Auto news on Youtube Jan 30 2019

So open-angle glaucoma

Treatment well in this video I get to review the different eye drops for glaucoma and glaucoma surgery. So let's take a look

Hey guys welcome this is dr

Joe Allen here from doctor eye health bringing the best in education about the eyes vision and vision product

So if you new here consider subscribing

Also at any point throughout the video check out the show notes and links below for further information about everything that we go over

Also, keep in mind this video is part of a complete video series about glaucoma

So if you're new here, that's great

But don't miss out on all the other good videos about glaucoma and I'll hook you up with a link to that in the description

Below as well as in the YouTube card up above otherwise, let's go over open-angle glaucoma

Treatments now when it comes to glaucoma treatment, there are many different treatments out there

however

the same

concept across the board for all those treatments is the same we treat glaucoma by lowering the pressure of the eye and

We can do that with Medicated eyedrops. We can do that with laser surgeries

we can even do that with more intense surgeries in the operating room where we physically make an

Increased drainage canal or we can do implants to again increase the drainage of the eye or we can use a combination

of all those different strategies

So overall the treatment outlook for glaucoma is usually very good

now if you are diagnosed with open-angle glaucoma here in the United States and you're gonna be started on treatment you usually

Started on a medication called a prostaglandin

Analog these eyedrops come with a little kind of Bluegreen almost a teal colored cap

Now I don't have any affiliation with brands or anything. One of the more common ones is called Xalatan

The generic form is called latanoprost now. These drops are excellent

The reason they're prescribed usually first-line is because one they're pretty cheap

the generic form has been out since I think like the mid 90s and

Over all that are pretty cheap for people to take also they're incredibly effective

So just using this drop one time at night every day in both eyes will lower the pressure of the eyes

Anywhere from 25 to 33 percent

That's an excellent decrease in eye pressure. And so for again that the kind of the cost benefit of taking this medication and

a

Significant drop in eye pressure it makes this really the first line for first line treatment for glaucoma now

because this glaucoma medication is

Used so commonly there are some side-effects. I wanted to kind of mention

So if you're taking this medication already, you could notice that these drops make the eyes a little bit red or a hyperemic

That's what we call it in the in the clinic. But usually you're using this drop right before bedtime

So you're going to bed anyway, so it's not really that huge of a deal

Some people will notice their eyelashes grow a lot longer thicker and fuller

Actually a lot of our lady patients who are put on this medication

they don't really mind too much because it's basically like getting a prescription for Latisse the

Medication that can actually grow your eyelashes longer. In fact, they're the same classification of medication. They're both prostaglandin analogues

now

Beyond just that this medication is known for helping change the eye color

Now no one really prescribes this for this reason, but as a side effect people with lighter colored eyes

Like myself I have blue eyes

if I was to start taking this medication and I took it for a long time a couple eight years then the pigment of my

eye you could actually maybe notice it start to get darker and

Eventually, some people even can do that kind of light brown eyes from taking this medication

One of the more lesser common known side effects of a prostaglandin analog is it changes the fat deposition.

around the eyes

So usually we don't prescribe a prostaglandin analog in just one eye by themselves

but

Occasionally if somebody is using it in just one eye and not the other that one I could start to look like it's sunken back

Deeper inside the skull and that's this because the fat around the eye is just not kind of depositing

Normally as it would be in the eye that's not taking that medication

Now beyond just using a prostaglandin analog if your doctor feels that that medication either isn't right for you

Or maybe it's not being effective enough

Maybe you need your eye pressure lowered even more they'll consider adding another medication now

It's always up to your doctor which medication they choose for you

next and which one's the best for you based on your health and make a shion's you're taking but

Often times here in the United States probably the second most commonly prescribed

I drop for glaucoma. It fits into a classification called beta blockers

One of the most famous names is called timolol. There's a couple of different concentrations of timolol. There's either timolol eyedrops

There's tomorrow gel drops. They're a little bit thicker

Usually these drops come in a cat come in the bottle with a yellow cap

And these drops are usually prescribed at least once a day

I've seen a prescribed twice a day, but usually at least once a day and in the mornings

These medications do lower the eye pressure by about

25% and they do that by decreasing the formation of the fluid inside the eye

Prostaglandins actually help decrease the fluid by help actually getting the fluid to drain out of the eye better

So again prostoglandins help drain the fluid out of the eye and then Tim will or beta-blockers will help

Decrease the formation of fluid inside the eye and so if you actually push the doctor was to prescribe these both together

It's a very powerful effect. Now, of course with latanoprost, you know, we have to watch about some of those

Complications those contraindications or side effects with timolol the few side effects that can occur

Usually your doctor has to kind of screen to make sure you're not known of a history of asthma

Or a breathing issues like with COPD and there's other type of medications that could interact

So again, those are things your doctor will consider now beyond using either latanoprost again the teal green cap

Or you got timolol the beta blocker that comes with a yellow cap.

Then there's other medications one that comes in an orange cap is called a carbonic anhydrase

inhibitor or CA is and that's either gonna be called a brinzolamide or dorzolamide now these medications

They actually do lower the eye pressure by decreasing the formation of the fluid just like timolol

But on their own they only decrease the eye pressure just a little bit. So usually these ones are used in

combination with something like timolol

And that actually helps amplify the amount of decreased eye pressure by up to about 15 percent

Now again these medications if they're prescribed alone usually are three times a day

But oftentimes they prescribe just twice a day because using it in combination with the other eyedrops

beyond the carbonic anhydrase inhibitors

Then there's a medication that comes in a purple cap, and that one's called an alpha

Agonist and that one is called brimonidine

now bromonidine this alpha agonist not only decreases the formation of fluid inside the eye but it also increases the

Outflow of the fluid inside the eye. So this medication again works pretty well

Oftentimes it is used as an adjunct to either Latanoprost or perhaps timolol

But again, these are all actually the major

Classifications of the different medications the different eye drops for glaucoma now beyond just these drops that we've mentioned again

There are combo drops out there. These are medications that are kind of like having the shampoo and conditioner

Combos that you have in the shower, these medications are basically the mix of the other ones we mentioned

They work fantastic

but they're basically

just put together like that to make it more convenient rather than having like five or six bottles that you got a dump in your

