R.L.
“Pleurisy” is a term for inflammation of the pleura, the lining of the lungs. The major symptom is pain in the chest that worsens in certain positions or when breathing. There are many causes of pleurisy, and treatment depends on the diagnosis.
Infection — bacterial or viral — is the leading cause. Viral pleurisy can be mild severe enough to raise fears of heart attack or blood clots in the lung.
Bacterial pleurisy usually is associated with pneumonia, with its attendant fever and cough. Tuberculosis was once a common cause, but is not so anymore.
Pleurisy with fever or other worrisome symptoms should be evaluated right away, as should pleurisy that lasts more than a few days. Aspirin, an anti-inflammatory medicine, can be useful for non-urgent cases of pleurisy. I woul still recommend getting this evaluated if it isn’t getting better.
Dear Dr. Roach: In 2010, I was diagnosed with a pituitary tumour. I had two surgeries for a benign tumour. My neurosurgeon now wants to treat the remaining tumour with gamma knife surgery. I am concerned about the long-term effect of radiation on the pituitary gland. Can you discuss the risks (greater than 10 years) on the pituitary?
D.B.
The pituitary gland sits above the optic nerve. Tumours of this gland usually are benign. They usually cause symptoms through pressing on the optic nerve, causing specific visual problems, or through secreting hormones.
Surgery or medication is usually first-line treatment, but neither is effective 100 per cent of the time. Gamma knife is a way of delivering radiation to the tumour while minimizing the amount of radiation damage to surrounding structures.
I was able to find one Swedish study that showed good results, both in terms of controlling the tumour as well as side effects, up to eight years after surgery. Since gamma knife is relatively new, longer-term results are hard to come by. Based on the principles, I would expect that the good results would continue long term, although lifetime follow-up is necessary. The brain is relatively resistant to the effects of radiation, and gamma knife is designed to focus the radiation precisely on the tumour.
All that being said, your neurosurgeon knows far more about you, about pituitary tumour and about gamma knife than I do. My advice is to trust him.
