The body receives its source of energy and nutrition through the blood, which is the transport medium. The blood runs through a highly complex network of blood vessels, with the aorta being the largest one. It originates in the heart, the left ventricle precisely and supplies oxygenated blood to all parts of the body. Coarctation is a condition where there is a narrowing of the aorta. The heart, therefore, has to exert extra pressure to push out blood so that blood supply to the target organs is not affected.

The exact cause of aortic coarctation is not known, though it often develops at birth and so is known as a congenital disorder. Depending on the severity of the narrowing, symptoms develop at various times in life. While some infants demonstrate symptoms, some may not show any symptoms well into adulthood. Infants with severe narrowing may manifest the below symptoms quite early in life.

Difficulty in breathing may gasp
Difficulty in feeding
Be extremely irritable
Profuse sweating
Pale skin
When these symptoms are not noticed and treated in time, the child may have heart failure or even die. If the symptoms do not manifest early in life, the infant can grow into childhood quite normally. Symptoms may then manifest which would be different, as below.

Increased blood pressure
Headaches (frequent)
Weakness in the muscles
Nosebleeds
Chest pain
Frequent fainting spells
These are generic symptoms and it is difficult to suspect coarctation of the aorta. Therefore, further imaging would be required to rule out coarctation of the aorta. There are some risk factors, most related to the heart, which puts one at increased risk of developing aortic coarctation.

Bicuspid aortic valve
Aortic valve stenosis and/or regurgitation
Mitral valve stenosis and/or regurgitation
Patent ductus arteriosus
Treatment: Diagnosis is the first step in treating coarctation of the aorta. This would include a series of imaging tests including an echocardiogram, electrocardiogram, chest x-ray, CT scan, and MRI.
Surgery is often the most definitive mode of treatment, and the approach chosen depends on the severity and stage of identification. The most common approach is to open up the narrowed portion and keep it from collapsing again, so that blood flow is restored. This is known as a balloon angioplasty and stenting. Some of the other procedures used include:

Resection with end-to-end anastomosis
Bypass graft repair
Subclavian flap aortoplasty
Patch aortoplasty
In all affected individuals, after surgery, medications are prescribed to maintain blood pressure levels, which is often increased. In addition, lifestyle changes including exercise and healthy eating habits have to be developed.

Coarctation of the Aorta - Symptoms and Treatment

Ovarian cysts and fertility: Is there a connection?

Having a child is one of the most profound experiences in a woman s life. The joy of being a mother and welcoming a new life is unparalleled. In the midst of such expectation, an inability to conceive can take a serious toll on any woman s health. The mental scars from such an event can never be obliterated.

This does not mean you should give up. Consult a doctor to find the cause and rectify it. With advances in medical science and technologies like IVF in the market, no fertility challenge is insurmountable.

One of the most common cause of infertility is ovarian cysts. According to research conducted by the American Society For Reproductive Medicine, ovarian cysts resulting in ovulation abnormality and infertility has been recorded among 25% of women.

There are two types of cysts that are produced as byproducts of ovulation-

1. Follicular Cysts which does not break open to release the eggs. Rather the follicle stays as a whole while the cyst continues to grow.

2. Corpus Cysts or luteal cysts is a condition when after the egg has bronek free, the follicles seal itself rather than shrinking and the fluid builds up inside.

Causes-

Ovarian cysts are mainly caused due to hormonal imbalance, abnormal cell growth where the cells overgrow and develop into cysts, pelvic infections that spread to the ovaries and fallopian tubes and causes severe harm to them, and endometriosis when the tissue attaches to an ovary and forms cell growth.

Which ovarian cyst affects fertility?

Ovarian cysts that generate complications during pregnancy include-

1. Endometriomas - This is the condition when the tissues lining your uterus or endometrium grows outside the uterus or the fallopian tubes and is largely associated with fertility problems. Endometriomas can differ in sizes from the range of less than an inch to over 6 inches. They are filled with dark coloured blood.

Some studies have demonstrated that women suffering from mild endometriosis develop a lower (2%-4%) chance of getting pregnant each month when compared to women who are healthy and have a 15%-20% chance. Another research states that 40% of unexplained infertility results from endometriosis through anatomical distortion or inflammation.

2. Polycystic Ovary Syndrome - PCOS is the condition where small cysts form inside your ovaries which prompts irregular periods, excessive stomach cramps and large hormonal imbalance. Connected to immature ovaries, they do not assist in ovulation and thus produces complications infertility. The immature follicles with an immature egg cause the ovary to be politic.

This chronic lack of ovulation also alters the hormonal levels in your body that assists in ovulation. Women with PCOS develop high levels of androgen or male hormones in your body, which gets converted to estrogen. As a result, they do not ovulate.

Does the treatment of ovarian cysts also affect fertility?

This usually depends on the kind of treatment you receive. Hormonal birth control doesn t have a long-term effect on fertility. Although surgeries can invariably damage some healthy eggs inside your body, the doctors recommend that the ovaries be removed before you have more complications. However, in both the situations, the egg count in your body decreases significantly.

