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Parkinson’s Disease: 
This slowly progressive, degenerative neurologic disorder. This disorder
is one of the most common crippling disorder in the US.  Deterioration
progresses for an average of 10 years, at which time secondary disorders
occurs such as pneumonia, aspiration or some other infection which can
lead to death.  Parkinson’s disease affects men more often than women.

Cause:  Uncertain.  Dopamine
deficiency prevents affected brain cells from performing their normal inhibitory
function within the central nervous system

Symptoms:

Insidious tremor that begins in the fingers (unilateral
pill roll tremor), increases during stress or anxiety and decreases with
purposeful movement and sleep

Muscle rigidity causing resistance to passive
muscle stretching, which may be uniform or jerky

Difficulty walking (gait lacks normal parallel
motion and may be retropulsive or propulsive)

High-pitched monotone voice

Drooling

Masklike facial expression with poor blink reflex
and wide-open eyes

Walks with body bent forward (loss of positive
control)

Slurred speech

Oculogyric crises (eyes are fixed upward, with
involuntary tonic movements)

Difficulty swallowing (dysphagia)

Treatment:

No cure at present

Treatment seeks to relieve symptoms and keep the
patient functional as long as possible.

Drug therapy

Physical therapy

Stereotactic neurosurgery

Patent: open, unobstructed

Ductus: fetal blood vessel which joins the aorta and
pulmonary artery

Arteriosus:  pertaining to artery

Patent Ductus Arteriosus:  (PDA)  This
abnormal opening between the pulmonary artery and the aorta allows left
to right shunting of blood from the aorta to the pulmonary artery. 
This results in recirculation of arterial blood through the lungs.

In the early stages, PDA may produce no clinical effects, but in time
it can precipitate pulmonary vascular disease, causing symptoms to appear
by age 40.  The patients with a small shunt or who undergo effective
surgical repair have a good chance of recovery.  But PDA may advance
to intractable CHF, which may be fatal.

Most prevalent in premature infants, PDA often accompanies rubella syndrome. 
It may be associated with other congenital defects, such as coarctation
of the aorta, ventricular septal defect, and pulmonary and aortic stenoses.

Cause:  Results from failure of the fetal ductus arteriosus
(a fetal blood vessel that connects the pulmonary artery to the descending
aorta) to close within days to weeks after birth.

Symptoms:

For infants, especially premature ones with a large PDA usually develop
respiratory distress with signs of CHF. 

Frequent respiratory infections

Slow motor development

Failure to thrive.

Most children with PDA have only cardiac symptoms.  Others may
exhibit signs of heart disease, such as physical underdevelopment and fatigability.

By age 40, adults with untreated PDA may develop fatigability and dyspnea
on exertion.  Cyanosis appears in the final stages of illness.

Murmur (called Gibson murmur)  This continuous murmur is best heard
at the base of the heart, at the second left intercostal space under the
left clavicle in most children with PDA.

May have bounding peripheral arterial pulses (Corrigan’s pulse), may
have widened pulse pressure.

Cardiomegaly

Tachycardia

Dilated ascending aorta

Treatment:

For infants with PDA that has no symptoms (asymptomatic) the patient
may not require immediate treatment.

Those with CHF require fluid restriction, diuretic, and digitalis to
minimize or control symptoms.  If theses measure does not control
CHF, the patient requires surgery to ligate the ductus.  The doctor
may delay surgical correction until age 1 if the patient has only mild
symptoms.

Before surgery, children with PDA require antibiotics to protect against
infective endocarditis.

Other forms of therapy include cardiac catheterization to deposit a
plug in the ductus to stop shunting, or administration of indomethacin
I.V. (a prostaglandin inhibitor that provides an alternative to surgery
in premature infants) to induce ductus spasm and closure.

Polycystic Kidney Disease: 
Characterized by multiple, bilateral, grape-like clusters of fluid filled
cysts that grossly enlarge the kidneys, compressing and eventually replacing
functioning renal tissue.  This disorder is inherited.  It appears
in two distinct forms.  The infantile form causes stillbirth or early
neonatal death.  Infants with this disease may survive for 2 years
and then develop fatal renal, congestive heart, or respiratory failure. 
Onset of the adult form is insidious but commonly becomes obvious between
ages 30 and 50.  Rarely, polycystic kidney disease doesn’t cause symptoms
during an individual’s life-time, and may only be found during autopsy. 
Renal deterioration in the adult form of this disorder is slower than in
the infantile form, but often leads to renal failure.

Cause:  The infantile form appears
to be inherited as an autosomal recessive trait.  The adult form appears
to be autosomal dominant trait.

Symptoms:

Infantile: 

Pronounced epicanthal folds (a vertical fold
of skin on either side of the nose)

Pointed nose

Small chin

Floppy, low set ears

Huge bilateral masses on the flanks. 

Enlarged kidney

Adult : 

Hypertension 

Polyuria 

Signs and symptoms of urinary tract infection 

Lumbar pain 

Widening girth, and swollen or tender abdomen 

Hematuria 

Life threatening retroperitoneal bleeding 

Proteinuria 

Colicky abdominal pain

Enlarged kidney

Diagnostic test:

Retrograde pyelography reveals enlarged kidneys,
with elongation of the pelvis, flattening of the calyces, and indentations
caused by cysts.

