Nevus Pigmentosus

Definition: pigmentosus nevus is a benign tumor composed of nevus cells. Skin disorders are accompanied by pigmentation is a problem that is found in the clinic, one of which is a nevus pigmentosus. Almost everyone has nevus, nevus while undergoing changes, has 400 times higher risk to become malignant. Synonyms: nevus cell nevus, nevus nevoseluler

Skin Bening Tumors

Benign tumors are manifestations of damage skin growths that are congenital or akuisita, without invasive tendencies, and metastasis, can be derived from the vascular and non-vascular. Benign tumors facial skin, a benign tumor that requires special attention. Because of its location on the face, the aesthetic aspect / cosmetic prominent role.

Therapy for Condyloma Acuminata

1. Chemotherapy

a. Podophyllin

25% podophyllin tincture. The surrounding skin is protected with petroleum jelly or paste, to avoid irritation, after 4-6 hours and then washed. If there is no cure, it can be repeated after 3 days. Every administrated, do not exceed 0.3 cc because it will be absorbed and toxic. Symptoms of toxicity are nausea, vomiting, abdominal pain, respiratory irritation, and skin with cold sweat. Can also occur bone marrow suppression with thrombocytopenia and leukopenia. In pregnant women should not be given because of fetal death can occur. Also, please do not used for the treatment of lesions in the vagina and cervix because this drug can be absorbed so that the toxic and may cause carcinoma.

Clinical Manifestattions of Condyloma Acuminata

Condyloma acuminata incubation period lasts between 1-8 months (average 2-3 months). HPV enters the body through the micro-lesions on the skin, so condyloma acuminatum often arise in areas prone to trauma during sexual intercourse.

Pathophysiology of Condyloma Acuminata

Condyloma acuminata can be caused contact with patients infected with HPV. Until now more than 100 known types of HPV, which often causes condyloma acuminata namely HPV types 6 and 11 is entered through a micro-lesions on the skin, usually in the genital area and penetrate the skin, causing the surface epithelial abrasion. 

Condyloma Acuminata Genital Warts

Condyloma Acuminata Genital Warts
Condyloma Acuminata in Penis
Condyloma acuminata is a Sexual Transmitted Diseases caused by Humanpapilloma virus (HPV) types specific to a disorder of the skin and mucosa fibroepitelioma. There are more than 100 types of HPV, 30 types of HPV of which is the cause of genital infection or Condyloma acuminata. Condyloma acuminata is often referred to as a chicken's comb disease, genital warts.

Treatment and Therapy of syphilis

       In the treatment and therapy of syphilis should not be forgotten that their sexual partners are also treated, and as long as the patient has not recovered copulate prohibited. Treatment is started as early as possible, the earlier the better result. In latent syphilis therapy intended to prevent further processing.

Differential Diagnosis of Syphilis

A. The differential diagnosis of SI (Syphilis I)
        Basic diagnosis of S I as follows. In history it is known mass of incubation; there is no constitutional symptoms, as well as local symptoms ie no pain. In primary affective important there is erosion / ulceration were clean, Solitar, round / oval, regular, with indolent induration: T. pallidum positive. The disorder can be painful if accompanied by secondary infection. Regional nodes may be enlarged, indolent, no groups, no periadenitis, without suppuration. Serologic test after a few weeks of weak positive reaction.

Syphilis Classification and Clinical Manifestations

According to the WHO, syphilis classification are early and late syphilis, with the time difference between the two is two years, and some even say four years. This classification is based on epidemiological considerations. Early syphilis can transmit the disease due to there is Treponema pallidum in skin disorders. Late Syphilis is no longer contagious because there are no bacteria in the lesion. In pregnant women, Treponema pallidum can enter the body of the fetus.

Pathogenesis of Syphilis

A. Early Stage

         In acquired syphilis T.pallidum get into the skin through a micro-lesions or mucous membranes, usually through sex. The germs multiply, tissue reacts by forming infiltrates consisting of lymphocytes and plasma cells, particularly in the perivascular, small blood vessels proliferate, T.pallidum and surrounded by inflammatory cells. Treponema is located between the capillary endothelium and perivascular tissue around it. Loss of bleeding will cause erosion, on clinical examination appear as SI.

Syphilis and Etiology

Syphilis in Penis Male
Syphilis Ulcer in Male
Syphilis is an infectious disease which caused by Treponema pallidum. its a chronic and systemic diseases which during the course of the disease can affect all organs of the body. There is a latency period without manifestations of lesions in the body. Syphilis is a highly contagious disease spread primarily by sexual activity, including oral and anal sex.