Ovarian Cysts & Fertility - Is There A Connection?

Splenectomy is an operation conducted to remove the spleen. The spleen plays a vital role in building immunity against bacterial infections, located in the uppermost area of the left hand side of the abdomen, just below the diaphragm. There are some specific requirements with regard to the immunizations as well as blood work that might need to be completed before this surgery takes place.

Why is Splenectomy need to be performed?
There are a number of chronic illnesses like Hereditary Spherocytosis or Idiopathic Thrombocytopenic Purpura, which make it a necessity to get a child s spleen removed. Though it is a rare case but still any kind of trauma to the spleen along with uncontrolled bleeding can create a very serious situation, wherein an emergency might arise to get the spleen removed immediately.

Immunization of child before the operation
Before the surgery of Splenectomy is conducted, immunizations are given to children as a preventive against some specific kinds of infections that are most common for patients to arise after having undergone the surgery of Splenectomy.

How is the surgery performed?
The paediatric surgeon, who performs the surgery, need not require making a large incision for going about the process of operation. In most of the instances, a splenectomy is performed in the following manner, which includes:

A laparoscopic way through which a Paediatric Surgeon makes use of a small telescope along with some instruments of miniaturized nature, while placing them through small band-aid sized cuts on the abdomen.
The operation gets completed within three hours
At the time of hospitalization, a child would receive intravenous fluids, antibiotics as well medicines to get relieve from any kind of pain.
As and when the child feels as if he or she is fit enough, he or she would be allowed to eat, drink and also take medicines by mouth.
Essentials after the Surgery
After the surgery has taken place and the child returns home after a couple of days, there are certain essentials that require to be kept in mind:

Pain Management: Management of pain is the very first thing which should be kept in mind. The medicines prescribed by doctor for dealing with pain are not required after getting discharged from the hospital.
Most of the children would only need Acetaminophen or Ibuprophen once they get back home.
Care for Dressings: One may remove the gauze and clear plastic, which are placed over the small cuts, a couple of days after the surgery. The skin that surrounds the incision might have a reddish tinge and look bruised, which can last for few weeks.
Restrictions related to Activities: There are no real restrictions with regard to the resumption o regular activities. A child can go back to school as and when he or she feels totally comfortable.

Spleen Removal - Why Is It Performed In Kids?

Gastroesophageal reflux disease (GERD) is also called as acid reflux. It is a long-term digestive disorder that affects the lower esophageal sphincter, the ring of muscle between the esophagus and stomach which causes the stomach contents to come back up into the esophagus resulting in either symptoms or complications. Gastroesophageal reflux disease is mild acid reflux that occurs at least twice a week or moderate-to-severe acid reflux which occurs at least once a week.

Epidemiology

In western populations, GERD affects approximately 10% to 20% of the population and 0.4% newly develop the condition. In developed nations, the prevalence rate of GERD is associated with age; with adults aged 60 to 70 being the most commonly affected.

Signs and Symptoms

Esophageal symptoms include:

Heartburn
Regurgitation of food or sour liquid
Dysphagia
Sensation of a lump in the throat
Extraesophageal symptoms include:

Coughing and/or wheezing
Hoarseness, sore throat, or 
Otitis media
Noncardiac chest pain
Enamel erosion or other dental manifestations
New or worsening asthma
Disrupted sleep
Risk Factors

Obesity
Pregnancy
Hiatus hernia
Scleroderma and systemic sclerosis
The use of medicines such as prednisolone 
Delayed stomach emptying Zollinger-Ellison syndrome which can show an increase in gastric acidity because of gastrin production
A high blood calcium level which can increase gastrin production, leading to increased acidity
Visceroptosis or Gl nard syndrome, in which the stomach has sunk in the abdomen upsetting the motility and acid secretion of the stomach.
Factors that can increase acid reflux involve:

Smoking habit
Eating heavy meals or eating late at night
Eating fatty or fried foods
Drinking certain beverages, such as alcohol or coffee
Medications, such as aspirin
Tight clothes
Increased intra-abdominal pressure
Differential Diagnosis

Heart disease causing chest pain
Laryngopharyngeal reflux OR extraesophageal reflux disease
Infection
Peptic ulcer
Esophageal spasm
Complications

Narrowing of the esophagus (esophageal stricture): Stomach acid causes the formation of a scar tissue which narrows the food pathway.
An open sore in the esophagus (esophageal ulcer): Acid causes an open sore which bleeds, causes pain, and makes swallowing difficult.
Precancerous changes in the esophagus (Barrett's esophagus): Damage from acid can cause changes in the tissue lining the lower esophagus
Anemia
How to arrive at the diagnosis?