IVP: neonate shows poor excretion of contrast
medium

CT scan and ultrasound show kidney enlargement
and the presence of cysts

Urinalysis and creatinine clearance tests indicate
abnormalities.

Treatment:

Goal:  to preserve the renal parenchyma and
avoid infection.

No known cure.  Careful management of associated
urinary  tract infections and secondary hypertension may prolong life.

Antibiotic therapy 

Dialysis or kidney transplantation.

Prostatitis:  Inflammation
of the prostate gland.  This disorder may be acute or chronic. 
Acute prostatitis most often results from gram-negative bacteria and is
easy to  recognize and treat.  Chronic prostatitis, the most
common cause of recurrent Urinary Tract Infection in men, isn’t easily
recognizable.

Cause:  Primarily from infection
by Escherichia coli.  It also results from infection by Klebsiella,
Enterobacter, Proteus, Pseudomonas, Streptococcus, or Staphylococcus.

Symptoms:

Acute prostatitis:  Sudden fever, chills,
low back pain, myalgia, perineal fullness, arthralgia,  urinary urgency,
possibly painful urination, nocturia, cloudy urine.  Rectal palpation
of the prostate reveals marked tenderness, induration, swelling, firmness,
and warmth.

Chronic prostatitis:  may present no symptoms. 
Usually having the same symptoms as an acute prostatitis, but is less severe.

Other symptoms may include:  painful ejaculation,
hemospermia, persistent urethral discharge, and sexual dysfunction

Treatment:

Systemic antibiotic therapy

Chronic prostatitis usually requires a long term
course of treatment

Epididymitis:  Infection of
the epididymis.  The cordlike excretory duct of the testis, is one
of the most common infections of the male reproductive tract.  Usually,
the causative organisms spread from established UTI or prostatitis and
reach the epididymis through the lumen of the vas deferens.  Rarely,
epididymitis is secondary to a distant infection, such as pharyngitis or
tuberculosis, that spreads through the lymphatic system or, less commonly,
the bloodstream.  Epididymitis may spread to the testis itself.

Cause:  Usually results from
pyogenci organisms, such as staphylococci, Escherichia coli, and streptococci. 
Other causes include:  gonorrhea, syphilis, chlamydial infection,
trauma, prostatectomy, and chemical irritation resulting form extravasation
of urine through the vas deferens.

Symptoms:

Pain

Extreme tenderness

Swelling in the groin and scrotum

High fever

Malaise

Treatment:

Broad spectrum antibiotic

Analgesics

Ice bag may be applied to the area to reduce swelling
and relieve pain

Bedrest may be needed

In older patient undergoing open prostatectomy,
bilateral vasectomy may be necessary to prevent epididymitis as a postoperative
complication.  When epidymitis is refractory to antibiotic, epididymectomy
under local anesthesia is necessary.

Corticosteroids may be prescribed to help counteract
inflammation (but their use is controversial)

Prostatic Cancer:  Is the
second most common cancer in men over age 50.  Incidence is highest
among blacks and in men with blood type A, and lowest in Asians. 
It is important that all males over age 40 should undergo a rectal examination
as part of their annual physical examination.

Cause:  Unknown

Symptoms:

Usually signs and symptoms of prostatic cancer
appear in the advanced stages of the disease.

Difficulty urinating

Urine dribbling

Urine retention

Unexplained cystitis and hematuria

A hard nodule may appear on rectal examination
(this may be felt before symptoms develop.

Treatment:

Varies with each stage of the disease but generally
include:

Radiation

Prostatectomy

Orchiectomy (to decrease androgen production)

Hormone therapy

Acute pyelonephritis or kidney infection: 
One of the most common renal diseases.  Pyelonephritis most commonly
results from an ascending infection.  The most common infecting organism
is Escherichia coli.  Others are Proteus, Pseudomonas, Staphylococcus
aureus, and Streptococcus faecalis.  It primarily affects the interstitial
area and the renal pelvis and, less often, the renal tubules.  Risk
factors can include diagnostic and therapeutic use of instruments, as in
catheterization, cystoscopy, or urologic surgery.  Inability to empty
the bladder, urine stasis (stoppage), urinary obstruction from tumors,
strictures, or benign prostatic hypertrophy can also lead to pyelonephritis. 
Other risk factors includes; sexual activity in women (intercourse increases
the risk of bacterial contamination), pregnancy – approx. 5% of pregnant
women develop asymptomatic bacteriuria, if left untreated, about 40% 
develop pyelonephritis.  diabetes are also prone to develop pyelonephritis
(glycosuria may support bacterial growth in the urine) 

Symptoms: 

Urinary urgency

urinary frequency

Burning during urination

Dysuria (difficulty and or painful urination)

Nocturia (excessive urination at night)

Hematuria (blood in the urine) usually microscopic but possibly gross
(visible)

Possible cloudy urine

urine may have a foul smell – fishy odor

Fever of 102 degrees or higher

Chills, shaking chills

Flank pain

Anorexia

Fatigue

Treatment:

Antibiotic therapy for specific infecting organism.

If the infecting organism can’t be identified, treatment consist of
a broad – spectrum antibiotic.