Muscle Cramps

A muscle cramp is a sudden and involuntary contraction of one or more of the body muscles. Muscle cramps can cause excruciating pain. Excess exercise or physical labour, particularly in hot weather, may lead to muscle cramps.

Symptoms:

Most muscle cramps develop in the leg muscles, particularly the muscle of the calf. There is sudden and sharp pain in the muscle and the patient may be able to feel or see a hard lump of muscle tissue beneath the skin.

-          Sharp and sudden pain in the muscle involved.

-          May cause severe discomfort in the hands and feet.

-          Is associated with leg swelling, redness or skin changes.

-          Associated with muscle weakness.

Causes:

• Overuse of a muscle, dehydration, muscle strain or simply holing a position for a prolonged period of time may result in a muscle cramp.
•   Inadequate blood supply: Narrowing of the arteries that deliver blood to the legs, as in arteriosclerosis, can produce cramp like pain in the legs and feet while exercising.
•    Nerve compression: Compression of nerves in the spine can produce cramp like pain in the legs. The pain usually worsens the longer the patient walks.
•  Mineral Depletion: Deficiency of Potassium, sodium, calcium or magnesium in the diet can cause leg cramps.
•   Diuretics: Diuretics are water pills which are used in high blood pressure. They cause depletion of minerals like Sodium, Potassium, magnesium and calcium, causing cramps.

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-         Risk Factors:

Factors that may increase your risk of muscle cramps include.

-          Age: Older people lose muscle mass. The remaining muscle may get overstressed more easily. This may increase the risk of muscle cramps.

-          Dehydration: Dehydration causes frequent muscle cramps.

-          Pregnancy: Muscle cramps also are more common during pregnancy.

-          Medical Diseases: Certain medical diseases like diabetes, liver diseases and thyroid disease is associated with a higher risk of muscle cramps.

Treatment:

• Stretching exercises and drinking plenty of fluid, such as water, is helpful in treating simple muscle cramps.
•    Sufficient salt intake improves symptoms. Sodium loss causes cramps.
•  Vitamin E, calcium and vitamin D3, vitamin B complex, folic acid and iron helps in prevention and treatment of cramps.
•   Calcium channel blockers and Quinine tablets are effective in cases not controlled by conservative treatment.

Prevention:

-          Fruits, fruit juices and green leafy vegetables

-          Avoid dehydration. Drink plenty of fluids.

-          Stretch the muscles. Stretch before and after you use any muscle for an extended period. If you tend to have leg cramps at night, stretch before bedtime. Light exercise, such as riding a stationary bicycle for a few minutes before bedtime, also may help prevent cramps while you’re sleeping.

STRESS OBESITY

Stress and anger is a potent mix. Anger leads to weight gain and stress prevents weight loss. Many women struggling with weight loss actually don’t eat much, but are unable to slim down. There are various reasons for this kind of rigidity of weight, and most are part of our daily lives.

THE ROLE OF ANGER.

An average city dweller experiences more anger than other people. When we get angry, the body pumps a large quantity of the fighter hormone (cortisol), which rushes to all parts of the body to prepare itself for a “fight or defend” situation. This hormone stays in the body for a long time and changes a person’s metabolism from the ‘consumption pattern’ to the ‘storage pattern’ variety. So the same foods that could have been used up by the body are now stored, which increases a person’s bulk. This hormone is also responsible for weak muscles and pot-belly fat, which are typical indicators of stress-related obesity.

FOOD CRAVINGS

Anger and stress also cause hormones (neuro-peptides Y) to set off cravings for food that are high in fat, sugar and salt. People find dieting painful not because they eat less food, but because their minds and bodies cry out for junk food. A stress-obese body displays certain body traits. In men, the person develops weak or soft arms or leg muscles, fat around the belly, an emerging double chin and darkening or hyper pigmentation. In women, stress obesity shows us as excessive fat around the belly, skin changes such as acne or roughness, and as fat deposits on the back and waist. They may also develop excessive facial hair, and retain water, causing them to feel bloated all the time.

