Acetylcholine receptor antibody > Acquired platelet function defect | Medical Encyclopedia

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Medical Encyclopedia



1. Acetylcholine receptor antibody
2. Achalasia
3. Aches and pains during pregnancy
4. Achilles tendinitis
5. Achilles tendon repair
6. Achilles tendon rupture - aftercare
7. Achondrogenesis
8. Achondroplasia
9. Acid loading test (pH)
10. Acid mucopolysaccharides
11. Acid soldering flux poisoning
12. Acid-fast stain
13. Acidosis
14. ACL reconstruction
15. ACL reconstruction - discharge
16. Acne
17. Acne - self-care
18. Acoustic neuroma
19. Acoustic trauma
20. Acquired platelet function defect

Acetylcholine receptor antibody

Acetylcholine receptor antibody is a protein found in the blood of most people with myasthenia gravis. The antibody affects a chemical that sends signals from nerves to muscles and between nerves in the brain.
This article discusses the blood test for acetylcholine receptor antibody.

How the Test is Performed

A blood sample is needed. Most of the time, blood is drawn from a vein located on the inside of the elbow or the back of the hand.

How to Prepare for the Test

Most of the time you do not need to take special steps before this test.

How the Test will Feel

You may feel slight pain or a sting when the needle is inserted. You may also feel some throbbing at the site after the blood is drawn.

Why the Test is Performed

This test is used to help diagnose myasthenia gravis.

Normal Results

Normally, there is no acetylcholine receptor antibody (or less than 0.05 nmol/L) in the bloodstream.
Note: nmol = nanomole
Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.
The example above shows the common measurement for results for these tests. Some laboratories use different measurements or may test different specimens.

What Abnormal Results Mean

An abnormal result means acetylcholine receptor antibody has been detected in your blood. It confirms the diagnosis of myasthenia gravis in people who have symptoms. Nearly half of people with myasthenia gravis limited to their eye muscles (ocular myasthenia gravis) have this antibody in their blood.
However, the lack of this antibody does not rule out myasthenia gravis. About 1 in 5 people with myasthenia gravis do not have signs of this antibody in their blood.

References

Vincent A, Evoli A. Disorders of neuromuscular transmission. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine.
Meriggioli MN. Sanders DB. Disorders of neuromuscular transmission In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds.Bradley's Neurology in Clinical Practice.

Achalasia

Achalasia is a disorder of the esophagus, the tube that carries food from the mouth to the stomach. This condition affects the ability of the esophagus to move food into the stomach.

Causes

There is a muscular ring at the point where the esophagus and stomach meet, called the lower esophageal sphincter. Normally, this muscle relaxes when you swallow. In people with achalasia, it does not relax as well. In addition, the normal muscle activity of the esophagus (peristalsis) is reduced.
This problem is caused by damage to the nerves of the esophagus.
Other problems can cause similar symptoms, such as cancer of the esophagus or upper stomach, and a parasite infection that causes Chagas disease.
Achalasia is rare. It may occur at any age, but is most common in middle-aged or older adults. The problem may be inherited in some people.

Symptoms

• Backflow (regurgitation) of food
• Chest pain, which may increase after eating or may be felt in the back, neck, and arms
• Cough
• Difficulty swallowing liquids and solids
• Heartburn
• Unintentional weight loss

Exams and Tests

Physical exam may show signs of anemia or malnutrition.
Tests include:
• Esophageal manometry
• Esophagogastroduodenoscopy
• Upper GI x-ray

Treatment

The goal of treatment is to reduce the pressure at the lower esophageal sphincter. Therapy may involve:
• Injection with botulinum toxin (Botox). This may help relax the sphincter muscles. However, the benefit wears off within a few weeks or months.
• Medications, such as long-acting nitrates or calcium channel blockers. These drugs can be used to relax the lower esophagus sphincter.
• Surgery (called an esophagomyotomy). This procedure may be needed to decrease the pressure in the lower sphincter.
• Widening (dilation) of the esophagus at the location of the narrowing. This is done during esophagogastroduodenoscopy.
Your doctor can help you decide which treatment is best for you.

Outlook (Prognosis)

The outcomes of surgery and nonsurgical treatments are similar. Sometimes more than one treatment is necessary.

Possible Complications

Complications may include:
• Backflow (regurgitation) of acid or food from the stomach into the esophagus (reflux)
• Breathing food contents into the lungs (aspiration), which can cause pneumonia
• Tearing (perforation) of the esophagus

When to Contact a Medical Professional

Call your health care provider if:
• You have trouble swallowing or painful swallowing
• Your symptoms continue, even with treatment for achalasia

Prevention

Many of the causes of achalasia cannot be prevented. However, treatment may help to prevent complications.

Alternative Names

Esophageal achalasia

References

Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Shafer AI, eds.Cecil Medicine

Aches and pains during pregnancy

During pregnancy your body will go through a lot of changes as your baby grows and your hormones change. Along with the other common symptoms during pregnancy, you will often notice new aches and pains.

Headaches

Headaches are common during pregnancy. Before you take medicine, ask your health care provider if it is safe to take. Other than medicine, relaxation techniques may help.
Headaches can be a sign of preeclampsia (high blood pressure during pregnancy). If your headaches get worse, and they do not go away easily when you rest and take acetaminophen (Tylenol), especially toward the end of your pregnancy, tell your provider.

Pain in Your Lower Abdomen (Belly) or Groin

Most often, this happens between 18 and 24 weeks. When you feel stretching or pain, move slowly or change positions.
Mild aches and pains lasting for short periods of time are normal. But see your provider right away if you have constant, severe abdominal pain, possible contractions, or you have pain and are bleeding or have fever. These are symptoms that can indicate more severe problems, such as:
• Placental abruption (the placenta separates from the uterus)
• Preterm labor
• Gallbladder disease
• Appendicitis

Numbness and Tingling

As your uterus grows, it may press on the nerves in your legs. This may cause some numbness and tingling (feeling of pins and needles) in your legs and toes. This is normal and will go away after you give birth (it may take a few weeks to months).
You may also have numbness or tingling in your fingers and hands. You may notice it more often when you wake up in the morning. This also goes away after you give birth, though, again, not always right away.
If it is uncomfortable, you can wear a brace at night. Ask your provider where to get one.
Have your provider check any persistent numbness, tingling, or weakness in any extremity to ensure there is not a more serious problem.

Backache

Pregnancy strains your back and posture. To avoid or reduce backaches, you can:
• Stay physically fit, walk, and stretch regularly.
• Wear low-heeled shoes.
• Sleep on your side with a pillow between your legs.
• Sit in a chair with good back support.
• Avoid standing for too long.
• Bend your knees when picking things up. DO NOT bend at the waist.
• Avoid lifting heavy objects.
• Avoid gaining too much weight.
• Use heat or cold on the sore part of your back.
• Have someone massage or rub the sore part of your back. If you go to a professional massage therapist, let them know you are pregnant.
• Do back exercises that your provider suggests.

Leg Aches and Pains

The extra weight you carry when you are pregnant can make your legs and back hurt.
Your body will also make a hormone that loosens ligaments throughout your body to prepare you for childbirth. However, these looser ligaments are more easily injured, most often in your back, so be careful when you lift and exercise.
Leg cramps are common in the last months of pregnancy. Sometimes stretching your legs before bed will reduce the cramps. Your provider can show you how to safely stretch.
Watch for pain and swelling in one leg, but not the other. This can be a sign of a blood clot. Let your provider know if this happens.

