00068
What is TMJ?
jaw mandible TMJ Digestive System temporomandibular joint alignment
misalignment joints musculoskeletal system connective tissue tissues mouth
mandibulae
VolumeI-11,M-11
What is TMJ?
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QUESTION: What is TMJ? Would you please discuss it and its treatment?
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ANSWER: "TMJ" stands for "temporomandibular joint" and usually refers to
problems with that joint. The joint is the one that allows your jaw to open,
shut and slide your chin forward. It's a joint that takes a lot of stress,
even under the best of conditions. Its proper alignment and function depends
on many factors, including your teeth, the muscles of your face and mouth, and
your ways of coping with stress.
The range of problems with TMJ is broad, but any disruption of its
function usually results in a misalignment of the teeth and jaw and gradual
deterioration of the joint.
The causes of TMJ problems are varied; I'll discuss a few of them. Mouth
or jaw injuries, such as those occurring in auto accidents or sports injuries
often start the TMJ problems. The jaw becomes misaligned due to the injury,
and the joint wears unevenly due to the misalignment. The TMJ problems may
develop slowly, over a period of years after the injury. Personal habits such
as chewing pencils or ice, grinding teeth, or clenching the jaw from tension
can also create a TMJ problem.
What are the symptoms of TMJ? Face or jaw pain, noises such as a
clicking when the jaw is opened, or difficulty in opening the jaw are all
symptoms. Some people report that the jaw pain travels to the head, neck,
ears, shoulders and arms. TMJ should be suspected in anyone who suffers from
frequent headaches that have no known cause. The symptoms worsen over the
years unless the problem is treated.
Accurate diagnosis of TMJ is important before treatment can be begun.
Specialized x-rays, especially a process called video arthrography, are part
of the diagnostic workup. Determining exactly how the different parts of the
temporomandibular joint function in relation to one another is crucial to
treating the problem with success.
The problem may not be in the joint itself; it may be located in the
powerful muscles of the jaw. If this is the case, muscle relaxation is the
goal. This may be accomplished by learning to control stress, using physical
therapy to exercise the jaw muscles, or using local anesthetic pain control.
Sometimes, muscle relaxants are prescribed to help the jaw muscles relax and
heal. In some cases, a special mouthpiece is designed to realign the mouth
and ease the pressure on the jaw joint.
If the problem is severe and does not respond to less permanent
treatment, the alignment of the jaw and mouth must be altered. This can be
accomplished in a variety of ways, but should only be undertaken when other
methods fail, because the treatment is permanent and cannot be reversed.
Changing the alignment of the teeth and jaw should only be attempted by
someone who is well-experienced in successful treatment of TMJ. Sometimes the
alignment of teeth is altered by grinding the surfaces so that the upper and
lower teeth meet more harmoniously. In more severe cases, surgery is
performed to repair the temporomandibular joint. If the jaw joint is found to
be deteriorated beyond repair, an artificial joint can be used to replace it.
In some parts of the country, arthroscopes are being utilized to diagnose
and treat some forms of TMJ disorder. This shows great promise, because the
physician can see directly into the joint with only a minimal incision, and he
can treat the problem without extensive surgery.
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The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.
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00069
stones kidney surgery Genitourinary System stone kidneys surgeries
PNL percutaneous nephrolithotomy urinary tract urethroscopy urethroscope ESWL
extracorporeal shock-wave lithotripsy operation operations special procedure
procedures
VolumeJ-16,P-16
Log
Anatomy of the Kidney*0004801.scf
Small Kidney Stones*0004802.scf
Stag-Horn Kidney Stones*0004803.scf
Passage of a Kidney Stone*0004804.scf
Surgery for Kidney Stones
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QUESTION: Is it always necessary to be operated on for kidney stones?
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ANSWER: Well, let me begin by telling you of my experience. Ralph had become
a statistic, as well as my patient. He had become one out of each eight men
in this country, who by the age of 70, will develop a kidney stone. He came
to me in distress and pain. A while back, he would have had two choices;
either he would have been able to pass the stone or invasive, open surgery
would have been performed. Of course, surgery was and still is dictated by
some hard and fast rules. The first is the size of the stone and its ability
to be passed. Usually stones smaller than 4 mm have a 75% change of being
passed. Other criteria are persistent pain or bleeding, partial obstruction,
chronic infection, and stones increasing in size. Well, Ralph had all these
symptoms, but as a doctor practicing medicine in 1988, I had at my disposal
three noninvasive techniques for the elimination of kidney stones, which I
explained to Ralph.
The first technique is called PNL (percutaneous nephrolithotomy) and
involves the use of a needle to gain access to the kidney. A contrasting dye
is instilled into the urinary tract to gain knowledge of the location of
stones, and then the tract is dilated and removal is accomplished through
forceps. This procedure is not for patients with bleeding problems or those
who have hypersensitivity to the contrast medium. A second procedure is
called urethroscopy and involves the use of a urethroscope; this procedure is
for stones located in the ureter. The most recent procedure is ESWL
(extracorporeal shock-wave lithotripsy), a method first used in Germany in
1980 and approved by the FDA for use in this country in 1984. This method
uses shock waves, which break the stone into small sand-like particles, which
the patient will pass in the next two- to three-week period.