Medical Treatment Therapy for Viral Encephalitis

a. General Therapy:
1 Bed rest total.
2 When the estimated infection due to enteroviruses personal hygiene should be observed.
3 Headache and high heat necessary to handle the administration of antipyretics to be given acetaminophen / paracetamol.

Clinical Manifestations of Viral Encephalitis

      Encephalitis can be a part of systemic diseases such as varicella or measles, by itself is the first manifestation of disease symptoms initially. If the encephalitis is not a part of a systemic viral disease, it is likely to be found complaints that precedes neurological syndrome include headache, weakness or malaise, myalgia, complaints of upper respiratory tract disorders and fever.

Pathophysiology of Viral Encephalitis

Pathophysiology of Viral Encephalitis
Viral infection of the central nervous system can be in several ways:
1 Invasion directly through anatomical barrier.
a. Scalp, skull and dura mater forming an effective barrier against infection directly from the surrounding environment. Infection with the direct path is usually due to trauma or surgery wounds.
2. axonal transport by neurons of the peripheral.
a. Neurons can be road traffic from and to the "Cell Body" and antegrade and retrograde transport systems, such as rapid retrograde transport an average of 200-300 mm / day, for example, the herpes simplex virus and varicella zozter are transported of replication in skin and mucosa by sensory fibers to the dorsal nerve roots.
3 The entrance of respiratory tract pass through the olfactory epithelium.
a. How to enter the organism in the olfactory mucosa through the apical process of nerve cell receptors that stand out on the edge of the epithelium as "olfactory rads", so that the particle is placed on the olfactory mucosa can be taken by pinocytic vesicles and transported to the olfactory bulb.
4 Infection through blood vessels pass through the capillary endothelium or epithelial plexus choroideus.

Etiology of Viral Encephalitis

Various Etiology of Viral Encephalitis:
a. Epidemic Viral infection :
1. Group enteroviruses, = poliomyelitis, coxsackie virus, ECHO virus.
2. Group Arbo virus, = equire western encephalitis, St. louis encephalitis, Eastern equireencephalitis, Japanese B encephalitis, Murray valley encephalitis
b. Sporadic Viral infections : rabies, herpes zoster, lymphogranuloma, mumps, limphotic, choriomeningitis and other types that are considered caused by a virus but it is not yet clear.
c. Post-infection encephalitis, post morbili, post-varicella, rubella post, post-vaccinia, pascamononucleosis, infectious and other types of respiratory tract infections that follow are not specific.

Viral Encephalitis

Definition of Viral Encephalitis
       In normal circumstances, the Central Nervous System (CNS) are well protected against attack from organisms that can cause inflammation, and inflammation in the CNS is the most unusual complication of an infection acquired daily. One of the CNS inflammation is encephalitis, which is inflammation of the brain (Encephalon). Viral Encephalitis is the inflammation of encephalon which  cause is a virus. Encephalitis caused by a viral infection causing parenchymal damage varying from mild to very severe.

Gonorrhea Treatment and Therapy

For Gonorrhea Treatment and Therapy, what needed to be considered are the effectiveness, price, and minimal toxic effects. Management pathways is depend on the existing diagnostic facilities as seen in Table 1,2,3. The selection of treatment regimens should consider also the site of infection, strains of N. gonorrhoeae resistance to antimicrobials, and the possibility of Chlamydia trachomatis infections are occurring simultaneously. Therefore often co-infected with C. trachomatis occurs, then at an with gonorrhea are also suggested to be given simultaneously with the treatment regimen appropriate for C. trachomatis in accordance with the table number 4.

Clinical Manifestations of Gonorrhea

Clinical Manifestations and complications of gonorrhea are very closely related to the composition of genital anatomy and physiology. Therefore, the necessary knowledge about composition of the male and female genital anatomy. Disorders arising from sexual relations other than genito-genital ways, in men and women can be orofaringitis, proctitis, and conjunctivitis.

Pathophysiology of Gonorrhea

Neisseria gonorrhoeae is a gram-negative, intracellular, aerobic diplococci that affect cuboidal or columnar epithelium of the host. A wide variety of factors that affect the way mediate gonococcal virulence and pathogenicity.