References

Gregory KD, Niebyl JR, Johnson TRB. Preconception and prenatal care: part of the continuum. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds.Obstetrics: Normal and Problem Pregnancies

Achilles tendinitis

Achilles tendinitis occurs when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. This tendon is called the Achilles tendon. It allows you to push your foot down. You use your Achilles tendon when walking, running, and jumping.

Causes

There are two large muscles in the calf. These create the power needed to push off with the foot or go up on the toes. The large Achilles tendon connects these muscles to the heel.
Heel pain is most often due to overuse of the foot. Rarely, it is caused by an injury.
Tendinitis due to overuse is most common in younger people. It can occur in walkers, runners, or other athletes.
Achilles tendinitis may be more likely to occur if:
• There is a sudden increase in the amount or intensity of an activity.
• Your calf muscles are very tight (not stretched out).
• You run on hard surfaces, such as concrete.
• You run too often.
• You jump a lot (such as when playing basketball).
• You do not wear shoes that give your feet proper support.
• Your foot suddenly turns in or out.
Tendinitis from arthritis is more common in middle-aged and older adults. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling. Flat feet will put more tension on the tendon.

Symptoms

Symptoms include pain in the heel and along the length of the tendon when walking or running. The area may feel painful and stiff in the morning.
The tendon may be painful to touch or move. The area may be swollen and warm. You may have trouble standing up on one toe.

Exams and Tests

The health care professional will perform a physical exam. They will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes.
X-rays can help diagnose bone problems.
An MRI scan may be done if you are considering surgery or there is a chance that you have a tear in the Achilles tendon.

Treatment

The main treatments for Achilles tendinitis do not involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away.
Try putting ice on the Achilles tendon area for 15 to 20 minutes, two to three times per day. Remove the ice if the area gets numb.
Changes in activity may help manage the symptoms:
• Decrease or stop any activity that causes pain.
• Run or walk on smoother and softer surfaces.
• Switch to biking, swimming, or other activities that put less stress on the Achilles tendon.
Your health care provider or physical therapist can show you stretching exercises for the Achilles tendon.
You may also need to make changes in your footwear, such as:
• Using a brace, boot or cast to keep the heel and tendon still and allow the swelling to go down
• Placing heel lifts in the shoe under the heel
• Wearing shoes that are softer in the areas over and under the heel cushion
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, can help ease pain or swelling.
If these treatments do not improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. If there is a bone spur irritating the tendon, surgery can be used to remove the spur.
Extracorporeal shock wave therapy (ESWT) may be an alternative to surgery for people who have not responded to other treatments. This treatment uses low-dose sound waves.

Outlook (Prognosis)

In most cases, lifestyle changes help improve symptoms. Keep in mind that symptoms may return if you do not limit activities that cause pain, or if you do not maintain the strength and flexibility of the tendon.

Possible Complications

Achilles tendinitis may make you more likely to have an Achilles rupture. This condition most often causes a sharp pain that feels as if you have been hit in the back of the heel with a stick. Surgical repair is necessary. However, the surgery may be hard to do because the tendon is not normal.

When to Contact a Medical Professional

Call your health care provider if:
• You have pain in the heel around the Achilles tendon that is worse with activity.
• You have sharp pain and are unable to walk without extreme pain or weakness.

Prevention

Exercises to keep your calf muscles strong and flexible will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.

Alternative Names

Tendinitis of the heel

References

Gollwitzer H, Diehl P, von Korff A, Rahlfs VW, Gerdesmeyer L. Extracorporeal shock wave therapy for chronic painful heel syndrome: a prospective, double blind, randomized trial assessing the efficacy of a new electromagnetic shock wave device.J Foot Ankle Surghttp://www.ncbi.nlm.nih.gov/pubmed/17761319
Irwin TA. Tendon injuries of the foot and ankle. In: Miller MD, Thompson SR eds.DeLee and Drez's Orthopaedic Sports Medicine

Achilles tendon repair

Your Achilles tendon joins your calf muscle to your heel. You can tear your Achilles tendon if you land hard on your heel during sports, from a jump, or when stepping into a hole.
Surgery to repair the Achilles tendon is done if your Achilles tendon has been torn into 2 pieces.

Description

To fix your torn Achilles tendon, the surgeon will:
• Make a cut down the back of your heel
• Make several small cuts rather than one large cut
After that, the surgeon will:
Bring the ends of your tendon together
• Sew the ends together
• Stitch the wound closed

Why the Procedure is Performed

Before surgery is considered, you and your doctor will talk about ways to take care of your Achilles tendon rupture.
You may need this surgery if your Achilles tendon has been torn into 2 pieces.
You need your Achilles tendon to point your toes and push off your foot when walking. If your Achilles tendon is not fixed, you can have problems walking up stairs or raising up on your toes.

Risks

Risks from anesthesia and surgery are:
• Breathing problems
• Reactions to medicines
• Bleeding or infection
Possible problems from Achilles tendon repair are:
• Damage to nerves in the foot
• Foot swelling
• Problems with blood flow to the foot
• Wound healing problems, which may require a skin graft or other surgery
• Scaring of the Achilles tendon
• Blood clot or deep vein thrombosis
• Some loss of calf muscle strength
There is a small chance that your Achilles tendon could tear again. About 5 out of 100 people will have their Achilles tendon tear again.

Before the Procedure

Always tell your doctor or nurse:
• If you could be pregnant
• What medicines you are taking, including medicines, herbs, or supplements you bought without a prescription
• If you have been drinking a lot of alcohol
During the days before the surgery:
• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other medicines that make it hard for your blood to clot.
• Ask your doctor which medicines you should still take on the day of the surgery.
• If you smoke, try to stop. Ask your doctor or nurse for help quitting.
On the day of the surgery:
• You will probably be asked not to drink or eat anything for several hours before the surgery. Take the medicines your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive.

After the Procedure

Work with your health care providers to keep your pain in control. Your heel may be very sore.
You will be wearing a cast or splint for a period of time.
Many persons can be discharged the same day of the surgery. Some persons may require a short stay in the hospital.

Outlook (Prognosis)

You will be able to resume full activity in about 6 months. Expect full recovery to take about 9 months.

Alternative Names

Achilles tendon rupture-surgery; Percutaneous Achilles tendon rupture repair

References

Azar, FM. Traumatic disorders. In: Canale ST, Beaty JH, eds.Campbell's Operative Orthopaedics.
Irwin, T. Tendon injuries of the foot and ankle. In: Miller MD, Thompson SR, eds.DeLee and Drez's Orthopaedic Sports Medicine.

Achilles tendon rupture - aftercare

Heel cord tear; Calcaneal tendon rupture

What is an Achilles tendon rupture?

The Achilles tendon connects your calf muscles to your heel bone. Together, they help you push your heel off the ground and go up on your toes. You use these muscles and your Achilles tendon when you walk, run, and jump.
If your Achilles tendon stretches too far, it can tear or rupture. If this happens, you may:
• Hear a snapping, cracking, or popping sound and feel a sharp pain in the back of your leg or ankle
• Have trouble moving your foot to walk or go up stairs
• Have difficulty standing on your toes
• Have bruising or swelling in your leg or foot

About your injury

Most likely your injury occurred when you:
• Suddenly pushed your foot off the ground, to go from walking to running, or to running uphill for example
• Tripped and fell, or had another accident
• Played a sport like tennis or basketball, with a lot of stopping and starting
Most injuries can be diagnosed during a physical exam. You may need an MRI scan to see what type of Achilles tendon tear you have. An MRI is a type of imaging test.
• A partial tear means at least some of the tendon is still OK.
• A full tear means your tendon is torn completely and the two sides are not attached to each other.