STOP WEIGHT GAIN

Stress obesity cannot simply be treated by going on a diet because there is a combination of several hormones resisting weight loss. It requires greater help in terms of professional treatment, which involves herbal medicines, stress management, specific exercises and regulation of diet patterns. However there are certain steps that can easily be taken at home to halt the march of stubborn weight gain.

WHAT YOU CAN DO

-          Drink two litres of water every day. Begin your day with two glasses of water on an empty stomach.

-          Have triphala in the night to increase alkaline levels in the gut.

-          Keep dinner as light as possible with minimum or no salt.

-          Take natural diuretics such as jasmine tea, barley water, nimbu paani etc.             

Fibromatosis

The term 'Fibromatosis' was intoduced for the first time by Arthur Purdy Stout.
Fibromatosis includes a broad group of related fibrous lesions . The term fibromatosis refers to a group of benign soft tissue tumors (fibromas), which have certain characteristics in common, including absence of cytologic and clinical malignant features, a histology consistent with proliferation of well-differentiated fibroblasts, an infiltrative growth pattern, and aggressive clinical behavior with frequent local recurrence.

Salient Features:

1. Macroscopically, cut surface is usually pale, whorled and fibrous with irregular margin.
2. Microscopically,  there is proliferation of palely eosinophilic fibroblasts and myofibroblasts.   
3. Infiltrative pattern
4. Presence of abundant collagen between the tumour cells.
5. Absence of cytological features of malignancy.
6. Cellularity and mitotic activity are extremely variable.
7. Other light microscopic features include:
    i.   thick-walled blood vessels sharply outlined from surrounding tissue.
    ii.  perivascular lymphocytic infiltrate at the advancing edge of the tumour.
    iii. rarely metaplastic ossification or cartilage formation.
8. Immunohistochemistry: Vimentin -Positive; Variably positivity for SMA, CD117 & desmin ; CD34 - Negative.  Staining correlates with the cellularity.
9. Aggressive clinical behaviour characterized  by repeated local recurrences. There is no evidence of metastasis.
10. Ultrastructural study confirms fibroblastic and myofibroblastic features. Presence of intracytoplasmic collagen formation has been described.

Fibromatosis is subdivided into two major groups: 

I  Superficial (fascial) fibromatoses: 

Features: 1. Slow growing tumour ; 2. Small size ;  3. Arise from fascia or aponeurosis ;   4. Less aggressive.

A. Palmar fibromatosis (Dupuytren's contracture)
B. Plantar fibromatosis (Ledderhose's disease)
C. Penile fibromatosis (Peyronie's diseasee)
D. Knucle pads

II  Deep (musculoaponeurotic) fibromatoses:

Features: 1. Rapidly growing tumour ;  2. Usually attain large size ;  3. Involve deeper structures (musculature of trunk and the extremities).

A. Extraabdominal fibromatosis (extraabdominal desmoid)
B. Abdominal fibromatosis (abdominal desmoid)
C. Intraabdominal fibromatosis (intraabdominal desmoid)
            1. Pelvic fibromatosis
            2. Mesenteric fibromatosis
            3. Gardner's syndrome (Familial adenomatous polyposis)

Desmoid tumor can be defined as a pseudoencapsulated infiltrative growth of well-differentiated collagenous fibroblasts and fibrocytes arising either in fascia or musculoaponeurotic structures.

The etiology of desmoid tumors is poorly defined. The most commonly implicated etiologic factors are trauma, hormonal disturbances, and genetic or hereditary factors.

Desmoid tumours of the anterior abdominal wall are much less common than extra-abdominal desmoids.

They may occur at any age but are most common in the third and fourth decades.

Although both sexes may be affected, abdominal desmoids predominate in females, particularly in females of childbearing age.

Extra-abdominal desmoids, which most commonly occur on the back, chest wall, head and neck, or lower extremity, have a male predominance.

Most patients complain of a painless mass of several months or years' duration.

The microscopic picture is variable and generally corresponds to the patient's age. The pattern usually found in the older child exhibits moderate cellular fibrous tissue with an intertwining fascicular pattern. Less cellular examples of the tumour are associated with larger amounts of collagen and are encountered in older subjects.

The primary consideration in surgical treatment of desmoid tumours should be the prevention of local recurrence.