Eye throughout the day. It just makes it more convenient

increases the adherence to the medication

Things like that. There is another medication that just came out maybe about a year ago. I think it finally got FDA approved in

2017 and that one's called Ropressa. That's the brand name

I have no association with that brand but that medication actually helps again drain the fluid out of the eye through the

Trabecular meshwork, that's one and again that ways that the fluid actually drains out of the eye

Being that this medication is newer. It is a bit more expensive

however

It is kind of making its run for its money because it actually has such a good effect at lowering the eye pressure

I think it's also pretty close to that of a prostaglandin analogue

Now again, it's just a newer medication. We want to kind of throw it out there

I don't think too many people are using it yet

But it could be on the rise as a future big name for glaucoma treatment now

I also want to mention that if you are taking any of these eye drops

it is very likely that a lot of people will start off taking these medications and it

because glaucoma has no symptoms people will start taking it and then they'll just stop taking their eye drops or it's easy for them to

Forget but it's really important that if you're taking these drops for any reason for glaucoma

You try not to forget don't stop doing it. Unless your doctor told you to stop taking them

Really, you know damage from glaucoma is permanent

There's no way for us to back the train up and get vision back from this damage

so really taking these eye drops is the only way for your eye doctor to control the pressure and

prevent or delay for their vision loss and if you're somebody who's taking any of these eye drops and you're having

Difficulty getting the drops in I did make another video on how to put eye drops in on your own and I'll hook that up

Here in the YouTube card up above as well as in the description below now beyond taking those medications

There are a couple other treatments and that involves different types of glaucoma

Surgery, the two major forms a surgery that we're gonna cover today is laser trabeculoplasty

And then we're gonna roughly review some of the different

Implants and the different kind of more invasive procedures that can be used for glaucoma now

The first one is laser trabeculoplasty

This actually it I actually really like laser trabeculoplasty

Because this is a way for us to pay much get rid of some of the eye drops if somebody doesn't want to take them

now laser trabeculoplasty

involves putting a special type of

Mirror contact lens on the eye while the patient sits behind a small

Laser device we have in the clinic and then the doctor will activate this laser and they'll actually burn in burn little drainage canals

Into the already existing drainage canal of the eye

So they basically widen the drainage canal to increase the outflow

Now this procedure isn't ideal for everybody with open-angle glaucoma

You basically do need

Some type of pigment in the drainage canal of your eye for this to work if you don't have any pigment

Then you are not an ideal candidate for this procedure

However, by having this done again

We can lower the eye pressure and some people can lower the pressure so much

That they maybe can stop taking all their other eye drops

They don't have to pay for those drops. They don't have to take them throughout the day

however, saying however

Then now that I said that there are sometimes people will get that procedure and then they still have to be on eyedrops

So it's not a panacea. It's not a cure-all

This method this sort of treatment. However is not always first-line

it can actually be done just about at any point throughout the treatment period

The only real big downsides again is that it's not available for everybody and it actually tends to wear off. So after about five years

Of having the benefits of having this procedure it can wear off and has to be repeated again

So this isn't a fantastic option and I do think it's great for some people

But you have to also there's a few other things you have to weigh out with your eye doctor

With the patient to make sure that hey they're a good candidate. Also. This procedure isn't always covered by insurance

And so sometimes this can cost quite a bit of money to have done

I've actually seen it anywhere from four to up to like seven thousand dollars to have this procedure completed here in the United States

so again

If it's something you're interested in if maybe you're having trouble taking medications talk to your doctors about this option of having a laser trabeculoplasty

now beyond just taking

Medications to lower the eye pressure or having the laser procedure to lower the pressure

If for some reason the pressure isn't low enough or the advanced or glaucoma continues to advance then your doctor will recommend more

intensive

More invasive surgeries. Now. These surgeries are always our last line of defense

They're not recommended right away because they are associated with more

complications

Classically we have the trabeculectomy or maybe an external tube shunt such as the ahmed valve these do lower the eye pressure

Considerably. However, they are associated with more complications

So now we're recommending what are called MiG's these are minimally invasive glaucoma surgeries

And these usually involve really tiny implants inside of the eye again to decrease that eye pressure

And what's great is that these can oftentimes be is so be combined with other surgeries such as cataract surgery

So it's kind of like getting a two-for-one. So these are excellent

They're less complication rates and they usually lower the considerable amounts. No if you're gonna have any of these surgeries

Do keep in mind that you are gonna be on several eye drops before the surgery. Probably even more eye drops after the surgery

And sometimes even after surgeries

People are still on I pressure lowering medications

You have to see your doctor several times a year just to keep that pressure low and verify that it's in a safe

Level and if for some reason these surgeries really just don't take well, it doesn't it doesn't go well for you

Sometimes they have to be repeated again

And yeah, that kind of stinks but we have to do whatever we can to preserve vision

All right

So I health question of the day which glaucoma treatments have you heard of which are some of your favorites?

Do you have any other questions, please? Go ahead and comment in the section below. Alright, everyone. Thanks so much for watching

Go ahead and like the video subscribe if you're new and share this video with any friends or family that you think it might help

Otherwise if you'd like to catch other cool videos from dr

Eye health just click or tap the screen up here to the side or click or tap the screen down here

Otherwise again, this is doctor Joe Allen hear from dr. Eye health bringing the best in education about the eyes vision and vision products

Keep an eye on it. We'll talk to you soon

Hey guys, so I got a couple of quick hey guys, so I had a pup. Okay. Hey guys, so I had

For more infomation >> Open Angle Glaucoma Treatment : Eye Drops for Glaucoma and Glaucoma Surgery - Duration: 14:43.

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Water treatment facility on westside - Duration: 2:15.

For more infomation >> Water treatment facility on westside - Duration: 2:15.

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US NEWS | Frostbite Symptoms, causes, photos and treatment - Duration: 3:07.

US NEWS | Frostbite Symptoms, causes, photos and treatment

Cold and wind chill

Frostbite is not only dependent on the outside temperature; its also affected by the wind chill factor. As the speed of the wind increases, our bodies cool at a faster rate, causing the skin temperature to drop. Higher altitudes can also affect the speed at which skin can freeze.

