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Enron Case

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Marfan syndrome can affect many parts of the body, including the skeleton, eyes and cardiovascular system (heart and blood vessels.
The symptoms of Marfan syndrome tend to get more severe as you get older.
Skeleton
Includes: * tall * slim * have long, thin arms and legs * have loose and very flexible joint
Other physical signs of Marfan syndrome can include: * a small lower jaw * a high, arched palate (roof of the mouth) * deep-set eyes * flat feet * a breastbone (sternum) that either protrudes outwards or indents inwards * crowded teeth
Scoliosis
Marfan syndrome can cause the spine to become abnormally curved to the sides. This is known as scoliosis.
Curvature of the spine can cause long-term backache. In severe cases, it can also make breathing difficult or the spine may press against the heart and lungs.
Spondylolisthesis
Spondylolisthesis occurs when one vertebra (the small bones that make up your spine) slips forward over another vertebra.
This usually occurs at the bottom end of the spine, and can cause back pain and stiffness. Anyone can develop spondylolisthesis, but it more commonly affects people with Marfan syndrome.
Dural ectasia
The dura is the membrane (thin layer of cells) that lines your brain and spinal cord. Dural ectasia is a condition that occurs when the dura becomes weakened and expands outwards.
People with Marfan syndrome are at particular risk of developing dural ectasia. As the membrane expands it can press on the vertebrae in your lower back, which can cause: * backache * headache * numbness or pain in your legs
Eyes
Many people with Marfan syndrome have some type of vision problem.
Lens dislocation affects half of all people with the syndrome. This is where the eye's lens (the transparent structure in the middle of your eye) falls into an abnormal position.
Other eye-related symptoms of Marfan syndrome include: * myopia (short-sightedness) * glaucoma – increased pressure in the eyeball, which, left untreated, can cause permanentvision loss * cataracts – where the eye's lens becomes clouded * retinal detachment – where the retina (the thin lining at the back of your eye) begins to pull away from the blood vessels that supply it with oxygen and nutrients
Cardiovascular system
Marfan syndrome can affect the cardiovascular system, which is made up of your heart and blood vessels. It is particularly serious if your aorta and heart valves are affected.
Aorta
The aorta is the main artery (blood vessel) in the body. It runs from your heart, down the centre of your chest and through your abdomen.
In people with Marfan syndrome, the walls of the aorta are weak. This can sometimes cause the aorta to become enlarged and balloon, which is known as an aortic aneurysm.
In severe cases, the aorta can rupture (split) and cause potentially fatal internal bleeding.
Valves
Your heart has four chambers that pump blood to and from the rest of the body. To control the flow of blood through your heart's chambers, your heart has four valves: * mitral valve * aortic valve * tricuspid valve * pulmonary valve
These valves act as one-way gates, allowing blood to flow through in one direction. In some people with Marfan syndrome, the mitral or tricuspid valves don't close properly and blood leaks back through the valve. Read about common mitral valve problems.
The aortic valve may also leak, leading to the main pumping chamber (the left ventricle) gradually becoming enlarged.
Treatment for marfan:
How Is Marfan Syndrome Treated?
Marfan syndrome has no cure. However, treatments can help delay or prevent complications, especially when started early.
Marfan syndrome can affect many parts of your body, including your heart, bones and joints, eyes, nervous system, and lungs. The type of treatment you receive will depend on your signs and symptoms.
Heart Treatments
Aortic dilation, or aortic aneurysm, is the most common and serious heart problem linked to Marfan syndrome. In this condition, the aorta—the main artery that carries oxygen-rich blood to your body—stretches and grows weak.
Medicines are used to try to slow the rate of aortic dilation. Surgery is used to replace the dilated segment of aorta before it tears.
If you have Marfan syndrome, you'll need routine care and tests to check your heart valves and aorta.
Medicines
Beta blockers are medicines that help your heart beat slower and with less force. These medicines may help relieve strain on your aorta and slow the rate of aortic dilation.
Some people have side effects from beta blockers, such as tiredness and nausea (feeling sick to your stomach). If side effects occur, your doctor may prescribe a calcium channel blocker or ACE inhibitor instead of a beta blocker. Both medicines help relieve stress on the aorta.
Studies suggest that blocking a protein called TGF-beta may help prevent some of the effects of Marfan syndrome. Research shows that the medicine losartan may block the protein in other conditions.
The National Heart, Lung, and Blood Institute currently is sponsoring a study comparing losartan to a beta blocker in children and adults who have Marfan syndrome. The study's goal is to find out which medicine, if either, is best at slowing the rate of aortic dilation.
Surgery
If your aorta stretches, it's more likely to tear (a condition called aortic dissection). To prevent this, your doctor may recommend surgery to repair or replace part of your aorta.
Surgery may involve: * A composite valve graft. For this surgery, part of the aorta and the aortic valve are removed. The aorta is replaced with a man-made tube called a graft. A man-made valve replaces the original valve. * Aortic valve-sparing surgery. If your aortic valve is working well, your doctor may recommend valve-sparing surgery. For this surgery, your doctor replaces the enlarged part of your aorta with a graft. Your aortic valve is left in place.
After aortic surgery, you may need medicines or followup tests. For example, after a composite valve graft, your doctor will prescribe medicines called anticoagulants, or "blood thinners."
Blood thinners help prevent blood clots from forming on your man-made aortic valve. You'll need to take these medicines for the rest of your life. If you've had valve-sparing surgery, you'll only need to take blood thinners for a short time, as your doctor prescribes.
If you've had a composite valve graft, you're at increased risk for endocarditis (EN-do-kar-DI-tis). This is an infection of the inner lining of your heart chambers and valves. Your doctor may recommend that you take antibiotics before certain medical or dental procedures that increase your risk of endocarditis.
Your doctor also may advise you to continue taking beta blockers or other medicines after either type of aortic surgery.
After surgery, you may have routine cardiac magnetic resonance imaging (MRI) orcardiac computed tomography (CT) scans to check your aorta.
Cardiac MRI is a painless test that uses radio waves and magnets to created detailed pictures of your organs and tissues. Cardiac CT is a painless test that uses an x-ray machine to take clear, detailed pictures of your heart.
Bone and Joint Treatments
If you have scoliosis (a curved spine), your doctor may suggest a brace or other device to prevent the condition from getting worse. Severe cases of scoliosis may require surgery.
Some people who have Marfan syndrome need surgery to repair a chest that sinks in or sticks out. This surgery is done to prevent the chest from pressing on the lungs and heart.
Eye Treatments
Marfan syndrome can lead to many eye problems, such as a dislocated lens, nearsightedness, early glaucoma (high pressure in the fluid in the eyes), and cataracts (clouding of an eye's lens).
Glasses or contact lenses can help with some of these problems. Sometimes surgery is needed.
Nervous System Treatments
Marfan syndrome can lead to dural ectasia. In this condition, a substance called the dura (which covers the fluid around your brain and spinal cord) stretches and grows weak. This can cause the bones of the spine to wear away. Dural ectasia usually is treated with pain medicines.
Lung Treatments
Marfan syndrome may cause pneumothorax, or collapsed lung. In this condition, air or gas builds up in the space between the lungs and the chest wall.
If the condition is minor, it may go away on its own. However, you may need to have a tube placed through your skin and chest wall to remove the air. Sometimes surgery is needed.

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