What to expect

If you have a complete tear, you may need surgery to repair your tendon. Your doctor will discuss the pros and cons of surgery with you. Before surgery, you will wear a special boot that keeps you from moving your lower leg and foot.
For a partial tear:
• You may need surgery.
• Instead of surgery, you may need to wear a cast, leg brace, splint, or boot for about 6 weeks. During this time, your tendon grows back together.
If you have a cast, it will cover your foot and go to your knee. Your toes will be pointing downward. The cast will be changed every 2 to 3 weeks to help stretch your tendon.
If you have a leg brace, splint, or boot, it will keep you from moving your foot. This will prevent further injury. You can walk once your doctor says it is OK to.

Symptom relief

To relieve swelling:
• Put an ice pack on the area right after you injure it.
• Use pillows to raise your leg above the level of your heart when you sleep.
• Keep your foot elevated when you are sitting.
You can take ibuprofen (such as Advil or Motrin), naproxen (such as Aleve or Naprosyn), or acetaminophen (such as Tylenol) for pain.
• Do not give aspirin to children.
• If you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or bleeding, talk with your doctor before using these medicines.
• Do not take more than the amount recommended on the bottle.

Rehab and activity

At some point as you recover, your doctor will ask you to begin moving your heel. This may be as soon as 2 to 3 weeks or as long 6 weeks after your injury.
With the help of physical therapy, most people can return to normal activity in 4 to 6 months. In physical therapy, you will learn exercises to make your calf muscles stronger and your Achilles tendon more flexible.
When you stretch your calf muscles, do so slowly. Also, do not bounce or use too much force when you use your leg.
After you heal, you are at greater risk for injuring your Achilles tendon again. You will need to:
• Stay in good shape and stretch before any exercise
• Avoid high-heeled shoes
• Ask your doctor if it is OK for you to play tennis, racquetball, basketball, and other sports where you stop and start
• Do proper amount of warm up and stretching ahead of time

When to call the doctor

Call your doctor if you have any of these symptoms:
• Swelling or pain in your leg, ankle, or foot becomes worse
• Your leg or foot turns purple
• Fever
Also call your doctor if you have questions or concerns that cannot wait until your next visit.

References

Managing Your: Achilles Tendon Rupture. In: Ferri FF, ed.Ferri's Clinical Advisor 2015
Sokolove PE, Barnes DK. Extensor and Flexor Tendon Injuries in the Hand, Wrist, and Foot. In: Roberts JR, Hedges JR, eds.Clinical Procedures in Emergency Medicine

Achondrogenesis

Achondrogenesis is a rare type of growth hormone deficiency in which there is a defect in the development of bone and cartilage.

Causes

Achondrogenesis is inherited, which means it is passed down through families.
Some types are known to be recessive, meaning both parents carry the defective gene and the chance for a subsequent child to be affected is about 25%.

Symptoms

• Very short trunk, arms, legs, and neck
• Head appears large in relation to the trunk
• Small lower jaw
• Narrow chest

Exams and Tests

X-rays show bone problems associated with the condition.

Treatment

There is no current therapy. Talk to your doctor about care decisions.
Genetic counseling may be appropriate.

Outlook (Prognosis)

The outcome is generally very poor. Many infants with achondrogenesis are stillborn or die shortly after birth because of breathing problems related to the abnormally small chest.

Possible Complications

This condition is often fatal early in life.

When to Contact a Medical Professional

This condition is often diagnosed on the first examination of an infant.

References

Horton WA, Hecht JT. Disorders involving ion transporters. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics.

Achondroplasia

Achondroplasia is a disorder of bone growth that causes the most common type of dwarfism.

Causes

Achondroplasia is one of a group of disorders called chondrodystrophies or osteochondrodysplasias.
Achondroplasia may be inherited as an autosomal dominant trait, which means that if a child gets the defective gene from one parent, the child will have the disorder. If one parent has achondroplasia, the infant has a 50% chance of inheriting the disorder. If both parents have the condition, the infant's chances of being affected increase to 75%.
However, most cases appear as spontaneous mutations. This means that two parents without achondroplasia may give birth to a baby with the condition.

Symptoms

The typical appearance of achondroplastic dwarfism can be seen at birth. Symptoms may include:
• Abnormal hand appearance with persistent space between the long and ring fingers
• Bowed legs
• Decreased muscle tone
• Disproportionately large head-to-body size difference
• Prominent forehead (frontal bossing)
• Shortened arms and legs (especially the upper arm and thigh)
• Short stature (significantly below the average height for a person of the same age and sex)
• Spinal stenosis
• Spine curvatures called kyphosis and lordosis

Exams and Tests

During pregnancy, a prenatal ultrasound may show excessive amniotic fluid surrounding the unborn infant.
Examination of the infant after birth shows increased front-to-back head size. There may be signs of hydrocephalus ("water on the brain").
X-rays of the long bones can reveal achondroplasia in the newborn.

Treatment

There is no specific treatment for achondroplasia. Related abnormalities, including spinal stenosis and spinal cord compression, should be treated when they cause problems.

Outlook (Prognosis)

People with achondroplasia seldom reach 5 feet in height. Intelligence is in the normal range. Infants who receive the abnormal gene from both parents do not often live beyond a few months.

Possible Complications

• Clubbed feet
• Fluid buildup in the brain (hydrocephalus)

When to Contact a Medical Professional

If there is a family history of achondroplasia and you plan to have children, you may find it helpful to speak to your health care provider.

Prevention

Genetic counseling may be helpful for prospective parents when one or both have achondroplasia. However, because achondroplasia most often develops spontaneously, prevention is not always possible.

References

Horton WA, Hecht JT. Disorders involving transmembrane receptors. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics

Acid loading test (pH)

The acid loading test (pH) measures the ability of the kidneys to send acid to the urine when there is too much acid in the blood. This test involves both a blood test and urine test.

How the Test is Performed

Before the test, you will need to take a medicine called ammonium chloride for 3 days. Follow instructions exactly on how to take it to ensure an accurate result.
A urine and blood sample are then taken.

How to Prepare for the Test

Your provider will tell you to take ammonium chloride capsules by mouth for 3 days before the test.

How the Test will Feel

When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or slight bruising. These soon go away.

Why the Test is Performed

This test is done to see how well your kidneys control the body's acid-base balance.

Normal Results

Urine with a pH less than 5.3 is normal.
Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

The most common disorder associated with an abnormal result is renal tubular acidosis.

Risks

There are no risks with providing a urine sample.
The risks of having blood drawn include:
• Excessive bleeding
• Fainting or feeling lightheaded
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)
Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

References

McPherson RA, Ben-Ezra J. Basic examination of urine. In: McPherson RA, Pincus MR, eds.Henry's Clinical Diagnosis and Management by Laboratory Methods
Seifter JL. Acid-base disorders. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine

Acid mucopolysaccharides

Acid mucopolysaccharides is a test that measures the amount of mucopolysaccharides released into the urine over a 24-hour period.
Mucopolysaccharides are long chains of sugar molecules in the body. They are often found in mucus and in fluid around the joints.