 What is Gonorrhea? 
         Definition of Gonorrhea is an infectious disease caused by the bacteria Neisseria gonorrhoeae and have clinical signs such as discharge of urethral pus or purulent discharge after sexual intercourse or sexually transmitted disease (STD).  Meanwhile, according to Dorland's medical dictionary, gonorrhea is an infection caused by nisseria gonorrhoeae is transmitted through sexual intercourse in most cases, but also by contact with infected exudates in the neonate at birth.

Tuberculosis Meningitis Medical Treatment and Therapy

      Tuberculosis Meningitis Medical Treatment and Therapy by three different components: administration of anti TB drugs, modulating the immune response and management or increased intracranial pressure treatment and therapy. Here are the guidelines and anti-TB drug delivery dosage for infant and children both first-line and second-line.

Diagnosis of Tuberculous Meningitis

      Diagnosis or suspected TB meningitis symptoms and signs of meningitis requires that accompanied the drive to clinical tuberculous infection and the results of X-ray photograph and cerebrospinal fluid showed infection by Mycobacterium tuberculosis. Tuberculous meningitis can occur through two stages.

Tuberculous Meningitis

         Tuberculous meningitis is an inflammation of the lining of the brain or meninges caused by the bacterium Mycobacterium tuberculosis. Tuberculous meningitis is the result of hematogenous spread of Mycobacterium tuberculosis and limfogen of primary infection in the lung.

Treatment and Therapy for Viral Meningitis

      The most therapies for viral meningitis are supportive. Rest, rehydration, antipyretic, and anti-inflammatory or pain medication may be given if required, the most important decision is either provide initial antimicrobial therapy for bacterial meningitis in the meantime, while waiting for the main cause can be identified.

Diagnosis of Viral Meningitis

A. Laboratory Studies
1. Hematology and chemistry tests should be performed
2. Examination of CSF is an important examination in the examination of the causes of meningitis. CT scans should be performed in cases related to abnormal neurological signs to exclude intracranial lesions or obstructive hydrocephalus before lumbar puncture (LP). CSF culture remains the criterion standard examination piogen of bacterial or aseptic meningitis. Again, patients who handled the majority of bacterial meningitis can occur with gram-negative staining and then the resulting aseptic. The following is a characteristic CSF is used to support the diagnosis of viral meningitis:

Clinical Manifestations of Viral Meningitis

• Most patients reported fever, headache, iritabilitasm nausea, vomiting, stiff neck, or fatigue within 18-36 hours earlier.

• Headache is almost always there and often reported with severe intensity.

• other constitutional symptoms are vomiting, diarrhea, cough and myalgia that arise in 50% of patients.

Pathophysiology of Viral Meningitis

         How can virus causing meningitis? this is explain about Pathophysiology of Viral Meningitis. Viral pathogens can reach the CNS access through 2 main pathways: hematogenous or neural. Hematogenous is the most common pathway of viral pathogens known. Penetration neural shows the distribution along the nerve and is usually limited to the herpes viruses (HSV-1, HSV-2, and varicella zoster virus [VZV] B virus), and the possibility of some enteroviruses.

Viral Meningitis

Meningitis in Brain
Aseptic meningitis is a general term that indicates non-pyogenic cellular responses induced by agents of different etiologies. Patients usually show acute meningeal symptoms, fever, CSF pleocytosis dominated by lymphocytes. After several laboratory tests, obtained the causes of aseptic meningitis is mostly derived from the virus, including enterovirus and Herpes Simplex Virus (HSV).

Clinical Symptoms of Meningitis

Meningitis is characterized by symptoms such as sudden high fever, lethargy, vomiting and seizures. The diagnosis is confirmed by examination of cerebrospinal fluid (CSS) via lumbar puncture.

Pathophysiology of Tuberculous Meningitis

       Tuberculous meningitis usually appear as the spread of primary tuberculosis. Usually there is a primary focus of infection in the lungs, but can also be found in the abdomen (22.8 %), neck lymph nodes (2.1 %), with no evidence of primary focus (1.2 %). From the primary focus, the Mycobacteria enter the blood circulation via the thoracic duct and regional lymph nodes, and can cause severe infections such as miliary tuberculosis or just cause some focus metastases are usually quiet.

