Diseases & Conditions Archive

Q. I have Dupuytren's contracture in both hands. I've had "needle" surgery in one hand, and the fingers straightened. But they seem to want to contract again. What can I do?

A. Dupuytren's contracture is a disorder that develops when the palmar fascia — the tissue between the skin and tendons in the palm — thickens and contracts due to an abnormal buildup of collagen, causing one or more fingers (usually the little and ring fingers) to bend inward. Over time, Dupuytren's can make it difficult or impossible to grasp objects, button buttons, use a computer, and perform many other everyday activities. The treatment you mention sounds like needle aponeurotomy (also called percutaneous needle fasciotomy), in which a needle is used to sever the cords that are causing the fingers to contract. Unfortunately, recurrence following treatment is common.

Q. I'm 64 and have been diagnosed with uveitis in my right eye. What causes it, and what is the best treatment for it?

A. Uveitis is inflammation of one or more of the parts of the uvea — the layer of tissue that lies between the retina and the white of the eye (the sclera). These three layers — the retina, uvea, and sclera — surround the cavity of the eyeball, which contains the gel-like vitreous humor (see the illustration).

Q. I have wet macular degeneration. I am trying to decide between Avastin and Lucentis. Which drug is better?

A. This is a complicated and very unsettled area. All of the professional organizations for ophthalmologists are struggling with it.

Q. A friend has a condition called gastroparesis. Please explain what it is and how it can be treated.

A. Gastroparesis is the term used for sluggish emptying of food from the stomach into the small intestine. Normally, your stomach moves about half of an average meal into the small intestine within two hours after you eat, and about 90% within four hours. If you have gastroparesis, food stays in the stomach much longer. Nausea and upper abdominal pain are common symptoms. It may become difficult to keep a full meal down. People with serious cases may eat so little they become dangerously thin and malnourished.

Results have been discouraging for Alzheimer's disease, but they may help stroke patients in a variety of ways.

Alzheimer's disease and the depression that often affects people starting at about age 65 can easily be mistaken for one another. Depression can cause dementia-like deficits in memory and other mental functions, and Alzheimer's disease can cause depressive-like apathy and withdrawal.

Q. My wife has morphea spots on many areas of her body. We are currently treating them with Dovonex cream, which seems to help a little but is very expensive. Do you have a better way to treat this disease? We have been told that very little is known about how to treat it.

A. Morphea (pronounced more-FEE-ah) is a fairly unusual skin condition. I see perhaps one or two cases a year. The plaque type — which is the most common and probably what your wife has — affects women more often than it does men and typically is seen on the trunk. It's caused by an overproduction of collagen by cells in the skin called fibroblasts. Why fibroblasts start overproducing collagen is unclear.

It sounds like a new threat to health, but it was first diagnosed in 1888 as "senile rheumatic gout." It sounds rare, even exotic, but it's actually quite common. It sounds serious, even ferocious, but it responds beautifully to proper treatment. It's polymyalgia rheumatica (PMR), a painful, sometimes disabling condition that can be associated with giant cell arteritis (GCA), a disease that is much less common but much more serious.

You don't have to remember the unfamiliar name or even the simple initials, but you should understand the symptoms and treatments that can restore comfort in PMR and, in the case of GCA, preserve your vision.

The average human gut harbors between 500 and 1,000 bacterial species, the majority of which reside in the large intestine. Most of these inhabitants are helpful — indeed, essential — serving functions like producing vitamin K or stimulating the immune system. When this "intestinal microbiome" is disrupted by infection, illness, or treatment with antibiotics, a person's ability to digest food can be impaired and overall health affected.

In this country, recurrent infections with Clostridium difficile bacteria are one of the main causes of this kind of intestinal distress. C. difficile (pronounced see dif-uh-SEAL) infects as many as 7,000 hospitalized Americans a day, and treatment of those infections is a major cause of antibiotic-associated diarrhea. C. difficile competes for survival with other bacteria in the gut. Antibiotics are capable of killing many of its bacterial competitors, but often not C. difficile, which allows C. difficile to run wild.

Q. I read something about antidepressants causing cataracts. Is there any truth to it?

A. Results from a Canadian study reported in June 2010 did show that older people (ages 65 and up) who were taking selective serotonin reuptake inhibitor (SSRI) antidepressants were 15% more likely to develop cataracts than those not taking these medications. The SSRI antidepressants include fluoxetine (Prozac), and several other medications, although when the researchers broke down the data by individual drugs, fluoxetine was not among those associated with cataract risk.