How the Test is Performed

For this test, you must urinate into a special bag or container every time you use the bathroom for 24-hour period.
• On day 1, urinate over the toilet into the container or bag when you wake up in the morning. Close the container tightly. Keep it in the refrigerator or a cool place during the collection period.
• Urinate into the special container every time you use the bathroom for the next 24 hours.
• On day 2, urinate into the container in the morning again when you wake up.
• Label the container with your name, the date, the time of completion, and return it as instructed.
For an infant:
Thoroughly wash the area around the urethra (the hole where urine flows out). Open a urine collection bag (a plastic bag with an adhesive paper on one end).
• For males, place the entire penis in the bag and attach the adhesive to the skin.
• For females, place the bag over the two folds of skin on either side of the vagina (labia). Put a diaper on the baby (over the bag).
Check the infant often, and change the bag after the infant has urinated. Empty the urine from the bag into the container provided by your doctor.
Active babies can move the bag causing the urine to go into the diaper. You may need extra collection bags.
When finished, label the container and return it as you have been told.

How to Prepare for the Test

There is no special preparation needed.

How the Test will Feel

The test involves only normal urination, and there is no discomfort.

Why the Test is Performed

This test is done to diagnose a rare group of genetic disorders called mucopolysaccharidoses (MPS). These include, Hurler, Scheie, and Hurler/Scheie syndromes (MPS I), Hunter syndrome (MPS II), Sanfilippo syndrome (MPS III), Morquio syndrome (MPS IV), Maroteaux-Lamy syndrome (MPS VI), and Sly syndrome (MPS VII).
Most of the time, this test is only done in infants who have a family history of one of these disorders.

Normal Results

Normal levels vary with age and from lab to lab. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

Abnormally high levels could be consistent with a type of mucopolysaccharidosis. Further tests are needed to determine the specific type of mucopolysaccharidosis.

Alternative Names

AMP; Dermatan sulfate - urine; Urine heparan sulfate; Urine dermatan sulfate; Heparan sulfate - urine

Acid soldering flux poisoning

Acid soldering flux is a chemical used to clean and protect the area (joint) where two pieces of metal come together. Flux poisoning occurs when someone swallows this substance.
This is for information only and not for use in the treatment or management of an actual poison exposure. If you have an exposure, you should call your local emergency number (such as 911) or the National Poison Control Center at 1-800-222-1222.

Poisonous Ingredient

Hydrocarbons (including ammonium chloride, rosin, hydrochloric acid, and zinc chloride)

Where Found

Soldering flux
Note: This list may not include all sources of fluxes.

Symptoms

Eyes, ears, nose, and throat:
• Loss of vision
• Severe pain in the throat
• Severe pain or burning in the nose, eyes, ears, lips, or tongue
Kidneys and bladder:
• Decreased urine output
• Kidney failure
Gastrointestinal system:
• Blood in the stool
• Burns of the food pipe (esophagus)
• Severe abdominal pain
• Vomiting
• Vomiting blood
Heart and blood vessels:
• Collapse
• Irregular heart beat
• Low blood pressure that develops rapidly
Lungs and airways:
• Breathing difficulty (from breathing in chemical)
• Throat swelling (which may also cause breathing difficulty)
Skin:
• Burn
• Holes (necrosis) in the skin or tissues underneath
• Irritation

Home Care

Get medical help right away. Do NOT make a person throw up unless told to do so by poison control or a health care professional.
If the chemical is on the skin or in the eyes, flush with lots of water for at least 15 minutes.
If the chemical was swallowed, immediately give the person water or milk, unless instructed otherwise by a health care provider. Do NOT give water or milk if the person is having symptoms (such as vomiting, convulsions, or a decreased level of alertness) that make it hard to swallow.
If the person breathed in the poison, immediately move him or her to fresh air.

Before Calling Emergency

Determine the following information:
• Person's age, weight, and condition
• Name of the product (ingredients and strengths, if known)
• Time it was swallowed
• Amount swallowed

Poison Control

The National Poison Control Center (1-800-222-1222) can be called from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.
This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.
See: Poison control center - emergency number

What to Expect at the Emergency Room

The health care provider will measure and monitor your vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. You may receive:
• Breathing support, including tube through the mouth into the lungs, and breathing machine (ventilator)
• Bronchoscopy -- camera down the throat to see burns in the airways and lungs
• Chest x-ray
• EKG (heart tracing)
• Endoscopy -- camera down the throat to see burns in the esophagus and the stomach
• Fluids through the vein (by IV)
• Tube through the mouth into the stomach to wash out the stomach (gastric lavage)
• Surgical removal of burned skin (skin debridement)
• Washing of the skin (irrigation) -- perhaps every few hours for several days

Outlook (Prognosis)

How well you do depends on the amount of poison swallowed and how quickly treatment is received. The faster you get medical help, the better the chance for recovery.
Damage can continue to occur for several weeks after the poison was swallowed.

Alternative Names

Fluxes; Flux poisoning

References

Lee DC. Hydrocarbons. In: Marx JA, Hockberger RS, Walls RM, et al., eds.Rosen's Emergency Medicine: Concepts and Clinical Practice
Mirkin DB. Benzene and related aromatic hydrocarbons. In: Shannon MW, Borron SW, Burns MJ, eds.Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose
Wax PM, Yarema M. Corrosives. In: Shannon MW, Borron SW, Burns MJ, eds.Haddad and Winchester's Clinical Management of Poisoning and Drug Overdose

Acid-fast stain

The acid-fast stain is a laboratory test that determines if a sample of tissue, blood, or other body substance is infected with the bacteria that causes tuberculosis and other illnesses.

How the Test is Performed

Your health care provider will collect a sample of urine, stool, sputum, bone marrow, or tissue, depending on the location of the suspected infection.
The sample is then sent to a laboratory. There, some of the sample is placed on a glass slide, stained, and heated. The cells in the sample hold onto the dye. The slide is then washed with an acid solution and a different stain is applied.
Bacteria that hold onto the first dye are considered "acid-fast" because they resist the acid wash. This type of bacteria is associated with tuberculosis and other infections.

How to Prepare for the Test

Preparation depends on how the sample is collected. Your health care provider will tell you how to prepare.

How the Test will Feel

The amount of discomfort depends on how the sample is collected. Your health care provider will discuss this with you.

Why the Test is Performed

The test can tell if you are likely infected with the bacteria that causes tuberculosis and related infections.

Normal Results

A normal result means no acid-fast bacteria were found on the stained sample.
Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test result.

What Abnormal Results Mean

Abnormal results may be due to:
• Tuberculosis and related infections
• Nocardia infections

Risks

Risks depend on how the sample is collected. Ask your health provider to explain the risks and benefits of the medical procedure.

References

Fitzgerald DW, Sterling TR, Haas DW. Mycobacterium tuberculosis. In: Mandell GL, Bennett JE, Dolin R, eds.Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases.
Reynolds J. Differential staining of bacteria: acid fast stain. Curr Protoc Microbiol.


Acidosis

Acidosis is a condition in which there is too much acid in the body fluids. It is the opposite of alkalosis (a condition in which there is too much base in the body fluids).