So, though Ralph was a candidate for removal of his kidney stones, he did
not need open surgery. We discussed the best method for him and he was spared
the lengthy hospitalization, the increased risk, and the drain on his
finances. What these three methods have in common are a good success rate,
and the ability to make a patient as good as new in a short period of time.
----------------
The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.
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00070
Cancer of the Prostrate: Causes and Treatments
prostate cancer rectal Genitourinary System neoplasm neoplasms
malignancy older rectal examination lump pelvis lower spine urination
dribbling constipation urinary tract carcinoma cancers radiation therapy
impotent potent age aging old
VolumeJ-15, B-15
Log
Anatomy of the Male Productive System*0006001.scf
Cancer of the Prostrate*0007601.scf
Cancer of the Prostrate: Causes and Treatments
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QUESTION: I'm worried about cancer of the prostrate. Please explain its
causes and treatments.
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ANSWER: Prostate cancer is the most common malignancy found in older men.
Usually it is first discovered during a rectal examination as a nonsymptom
producing lump or swelling in the prostate gland. The nodule is most often
small (less than 2 cm in diameter), hard, irregular in shape, and
self-contained. Other indicators of prostate cancer are unexplained bone pain
in the pelvis and lower spine, and bladder problems such as painful urination,
dribbling, and straining to void, which might indicate an obstruction.
While the exact cause of this type of malignancy remains a mystery, the
predictable way it progresses helps the physician make an accurate and quick
diagnosis so that proper treatment can begin. Blood tests, a needle biopsy,
x-rays of the kidneys and the urinary tract, and computerized ultrasound
pictures (CT scans) of the lower abdomen to see if the lymph nodes are
involved are useful components of a complete workup that may be performed to
define what stage the carcinoma is in. These stages range from (A) diseased
tissue with no lumps to (B) lesions confined to the prostate capsule to (C)
tumors which cover the outside of the capsule, and finally (D) disease which
spreads to other body parts.
Treatment varies according to the severity of the condition and other
factors such as patient's age (young men tend to develop fast growing
cancers), desire to remain sexually potent, and other medical problems that
may exist. For instance, early stage A cancers are without symptoms and are
discovered when tissue removed during operations for enlarged prostates
considered benign, are examined under the microscope. No further treatment
may be necessary, unless the patient is under 55, and the cancer cells seem
advanced, in which case radiation therapy is suggested. Stages B and C
require either a complete surgical removal of the prostate gland or intensive
radiation therapy, which reaps a similar result. The symptoms of stage D
(advanced) disease can be lessened with hormone therapy as well as surgery.
Though the manner and timing of such therapy remains controversial, its goal
is to reduce symptoms and make the patient more comfortable.
New advances in treatment are being developed every day. For example, a
new surgical technique called a subcapsular prostatectomy (or partial removal
of the prostate gland) seems to be successful in halting some cancers without
causing the patient to become impotent. Unfortunately, long-term results are
not yet known.
----------------
The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.
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00071
Is There Such a Thing as a Male Contraceptive?
contraception male Genitourinary System Contraceptive Contraceptives
contraceptions luteinizing hormone releasing hormones LHRH hypothalamus gland
prophylactic prophylaxis prophylactics lifestyle lifestyles
VolumeJ-22,R-23
Log
Hormones of the Hypothalamus*0002902.scf
Types of Birth Control*0002001.scf
Is There Such a Thing as a Male Contraceptive?
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QUESTION: Is there such a thing as a male contraceptive?
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ANSWER: Except for condoms, there is no reversible form of male
contraceptive--yet. Research is, however, underway to find one.
One male contraceptive that is currently under investigation is
luteinizing hormone-releasing hormone (LHRH), which is a natural hormone
secreted by the hypothalamus gland. Researchers at Vanderbilt University have
been testing LHRH on male volunteers and found that it does suppress the
production of sperm when taken for at least three months. They will begin
further testing soon to evaluate LHRH for side effects.
The LHRH they are using must be injected daily, which will not make it
either popular or cost effective. If the drug were to be developed
commercially--something that won't happen for more than 10 years even if all
goes well--it would probably be a monthly injection or be administered in some
other way.
----------------
The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.
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00072
Pap Smear Classification
Pap smear cancer cancers Genitourinary System Paps Smears vagina
vaginal uterus cervix classification classifications Papanicolaou carcinoma
special procedure procedures lab laboratory tests test
VolumeJ-14, P-14
Log
Abrasion Biopsy of Uterus*0001901.scf
Diseases of the Female Reproductive System*0009001.scf
Pap Smear Classification
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QUESTION: I have been required to return to my physician on several occasions
because my Pap smear is a "2". He keeps treating me and then taking another
smear. I am afraid I have cancer, because I don't understand what's going on.
Can you help?
