Rx for Readers: Galling problems

The best treatment available today for gallstones is surgical removal of the gallbladder.

By JUDY SIEGEL-ITZKOVITCH
September 24, 2010 16:35
4 minute read.
A patient visits hs doctor for a checkup.

311_doctors office. (photo credit: MCT)

 
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I am a 28-year-old man with gallstones. My doctor said I have to undergo surgery – keyhole surgery – to remove them. I recall reading that just as kidney stones are pulverized with shock waves to remove them, gallstones are as well, and that the patient goes home soon after. Is such a technique no longer used for this? How fast is the recovery?
                                                                                                                T.C., Jerusalem

Dr. Yoav Mintz, director of the Center for Innovative, Minimally Invasive and Robotic-Assisted Surgery at the Hadassah University Medical Center in Jerusalem’s Ein Kerem, replies:

Gallbladder stones are different from kidney stones and so is their treatment. Although it was once thought that we could crush the stones via shock waves, as we do for kidney stones, we realized that this might be very harmful to the patient. The reason is that by doing that, we create many small fragments of stones that could then easily pass from the gallbladder into the biliary system and obstruct it, thereby causing obstructive jaundice, cholangitis and pancreatitis – illnesses that are far more severe than the usual pain from the gallbladder stones or infection. Therefore we do not recommend any shock wave treatment or any alternate technique that induces gallbladder contraction and forcible ejection of the stones into the biliary system.

The best treatment available today is surgical removal of the gallbladder (annually in the US, a million patients have theirs removed). With minimally invasive surgery, this operation can be performed through a single small incision in the navel and with minimal pain, followed by a speedy recovery.

My teenage daughter has had a skin infection called mollescum contagiosum for a while now, and I, a physician but not a dermatologist from the US, am thinking it’s worth trying cantharadine treatment. The trade names I’m familiar with are Canthacur and Cantharone. We are now in Israel for a visit. What is the disorder, how should it be treated and are the drugs available in Israel?
                                                                                                  G.G., New York

Dr. Julian Schamroth, a veteran Jerusalem dermatologist, comments:

Molluscum contagiosum is a common viral infection of the skin that occurs worldwide and is caused by a virus belonging to the pox group. It occurs mainly in children below the age of 10, but it can affect any age group of both sexes and in all races. As the name implies, it is contagious, and is acquired by direct contact with another infected individual. It often occurs in schools or in families. Simultaneous bathing of several children, contact sports such as wrestling and confined living facilities may all predispose to its development. The disorder is found only in humans, and cannot be “caught” from pets or other animals.

It appears as small wart-like sores, each about one to four millimeters in diameter. They may have a small dimple (umbilication) on the surface. There may be few or many hundreds of lesions present. Occasionally, the lesion may become red and swollen, giving the impression that it is infected, but these inflamed lesions usually pass by themselves within a few days. In about 15 percent of cases, the surrounding skin develops eczema and becomes dry, scaly and itchy. The lesions can occur almost anywhere on the body, but are most commonly seen on the face, near the armpits, in the groin area and on the upper legs and buttocks.

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If left alone, molluscum contagiosum clears up spontaneously. In about 90 percent of cases, the lesions will resolve within nine to 12 months. Rarely, the lesions may last two or three years. As it is a benign disorder that heals spontaneously, it usually does not have to be treated, but there are several methods including freezing, cauterizing, breaking the roof of the wart open with a needle and the topical application of caustic agents such as cantharadine (which is not available in Israel) and other chemicals. All these methods have associated problems. Treatment is usually painful, especially for small children; treatment isn’t always successful; new lesions may pop up in surrounding areas; treatment may cause permanent scarring; and lesions on some areas, such as the eyelids, cannot be treated with the above-mentioned therapies.

In view of these problems, I think you should leave the lesions untreated. The associated eczematous rash, if present, is easily treated with topical cortisone and/or antibiotic creams.

Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to jsiegel@jpost.com.

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