In most instances, this can be achieved by wide local excision or muscle group resection.

Recurrence after surgery is well recognized and tumour recurrence as late as 5 and 10 years after initial surgery has been documented.

Desmoplastic fibroma of bone is considered the osseous counterpart of the soft tissue desmoid tumour.

Differential Diagnosis:

Gastrointestinal Stromal Tumour:

Gross features:

GIST: Soft and lobulated with hemorrhage, necrosis, or cystification.

Intra-abdominal fibromatosis: firm, tan and homogenous.

Micorscopic features:

GIST: Presence of spindle or epithelial cells with variable architecture, nuclear atypia and myxoid or hyalinized stroma. Necrosis and hemorrhage present in some cases.

Intra-abdominal fibromatosis: Composed of broad, sweeping fascicles of monotonous spindle cells. Bland nuclear features, and finely collagenous stroma. Necrosis, hemorrhage, and myxoid denegeration are not seen.

HIFU in Uterine Fibroids

Uterine fibroids or myomas are the most common tumours to affect women, and are present in up to 40% of women in the reproductive age group. Not all of these women are symptomatic, and they usually do not require any treatment for these fibroids. Occasionally, the fibroids can cause pain, heavy menstrual as well as inter-menstrual bleeding, and pressure effects such as frequency of urination due to the size of the fibroid. In a small number of cases, fibroids can be a cause of infertility.

Fibroids are traditionally known to grow very slowly throughout the reproductive life of a woman, and they exhibit a growth spurt during pregnancy. After menopause, a fibroid typically begins regressing in size, and at this stage, fibroids rarely need to be treated.

Attempts at symptomatic relief through medications have largely been unsuccessful, leaving the patient suffering from fibroids no option other than surgery.

The mainstay of treatment of symptomatic fibroids has been surgery, which could be either myomectomy (removal of the fibroid), or hysterectomy (removal of the uterus). Of these, only hysterectomy ensures that the patient will never suffer from fibroids again, but is a rather radical option for a benign tumour that only requires symptomatic relief. Also, a hysterectomy is followed by a lengthy recovery period before the patient returns to normal activities. Both hysterectomy as well as myomectomy can also be done laparoscopically (key-hole surgery), dramatically reducing the post- operative morbidity. However, even these are invasive techniques, and the risks and possible complications of surgery and anesthesia remain a constant threat.

The search for non-invasive techniques to provide the patient with relief from this otherwise non- threatening illness led to other minimally invasive options like Uterine Artery Embolisation, and Radio- Frequency Ablation which however had limited efficacy, and considerable adverse effects like excruciating post-treatment pain.

MRI guided HIFU or Magnetic Resonance Imaging- guided High Intensity Focused Ultrasound is an innovative mode for genuinely non-invasive treatment of fibroids. Under MRI guidance, sound waves are passed into the body and focused into the fibroid to heat and coagulate the tissues.

As fibroids are almost always benign, with a neglible percentage showing the presence of a sarcoma (malignancy),fibroids only require treatment for the alleviation of symptoms due to the fibroid.

This is a day-care surgery, where the patient reports to the clinic for the procedure, undergoes the procedure and is able to walk out and go home after the procedure. The patient is able to go back to her regular routine within the next 24 hours, and the symptomatic relief obtained with this procedure is comparable to that following a myomectomy in the long term

In this procedure, the MRI acquires high resolution 3-D images of the fibroid and surrounding structures. These images are used for accurate planning and mapping of the treatment. During treatment, the HIFU transducer focuses the ultrasound beam into the fibroid as per the planned areas (cells) and heats the tissue up to 65 degree Celsius, coagulating it. This is called sonication.

MRI guided HIFU ensures patient safety by having a number of safety mechanisms built into the system. All of these ensure that apart from the tissue being targeted, no other organ or tissue is affected by the treatment.

