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Magnetic resonance imaging (MRI) can be an important tool in the diagnosis of multiple sclerosis (MS). MRI can also be used to monitor the progression of the disease in people living with MS. How does it work? MRI uses very strong magnets, radio signals, and computer software to take 3-dimensional pictures of the inside of the body. Will I need contrast material? Maybe. Contrast material is a substance that temporarily changes the way imaging tools interact with the body. They are often used to visualize certain types of MS disease activity on the MRI. If your doctor thinks your scan requires this contrast material, you may get an injection before you get in the MRI machine. How long will it take? The time may vary based on the type of MRI. Be sure to discuss with your doctor in advance so he or she can provide you with exact timing. But don’t worry, you won’t have to stay still the whole time. The technician will let you know when they’re starting a new image.
Dacryocystorhinostomy (DCR) is a procedure performed for the treatment of tearing (epiphora) due to blockage of the nasolacrimal duct. Tears originate in the lacrimal gland, located at the upper outer margin of the eye. As tears cross the eye with each blink, they are directed into small openings in the eyelids called puncta. From this point, tears travel through a pathway known as the canalicular system into the lacrimal sac. The lacrimal sac is located between the eye and the nose, and funnels tears into the nasal cavity through the nasolacrimal duct (Figure 1). As this is quite a long path for tears to travel, there can be many causes of excessive tearing. Blockage of the nasolacrimal duct is one common cause, and can be treated by creating a direct opening from the lacrimal sac into the nasal cavity in a procedure known as DCR. The evaluation and management of tearing may involve both an ophthalmologist and an otolaryngologist.
Prompt treatment to break up the clot greatly reduces the risk of death. This can be done with blood thinners and drugs or procedures. Compression stockings and physical activity can help prevent clots from forming in the first place.
Alcohol not broken down by the liver goes to the rest of the body, including the brain. Alcohol can affect parts of the brain that control movement, speech, judgment, and memory. These effects lead to the familiar signs of drunkenness: difficulty walking, slurred speech, memory lapses, and impulsive behavior.
Neurosyphilis is an infection of the brain or spinal cord caused by the spirochete Treponema pallidum. It usually occurs in people who have had chronic, untreated syphilis, usually about 10 to 20 years after first infection and develops in about 25%–40% of persons who are not treated. The United States' Centers for Disease Control and Prevention (CDC) advises that neurosyphilis can occur at any stage of a syphilis infection.
St. John's wort (Hypericum perforatum) is an over-the-counter herbal supplement used for its antidepressant, anti-inflammatory, and wound-healing properties. Although it has been prescribed in Europe for mild to moderate depression, negative clinical trials and multiple reports of adverse drug interactions have raised concern about its use. St. John's wort induces various P450 isozymes (CYP 1A2, 2C19, 2C9, and 3A4) and P-glycoprotein systems. Drug interactions with the herbal product can lead to treatment failures with many medications, including hormonal contraceptives, antiretrovirals, immunosuppressive agents, narcotics, anticoagulants, and antifungals. There is also a risk for serotonin syndrome when St. John's wort is used in combination with other serotonergic antidepressants. The lack of strict regulation of herbal products that results in variable quality and content (unknown toxic ingredients or inactive ingredients) is also a concern.
Pediatric orthopedic surgeons at Columbia are using a new device with magnetic technology that avoids the need for multiple spine-lengthening surgeries to correct early-onset scoliosis, a severe curvature of the spine in young children. In April 2014, Michael Vitale, MD, the Ana Lucia Professor of Pediatric Orthopedic Surgery at CUMC and 1995 graduate of P&S, performed the first procedure in the New York area, using the device to treat a 5-year-old boy. When braces and casts cannot control scoliosis in young children, surgeons turn to growing rods, which help correct the curve while allowing the spine to grow. When spinal maturity is near, the rods are removed and a spinal fusion can be performed. But during years of treatment with growing rods, patients must undergo surgery every six months to lengthen the rods to keep up with the patients’ growth. A patient may undergo eight to 10 procedures, which are costly and result in lost time for parents at work and children at school. The new device—MAGEC (MAGnetic Expansion Control) rods—contains a mechanism inside the growing rods that allows surgeons to lengthen the rods with a handheld external magnet, without surgery.
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Surgery is an elective procedure done in people who have had extensive testing to decide if they are potential candidates. The following criteria are considered when determining if a person may be a good candidate for surgery. Person has failed adequate trials of two first-line seizure medicines (ones that are commonly effective in controlling the type of seizures the person is experiencing) and one combination of at least two drugs. A trial of a medication is considered adequate when it has been increased gradually to the maximum dosage that does not cause serious side effects. If the person has frequent seizures, any improvement will be obvious after a short time. If the seizures generally occur far apart, however, it may take months to determine whether a medication is helping. At some epilepsy centers, patients are offered additional conventional or experimental medications before surgery is considered. But research suggests that each time a trial of medication fails to control a person's seizures, it becomes less likely that a different medicine or combination will be successful. Since uncontrolled seizures present serious physical risks and social and psychological consequences, the trend these days is to proceed with surgery much sooner than in the past if it seems appropriate for that person.
With so many antibiotics available, it isn't possible to list all of them here. But common antibiotics that are generally considered safe during pregnancy include penicillins (such as amoxicillin and ampicillin), cephalosporins (such as cephalexin), and erythromycin.
High-Cervical Nerves (C1 – C4) Most severe of the spinal cord injury levels Paralysis in arms, hands, trunk and legs Patient may not be able to breathe on his or her own, cough, or control bowel or bladder movements. Ability to speak is sometimes impaired or reduced. When all four limbs are affected, this is called tetraplegia or quadriplegia. Requires complete assistance with activities of daily living, such as eating, dressing, bathing, and getting in or out of bed May be able to use powered wheelchairs with special controls to move around on their own Will not be able to drive a car on their own Requires 24-hour-a-day personal care