinate dysfunction. Nasal sprays of decongestants are extremely powerful but prolonged use can cause rebound swelling of the structures inside the nose, so that a patient would keep on using more of the drug. The blood vessels may be so severely shrunk that the membranes would die out all together.
Surgical therapy is reserved for severely affected patients whose symptoms cannot be controlled with medicine.
Prevention:
Some degree of turbinate dysfunction is almost universal and cannot be prevented. Prompt treatment of infectious and allergic conditions of the nose would, however, prevent the dysfunction from getting worse.