The National Weather Service has created a that shows the time it might take to develop frostbite at varying temperatures and wind speed. The index was tested on human face models.

For example, if it was zero degrees Fahrenheit and calm, your chance of frostbite is relatively low. Add wind at 15 miles per hour, and it would take only 30 minutes before frostbite sets in. If the wind rose over 50 mph, it would take a mere 10 minutes for frost to bite.

Your skin would freeze in a scant five minutes if you were out in minus 25 degree with a wind speed of just over 25 mph.

Who is at risk?

You are more susceptible to frostbite if you smoke, take medications called beta blockers, have , or have diabetes or a condition in which strong emotions or cold temperatures cause blood vessels to spasm and block blood flow to extremities.

Older people and the homeless without proper clothing, heating and food are also at high risk, as are hikers and hunters who arent properly clothed and stay outdoors too long. The US Centers for Disease Control and Prevention also warns that anyone who drinks excess alcohol or uses illicit drugs is at high risk; while you may feel like your body is warmer, your core temperature and blood pressure actually drop.

And of course you are more likely to get frostbite if you arent dressed properly for the weather. The CDC has a visual chart that shows the critical areas to keep covered in extreme cold.

The stages of frostbite

The first stage of frostbite is often called "frostnip" and begins with redness and a pins and needles feeling. Get out of the cold quickly at this time to avoid further damage to the skin.

A mild nip could be warmed up with your own body heat; try sticking those fingers into your armpit, for example. Rewarm those red toes with a soak in warm never hot water for up to 30 minutes. Since you wont be able to tell with those zapped toes, test the water with another part of the body to be sure its comfortable. Rewarm ears, nose and cheeks with warm cloths; re soak and reapply repeatedly.

Be prepared for a bit of pain as the frostbitten areas come back to life. Youll know when warming is complete when the skin is soft and all feeling has returned. But dont use stoves or warming pads, t. Those numb bits cant tell the temperature, and they could easily burn as they warm up.

Superficial frostbite is the second stage. Its known as second degree frostbite and begins when your skin begins to turn pale white or grayish yellow instead of red. It might even begin to appear blue. Crystals of ice are beginning to form in the skin, and it may become hard and numb to sensation. Some people say it feels "waxy."

Because the pain and redness are subsiding, unfortunately, people often dont realize what is happening to them. But soon, the skin might warm and begin to swell, which is a sign that damage to tissue is occurring. This is the time at which prompt medical treatment is needed to prevent further, more serious damage.

Immediate rewarming is key, but it should be done carefully by trained medical professionals, who will immediately wrap the injured area to protect it. At times, blisters filled with fluid can develop, and the skin can sting, burn and swell dramatically.

Deep frostbite is the next stage, in which the skin can appear blue and mottled, and numb to pain and cold. Blood filled blisters can form. Muscles next to the area might fail to work properly. At this point you are in danger of blood clots and will need anti clotting medications to increase blood flow to the area.

Medical attention is crucial at this stage to avoid amputation of the injured tissue. Depending on the severity of the injury, the tissue can look black and feel hard after its rewarmed. If the tissue has died, a process called gangrene, then the dead areas may have to be excised or amputated. At times, there can be long lasting damage to muscles, tendons, nerves and bones in the area as well.

If medical care isnt around

If medical care isnt immediately available, wrap the affected areas in sterile dressings, carefully separating injured fingers and toes from each other. But try to move the affected areas as little as possible to avoid further tissue damage.

If a frostbitten area is warmed and then refrozen, damage can be even more severe. According to the US National Library of Medicine, if refreezing is not guaranteed, it might be best to delay the initial warming process until a warm location can be found. Warm drinks are best for replacing lost body fluids.

Two more warnings from the CDC: Dont rub with snow or otherwise massage any frostbitten areas. Youll just make any tissue damage worse. The same applies to walking on frostbitten feet or toes, so avoid that unless absolutely necessary.

Be sure to check out our as well.

For more infomation >> US NEWS | Frostbite Symptoms, causes, photos and treatment - Duration: 3:07.

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HOT | Frostbite Symptoms, causes, photos and treatment - Duration: 0:59.

HOT | Frostbite Symptoms, causes, photos and treatment

Cold and wind chill

Frostbite is not only dependent on the outside temperature; its also affected by the wind chill factor. As the speed of the wind increases, our bodies cool at a faster rate, causing the skin temperature to drop. Higher altitudes can also affect the speed at which skin can freeze.

The National Weather Service has created a that shows the time it might take to develop frostbite at varying temperatures and wind speed. The index was tested on human face models.

For example, if it was zero degrees Fahrenheit and calm, your chance of frostbite is relatively low. Add wind at 15 miles per hour, and it would take only 30 minutes before frostbite sets in. If the wind rose over 50 mph, it would take a mere 10 minutes for frost to bite.

Your skin would freeze in a scant five minutes if you were out in minus 25 degree with a wind speed of just over 25 mph.

Who is at risk?

You are more susceptible to frostbite if you smoke, take medications called beta blockers, have , or have diabetes or a condition in which strong emotions or cold temperatures cause blood vessels to spasm and block blood flow to extremities.

Older people and the homeless without proper clothing, heating and food are also at high risk, as are hikers and hunters who arent properly clothed and stay outdoors too long. The US Centers for Disease Control and Prevention also warns that anyone who drinks excess alcohol or uses illicit drugs is at high risk; while you may feel like your body is warmer, your core temperature and blood pressure actually drop.

And of course you are more likely to get frostbite if you arent dressed properly for the weather. The CDC has a visual chart that shows the critical areas to keep covered in extreme cold.

The stages of frostbite

The first stage of frostbite is often called "frostnip" and begins with redness and a pins and needles feeling. Get out of the cold quickly at this time to avoid further damage to the skin.

A mild nip could be warmed up with your own body heat; try sticking those fingers into your armpit, for example. Rewarm those red toes with a soak in warm never hot water for up to 30 minutes. Since you wont be able to tell with those zapped toes, test the water with another part of the body to be sure its comfortable. Rewarm ears, nose and cheeks with warm cloths; re soak and reapply repeatedly.

Be prepared for a bit of pain as the frostbitten areas come back to life. Youll know when warming is complete when the skin is soft and all feeling has returned. But dont use stoves or warming pads, t. Those numb bits cant tell the temperature, and they could easily burn as they warm up.