Causes

The kidneys and lungs maintain the balance (proper pH level) of chemicals called acids and bases in the body. Acidosis occurs when acid builds up or when bicarbonate (a base) is lost. Acidosis is classified as either respiratory or metabolic acidosis.
Respiratory acidosis develops when there is too much carbon dioxide (an acid) in the body. This type of acidosis is usually caused when the body is unable to remove enough carbon dioxide through breathing. Other names for respiratory acidosis are hypercapnic acidosis and carbon dioxide acidosis. Causes of respiratory acidosis include:
• Chest deformities, such as kyphosis
• Chest injuries
• Chest muscle weakness
• Chronic lung disease
• Overuse of sedative drugs
Metabolic acidosis develops when too much acid is produced in the body. It can also occur when the kidneys cannot remove enough acid from the body. There are several types of metabolic acidosis:
• Diabetic acidosis (also called diabetic ketoacidosis and DKA) develops when substances called ketone bodies (which are acidic) build up during uncontrolled diabetes.
• Hyperchloremic acidosis is caused by the loss of too much sodium bicarbonate from the body, which can happen with severe diarrhea.
Lactic acidosis is a buildup of lactic acid. This can be caused by:
• Cancer
• Drinking too much alcohol
• Exercising vigorously for a very long time
• Liver failure
• Low blood sugar (hypoglycemia)
• Medications, such as salicylates
• MELAS (a very rare genetic mitochondrial disorder that affects energy production)
• Prolonged lack of oxygen from shock, heart failure, or severe anemia
• Seizures
Other causes of metabolic acidosis include:
• Kidney disease (distal renal tubular acidosis and proximal renal tubular acidosis)
• Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol
• Severe dehydration

Symptoms

Metabolic acidosis symptoms depend on the underlying disease or condition. Metabolic acidosis itself usually causes rapid breathing. Confusion or lethargy may also occur. Severe metabolic acidosis can lead to shock or death.
Respiratory acidosis symptoms can include confusion, fatigue, lethargy, shortness of breath, and sleepiness.

Exams and Tests

The doctor will perform a physical examination and ask about your symptoms.
Laboratory tests that may be ordered include:
• Arterial blood gas analysis
• Electrolytes test, such as a basic metabolic panel to confirm acidosis and show whether it is metabolic or respiratory acidosis.
Other tests may be needed to determine the cause of the acidosis.

Treatment

Treatment depends on the cause.

Outlook (Prognosis)

Acidosis can be dangerous if untreated. Many cases respond well to treatment.

Possible Complications

Complications depend on the specific type of acidosis.

When to Contact a Medical Professional

All the types of acidosis will cause symptoms that require treatment by your health care provider.

Prevention

Prevention depends on the cause of the acidosis. Many causes of metabolic acidosis can be prevented, including diabetic ketoacidosis and some causes of lactic acidosis. Normally, people with healthy kidneys and lungs do not have serious acidosis.

References

Seifter JL. Acid-base disorders. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine

ACL reconstruction

ACL reconstruction is surgery to rebuild the ligament in the center of your knee. The anterior cruciate ligament (ACL) keeps your shin bone (tibia) in place. A tear of this ligament can cause your knee to give way during physical activity.

Description

Most people have general anesthesia right before surgery. This means you will be asleep and pain-free. Other kinds of anesthesia may also be used for this surgery.
The tissue to replace your damaged ACL will come from your own body or from a donor. A donor is a person who has died and chose to give all or part of his or her body to help others.
• Tissue taken from your own body is called an autograft. The two most common places to take tissue from are the knee cap tendon or the hamstring tendon. Your hamstring is the muscle behind your knee.
• Tissue taken from a donor is called an allograft.
The procedure is usually performed with the help of knee arthroscopy. With arthroscopy, a tiny camera is inserted into the knee through a small surgical cut. The camera is connected to a video monitor in the operating room. Your surgeon will use the camera to check the ligaments and other tissues of your knee.
Your surgeon will make other small cuts around your knee and insert other medical instruments. Your surgeon will fix any other damage found, and then will replace your ACL by following these steps:
• The torn ligament will be removed with a shaver or other instruments.
• If your own tissue is being used to make your new ACL, your surgeon will make a larger cut. Then, the autograft will be removed through this cut.
• Your surgeon will make tunnels in your bone to bring the new tissue through. This new tissue will be in the same place as your old ACL.
• Your surgeon will attach the new ligament to the bone with screws or other devices to hold it in place. As it heals, the bone tunnels fill in. This hold the new ligament in place.
At the end of the surgery, your surgeon will close your cuts with sutures (stitches) and cover the area with a dressing. You may be able to view pictures after the procedure of what the doctor saw and what was done during the surgery.

Why the Procedure is Performed

If you don’t have your ACL reconstructed, your knee may continue to be unstable. This increases the chance you may have a meniscus tear. ACL reconstruction may be used for these knee problems:
• Knee that gives way or feels unstable during daily activities
• Knee pain
• Inability to continue playing sports or other activities
• When other ligaments are also injured
Before surgery, talk to your doctor about the time and effort you will need to recover. You will need to follow a rehabilitation program for 4 to 6 months. Your ability to return to full activity will depend on how well you follow the program.

Risks

The risks from any anesthesia are:
• Allergic reactions to medicines
• Breathing problems
The risks from any surgery are:
• Bleeding
• Infection
Other risks from this surgery are:
• Blood clot in the leg
• Failure of the ligament to heal
• Failure of the surgery to relieve symptoms
• Injury to a nearby blood vessel
• Pain in the knee
• Stiffness of the knee or lost range of motion
• Weakness of the knee

Before the Procedure

Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
During the 2 weeks before your surgery:
• You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you have diabetes, heart disease, or other medical conditions, your surgeon will ask you to see your doctor who treats you for these conditions.
• Tell your doctor if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
• If you smoke, try to stop. Ask your doctor for help. Smoking can slow down wound and bone healing.
• Always let your doctor know about any cold, flu, fever, herpes breakout, or other illnesses you may have before your surgery.
On the day of your surgery:
• You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take your drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

Most people can go home the day of your surgery. You may have to wear a knee brace for the first 1 to 4 weeks. You also may need crutches for 1 to 4 weeks. Most people are allowed to move their knee right after surgery. This can help prevent stiffness. You may need medicine for your pain.
Physical therapy can help many people regain motion and strength in their knee. Therapy can last 4 to 6 months.
How soon you return to work will depend on the kind of work you do. It can be from a few days to a few months. A full return to activities and sports will often take 4 to 6 months.

Outlook (Prognosis)

Most people will have a stable knee that does not give way after ACL reconstruction. Better surgical methods and rehabilitation have led to:
• Less pain and stiffness after surgery
• Fewer complications with the surgery itself
• Faster recovery time.

Alternative Names

Anterior cruciate ligament repair

References

Phillips BB, Mihalko MJ. Arthroscopy of the lower extremity. In: Canale ST, Beaty JH, eds.Campbell's Operative Orthopaedics
Honkamp NJ, Shen W, Okeke N, Ferretti M, Fu FH. Knee: Anterior cruciate ligament injuries in the adult. In: DeLee JC, Drez D Jr, Miller MD, eds.DeLee and Drez's Orthopaedic Sports Medicine
Amy E, Micheo W. Anterior cruciate ligament tear: Knee and lower leg. In: Frontera WR, Silver JK, Rizzo TD Jr, eds.Essentials of Physical Medicine and Rehabilitation

ACL reconstruction - discharge

You had surgery to reconstruct your anterior cruciate ligament (ACL). The surgeon drilled holes in the bones of your knee and placed a new ligament through these holes. The new ligament was then attached to the bone. You may also have had surgery to repair other tissue in your knee.

