Craniopharyngioma

Craniopharyngioma

This illustration was produced for the Johns Hopkins University’s Suburban Hospital Magazine, New Directions, Fall 2012 issue.

A craniopharyngioma is a benign tumor that develops near the pituitary gland (a small endocrine gland at the base of the brain). This tumor most commonly affects children 5 – 10 years of age. Adults can sometimes be affected. Boys and girls are equally likely to develop this condition.
Craniopharyngioma causes symptoms in the following ways:

  1. Increasing the pressure on the brain (intracranial pressure)
  2. Disrupting the function of the pituitary gland
  3. Damaging the optic nerve

Increased pressure on the brain causes headache, nausea, vomiting (especially in the morning), and difficulty with balance. Damage to the pituitary gland causes hormone imbalances that can lead to excessive thirst, excessive urination, and stunted growth. When the optic nerve is damaged by the tumor, vision problems develop. These defects are often permanent, and may get worse after surgery to remove the tumor.

Behaviorial and learning problems may be present. Most patients have at least some vision problems and evidence of decreased hormone production at the time of diagnosis.

Traditionally, surgery has been the main treatment for craniopharyngioma. However, radiation treatment instead of surgery or along with a smaller surgery may be the best choice for some patients. In tumors that cannot be removed completely with surgery alone, radiation therapy is usually necessary. If the tumor has a classic appearance on CT scan, a biopsy may not be necessary if treatment with radiation alone is planned. Stereotactic radiosurgery is performed at some medical centers. This tumor is best treated at a center with experience in treating patients with craniopharyngiomas. [Source: A.D.A.M. Medical Encyclopedia.]

Irritable Bowel Disease

Irritable Bowel Disease

This illustration is one of the latest editorial pieces completed for the American Academy of Family Physicians featuring Irritable Bowel Disease.

Depicted are a montage of images illustrating common symptoms and treatment for IBD including stomach cramping, abdominal discomfort, the urge to use the bathroom, colon spasms and the use of antispasmodics such as hyoscyamine sulfate.

According to the featured article, “Irritable bowel syndrome (IBS) is defined as abdominal discomfort or pain associated with altered bowel habits for at least 3 days per month in the last 3 months in the absence of organic disease.  In the U.S., the prevalence of IBS is 5-10% with peak prevalence in the third and fourth decades.  Abdominal pain is the most common symptom and is often described as a cramping sensation.  The absence of abdominal pain essentially excludes IBS. Other common symptoms include diarrhea, constipation, or alternating diarrhea and constipation.  The goals of treatment are alleviation of symptoms and improvement in quality of life.  Exercise, psyllium fiber, antibiotics, antispasmodics, peppermint oil and probiotics appear to improve symptoms of IBS.  Over-the-counter laxatives and antidiarrheals may improve stool frequency but not pain.  There is conflicting evidence to support the use of antidepressants; however, psychological therapies are effective compared to usual care treatments for improvement in IBS symptoms. Lubiprostone (Amitiza™) is effective for the treatment of constipation-predominant IBS.  Alosetron (Lotronex™) and Tegaserod (Zelnorm™) are FDA-approved for patients with severe IBS symptoms who have failed conventional therapy.”

 

Modular Taper Junctions

Modular Taper Junctions

Illustration created for the article Evaluation and Treatment of Painful Total Hip Arthroplasties with Modular Metal Taper Junctions by R. Michael Meneghini, MD; Nadim J. Hallab, PhD; Joshua J. Jacobs, MD. Orthopedics May 2012, Volume 35, Number 5.

Modern primary total hip arthroplasty femoral components have emerged to include modular necks. Subsequently, the additional taper junction provides another interface as a potential source for mechanically assisted crevice corrosion, which is a complex process involving fretting and crevice corrosion. Furthermore, it is becoming evident that an adverse local tissue reaction may result in some patients due to the mechanically assisted crevice corrosion. This article details the clinical, radiographic, and laboratory evaluation of patients with these components who present with persistent pain. The relevant surgical strategies and techniques to address this pathology in symptomatic patients are addressed.

Male Wellness Exam

Male Wellness Exam

This illustration is one of the latest editorial pieces completed for the American Academy of Family Physicians featuring The Male Wellness Exam.

Depicted are a montage of images illustrating common considerations during history and physical examination during male wellness exams, including weight and obesity screening, colonoscopy screening for colorectal cancer and immunization schedules.

According to the featured article, “The adult well male examination should incorporate evidence-based guidance toward the promotion of optimal health and well-being, including screening tests shown to improve health outcomes.  Nearly one-third of men report not having a primary care physician, and 12% rate their overall health as poor.  Medical history should include tobacco, alcohol and illicit substance use; risks for sexually transmitted infections ; diet and exercise habits; and symptoms of depression.  Physical examination should include blood pressure screening and height and weight measurements.  Men with sustained blood pressures greater than 135>80 should be screened for diabetes.  Lipid screening is warranted in all men 35 years and older and in men ages 20 to 35 with cardiovascular risk factors.  Ultrasound screening for abdominal aortic aneurysm should occur once between ages 65 and 75 in men who have ever smoked.  There is insufficient evidence to recommend screening men for osteoporosis or skin cancer.  The U.S. Preventive Services Task Force has provisionally recommended against PSA-based screening for prostate cancer because the harms of testing outweigh potential benefits; other organizations advise shared decision making about PSA testing in men age 50 years and older.  Screening for colorectal cancer should begin at age 50 for average-risk men and continue until at least age 75 via annual high-sensitivity fecal occult blood testing (FOBT), flexible sigmoidoscopy every 5 years combined with FOBT, or colonoscopy every 10 years.  The USPSTF recommends against screening for testicular cancer and chronic obstructive pulmonary disease.  Immunizations should be recommended according to guidelines from the Advisory Committee on Immunization Practices.”

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