Superficial frostbite is the second stage. Its known as second degree frostbite and begins when your skin begins to turn pale white or grayish yellow instead of red. It might even begin to appear blue. Crystals of ice are beginning to form in the skin, and it may become hard and numb to sensation. Some people say it feels "waxy."

Because the pain and redness are subsiding, unfortunately, people often dont realize what is happening to them. But soon, the skin might warm and begin to swell, which is a sign that damage to tissue is occurring. This is the time at which prompt medical treatment is needed to prevent further, more serious damage.

Immediate rewarming is key, but it should be done carefully by trained medical professionals, who will immediately wrap the injured area to protect it. At times, blisters filled with fluid can develop, and the skin can sting, burn and swell dramatically.

Deep frostbite is the next stage, in which the skin can appear blue and mottled, and numb to pain and cold. Blood filled blisters can form. Muscles next to the area might fail to work properly. At this point you are in danger of blood clots and will need anti clotting medications to increase blood flow to the area.

Medical attention is crucial at this stage to avoid amputation of the injured tissue. Depending on the severity of the injury, the tissue can look black and feel hard after its rewarmed. If the tissue has died, a process called gangrene, then the dead areas may have to be excised or amputated. At times, there can be long lasting damage to muscles, tendons, nerves and bones in the area as well.

If medical care isnt around

If medical care isnt immediately available, wrap the affected areas in sterile dressings, carefully separating injured fingers and toes from each other. But try to move the affected areas as little as possible to avoid further tissue damage.

If a frostbitten area is warmed and then refrozen, damage can be even more severe. According to the US National Library of Medicine, if refreezing is not guaranteed, it might be best to delay the initial warming process until a warm location can be found. Warm drinks are best for replacing lost body fluids.

Two more warnings from the CDC: Dont rub with snow or otherwise massage any frostbitten areas. Youll just make any tissue damage worse. The same applies to walking on frostbitten feet or toes, so avoid that unless absolutely necessary.

Be sure to check out our as well.

For more infomation >> HOT | Frostbite Symptoms, causes, photos and treatment - Duration: 0:59.

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Pediatric brain tumors - causes, symptoms, diagnosis, treatment, pathology - Duration: 11:50.

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Pediatric brain tumors are masses of abnormal cells that generally occur in children, and

result from the uncontrolled growth of those cells within the brain.

OK - let's start with some basic brain anatomy.

First off, there's the cerebral cortex which is the part of the brain that's supratentorial

or above the tentorium, and the cerebellum, which is infratentorial or below the tentorium.

And the brain has four interconnected cavities called ventricles, which are filled with cerebrospinal

fluid - a fluid that helps provide buoyancy and protection, as well as metabolic fuel

for the brain.

Highest up, are two C-shaped lateral ventricles that lie deep in each cerebral hemisphere.

The two lateral ventricles drain their cerebrospinal fluid into the third ventricle, which is a

narrow, funnel-shaped, cavity at the center of the brain.

The third ventricle makes a bit more cerebrospinal fluid and then sends all of it to the fourth

ventricle via the cerebral aqueduct.

The fourth ventricle is a tent-shaped cavity located between the brainstem and the cerebellum.

After the fourth ventricle, the cerebrospinal fluid enters the subarachnoid space, which

is the space between the arachnoid and pia mater, two of the inner linings of the meninges

which cover and protect both the brain and the spine.

So this makes it possible for cerebrospinal fluid to also flow through the central canal

of the spine.

Now, focusing in on cells within the brain - there are many different types with specialized

functions.

For example, neurons communicate neurologic information through neurotransmitter regulated

electrical impulses.

Then there are cells that secrete hormones into circulation and regulate the functions

of other cells throughout the body.

These cells are found in glands, like the supratentorial pineal gland which is located

just behind the third ventricle.

Or the infratentorial pituitary gland located near the front of the third ventricle.

There is also a category of cells called neuroglial cells that help support brain homeostasis,

and neuronal functions.

These include astrocytes which have cellular processes coming off their cell body, giving

them a star-shaped appearance.

Astrocytes are found throughout the brain and spinal cord, and their main roles include

maintaining the blood-brain barrier, providing nourishment to neurons, and recycling neurotransmitters.

Ependymal cells are also neuroglial cells, and they're cuboidal-to-columnar - so square

to rectangular shaped - ciliated cells that line the ventricles and central canal.

One of their main roles is to regulate the circulation of cerebrospinal fluid.

Some brain cells have a limited ability to be replaced, especially during injury, and

they do it by having undifferentiated stem cells - called embryonic stem cells - in the

brain activate and mature into a specialized cell.

Now, a tumor develops if there's a DNA mutation in any of these cell types that leads to uncontrolled

cell division.

Typically these are mutations in proto-oncogenes which results in a promotion of cell division,

or mutations in tumor suppressor genes which results in a loss of inhibition of cell division.

You can think of proto-oncogenes as the accelerator or gas pedal and tumor suppressor genes as

the brakes.

Too much acceleration or an inability to brake can lead to runaway cell division.

As a result, the mutated cells can start piling up on each other and can become a tumor mass.

Some of these tumors are benign and stay well contained or localized.

But some become malignant tumors or cancers, and these are the ones that break through

their basement membrane and invade nearby tissues.

Malignant tumor cells can get into nearby blood or lymph vessels, and travel from the

primary site to establish a secondary site of tumor growth somewhere else in the body

- and that's called metastasis.

Brain tumors can be categorized by their primary site location as either supratentorial, or

infratentorial tumors – though some tumors can form in either.

They are typically named by the cell type involved, so for example an astrocytoma is

a tumor formed by mutated astrocytes.

But their severity is classified, or graded by the World Health Organization's (WHO)

scale.

The scale goes from I to IV based on the morphologic and functional features of the tumor cells;

a grade IV tumor being the most abnormal looking cells that also tend to be the most aggressive.

But not all tumors have all four grades because some tumors are basically always more benign,

whereas others are more aggressive.

So let's start with tumor types that are generally infratentorial tumors, because they

make up the majority of pediatric brain tumors.