What to Expect at Home

You may need help taking care of yourself when you first go home. Plan for a spouse, friend, or neighbor to help you. It can take from a few days to a few months to ready to return to work. How soon you return to work will depend on the kind of work you do. It often takes 4 to 6 months to return to your full level of activity and take part in sports again after surgery.

Activity

Your health care provider will ask you to rest when you first go home. You will be told to:
• Keep your leg propped up on 1 or 2 pillows. Place the pillows under your foot or calf muscle. This helps keep swelling down. Do this 4 to 6 times a day for the first 2 or 3 days after surgery. DO NOT put the pillow behind your knee. Keep your knee straight.
• Be careful not to get the dressing on your knee wet.
• DO NOT use a heating pad.
You may need to wear special support stockings to help prevent blood clots from forming. Your provider will also give you exercises to keep the blood moving in your foot, ankle, and leg. These exercises will also lower your risk of blood clots.
You will need to use crutches when you go home. You may be able to begin putting your full weight on your repaired leg without crutches 2 to 3 weeks after surgery. If you had work on your knee in addition to ACL reconstruction, it may take 4 to 8 weeks to regain full use of your knee. Ask your surgeon how long you will need to be on crutches.
You may also need to wear a special knee brace. The brace will be set so that your knee can move only a certain amount in any direction. DO NOT change the settings on the brace yourself.
• Ask your provider or physical therapist about sleeping without the brace and removing it for showers.
• When the brace is off for any reason, be careful not to move your knee more than you can when you have the brace on.
You will need to learn how to go up and down stairs using crutches or with a knee brace on.
Physical therapy most often begins about 2 weeks after surgery. It may last 2 to 6 months. You will need to limit your activity and movement while your knee mends. Your physical therapist will give you an exercise program to help you build strength in your knee and avoid injury.
• Staying active and building strength in the muscles of your legs will help speed your recovery.
• Getting full range of motion in your leg soon after surgery is also important.

Wound Care

You will go home with a dressing and an ace bandage around your knee. DO NOT remove them until the provider says it is ok. Until then, keep the dressing and bandage clean and dry.
You can shower again after your dressing is removed.
• When you shower, wrap your leg in plastic to keep it from getting wet until your stitches or tape (Steri-Strips) have been removed. Make sure that your provider says this is OK.
• After that, you may get the incisions wet when you shower. Be sure to dry the area well.
If you need to change your dressing for any reason, put the ace bandage back on over the new dressing. Wrap the ace bandage loosely around your knee. Start from the calf and wrap it around your leg and knee. DO NOT wrap it too tightly. Keep wearing the ace bandage until your provider tells you it is ok to remove it.

Pain

Pain is normal after knee arthroscopy. It should ease up over time.
Your provider will give you a prescription for pain medicine. Get it filled when you go home so that you have it when you need it. Take your pain medicine when you start having pain so the pain doesn't get too bad.
You may have received a nerve block during surgery, so that your nerves do not feel pain. Make sure you take your pain medicine, even when the block is working. The block will wear off, and pain can return very quickly.
Ibuprofen (Advil, Motrin) or another medicine like it may also help. Ask your provider what other medicines are safe to take with your pain medicine.
DO NOT drive if you are taking narcotic pain medicine. This medicine may make you too sleepy to drive safely.

When to Call the Doctor

Call your health care provider if:
• Blood is soaking through your dressing, and the bleeding does not stop when you put pressure on the area.
• Pain does not go away after you take pain medicine.
• You have swelling or pain in your calf muscle.
• Your foot or toes look darker than normal or are cool to the touch.
• You have redness, pain, swelling, or yellowish discharge from your incisions.
• You have a temperature higher than 101 °F (38.3°C).

Alternate Names

Anterior cruciate ligament reconstruction - discharge; ACL reconstruction - discharge

References

Micheo W, Amy E,.Sepulveda F. Anterior cruciate ligament tear In: Frontera, WR, Silver JK, Rizzo TD, eds.Essentials of Physical Medicine and Rehabilitation.
Niska JA, Petrigliano FA, McAllister DR. Anterior cruciate ligament injuries (Including Revision). In: Miller MD, Thompson SR, eds.DeLee and Drez's Orthopaedic Sports Medicine.
Phillips BB, Mihalko MJ. Arthroscopy of the lower extremity. In: Canale ST, Beaty JH, eds.Campbell's Operative Orthopaedics

Acne

Acne is a skin condition that causes pimples or "zits." Whiteheads, blackheads, and red, inflamed patches of skin (such as cysts) may develop.

Causes

Acne occurs when tiny holes on the surface of the skin become clogged. These holes are called pores.
• Each pore opens to a follicle. A follicle contains a hair and an oil gland. The oil released by the gland helps remove old skin cells and keeps your skin soft.
• When glands produce too much oil, the pores can become blocked. Dirt, bacteria, and cells build up. The blockage is called a plug or comedone.
• If the top of the plug is white, it is called a whitehead.
• If the top of the plug is dark, it is called a blackhead.
• If the plug breaks open, swelling and red bumps occur.
• Acne that is deep in your skin can cause hard, painful cysts. This is called cystic acne.
Acne is most common in teenagers, but anyone can get acne, even babies. The problem tends to run in families.
Some things that may trigger acne include:
• Hormonal changes that make the skin oilier. These may be related to puberty, menstrual periods, pregnancy, birth control pills, or stress.
• Greasy or oily cosmetic and hair products
• Certain drugs (such as steroids, testosterone, estrogen, and phenytoin)
• Heavy sweating and humidity
Research does not show that chocolate, nuts, and greasy foods cause acne. However, diets high in refined sugars or dairy products may be related to acne in some people.

Symptoms

Acne commonly appears on the face and shoulders. It may also occur on the trunk, arms, legs, and buttocks. Skin changes include:
• Crusting of skin bumps
• Cysts
• Papules (small red bumps)
• Pustules
• Redness around the skin eruptions
• Scarring of the skin
• Whiteheads
• Blackheads

Exams and Tests

Your doctor can diagnose acne by looking at your skin. Testing is not needed in most cases.