In a nutshell, MRI guided HIFU satisfies the need for a non-invasive procedure that is a safe, gentle, and convenient way to provide long-lasting relief from the symptoms caused by uterine fibroids

Watermelon - A feast for tongue and Health

Watermelon (Citrullus lanatus (Thunb), family Cucurbitaceae is a vine-like (scrambler and trailer) flowering plant originally from southern Africa. Its fruit, which is also called watermelon, is a special kind referred to by botanists as a pepo, a berry which has a thick rind (exocarp) and fleshy center (mesocarp and endocarp). Pepos are derived from an inferior ovary, and are characteristic of the Cucurbitaceae. The watermelon fruit, loosely considered a type of melon – although not in the genus Cucumis – has a smooth exterior rind (green, yellow and sometimes white) and a juicy, sweet interior flesh (usually pink, but sometimes orange, yellow, red and sometimes green if not ripe). It is also commonly used to make a variety of salads, most notably fruit salad.

Nutrition:

A watermelon contains about 6% sugar and 92% water by weight. As with many other fruits, it is a source of vitamin C.

The amino-acid citrulline is also extracted from watermelon 

Watermelon rinds, usually a light green or white color, are also edible and contain many hidden nutrients, but most people avoid eating them due to their unappealing flavor. They are sometimes used as a vegetable. In China, they are stir-fried, stewed or more often pickled. When stir-fried, the de-skinned and de-fruited rind is cooked with olive oil, garlic, chili peppers, scallions, sugar and rum. Pickled watermelon rind is also commonly consumed in the Southern US. Watermelon juice can be made into wine.

Watermelon is mildly diuretic and contains large amounts of beta carotene. Watermelon with red flesh is a significant source of lycopene.

Watermelon also helps in variety of medical conditions which are as under:

Kidney Disorders:Water Melon contains a lot of potassium, which is very helpful in cleaning orwashing off the toxic depositions in the kidneys. Moreover, it is helpful inreducing concentration of uric acid in the blood, thereby reducing the chancesof kidney damages and formation of renal calculi in it. Added to these, beinghigh in water content, it induces frequent urinating, which is again helpfulfor cleaning of kidneys. Also, the anti oxidants present in ensure good healthof kidneys for a long.

High Blood Pressure:A good amount of Potassium and magnesium, present in water melons, are verygood in bringing down the blood pressure. The carotenoids present in themprevent hardening of walls of arteries and veins, thereby helping reduce bloodpressure.

Prevent Heat Stroke:Water melon is effective in reducing your body temperature and blood pressure.Many people in the tropical regions eat the fruit daily in the afternoon during summers to protect themselves from heat stroke. In India, you will find thefruit being sold by vendors in almost every street during summers.

Diabetes:Diabetes patients, who are supposed to have low energy and low sugar diet,often complaint about starving since they don’t get to eat their staple diet totheir full, giving them a feeling of keeping half fed. Water Melons can be agood supplement for them. In spite of being sweet in taste, a thick wedge willgive you very few calories, since ninety nine percent of its total weight iscomposed of water and roughage. Moreover, the various vitamins and mineralssuch as potassium and magnesium help in proper functioning of insulin in thebody, thus lowering the blood sugar level. Arginine, another component found inwater melons, is very effective in enhancing impact of insulin on sugar.Diabetes patients can also have curries, steaks, salads made from water melon rinds which are even lower in sugar.

Heart Care:Lypocene, a carotenoid found in abundance in water melon, improves cardiacfunctions. Beta carotene, known for its remarkable anti oxidant and anti aging properties, also keeps you young at the heart and prevents age related cardiac problems. The roughage in water melon and its very low energy, with help from vitamin-C, Carotenoids and potassium (potassium cuts the risk of a heart attack), help reduce cholesterol and keep heart safe.

Macular Degeneration:Beta carotene, vitamin-C, Lutein and Zeaxanthin. They ensure protection of eyes from macular degeneration. These anti oxidants protect eyes from other age related ailments such as drying up of eyes and optical nerves, glaucoma etc.

Impotence: Arginine, present in water melon, is beneficial in curing erectile dysfunction.

Other Benefits:Lypocene is found to be effective in preventing cancer, prostrate growth andrepair damaged tissues. Water melon seeds are rich in good fats and proteins.Water melons also contain phytonutrients which have very good effect on the health and proper functioning of internal organs, eyes, secretion system etc.