It is considered a common occurrence and can be seen in 1 out of every 1,000 births. It is the most common congenital condition that affects the legs.  Half the time, a single extremity is affected and half the time both feet are affected.  Males are more affected, almost a 2 to 1 ratio.

Deformities can be seen in 3 different joints:

1.)   Inversion at the Subtalar Joint

2.)   Adduction at Talonavicular joint

3.)  Talipes Equinus at the Ankle joint

Causes of this condition often are divided according to Postural or Structural.

Overall causes include genetic conditions like Edward Syndrome, a defect in Chromosome 18.  Also Growth arrests and Compartment syndrome can also be causative.

Breech presentation is a large cause of Club Foot.

Other causes are less known, such as connective tissue disorders and possible risks in spina bifida

Diagnosis is often a debatable concept.  Because often the cause is unknown prior to delivery or visual confirmation through ultrasound. Many children may not be diagnosed until after birth.  When ultrasound is done at 20 weeks, not all cases will be seen.

Treatment of club foot is often difficult but most children respond well.   Surgery is one of the final options. Prior to that casting of the feet, serial casting, splints, braces or some combination are often seen.

Manipulation of the foot is often seen after two weeks from birth followed by a serial cast.

Serial Cast – when a new cast is placed every week slowly returning foot to normal position.

Even with successful treatment, the affected foot, may be smaller than the other foot. The calf muscle may be less defined.

It is characterized by diamond shape scales.

Infants are at highest risk for infections, dehydration, and breathing difficulties.

Improvements in management and treatment have extended the lives of those with this condition.

Check back at the end of the week to learn the name of this condition.

If you would like to guess – place your guess in the comment section below.

Update:  Friday December 9th

The Answer is indeed:  Harlequin-type ichthyosis

More about this condition is below:

This is a condition where the skin of an infant becomes thick and scaly.

The change occurs in the keratin layer of the skin.

Large and thick, diamond shaped scales, red in color, can be seen.

The scaly nature of the skin causes the infant to have difficulty with movement and respiration.

It is a very rare condition.

Symptoms:

- Severe cranial and facial deformities
- Ears and nose may be absent or poorly developed
- Ectropion [Everted or outward eyelids]
- Dryness of skin
- Thickening of skin
- Large scales
- Scales can be reddish in color
- Arms, feet, fingers can also be deformed
- Polydactyly – more than the usual number of toes or fingers

Cause:

- Mutation in the gene for protein – ABCA12
- This gene helps regulate healthy skin.
- This mutation can be inherited

Areas of skin affected:

1.) Face
2.) Eyes
3.) Ears
4.) Penis
5.) Extremities
6.) Other

Risk Factors

- Increase chance for infection due to cracks in skin
- Cracked Skin
- Dehydration
- Restricted or difficulty breathing
- Difficulty controlling water loss

Treatment

. Isotretinoin [Isotrex]

- Symptomatic treatment
- Treat Dryness
- Treat Infections

Liver Transplants

This is typically done in patients suffering from end-stage liver disease and acute liver failure.  As in other major surgeries, there is a substantial amount of risk during the procedure.

If a patient has end-stage liver disease or acute liver failure they don’t automatically qualify for liver transplant.

They must also be avoid of other competing medical issues that typical result in poor outcomes  such as: uncontrolled metastatic cancer – when it is outside of the liver, active drug abuse, active alcohol abuse, active infections.  HIV used to be on the list but this has recently changed.

Age, serious heart conditions, and other medical issues need to be reviewed in each patient before transplant would be approved.

Recently, several doctors and a recent study is trying to indicate that a patient shouldn’t have to prove that they are sober for six months to qualify for a transplant.

A small study in France indicates that they had several patients that were given a new liver and became sober years later.  Only 26 people were in the study where 77% were alive after six months and only three began drinking within the next three years.  All 26 had very stable and supportive group of family and friends.

It is to be noted that the study looked at individuals who were suffering from hepatitis related liver failure from alcohol abuse.

There has been an ongoing and difficult, often bitter debate over whether this is ethical and appropriate. Liver’s for transplant are already in high demand. Many point to George Best, a British soccer player who received a liver transplant in 2002, only to start drinking again and he eventually died three years later.

Excess alcohol abuse can cause liver damage including cirrhosis and hepatitis.  Just under 20% of current transplants go to current or former heavy abuse drinkers. Patients must give up heavy drinking for six months before a transplant center will approve them to be placed on the list.

The French study suggests dropping the ban only for patients with hepatitis related to excess alcohol abuse. Arguments are that obesity and drug abuse causing liver failure patients are a large majority of patients receiving liver transplants and these are lifestyle choices as well.

Last year alone, over 6,000 liver transplants were performed in the United States.  It has been reported that around 1,400 individuals died waiting for a transplant. This data is given by United Network for Organ Sharing.

Remember that alcohol alone is no the only way to have liver damage. Some patients with no history of alcohol, drug use or obesity are currently waiting for a transplant. Approving the drop in six months free of alcohol will affect them as well.