Pathophysiology of Meningitis

         Meningitis is generally as a result of the spread of disease in the organ or other body tissues. Viral / bacterial hematogenous spread to lining of the brain, for example in disease pharyngitis, tonsillitis, pneumonia, Bronchopneumonia and endocarditis. The spread of bacteria / viruses can also be continuitatum of inflammation of the organ or tissue that is near the lining of the brain, eg, brain abscess, otitis media, mastoiditis, cavernous sinus thrombosis and Sinusitis. The spread of germs can also occur as a result of head trauma with fracture open brain surgery or complications. Invasion of germs into space Subarachnoid cause an inflammatory reaction in the pia mater and the arachnoid, CSS (liquid Cerebrospinal) and the ventricle system.


 What is Meningitis?
        Meningitis is an inflammation of the meninges (brain and spinal membrane) which caused by infection. by bacteria, viruses, rickettsiae, or protozoa, which can occur acute and chronic. Meningitis is divided into two groups based on the change in the cerebrospinal fluid, namely: the serous meningitis and purulent meningitis.

Treatment and Tips for Ischialgia

Treatment for Ischialgia
namely :
1 . Drugs : analgesics, NSAIDs , muscle relaxan , medicine neurological recovery .
2 . Physical therapy Medical Rehabilitation Program
3 . Operation Discectomy : performed in the case of severe / very disturbing activities with drugs and Medical Rehabilitation program which can not help.

Pathophysiology of Ischialgia

Human vertebrae is consist of cervical, thorakal, lumbar, sacral, and coccyx. Part of vertebrae that form the lower back is the lumbar 1-5, the intervertebral disc and lumbar plexus also the sacral plexus. Lumbar plexus, exit through lumbar 1-4, which consists of iliohipogastric nerve, ilioinguinal nerve, femoral nerve, genitofemoral nerve, and the obturator nerve.

Ischialgia Classifications

Ischialgia divided into three, namely :
1 . Ischialgia, as a manifestation of primary neuritis ischiadicus
Ischialgia due to neuritis is the primary ischiadicus when ischiadicus exposed nerve inflammation process. The main signs and symptoms of primary ischiadicus neuritis is pain that is felt starting from the sacrum and hip joint area, precisely at the foramen infra piriformis or incisura ischiadica and spread throughout the trip and subsequent nerve ischiadicus peroneal and tibial nerve.

Ischialgia Etiology and Clinical Manifestations

        Ischialgia is pain felt along the leg. Judging from the sense of the word, then ischialgia is pain felt along N.ischiadicus. So ischialgia defined as pain felt along the nerve and subsequent ischiadicus along the legs. Ischialgia is a condition where the nerves Ischiadicus, which innervate butt to foot pinched area, in that case, which is pinched nerves Ischiadicus right side. This can happen due to some disease processes such as physical trauma, chemical, and electrical, infections, metabolic problems, and autoimmune. Ischialgia increase in frequency along with the many activities undertaken.

Treatment and Therapy of Cluster Headache

        Medical Treatment and Therapy of the cluster headache can be divided into the treatment of acute attacks, and preventive medicine, which aims to suppress the attack. Acute and preventive treatment started simultaneously when the initial period of the cluster. Latest surgical treatment options and neuro stimulation has replaced detrimental treatment approaches.

Diagnosis of Cluster Headache

Cluster Headache Diagnosis       Cluster headache diagnosis using the criteria by the International Headache Society ( IHS ) is as follows :
a. At least 5 attacks with such criteria under
b . Severe or very severe unilateral orbital, supraorbital and or temporal pain for 15-180 minutes if untreated .

Pathophysiology of Cluster Headache

Pathophysiology of Cluster Headache
    The pathophysiology of cluster headache is still remains unclear. However, there are several theories regarding the pathophysiology of Cluster headache. One theory is that the focus of the pathophysiology of cluster headache is located in the carotid artery which stimulates intracavernous pericarotis plexus. 

Cluster Headache

Cluster Headache
    Synonyms : Eritroprocephalgia Bing, ciliary neuralgia/migrenous (Harris), Eitromelalgia head, Horton headache, histaminic cephalgia, petrosal neuralgia (Gardner), spenopalatin neuralgia, neuralgia Vidian and Sluders, hemicrania neuralgiformis periodically .

Medical Treatment and Therapy for Tension Headache

Tension Headache Treatment
      The principle of treatment is psychologic approach (psychotherapy), physiological (relaxation) and pharmacological (analgesic, sedative and minor transquilizers). In practice, it needs an adequate explanation of the background of the pain that the patient understands, about the issues that are less or not realized.