Overall, the most common malignant tumor is a medulloblastoma, which typically forms in

or around the cerebellum, adjacent to the fourth ventricle.

Medulloblastomas originate from embryonic stem cells and they tend to be extremely aggressive.

One relatively unique feature is that they metastasize through the cerebrospinal fluid

in a process called drop metastasis where the tumor spreads to the base of the spine.

Because of this, medulloblastomas are typically only classified as grade IV.

Histologically, medulloblastomas often have a feature called Homer-Wright rosettes, which

are dense tangles of neurons and neuroglial cells, surrounded by ring-like structures

formed by tumors cells.

Now, while medulloblastoma may be the most common malignant tumor, the most common primary

pediatric tumor is a type of astrocytoma called a juvenile pilocytic astrocytoma.

Because astrocytes are found through the brain and spinal cord, astrocytomas can form throughout

those locations, but juvenile pilocytic astrocytomas are mostly infratentorial tumors in the cerebellum

or near the brainstem.

And while astrocytomas can be graded I through IV, juvenile pilocytic astrocytomas are only

grade I because they are generally benign and slow-growing.

Histologically, they can have cysts, or sacs filled with fluid; bodies of granular material;

and Rosenthal fibers, which are fibers that clump together in the cytoplasm of the astrocyte

and look a bit like a worm or a corkscrew.

Among the fibers is the structural protein glial fibrillary acidic protein that is typically

found in astrocytes.

Finally, another common infratentorial tumor is an ependymoma.

Now, again, they can form in the brain and spinal cord because that's where ependymal

cells are found, but pediatric ependymomas tend to form in the fourth ventricle.

Now, there are a few types of ependymomas and they're WHO graded I through III.

In grade II, classic ependymomas, tumor cells have a regular, round to oval nucleus.

Histologically, a prominent feature are their perivascular pseudorosettes, which are ring-like

structures formed by tumors cells with rod-shaped ependymal processes, like cilia, surrounding

a centralized blood vessel.

Ok, so, now let's focus on supratentorial pediatric tumors.

The most common is a craniopharyngioma, which forms near the pituitary gland.

During development, some cells migrate down from the brain and form the posterior pituitary;

while some cells migrate up from the back of the throat, called the oropharynx, first

forming the Rathke's pouch and then eventually forming the anterior pituitary gland.

Now, remnants of Rathke's pouch that do not mature can form craniopharyngiomas.

They're typically only classified as WHO grade I tumors because they are typically

benign and slow growing.

Histologically, it's a pretty complex tumor with lots of prominent features including

multiple cysts filled with a thick "motor-oil"-looking fluid; and cells that stratify, or arrange

themselves in layers.

The innermost layer tends to have loosely packed cells that retain their nuclei despite

being filled with keratin, a strong protein, creating what's called a "wet keratin"

appearance.

A rare supratentorial pediatric tumor is a pinealoma, which forms in the region of the

pineal gland.

Pinealomas primarily emerge from the endocrine cells of the pineal gland, and they can be

grade I through IV.

Histologically, prominent features include large, round tumor cells resembling germline

tumors; or small cells forming Homer-Wright rosettes.

Now, the most common symptoms of brain tumors include headaches, nausea, vomiting, and seizures

- and they are a result of the compression and destruction of healthy brain tissue.

In addition, it's important to consider the cell type that's involved.

So, for example, a pinealoma may lead to increased secretion of the hormone beta human chorionic

gonadotropin that can cause an early onset of puberty.

In addition, as the tumor grows in size, it can compress nearby cells and structures,

interrupting their normal functions.

For example, as pinealomas, medulloblastomas, and ependymomas enlarge - the mass of the

tumor can compress nearby ventricles blocking the flow of cerebrospinal fluid which causes

swelling, called hydrocephalus.

Generally, the diagnosis of central nervous system tumors includes medical imaging, like

CT scans but more commonly MRIs.

But definitive diagnosis needs to be made based on the histologic and molecular characteristics

of a tissue biopsy.

Treatments depend on the tumor type, grade, and symptoms.

And can include surgical removal, radiotherapy, or chemotherapy - frequently in a combination.

But specific courses of treatment are guided by the molecular characteristics of the tumor

based on the biopsy.

Finally, the chance of recurrence gets higher in high grade tumors and in tumors that have

not been fully removed or destroyed.

Ok, quick recap: Pediatric brain tumors can be infratentorial and supratentorial and form

from a variety of cells.

Tumor types are classified using WHO grading based on histologic and functional features.

Diagnosis includes medical imagining, with a definitive diagnosis being made with a tissue

biopsy.

Treatments are largely dependent on the molecular characteristics and tumor grade, and can incorporate

surgical removal and some combination of radiotherapy

and chemotherapy.

For more infomation >> Pediatric brain tumors - causes, symptoms, diagnosis, treatment, pathology - Duration: 11:50.

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HOT | Frostbite Symptoms, causes, photos and treatment - Duration: 0:59.

HOT | Frostbite Symptoms, causes, photos and treatment

Cold and wind chill

Frostbite is not only dependent on the outside temperature; its also affected by the wind chill factor. As the speed of the wind increases, our bodies cool at a faster rate, causing the skin temperature to drop. Higher altitudes can also affect the speed at which skin can freeze.

The National Weather Service has created a that shows the time it might take to develop frostbite at varying temperatures and wind speed. The index was tested on human face models.

For example, if it was zero degrees Fahrenheit and calm, your chance of frostbite is relatively low. Add wind at 15 miles per hour, and it would take only 30 minutes before frostbite sets in. If the wind rose over 50 mph, it would take a mere 10 minutes for frost to bite.

Your skin would freeze in a scant five minutes if you were out in minus 25 degree with a wind speed of just over 25 mph.

Who is at risk?

You are more susceptible to frostbite if you smoke, take medications called beta blockers, have , or have diabetes or a condition in which strong emotions or cold temperatures cause blood vessels to spasm and block blood flow to extremities.

Older people and the homeless without proper clothing, heating and food are also at high risk, as are hikers and hunters who arent properly clothed and stay outdoors too long. The US Centers for Disease Control and Prevention also warns that anyone who drinks excess alcohol or uses illicit drugs is at high risk; while you may feel like your body is warmer, your core temperature and blood pressure actually drop.