Controversy has been seen on this topic before and it appears that this new study will again draw in the sand lines of opposition.  Some state that the lines are becoming increasingly clear, while others states that facts just blur them into confusion.

Please comment as too where you stand.  One way or another, lives are at stake.  Please be mindful of that in the comment section.

The welfare system may changing – but for better or worse still remains to be seen.

Proposals in almost twenty-five states have shed light on drug testing requirements in order to receive benefits like unemployment assistance, job training, public housing, welfare, food stamps and more.

The concerns by the proponents are that some of the governmental assistance are being misused while others decry this as an attempt at signaling out the poor.  States that have already passed such requirements include: Arizona, India, Florida, and Missouri.

At the federal level, Senator David Vitter, a Louisiana Republican, has introduced the Drug Free Families Act of 2011, which would require all 50 states to drug-test welfare applicants.

“Working people today work very hard to make ends meet, and it just doesn’t seem fair to them that their tax dollars go to support illegal things,” said Ellen Brandom, a Republican state representative in Missouri.

So far, most proposals for change have failed to win the support needed.  This is believed to be the result of concerns about the legality of such proposals.

Kimberley Davis, the director of social services for Operation Breakthrough, said the legislation sent a bad message. “All this does is perpetuate the stereotype that low-income people are lazy, shiftless drug addicts and if all they did was pick themselves up from the bootstraps then the country wouldn’t be in the mess it’s in,” Ms. Davis said.  Operation Breakthrough provides day care services in Kansas City to low-income women.

Several studies that date back a decade or more indicate that drug use is not solely seen in the poor. In 1996, a report from the National Institute on Alcohol Abuse and Alcoholism found that there is no significant difference in the rate of illegal-drug use by welfare applicants and other people. Another study found that 70% of illegal-drug users between the age of 18 and 49 are employed full time.

It is estimated that one person dies every seven second from diabetes and things continue to get worse.

The International Diabetes Federation have reportedly called for systematic and concrete guidelines to stop this epidemic. In addition, they are signaling a need for this topic to be covered at the United Nations meeting next week.

Type I diabetes largely affect children and young adults.  These individuals are unable to make insulin, which is produced from the pancreas pancreas. Type II diabetes is much more common and is often closely affected by obesity. Type II can be described as a decrease in the amount of insulin [Relative Insulin Deficiency] and a difficulty to have the insulin entering the cells [Insulin Resistance].

Complications of Diabetes:

1.)  Eye complications

-    Retinopathy – a disorder of the retina.
-    Loss of eye sight
-    Cataracts – 60% more likely to get cataract when diabetic
-    Glaucoma – 40% more like to get glaucoma when diabetic
-    Check out the Anatomy of the Eye

2.)  Foot Complications

-    Callous, skin changes, Neuropathy, ulcers, and other problems
-    Poor circulation and amputations can be seen.

3.)  Skin changes

-    Increased fungal, bacterial, rashes and other skin changes can be seen.

4.)  Heart Disease

-    HA1c checks blood sugar – should be monitored and maintained
-    Increased Lipids [Cholesterol and Triglycerides need to be maintained.]

5.)  Hypertension

6.)  Depression and Stress

7.)  Ketoacidosis

-    Ketones produced when body burns fat instead of glucose
-    When a dangerously high levels are seen – can lead to stroke and death.

8.)  Hyperosmolar Hyperglycemic Nonketotic Syndrome  (HHNS)

-    Elevated blood sugar levels rise dangerously – rare but serious condition

9.)    Neuropathy  (Nerve Damage)

10.)  Kidney Disease  (Nephropathy)

-   High blood sugar can overwork the kidneys, causing them to stop working properly.

11.)   Peripheral Arterial Disease  (PAD)

12.)   Stroke

Here’s a medical condition that effects the skin. Typically this condition affects the layers of skin and a raised red patch can be seen.

In this condition, the immune system sends out faulty signals that cause the thickening of the skin.

The actual cause of this thickening of the skin is not known.

The big question is if this condition is contagious or not???

What do you think it is? Add your thoughts to the comment section.

Update: September 9th 2011 – 6:18 Eastern

*We got a ton of responses from Facebook and Twitter. Thanks to everyone for their guesses.

Drum roll……..Psoriasis is the Answer.

Below is a quick update on Psoriasis

Psoriasis

Caused by an immune system sending out faulty signals that speed the growth of the skin cells

Is classified as a chronic immune-medicated disease.

This condition is different than eczema with affects that outer side of the a joint.

Is chronic and reoccurring – which means that it can be difficult to treat.

Is a skin condition that effects the first layer of the epidermis [skin].

Between 10-40% of those having Psoriasis also has psoriatic arthritis which affects the joints like arthritis.

There is likely to be a genetic component, though psoriasis is not completely understood.

Types:

1.) Plaque
2.) Inverse
3.) Guttate
4.) Pustular
5.) Erythrodermic

Most common type is Plaque

- Commonly seen as red and white regions of scaly patches.
- Can be a silvery-white appearance
- Often found on elbows and knees
- Can also affect scalp, hands, fingers, legs, abdomen.