Clinical Manifestations of Tension Headache

        The symptoms that can occur in tension headache are: a headache that felt like a heavy head, stiff as tied rope wrapped around head, and pressed tight. Sometimes with throbbing headache. If prolonged, on palpation can be found swollen, hard and tenderness area. Can also be accompanied by symptoms are: nausea, vomiting, vertigo, fatigue, difficulty to sleep, nightmares, frequent waking early in the morning and fall asleep, hyperventilation, abdominal bloating, sadly, the loss of the will to learn or work, anorexia and other depressive complaints. Pain can also be felt as a tense feeling the pinch in the head and pain located in the area occipitocervicale.

Pathophysiology of Tension Headache

      Tension Headache pathophysiology is still not clearly known. In some of the literature and research results mentioned several circumstances relating to the occurrence of  Tension Headache as follows:
(1) central nervous system dysfunction that is more involved than the peripheral nervous system dysfunction of the peripheral nervous system which leads to more ETTH, whereas central nervous system dysfunction leads to CTTH (Chronic Tension Type Headache) ,

Tension Headache

       Type Tension headache or tension-type headache is defined as a sensation of heaviness or pressure that settled, on both sides of the head arising episodic and associated with stress, but it can be repeated almost every day without any psychological factors. The pain arises due to continued contraction of the muscles of the head and neck is m. splenius capitis, m. temporalis, m.maseter, m. sternocleidomastoid, m. trapezius, m. posterior cervical, and m. levator scapula.

Medical Treatment and Therapy for Migraine

Treatment therapy Migraine
Treatment and Therapy Migraine
Migraine Treatment Targets
Migraine treatment and therapy goals depends on length and intensity of pain, symptoms comorbidities, degree of disability and the start of treatment response and may also be found in other diseases such as epilepsy, anxiety, stroke, myocardial infarction. Because it must be wary of the medicine. When there are symptoms of nausea/vomiting, the medicine is given rectally, nasal, subcutaneous or intravenous.

Clinical Manifestations of Migraine

Clinical manifestations of Migraine
Migraine without aura
The attack began with a throbbing headache on one side with a duration of 4-72 hours. headache worsens with physical activity and followed by nausea and, photophobia or phonophobia.

Diagnosis of Migraine

Diagnosis Migraine
A. Migraine without Aura
     Previous term: Common migraine, hemicrania simplex.
Recurrent headache attacks with manifestation for 4-72 hours.  Characteristics unilateral head pain, throbbing, moderate intensity or  severe, worsen with routine physical activity and followed with nausea and photophobia and phonophobia or.

Pathophysiology of Migraine

Vascular Theory 

       Intracranial vasoconstriction in the outer cortex plays a role in the occurrence of migraine with aura. This opinion is reinforced by the presence of headache accompanied with the same heart rate. Blood vessels constrict primarily located in the brain due to activation of peripheral nociceptive nerve locals. This theory was initiated above observation that the extracranial veins that will undergo vasodilation palpable heartbeat. This vasodilation will stimulate people to experience headaches. In such conditions, vasoconstrictor drugs, such as ergotamine will reduce headaches, while vasodilators such as nitroglycerin will worsen headaches.


 Definition of Migraine
      According to the International Headache Society (IHS) migraine is a vascular headache with recurrent pain attacks that lasts 4-72 hours. The pain is usually one sided (unilateral), its throbbing, pain is moderate to severe intensity, aggravated by activity, and can be accompanied by nausea and or vomiting, photophobia and phonophobia.


       Headache is often referred to as headache, dizziness and others, is pain or an unpleasant taste in the whole area of ​​the head to the lower limit of the chin up to the area behind the head ( occipital area and some areas nape ).

Medical Treatment and Therapy for Syringomyelia

A. Pharmacological ( Non Surgical ) / Symptomatic 
There is no specific treatment and therapy for syringomyelia. But it can be treated with medication analgesics and muscle relaxan :

1. Analgesics
Neuropathic pain medication should be given multifactor working on various components of pain , including damage to neuronal activity (anticonvulsants and local anesthetics), potential improvements, lane barriers (antidepressants) or its center including the development and conduction nosiseptic response (analgesic).

Diagnosis of Syringomyelia

       The diagnosis of syringomyelia based on a specific syndrome (clinical symptoms) and laboratory , and definitely diagnosis using MRI

1. Specific Syndrome
       Syringomyelia is a symptom complex of certain clinical signs due to the syrinx and gliosis in the spinal cord, the clinical diagnosis is based on: the location and size of the syrinx, the expansion of the syrinx, and the underlying cause, also a slowly progressive process that takes place .
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