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ANSWER: I believe I can, and the news is good. You most probably do not have
cancer. Since Dr. George Papanicolaou published his paper in 1941 describing
the value of vaginal smears to detect cancer of the uterus, the technique has
been used routinely to discover early abnormal changes of the cells of the
cervix (the entrance to the uterus). The cells are scraped from the cervix by
the physician, placed on a glass slide and then stained. When these cells are
examined under a microscope, the subtle changes from normal can be detected,
and graded against a classification of results which allow an interpretation
to be made. There are 5 such classifications from I to V (we use Roman
Numerals as did Dr. Papanicolaou). Class I means there are no suspicious
cells that reveal any changes and is interpreted as negative for cancer. In
Class II ( as in your case) there are some changes in the cells, which can be
caused by an inflammation, but are not considered to be changes that are due
to or lead to cancer. Usually when the inflammation is treated and has
cleared up, the cells return to normal. Class III is made up of cells that
show mild or moderate changes that are suspicious of cancer, but for which a
diagnosis can not be made with certainty. It is Class IV that is used to
indicate that a cancer has started in the cervix, and Class V which tells of
malignancy and invasive carcinoma, that has attacked the uterus.
There are varying recommendations as to the frequency that the test
should be taken, or repeated, and it is a test that must be performed
correctly to obtain results that are accurate. The best time to obtain cells
for examination is at day 14 of the menstrual cycle when the hormone effect of
estrogen is at its maximum. Any patient with a classification of Class III or
higher should have a biopsy of the cervix performed, since this is a more
reliable test, and affords a more dependable diagnostic interpretation. When
inflammatory changes are noted, the Pap report may note the presence of an
infecting bacteria, which can help the physician determine the treatment.
Most physicians agree that Class II smears should be repeated three months
after treatment. It looks like your doctor is following this appropriate
course.
----------------
The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.
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00073
Cancer and Love Life
sex impotence cancer cancers carcinoma neoplasm neoplasms
chemotherapy Genitourinary System intimate intimacy sexual dysfunctions
dysfunction vagina vaginal atrophy coital chemotherapies menopause erectile
impotence prostatectomy pudendal penile orgasm orgasmic Intrapenile inflatable
implants implant libido
VolumeJ-15, B-15
Log
Total Hysterectomy*0008601.scf
Partial Hysterectomy*0008602.scf
Cancer of the Prostate*0007601.scf
Cancer and Love Life
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QUESTION: After being treated for cancer, I'm afraid my love life will
change. Will it?
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ANSWER: Chances are, it will. During a medical crisis such as the one you've
been through, there are bound to be all sorts of adjustments to be made--both
physical and emotional. However, with good communication between intimate
partners, many of the sexual dysfunctions that result from cancer and its
treatment can be overcome.
For women, gynecologic cancer surgery can cause a reduction in the depth
and width of the vagina, and common problems following chemotherapy can
include vaginal atrophy and loss of vaginal lubrication. Commercial
lubricants can restore the lubrication, and it is recommended that partners
use coital positions that allow the woman to regulate the degree of
penetration. To prevent vaginal atrophy, early resumption of sexual activity
is strongly advised, particularly since it may also help to relieve a
patient's anxiety which can cause sexual problems in itself.
Loss of sexual drive can also occur after cancer treatment. This can
have a biological basis since chemotherapy can cause menstrual abnormalities
and the onset of an early menopause. However, psychological factors such as
cancer-related depression or a difficult adjustment to the changes in one's
body image can certainly reduce one's sexual desire as well. Therefore, the
quality of your interpersonal relationship has a strong bearing on your
adjustment. Nonsexual expressions of love such as touching and prolonged skin
contact can frequently rekindle sexual desire and a healthy, fulfilling love
life can usually be achieved.
For men, erectile impotence is the major type of sexual dysfunction
resulting from prostate cancer. In radical prostatectomy, severed nerves are
responsible for the problem, and until recently, this was a constant
complication. Now, however, there is a nerve-sparing procedure and the
pudendal nerve, which carries penile sensations, lies outside the operative
area. The patient remains unable to gain an erection, but orgasmic function
is retained. For such patients and their partners, mutual intimate touching
is recommended for a continued satisfactory love life.
There are, however, other alternatives for dealing with erectile
impotence. There are a number of drugs that can be taken orally which will
enable a patient to gain an erection, but as a rule, they are only effective
for a few months and only work for a modest number of patients. Intrapenile
injections are successful for a large number of patients and can be easily
administered. However, repeated use may cause penile fibrosis (scarring)
which eliminates the option for a penile implant. Rigid, semirigid, and
inflatable implants are popular alternatives for couples for find penile
injections unacceptable. The inflatable ones are usually the preferred type
since they closely reproduce a physiologic erection.
Male patients, like female ones, often experience a decreased libido, and
frequently for the same reasons. Self-image and psychologic reactions to
cancer and its treatment play a major role in one's sexual image. Explore
new and alternative ways of expressing your affection for each other if the
old ones no longer work. Seek counsel with your doctor. And be assured that
you can still have a fulfilling love life.
----------------
The material contained here is "FOR INFORMATION ONLY" and should not replace
the counsel and advice of your personal physician. Promptly consulting your
doctor is the best path to a quick and successful resolution of any medical
problem.