Treatment

SELF-CARE
Steps you can take to help your acne:
• Clean your skin gently with a mild, nondrying soap (such as Dove, Neutrogena, Cetaphil, CeraVe, or Basics).
• Look for water-based or "noncomedogenic" formulas for cosmetics and skin creams. (Noncomedogenic products have been tested and proven not to clog pores and cause acne.)
• Remove all dirt or make-up. Wash once or twice a day, including after exercising.
• Avoid scrubbing or repeated skin washing.
• Shampoo your hair daily, especially if it is oily.
• Comb or pull your hair back to keep the hair out of your face.
What NOT to do:
• Try not to squeeze, scratch, pick, or rub the pimples. This can lead to skin infections and scarring.
• Avoid wearing tight headbands, baseball caps, and other hats.
• Avoid touching your face with your hands or fingers.
• Avoid greasy cosmetics or creams.
• Do not leave make-up on overnight.
If these steps do not clear up the blemishes, try over-the-counter acne medicines that you apply to your skin.
• These products may contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid.
• They work by killing bacteria, drying up skin oils, or causing the top layer of your skin to peel.
• They may cause redness or peeling of the skin.
A small amount of sun exposure may improve acne slightly, but tanning mostly hides the acne. Too much exposure to sunlight or ultraviolet rays is not recommended because it increases the risk for skin cancer.
MEDICINES FROM YOUR HEALTH CARE PROVIDER
If pimples are still a problem, a health care provider can prescribe stronger medications and discuss other options with you.
Antibiotics may help some people with acne:
• Oral antibiotics (taken by mouth) such as tetracycline, doxycycline, minocycline, erythromycin, trimethoprim, and amoxicillin
• Topical antibiotics (applied to the skin) such as clindamycin, erythromycin, or dapsone
Creams or gels applied to the skin may be prescribed:
• Retinoic acid cream or gel (tretinoin, Retin-A)
• Prescription formulas of benzoyl peroxide, sulfur, resorcinol, or salicylic acid
• Topical azelaic acid
For women whose acne is caused or made worse by hormones:
• A pill called spironolactone may help
• Birth control pills may help in some cases, though they may make acne worse in some women.
Minor procedures or treatments may also be helpful:
• A laser procedure called photodynamic therapy may be used.
• Your doctor may also suggest chemical skin peeling; removal of scars by dermabrasion; or removal, drainage, or injection of cysts with cortisone.
People who have cystic acne and scarring may try a medicine called isotretinoin (Accutane). You will be watched closely when taking this medicine because of its side effects.
Pregnant women should NOT take Accutane, because it causes severe birth defects.
• Women taking Accutane must use two forms of birth control before starting the drug and enroll in the iPledge program.
• Your doctor will follow you on this drug and you will have regular blood tests.

Outlook (Prognosis)

Most of the time, acne goes away after the teenage years, but it may last into middle age. The condition often responds well to treatment after 6 - 8 weeks, but may flare up from time to time.
Scarring may occur if severe acne is not treated. Some people become very depressed if acne is not treated.

When to Contact a Medical Professional

Call your doctor or a dermatologist if:
• Self-care steps and over-the-counter medicine do not help after several months
• Your acne is very bad (for example, you have a lot of redness around the pimples, or you have cysts).
• Your acne is getting worse.
• You develop scars as your acne clears up.
• Acne is causing emotional stress.
If your baby has acne, call the baby's health care provider if acne does not clear up on its own within 3 months.

Alternative Names

Acne vulgaris; Cystic acne; Pimples; Zits

References

Zaenglein AL, Thiboutot DM. Acne vulgaris. In: Bolognia JL, Jorizzo JL, Schaffer JV, et al, eds.Dermatology

Acne - self-care

Acne vulgaris - self-care; Cystic acne - self-care; Pimples - self-care; Zits - self-care

Description

Acne is a skin condition that causes pimples or "zits." Whiteheads, blackheads, and red, inflamed patches of skin (such as cysts) may develop, most often on the face or shoulders.
Acne occurs when tiny holes on the surface of the skin become clogged. These holes are called pores. The pores can become clogged by substances on the surface of the skin or when the skin itself produces "plugs." Acne is most common in teenagers. But anyone can get acne.
Acne breakouts can be triggered by:
• Hormonal changes
• Use of oily skin or hair care products
• Certain medicines
• Sweat
• Humidity

Daily skin care

To keep your pores from clogging and your skin from becoming too oily:
• Clean your skin gently with a mild, non-drying soap, such as Dove, Neutrogena, Cetaphil, or CeraVe.
• Remove all dirt or make-up. Wash once or twice a day, and also after exercising.
• Avoid scrubbing or repeated skin washing.
• Shampoo your hair daily, especially if it is oily.
• Comb or pull your hair back to keep the hair out of your face.
Acne medicines can cause skin drying or peeling. Use a moisturizer or skin cream that is water-based or "noncomedogenic."
A small amount of sun exposure may improve acne slightly. But tanning mostly hides it. Too much exposure to sun or in tanning booths increases the risk for skin cancer. Some acne medicines can make your skin more sensitive to the sun. Use sunscreen and hats if you are taking these medicines.
There is no evidence that you need to avoid chocolate, milk, or high-fat foods. However, avoid them if you find eating these foods seems to make your acne worse.
To further prevent acne:
• Do not squeeze, scratch, pick, or rub pimples. This can lead to skin infections and scarring.
• Avoid wearing tight headbands, baseball caps, and other hats.
• Avoid touching your face.
• Avoid greasy cosmetics or creams.
• Do not leave make-up on overnight.

Acne medicines

If daily skin care does not clear up blemishes, try over-the-counter acne medicines that you apply to your skin.
• These products may contain benzoyl peroxide, sulfur, resorcinol, or salicylic acid.
• They work by killing bacteria, drying up skin oils, or causing the top layer of your skin to peel.
• They may cause redness or peeling of the skin.

Treatments from your health care provider

If pimples are still a problem after you've tried over-the-counter medicines, your doctor may suggest:
• Antibiotics in the form of pills or creams that you put on your skin
• Prescription gels or creams that help clear up the pimples
• Hormone pills for women whose acne is made worse by hormonal changes
• Prescription medicine for severe acne
• A laser procedure called photodynamic therapy
• Chemical skin peeling

When to call the doctor

Call your doctor or a dermatologist if:
• Self-care steps and over-the-counter medicine do not help after several months
• Your acne is very bad (for example, you have a lot of redness around the pimples, or you have cysts)
• Your acne is getting worse
• You develop scars as your acne clears up
• Acne is causing emotional stress

References

Zaenglein AL, Thiboutot DM. Acne vulgaris. In: Bolognia JL, Jorizzo JL, Schaffer JV, et al, eds.Dermatology

Acoustic neuroma

An acoustic neuroma is a slow-growing tumor of the nerve that connects the ear to the brain. This nerve is called the vestibular cochlear nerve. It is behind the ear right under the brain.
An acoustic neuroma is not cancerous (benign). This means that it does not spread to other parts of the body. However, it can damage several important nerves as it grows.

Causes

Acoustic neuromas have been linked with the genetic disorder neurofibromatosis type 2 (NF2).
Acoustic neuromas are uncommon.

Symptoms

The symptoms vary based on the size and location of the tumor. Because the tumor grows so slowly, symptoms most often start after age 30.
Common symptoms include:
• Abnormal feeling of movement (vertigo)
• Hearing loss in the affected ear that makes it hard to hear conversations
• Ringing (tinnitus) in the affected ear
Less common symptoms include:
• Difficulty understanding speech
• Dizziness
• Headache
• Loss of balance
• Numbness in the face or one ear
• Pain in the face or one ear
• Weakness of the face

Exams and Tests

The health care provider may suspect an acoustic neuroma based on your medical history, an exam of your nervous system, or tests.
Often, the physical exam is normal when the tumor is diagnosed. Sometimes, the following signs may be present:
• Decreased feeling on one side of the face
• Drooping on one side of the face
• Unsteady walk
The most useful test to identify an acoustic neuroma is an MRI of the brain. Other tests to diagnose the tumor and tell it apart from other causes of dizziness or vertigo include:
• Hearing test (audiology)
• Test of equilibrium and balance (electronystagmography)
• Test of hearing and brainstem function (brainstem auditory evoked response)

Treatment

Treatment depends on the size and location of the tumor, your age, and your overall health. You and your health care provider must decide whether to watch the tumor (observation), use radiation to stop it from growing, or try to remove it.
Many acoustic neuromas are small and grow very slowly. Small tumors with few or no symptoms may be watched for changes, especially in older patients. Regular MRI scans will be done.
If they are not treated, some acoustic neuromas can damage the nerves involved in hearing and balance. They can also affect the nerves responsible for movement and feeling in the face. Very large tumors can lead to a buildup of fluid (hydrocephalus) in the brain, which can be life threatening.
Removing an acoustic neuroma is more commonly done for:
• Larger tumors
• Tumors that are causing symptoms
• Tumors that are growing quickly
• Tumors that are pressing on the brain
Surgery is done to remove the tumor and prevent other nerve damage. Any hearing that is left is often lost with surgery.
Stereotactic radiosurgery focuses high-powered x-rays on a small area. It is considered to be a form of radiation therapy, not a surgical procedure. It may be used:
• To slow down or stop the growth of tumors that are hard to remove with surgery
• To treat patients who are unable to have surgery, such as the elderly or people who are very sick
Removing an acoustic neuroma can damage nerves, which may cause loss of hearing or weakness in the face muscles. This damage is more likely to occur when the tumor is large.

