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Our three-year-old son was diagnosed with one undescended testis. At Soroka University Medical Center, we were told he needs to undergo surgery with a general anesthetic. We worry about that, even though he is otherwise healthy. Isn't it safer to have it done with a local or spinal anesthetic? And if general anesthesia, how about the new type in which the patient wakes up a few minutes after surgery? R.L., Arad
Dr. David Frenkel, a veteran anesthesiologist and director of the Jerusalem Surgical Center at Misgav Ladach Hospital, replies:
We do many minor and relatively minor operations in adults using local or spinal anesthesia, but with children, we mostly use general anesthesia, as children cannot control themselves and remain quiet without moving during surgery. There have been hundreds of studies comparing the results of surgery using general anesthesia and spinal, and for all patients - except for geriatric ones - there have been no more risks or complications with general anesthesia. This is especially so for operations below the waist. There is a possibility of doing an operation to repair undescended testes using a spinal, but it is very unusual. At our surgical center, we usually give parents a choice of anesthesia. My general advice on anesthesia is to agree to what that hospital is used to doing, because that is what they do best.
As for sevoflurane, in which children can wake up five minutes after surgery, it is very expensive, and in 30 percent of cases, the child suffers from emergence delirium, in which he cries inconsolably for an hour. It's a good drug, but this phenomenon is very disconcerting. When you use the conventional halofane, the child wakes up in half an hour and does not go into this tantrum.
I am a 91-year-old woman. A few months ago, I developed a very disturbing condition on my scalp with little bumps all over that form crusts on them. A dermatologist prescribed a shampoo (Agispor) to be used daily and a lotion (Diprosalic) to be applied afterward, as well as a cream for the face (Sebo). Is there any other treatment that can be considered? F.E., Ra'anana
Veteran Jerusalem dermatologist Dr. Julian Schamroth replies:
From the reader's description and therapy, it seems like she has seborrheic dermatitis, a very common condition that presents as itching and scaling on the scalp (dandruff) as well as redness and scaling on some areas of the face. It is usually hereditary, and may be associated with the presence of a yeast-like organism on the skin (determined by a laboratory culture). Although the condition is not caused by a fungus, anti-fungal agents - which act against this yeast-like organism - usually result in a marked improvement. The scalp condition is managed with special shampoos containing either tar or anti-fungal agents, as well as topical cortisone drops. The facial condition can be managed by topical cortisone creams or with topical anti-fungal agents. As to this treatment, you have received standard therapy for the condition. However, the crusts on the scalp may be infected excoriations due to scratching. A mild topical or oral antibiotic might therefore be indicated. You could also try a shampoo containing tar (there are several over-the-counter preparations available at all pharmacies). Unfortunately, this condition tends to recur, and even if therapy results in a cure, you might have to repeat the therapy once or twice a year.
I am 63 and was diagnosed with glaucoma at Hadassah University Medical Center in Ein Kerem after having done a field of vision test and subsequent intensive tests to confirm. A CT scan indicated that everything else was OK. Over the years, every pressure test I have done has shown low eye pressure, including those at Hadassah. The glaucoma specialist there suggested that there may be intermittent surges of eye pressure that have caused the glaucoma, but which have been undetected. I thought that maybe my menopausal heat flashes have caused these surges of eye pressure. I have had heat flashes for 15 years, and they have been "settling down" over the past six years to about every two or three hours; at night, I wake up with raging heat and a racing heart. Could this be causing the increased but undetected high intraocular pressure? R.B., Shadmot Mehola
Dr. Shimon Kurtz, head of the glaucoma service at Tel Aviv Sourasky Medical Center, answers:
As you described, the most probable diagnosis is normal tension glaucoma; I trust the experts at Hadassah that they did the correct clinical workup. Since they didn't find elevated intraocular pressure, the diagnosis of this glaucoma is done by elimination of other causes of optic nerve malfunction. There are many risk factors or etiologies related to this glaucoma - but heat flashes as you described are not included.
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