Upper gastrointestinal endoscopy/esophagogastroduodenoscopy
Esophageal manometry
Ambulatory 24-hour pH monitoring
Treatment

The goals of treatment are controlling symptoms, healing esophagitis, and prevention of recurrent esophagitis or other complications. Lifestyle modifications include the following:

Losing weight (if overweight)
Eating small and frequent meals instead of large meals
Waiting 3 hours after a meal to lie down
Elevating the head end of the bed by 8 inches
Avoiding bending or stooping positions
Medications

H2 receptor antagonists (ranitidine, cimetidine)
Proton pump inhibitors (omeprazole, pantoprazole)
Prokinetic agents (aluminum hydroxide)
Antacids (magnesium hydroxide)
Surgery

Transthoracic and transabdominal fundoplication
Placement of a device to augment the lower esophageal sphincter

Gastroesophageal Reflux Disease - What Causes It?

Losing weight is a daunting task. This becomes all the more difficult for obese people. In many cases, the patient may be advised to undergo bariatric surgery. There are many types of bariatric surgery. Some surgeries address both the stomach and the small intestines while others address only the stomach. A gastric band surgery is one such procedure.

For this procedure, an adjustable band is placed around the upper half of the stomach. This creates a small pouch that can hold a limited amount of food. The band is connected through a plastic tube to a small device placed under the abdominal skin. Sterile fluid may be injected or removed from the band through this device. By injecting saline, the band is made tighter and by removing the liquid the band is loosened. This allows the band to be customized to improve weight loss.

The result of a gastric band surgery may vary from person to person. Band adjustment starts after the third week of surgery. Because the size of the stomach is reduced, the person will feel full faster and hence eat less. In most cases, a person can expect to lose 60 to 75 % of their excess body weight. This should not be confused with a person s total weight. The procedure can be reversed at a later date if need be.



Some people may develop side effects like nausea and vomiting after the procedure. But why this procedure has not gained acceptance compared to other bariatric procedures like gastric bypass and sleeve gastrectomy is because, the compliance with the band is not very good and complications like band erosion, band slippage, band migration are very high. Another dreaded complication following the band surgery in non-compliant patients who eat large quantities and overstretch the small gastric pouch above the band is severe GERD.

In severe cases, rarely, grains of undigested food is seen in the mouth on waking up in the morning. This could be life-threatening. Vitamin deficiencies are rare provided supplements are taken regularly during the weight loss period.  

Gradual band adjustment is required and regular follow up with the bariatric surgeon will yield good results. Over adjustment is not good at all and could lead to higher chances of complications like band erosion. However, proper dietary compliance can make the results of a band better. Ideally, a patient should get follow up checks every month after such a surgery.

All said and done, the percentage of excess weight loss in the gastric bypass and sleeve gastrectomy are far superior to the adjustable gastric banding. Even the compliance, and maintenance of weight loss over years is better in the other bariatric procedures compared to the band.

Gastric Band Surgery - Know How Competent Is It?


Cancer is the most dangerous disease noticeable throughout the world. The most common type of cancer that affects men is prostate cancer. Prostate is a small exocrine gland situated directly below the bladder and in front of the rectum. This is gland is approximately in size of a walnut and plays an important role in production of a milky fluid during orgasm of sex in which the semen travels. During the climax stage of the prostate gland is forced to push the fluid and remove the semen out of the reproductive structures.

Prostate gland is a slow progressive disease which makes many males left unidentified even the presence of prostate cancer even until they die. 6 out of 100 male over the age of 60 are getting prostate cancer. Though prostate cancer can be cured at a better rate when compared to other type of cancer it is always best to stay protected. Prevention is always better than cure. Here are few tips to keep your prostate healthy.

Signs and symptoms of prostate cancer-
During the early stages of prostate cancer there are usually no symptoms. Most men at this stage find out they have prostate cancer after a routine check up or blood test. When symptoms do exist, they are usually one or more of the following:

The patient urinates more often
The patient gets up at night more often to urinate
He may find it hard to start urinating
He may find it hard to keep urinating once he has started
There may be blood in the urine
Urination might be painful
Ejaculation may be painful (less common)
Achieving or maintaining an erection may be difficult (less common).

If the prostate cancer is advanced the following symptoms are also possible:

Bone pain, often in the spine (vertebrae), pelvis, or ribs
The proximal part of the femur can be painful
Leg weakness 
Urinary incontinence 
Fecal incontinence 

Ways to have a healthy prostate  
Diet and weight   the most important factor is the diet to maintain a healthy weight. Avoid fatty food items and take fats from vegetables than from animals. Avoid dairy products and increase the intake of fresh fruits and vegetables.
Exercise   have a regular practise of doing exercise at least for 30mins a day. This really helps you to keep your body fit.
Be precautious   if you have a family history of prostate cancer or if you feel you are at high risk of getting prostate cancer talk with your doctor about it and take preventive drugs as per the doctor s advice.
Red foods   research shows that men who consume red foods like watermelon, tomato and other red fruits are at lower risk of getting prostate cancer as they contain a powerful antioxidant called lycopene
Caffeine   three to four cups of coffee per day reduces your risk of getting prostate cancer.
Stop smoking   if you are at high risk of getting prostate cancer it is best advised to quit smoking and alcohol. 


Prostate Cancer -  Signs and Symptoms

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