Outlook (Prognosis)

An acoustic neuroma is not cancer. The tumor does not spread (metastasize) to other parts of the body. However, it may continue to grow and press on structures in the skull.
People with small, slow-growing tumors may not need treatment.
Once hearing loss occurs, it does not return after surgery or radiosurgery.

Possible Complications

• Brain surgery can completely remove the tumor in most cases.
• Most people with small tumors will have no permanent paralysis of the face after surgery. However, about two-thirds of people with large tumors will have some permanent weakness of the face after surgery.
• About one-half of patients with small tumors may still be able to hear in the affected ear after surgery.
• There may be delayed radiation effects after radiosurgery, including nerve damage, loss of hearing, and paralysis of the face.

When to Contact a Medical Professional

Call your health care provider if you have:
• Hearing loss that is new or getting worse
• Ringing in one ear
• Dizziness (vertigo)

Alternative Names

Vestibular schwannoma; Tumor - acoustic; Cerebellopontine angle tumor; Angle tumor

References

Baloh RW, Jen J. Hearing and equilibrium. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine
Brackmann DE, Arriaga MA. Neoplasms of the posterior fossa. In: Cummings CW, Flint PW, Haughey BH, et al, eds.Otolaryngology: Head & Neck Surgery
Battista RA. Gamma knife radiosurgery for vestibular schwannoma.Otolaryngol Clin North Am
Sweeney P, Yajnik S, Hartsell W, Bovis G, Venkatesan J. Stereotactic radiotherapy for vestibular schwannoma.Otolaryngol Clin North Am
Conley GS, Hirsch BE. Stereotactic radiation treatment of vestibular schwannoma: indications, limitations, and outcomes. Curr Opin Otolaryngol Head Neck Surg

Acoustic trauma

Acoustic trauma is injury to the hearing mechanisms in the inner ear. It is due to very loud noise.

Causes

Acoustic trauma is a common cause of sensory hearing loss. Damage to the hearing mechanisms within the inner ear may be caused by:
• Explosion near the ear
• Firing a gun near the ear
• Long-term exposure to loud noises (such as loud music or machinery)

Symptoms

• Partial hearing loss that most often involves exposure to high-pitched sounds. The hearing loss may slowly get worse.
• Noises, ringing in the ear (tinnitus)

Exams and Tests

The health care provider will most often suspect acoustic trauma if hearing loss occurs after noise exposure. Audiometry may determine how much hearing has been lost.

Treatment

The hearing loss may not be treatable. The goal of treatment is to protect the ear from further damage. Eardrum repair may be needed.
A hearing aid may help you communicate. You can also learn coping skills, such as lip reading.

Outlook (Prognosis)

Hearing loss may be permanent in the affected ear. Wearing ear protection when around sources of loud sounds may prevent the hearing loss from getting worse.

Possible Complications

Progressive hearing loss is the main complication of acoustic trauma.
Tinnitus (ear ringing) can also occur.

When to Contact a Medical Professional

Call your health care provider if:
• You have symptoms of acoustic trauma
• Hearing loss occurs or gets worse

Prevention

• Wear protective ear plugs or earmuffs to prevent hearing damage from loud equipment.
• Be aware of risks to your hearing from activities such as shooting guns, using chain saws, or driving motorcycles and snowmobiles.
• Do not listen to loud music for long periods of time.

Alternative Names

Injury - inner ear; Trauma - inner ear; Ear injury

References

Lonsbury-Martin BL, Martin GK. Noise-induced hearing loss. In: Cummings CW, Flint PW, Haughey BH, et al, eds.Otolaryngology: Head & Neck Surgery.
O’Handley JG, Tobin EJ, Shah AR. Otorhinolaryngology. In: Rakel RE, ed.Textbook of Family Medicine

Acquired platelet function defect

Acquired platelet function defects are conditions that prevent clotting elements in the blood called platelets from working as they should. The term "acquired" means these conditions are not present at birth.

Causes

With platelet disorders can affect the number of platelets, how well they function, or both. Any platelet disorder affects normal blood clotting.
Disorders that can cause problems in platelet function include:
• Chronic myelogenous leukemia
• Primary myelofibrosis
• Polycythemia vera
• Primary thrombocythemia
Other causes include:
• Kidney (renal) failure
• Multiple myeloma
• Medicines such as aspirin, ibuprofen and other anti-inflammatory drugs, penicillins, phenothiazines, and prednisone (after long-term use)

Symptoms

• Abnormal menstrual periods
o Heavy menstrual periods
o Prolonged menstrual bleeding (more than 5 days per menstrual period)
• Abnormal vaginal bleeding
• Bleeding in the urine
• Bleeding under the skin or in the muscles (soft tissues)
• Gastrointestinal bleeding
o Bloody, dark black, or tarry bowel movements
o Vomiting blood or material that looks like coffee grounds
• Nosebleeds
• Prolonged bleeding, easy bruising
• Skin rash
o Bruises
o Pinpoint red spots (petechiae)

Exams and Tests

• Bleeding time
• Platelet aggregation test
• Platelet count
• PT and PTT

Treatment

Treatment is aimed at the cause of the problem.
• Bone marrow disorders are treated with platelet transfusions or removing platelets from the blood (platelet pheresis). Chemotherapy is can used to treat an underlying condition that is causing the problem.
• Platelet function defects caused by kidney failure are treated with dialysis or a drug called desmopressin (ddAVP).
• Platelet problems caused by a certain medicine are treated by stopping the drug.

Outlook (Prognosis)

Most of the time, treating the cause of the problem corrects the defect.

Possible Complications

• Prolonged bleeding
• Severe anemia

When to Contact a Medical Professional

Call your health care provider if:
• You have bleeding and do not know the cause
• Your symptoms get worse
• Your symptoms do not improve after you are treated for an acquired platelet function defect

Prevention

Using medicines as directed can reduce the risk of drug-related acquired platelet function defects. Treating other disorders may also reduce the risk. Some cases cannot be prevented.

Alternative Names

Acquired qualitative platelet disorders; Acquired disorders of platelet function

References

Diz-Kucukkaya R, Lopez JA, Acquired disorders of platelet function. In: Hoffman R, Benz EJ Jr, Silberstein LE, Heslop HE, Weitz JI, eds.Hematology: Basic Principles and Practice
Ragni MV. Hemorrhagic Disorders: Coagulation Factor Deficiencies. In: Goldman L, Schafer AI, eds.Goldman's Cecil Medicine
Published for educational purposes from the website: MedlinePlus
Disclaimer: The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.