And of course you are more likely to get frostbite if you arent dressed properly for the weather. The CDC has a visual chart that shows the critical areas to keep covered in extreme cold.

The stages of frostbite

The first stage of frostbite is often called "frostnip" and begins with redness and a pins and needles feeling. Get out of the cold quickly at this time to avoid further damage to the skin.

A mild nip could be warmed up with your own body heat; try sticking those fingers into your armpit, for example. Rewarm those red toes with a soak in warm never hot water for up to 30 minutes. Since you wont be able to tell with those zapped toes, test the water with another part of the body to be sure its comfortable. Rewarm ears, nose and cheeks with warm cloths; re soak and reapply repeatedly.

Be prepared for a bit of pain as the frostbitten areas come back to life. Youll know when warming is complete when the skin is soft and all feeling has returned. But dont use stoves or warming pads, t. Those numb bits cant tell the temperature, and they could easily burn as they warm up.

Superficial frostbite is the second stage. Its known as second degree frostbite and begins when your skin begins to turn pale white or grayish yellow instead of red. It might even begin to appear blue. Crystals of ice are beginning to form in the skin, and it may become hard and numb to sensation. Some people say it feels "waxy."

Because the pain and redness are subsiding, unfortunately, people often dont realize what is happening to them. But soon, the skin might warm and begin to swell, which is a sign that damage to tissue is occurring. This is the time at which prompt medical treatment is needed to prevent further, more serious damage.

Immediate rewarming is key, but it should be done carefully by trained medical professionals, who will immediately wrap the injured area to protect it. At times, blisters filled with fluid can develop, and the skin can sting, burn and swell dramatically.

Deep frostbite is the next stage, in which the skin can appear blue and mottled, and numb to pain and cold. Blood filled blisters can form. Muscles next to the area might fail to work properly. At this point you are in danger of blood clots and will need anti clotting medications to increase blood flow to the area.

Medical attention is crucial at this stage to avoid amputation of the injured tissue. Depending on the severity of the injury, the tissue can look black and feel hard after its rewarmed. If the tissue has died, a process called gangrene, then the dead areas may have to be excised or amputated. At times, there can be long lasting damage to muscles, tendons, nerves and bones in the area as well.

If medical care isnt around

If medical care isnt immediately available, wrap the affected areas in sterile dressings, carefully separating injured fingers and toes from each other. But try to move the affected areas as little as possible to avoid further tissue damage.

If a frostbitten area is warmed and then refrozen, damage can be even more severe. According to the US National Library of Medicine, if refreezing is not guaranteed, it might be best to delay the initial warming process until a warm location can be found. Warm drinks are best for replacing lost body fluids.

Two more warnings from the CDC: Dont rub with snow or otherwise massage any frostbitten areas. Youll just make any tissue damage worse. The same applies to walking on frostbitten feet or toes, so avoid that unless absolutely necessary.

Be sure to check out our as well.

For more infomation >> HOT | Frostbite Symptoms, causes, photos and treatment - Duration: 0:59.

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Frost Bite Prevention and Treatment - Duration: 9:58.

For more infomation >> Frost Bite Prevention and Treatment - Duration: 9:58.

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Local girl recalls her treatment for burns at Grossman Burn Center - Duration: 3:06.

For more infomation >> Local girl recalls her treatment for burns at Grossman Burn Center - Duration: 3:06.

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A Look At A Bipolar 2 Therapy Treatment Day - Duration: 3:19.

Hello everyone, so I am off to my bi-weekly therapy appointment right now.

And just as a reminder for everyone who doesn't know or I think pretty much most

of us do know at this point, therapy can be a pretty amazing way to tackle mental

health challenges. So, one thing that I wish was that therapy was a little more

accessible to people. Thanks to a plan I have at work I am able to afford going

to it and today I just want to give you a little bit of an idea of what kind of

thing happens with therapy. So today I'm gonna be going to therapy for a

50-minute session and some of the things that I've been working on are self

validation exercises right now. So something around body positivity for

sure and then other parts of my identity that I am just working on. Not accepting

because I accept them but understanding that I am the one who controls the

messaging around my identity. So that's some of the work that I'm looking to put

in today.

Yeah. Therapy. Therapy. Therapy. That's what I'm

gonna do today.

So just a bit of background on me I am bipolar 2 which

basically means that I experience some pretty intense highs and some pretty

intense lows. That's what my therapy sessions have been working to help me

identify and find the solutions. I was actually pretty relieved to find

out that bipolar 2 is what it was. I have often struggled with anxiety but it was

really nice to get a more formal diagnosis to know exactly why I do

experience these things. That's another big bonus of what my therapy has

delivered for me and now I'm about to walk in there and work through some of

the stuff for this week.

So I'm done my therapy session and it was another really good session. Actually

it was so good that we started talking about a plan for wrapping up my therapy

sessions. What I'm supposed to do is work on some of the things I think are

going to be hardest for me to do and places where I may relapse the most in

terms of the behaviors I exhibit in either a depressive state or in an

elevated state and then figure out how I would work through doing those things

going forward. This was a pretty awesome therapy session. I'm pretty glad

I had the opportunity. I wasn't expecting today to go this way but that's not a

bad thing. This is actually really nice to get some reaffirmation that what I've

been doing has been working and that there is a plan forward. As my therapist

said at this statement it is a model that is designed for me to fire her at

the end of it all. So yeah we had some great talks today.

For more infomation >> A Look At A Bipolar 2 Therapy Treatment Day - Duration: 3:19.

-------------------------------------------

HOT | Frostbite Symptoms, causes, photos and treatment - Duration: 0:59.

HOT | Frostbite Symptoms, causes, photos and treatment

Cold and wind chill

Frostbite is not only dependent on the outside temperature; its also affected by the wind chill factor. As the speed of the wind increases, our bodies cool at a faster rate, causing the skin temperature to drop. Higher altitudes can also affect the speed at which skin can freeze.

The National Weather Service has created a that shows the time it might take to develop frostbite at varying temperatures and wind speed. The index was tested on human face models.

For example, if it was zero degrees Fahrenheit and calm, your chance of frostbite is relatively low. Add wind at 15 miles per hour, and it would take only 30 minutes before frostbite sets in. If the wind rose over 50 mph, it would take a mere 10 minutes for frost to bite.