Classifications:

Nonpustular

Psoriasis Vulgaris

- Plaque-like psoriasis
- Affects 80-90% of those with psoriasis
- Raised areas of inflamed skin called plaques

Psoriatic erythroderma

- Widespread inflammation and exfoliation of skin
- Covers most of the body surface
- Severe itching
- Often swelling is associated
- Can be seen with abrupt stopping of systemic treatment
- This form of psoriasis can be fatal

Pustular

Pustular psoriasis

- Appears as raised bumps that are filled with pustules. [Not infections]
- Skin around pustules is red and often tender
- Often seen on hands and feet (palmoplantar pustulosis)
- Can be seen on any part of the body
- Types:
* Annular pustular psoriasis
* Acrodermatitis continua
* Generalized pustular psoriasis

Learn more here:

The research is taking place in Chicago at the Rush University Medical Center. Initial research was intriguing though additional studies are required before anything is certain.

Antibodies, found on the surface of ovarian cancer cells, were found in the blood of most of the women with ovarian cancer. These antibodies were also found with women who had previously known ovarian problems – but not necessarily cancer. Women with normal ovarian function and no ovarian cancer were found to not have this antibody.

Typical treatment of ovarian cancer is to removed the uterus completely.  This is usually done because the cancer is in an advanced stage. Single ovary removal along with the fallopian tubes can also be seen.  Following surgery chemotherapy is a possibility.  Radiation is rarely used as a treatment.

If the cancer is diagnosed early – the fiver year survival is very high.  If not, the survival rate is far lower.

In case you were wondering, this is a Spanish bullfighter – Julio Aparicio during a 2010 bullfight in Madrid.

What is the most dangerous activity that you’ve done?

Giving birth by Cesarean section or also called Cesarean section and C-section can be a difficult choice.  For many it becomes a life saving measure during an emergency while giving birth.  It is another valid option other than vaginal delivery.  The raise in number of C-sections is astounding.  Consider that in 1970 only 6 percent of all births were by C-section.  Back in 2005 that number had increased 5 times to over 30% of pregnancies.

C-section is a abdominal surgery then through the uterus to allow for the birth of a child. It is often considered riskier than vaginal birth but both procedures cause a risk for  mortality of both the baby and the mother.

The following are several reasons to have a C-section planned:

1.)  A previous C-section – although not must – having a previous C-section does not prohibit you from ever having a vaginal delivery again

2.)  Your baby is breech   [Bottom first]

3.)  Your baby is transverse  [sideways]

4.)  More than one baby – C-section may be an option

5.)  You develop a condition known as Placenta previa

6.)  Mother having HIV and a high viral load.    [HIV isn't passed through the placenta but can be transferred
during vaginal delivery

7.)  Complication to baby that otherwise would worsen with vaginal delivery

8.)  A very large baby

9.)  Others

Unplanned C-sections:

1.)  Difficulty during birth

2.)  Distress of baby during birth

3.)  Umbilical cord concerns

4.)  Placenta abruption  [placenta unattaches from uterine wall - loss of oxygen to baby]

5.)  Others
*** – remember that over 90% of preterm deliveries are done by C-section   http://www.marchofdimes.com/aboutus/22684_30185.asp

Let’s take a closer look at the data from the most recent study:

19 out of 50 states were studied

Florida (38.6%), New Jersey (38%) , and Texas (35.9%), had the highest rates.

Utah (22.4%), Wisconsin (25.1%), and Colorado (27.3%)  had the lowest rates.

Study was done by HealthGrades – this website allows a user to search and rate their physician.

From 2002 – 2009 C-section occurance raised from 27% to 34%

A separate study from the Centers for Disease Control put the number at 32% in 2007

What was your experiences with a C-section?

-  Please go to our comment section and let us know  – Elective vs. Medically Required

Take a look and in the comment section – give us your thoughts.

Check back later this week for a description.

We will also discuss prevention and treatment.

This is Cauliflower Ear

Is an Ear complication also called:  hematoma auris or traumatic auricular hematoma.

The external portion of the ear suffers an injury, blood clot or other cause for a collection of fluid to occur under the perichondrium.

The cartilage of the ear, separates from the perichondrium causing a fibrious tissues to develop.

This is pictured above – the thickening of the tissues is caused by the fibrious tissue.

The external ear resembles a cauliflower – and so it is named.

Hematoma is the accumulation of blood in a certain area.

Commonly seen:

1.)  Wrestlers

2.)  Fighters

3.)  Kick boxers or Martial Artists

4.)  Rugby players

Can be prevented or limited by Headgear – that protects the ears.

If untreated, can be painful and deformity and even hearing loss.

Treatment:

1.)  Antibiotics – when necessary.

2.)  Draining – when necessary

3.)  Tension or Compression dressing – placed around ears by a medical provider to limit the separation of the cartilage