Your skin would freeze in a scant five minutes if you were out in minus 25 degree with a wind speed of just over 25 mph.

Who is at risk?

You are more susceptible to frostbite if you smoke, take medications called beta blockers, have , or have diabetes or a condition in which strong emotions or cold temperatures cause blood vessels to spasm and block blood flow to extremities.

Older people and the homeless without proper clothing, heating and food are also at high risk, as are hikers and hunters who arent properly clothed and stay outdoors too long. The US Centers for Disease Control and Prevention also warns that anyone who drinks excess alcohol or uses illicit drugs is at high risk; while you may feel like your body is warmer, your core temperature and blood pressure actually drop.

And of course you are more likely to get frostbite if you arent dressed properly for the weather. The CDC has a visual chart that shows the critical areas to keep covered in extreme cold.

The stages of frostbite

The first stage of frostbite is often called "frostnip" and begins with redness and a pins and needles feeling. Get out of the cold quickly at this time to avoid further damage to the skin.

A mild nip could be warmed up with your own body heat; try sticking those fingers into your armpit, for example. Rewarm those red toes with a soak in warm never hot water for up to 30 minutes. Since you wont be able to tell with those zapped toes, test the water with another part of the body to be sure its comfortable. Rewarm ears, nose and cheeks with warm cloths; re soak and reapply repeatedly.

Be prepared for a bit of pain as the frostbitten areas come back to life. Youll know when warming is complete when the skin is soft and all feeling has returned. But dont use stoves or warming pads, t. Those numb bits cant tell the temperature, and they could easily burn as they warm up.

Superficial frostbite is the second stage. Its known as second degree frostbite and begins when your skin begins to turn pale white or grayish yellow instead of red. It might even begin to appear blue. Crystals of ice are beginning to form in the skin, and it may become hard and numb to sensation. Some people say it feels "waxy."

Because the pain and redness are subsiding, unfortunately, people often dont realize what is happening to them. But soon, the skin might warm and begin to swell, which is a sign that damage to tissue is occurring. This is the time at which prompt medical treatment is needed to prevent further, more serious damage.

Immediate rewarming is key, but it should be done carefully by trained medical professionals, who will immediately wrap the injured area to protect it. At times, blisters filled with fluid can develop, and the skin can sting, burn and swell dramatically.

Deep frostbite is the next stage, in which the skin can appear blue and mottled, and numb to pain and cold. Blood filled blisters can form. Muscles next to the area might fail to work properly. At this point you are in danger of blood clots and will need anti clotting medications to increase blood flow to the area.

Medical attention is crucial at this stage to avoid amputation of the injured tissue. Depending on the severity of the injury, the tissue can look black and feel hard after its rewarmed. If the tissue has died, a process called gangrene, then the dead areas may have to be excised or amputated. At times, there can be long lasting damage to muscles, tendons, nerves and bones in the area as well.

If medical care isnt around

If medical care isnt immediately available, wrap the affected areas in sterile dressings, carefully separating injured fingers and toes from each other. But try to move the affected areas as little as possible to avoid further tissue damage.

If a frostbitten area is warmed and then refrozen, damage can be even more severe. According to the US National Library of Medicine, if refreezing is not guaranteed, it might be best to delay the initial warming process until a warm location can be found. Warm drinks are best for replacing lost body fluids.

Two more warnings from the CDC: Dont rub with snow or otherwise massage any frostbitten areas. Youll just make any tissue damage worse. The same applies to walking on frostbitten feet or toes, so avoid that unless absolutely necessary.

Be sure to check out our as well.

For more infomation >> HOT | Frostbite Symptoms, causes, photos and treatment - Duration: 0:59.

-------------------------------------------

Frostbite Symptoms, causes, photos and treatment - Duration: 3:07.

Frostbite Symptoms, causes, photos and treatment

Cold and wind chill

Frostbite is not only dependent on the outside temperature; its also affected by the wind chill factor. As the speed of the wind increases, our bodies cool at a faster rate, causing the skin temperature to drop. Higher altitudes can also affect the speed at which skin can freeze.

The National Weather Service has created a that shows the time it might take to develop frostbite at varying temperatures and wind speed. The index was tested on human face models.

For example, if it was zero degrees Fahrenheit and calm, your chance of frostbite is relatively low. Add wind at 15 miles per hour, and it would take only 30 minutes before frostbite sets in. If the wind rose over 50 mph, it would take a mere 10 minutes for frost to bite.

Your skin would freeze in a scant five minutes if you were out in minus 25 degree with a wind speed of just over 25 mph.

Who is at risk?

You are more susceptible to frostbite if you smoke, take medications called beta blockers, have , or have diabetes or a condition in which strong emotions or cold temperatures cause blood vessels to spasm and block blood flow to extremities.

Older people and the homeless without proper clothing, heating and food are also at high risk, as are hikers and hunters who arent properly clothed and stay outdoors too long. The US Centers for Disease Control and Prevention also warns that anyone who drinks excess alcohol or uses illicit drugs is at high risk; while you may feel like your body is warmer, your core temperature and blood pressure actually drop.

And of course you are more likely to get frostbite if you arent dressed properly for the weather. The CDC has a visual chart that shows the critical areas to keep covered in extreme cold.

The stages of frostbite

The first stage of frostbite is often called "frostnip" and begins with redness and a pins and needles feeling. Get out of the cold quickly at this time to avoid further damage to the skin.

A mild nip could be warmed up with your own body heat; try sticking those fingers into your armpit, for example. Rewarm those red toes with a soak in warm never hot water for up to 30 minutes. Since you wont be able to tell with those zapped toes, test the water with another part of the body to be sure its comfortable. Rewarm ears, nose and cheeks with warm cloths; re soak and reapply repeatedly.

Be prepared for a bit of pain as the frostbitten areas come back to life. Youll know when warming is complete when the skin is soft and all feeling has returned. But dont use stoves or warming pads, t. Those numb bits cant tell the temperature, and they could easily burn as they warm up.

Superficial frostbite is the second stage. Its known as second degree frostbite and begins when your skin begins to turn pale white or grayish yellow instead of red. It might even begin to appear blue. Crystals of ice are beginning to form in the skin, and it may become hard and numb to sensation. Some people say it feels "waxy."

Because the pain and redness are subsiding, unfortunately, people often dont realize what is happening to them. But soon, the skin might warm and begin to swell, which is a sign that damage to tissue is occurring. This is the time at which prompt medical treatment is needed to prevent further, more serious damage.

Immediate rewarming is key, but it should be done carefully by trained medical professionals, who will immediately wrap the injured area to protect it. At times, blisters filled with fluid can develop, and the skin can sting, burn and swell dramatically.

Deep frostbite is the next stage, in which the skin can appear blue and mottled, and numb to pain and cold. Blood filled blisters can form. Muscles next to the area might fail to work properly. At this point you are in danger of blood clots and will need anti clotting medications to increase blood flow to the area.

Medical attention is crucial at this stage to avoid amputation of the injured tissue. Depending on the severity of the injury, the tissue can look black and feel hard after its rewarmed. If the tissue has died, a process called gangrene, then the dead areas may have to be excised or amputated. At times, there can be long lasting damage to muscles, tendons, nerves and bones in the area as well.

If medical care isnt around

If medical care isnt immediately available, wrap the affected areas in sterile dressings, carefully separating injured fingers and toes from each other. But try to move the affected areas as little as possible to avoid further tissue damage.

If a frostbitten area is warmed and then refrozen, damage can be even more severe. According to the US National Library of Medicine, if refreezing is not guaranteed, it might be best to delay the initial warming process until a warm location can be found. Warm drinks are best for replacing lost body fluids.

Two more warnings from the CDC: Dont rub with snow or otherwise massage any frostbitten areas. Youll just make any tissue damage worse. The same applies to walking on frostbitten feet or toes, so avoid that unless absolutely necessary.

Be sure to check out our as well.

For more infomation >> Frostbite Symptoms, causes, photos and treatment - Duration: 3:07.

-------------------------------------------

US NEWS | Frostbite Symptoms, causes, photos and treatment - Duration: 3:07.

US NEWS | Frostbite Symptoms, causes, photos and treatment

Cold and wind chill

Frostbite is not only dependent on the outside temperature; its also affected by the wind chill factor. As the speed of the wind increases, our bodies cool at a faster rate, causing the skin temperature to drop. Higher altitudes can also affect the speed at which skin can freeze.

The National Weather Service has created a that shows the time it might take to develop frostbite at varying temperatures and wind speed. The index was tested on human face models.

For example, if it was zero degrees Fahrenheit and calm, your chance of frostbite is relatively low. Add wind at 15 miles per hour, and it would take only 30 minutes before frostbite sets in. If the wind rose over 50 mph, it would take a mere 10 minutes for frost to bite.

Your skin would freeze in a scant five minutes if you were out in minus 25 degree with a wind speed of just over 25 mph.

Who is at risk?

You are more susceptible to frostbite if you smoke, take medications called beta blockers, have , or have diabetes or a condition in which strong emotions or cold temperatures cause blood vessels to spasm and block blood flow to extremities.

Older people and the homeless without proper clothing, heating and food are also at high risk, as are hikers and hunters who arent properly clothed and stay outdoors too long. The US Centers for Disease Control and Prevention also warns that anyone who drinks excess alcohol or uses illicit drugs is at high risk; while you may feel like your body is warmer, your core temperature and blood pressure actually drop.

And of course you are more likely to get frostbite if you arent dressed properly for the weather. The CDC has a visual chart that shows the critical areas to keep covered in extreme cold.

The stages of frostbite

The first stage of frostbite is often called "frostnip" and begins with redness and a pins and needles feeling. Get out of the cold quickly at this time to avoid further damage to the skin.

A mild nip could be warmed up with your own body heat; try sticking those fingers into your armpit, for example. Rewarm those red toes with a soak in warm never hot water for up to 30 minutes. Since you wont be able to tell with those zapped toes, test the water with another part of the body to be sure its comfortable. Rewarm ears, nose and cheeks with warm cloths; re soak and reapply repeatedly.

Be prepared for a bit of pain as the frostbitten areas come back to life. Youll know when warming is complete when the skin is soft and all feeling has returned. But dont use stoves or warming pads, t. Those numb bits cant tell the temperature, and they could easily burn as they warm up.

Superficial frostbite is the second stage. Its known as second degree frostbite and begins when your skin begins to turn pale white or grayish yellow instead of red. It might even begin to appear blue. Crystals of ice are beginning to form in the skin, and it may become hard and numb to sensation. Some people say it feels "waxy."

Because the pain and redness are subsiding, unfortunately, people often dont realize what is happening to them. But soon, the skin might warm and begin to swell, which is a sign that damage to tissue is occurring. This is the time at which prompt medical treatment is needed to prevent further, more serious damage.

Immediate rewarming is key, but it should be done carefully by trained medical professionals, who will immediately wrap the injured area to protect it. At times, blisters filled with fluid can develop, and the skin can sting, burn and swell dramatically.

Deep frostbite is the next stage, in which the skin can appear blue and mottled, and numb to pain and cold. Blood filled blisters can form. Muscles next to the area might fail to work properly. At this point you are in danger of blood clots and will need anti clotting medications to increase blood flow to the area.

Medical attention is crucial at this stage to avoid amputation of the injured tissue. Depending on the severity of the injury, the tissue can look black and feel hard after its rewarmed. If the tissue has died, a process called gangrene, then the dead areas may have to be excised or amputated. At times, there can be long lasting damage to muscles, tendons, nerves and bones in the area as well.

If medical care isnt around

If medical care isnt immediately available, wrap the affected areas in sterile dressings, carefully separating injured fingers and toes from each other. But try to move the affected areas as little as possible to avoid further tissue damage.

If a frostbitten area is warmed and then refrozen, damage can be even more severe. According to the US National Library of Medicine, if refreezing is not guaranteed, it might be best to delay the initial warming process until a warm location can be found. Warm drinks are best for replacing lost body fluids.

Two more warnings from the CDC: Dont rub with snow or otherwise massage any frostbitten areas. Youll just make any tissue damage worse. The same applies to walking on frostbitten feet or toes, so avoid that unless absolutely necessary.

Be sure to check out our as well.