Liver transplantation or hepatic transplantation is the second most carried out transplant procedure in the world. It is a potentially difficult surgery that is performed by a team of two to four surgeons along with the help of anesthesiologists and nurses. It takes around 10 to 12 hours to complete the procedure as there are many anastomoses, sutures, reconnections, and disconnections, which are to be performed under the liver bed which is necessary for the transplant to be a success.

Tests required before a transplant is planned

Computed tomography, or CT scan which employs X-rays and a computer to create pictures of the liver, showing its size and shape. CTs and chest X-rays are also recorded to evaluate your heart and lungs.
Laser Doppler flowmetry: to check if the blood vessels to and from the liver are normal.
Echocardiogram to check the status of heart function.
Pulmonary function test or lung capacity test to study and determine the lungs' ability to exchange oxygen and carbon dioxide.
Blood tests are performed to determine the patient's blood type, clotting ability, and biochemical status of blood, and to determine liver function.
The liver transplant procedure

After an admission at the hospital, an Intravenous line is started in the patient's arm or hand. Other tubes (catheters) are put in their neck and wrist, or their collarbone or the area between the belly and the thigh (the groin). These are used to check heart and blood pressure, and to get blood samples.
The patient is placed on the back, over the operating table.
If there is too much hair at the surgical site, it may be shaved.
A catheter is placed into the bladder to drain urine.
After the patient is sedated, the anesthesiologist will insert a tube into the lungs. This is done so that the breathing can be helped with a ventilator. The anesthesiologist will keep checking the heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
The skin at the surgical site will be cleaned with a sterile (antiseptic) solution.
The doctor will make a cut (incision) just under the ribs on both sides of the belly.
The doctor will carefully separate the diseased or the injured liver from the nearby organs and structures.
The attached arteries and veins are then clamped to stop the blood flow into the diseased liver.
The diseased liver will be cut off from the blood vessels and then removed.
The surgeon will check the donor liver before implanting it into the body.
The donor's liver is placed in the patient's body.
The incision will then be closed with sutures or surgical staples.
In case you have a concern or query you can always consult an expert & get answers to your questions!

Liver Transplant Surgery - Understanding The Procedure!

Herniated disc, bulged disc, protruded intervertebral disc (PIVD) are the different names of one condition. This is a condition where- disc in between the two vertebral bodies starts peeping out on one side- anterior or posterior. These discs are just like the bags filled with liquid material, which work like shock-absorbent. There are several hard bony vertebrae in the vertebral column and there is plenty of movements with these vertebrae. When we look on one side to other side, we look upwards, downwards or we twist and even we bend forward or backward in each and every condition, there will be a movement in these bones, these discs decide the free movements of the spine. Along with this- when we walk or run there will be shocks and jerks to all these bones and these bags decide that there won't be any kind of jerks in between the bones. So, these discs are of multiple uses.

Our spine is inverted  S  shaped. There are two main curvatures in the spine which are free to move- Cervical and Lumbar curvatures. These curvatures of the spine are maintained due to the spaces in between the two vertebrae. Whenever there is a loss or change (specially reduction) of this space between two vertebrae- pressure will be exerted on the intervertebral discs. This uneven pressure on the disc causes- protrusion/bulge/herniation of the disc- this is the condition known as SLIPPED DISC, in layman language. Why does disc slip

Generally, slipped disc condition is diagnosed by its signs and symptoms. When slipped disc starts exerting pressure on the nerves surround the disc- the nerve will be excited which gives the sensation of- Pain, Burning or Numbness in the related area of the nerve. This sensation can travel long far away to the areas, which are being supplied by the nerve and can be limited to a particular location in neck or back even. Sign & Symptoms of Slipped Disc.

Ayurveda about Slipped Disc

Where modern medical (Surgical) sciences believes that this is a problem of just bones and joints of the vertebral disc besides this Ayurveda takes a  Wholistic  (Complete and wholesome) approach towards this and tells that this is a problem at three levels-

Mamsa Dhatu, Asthi Dhatu, Majja Dhatu!!
These are different tissue levels according to Ayurveda- Mamsa is muscles, Asthi represents bones and the Majja denotes everything which is in between and in the bones.
Mamsa (the muscles) starts stiffening due to the dryness   improper diet and imbalanced lifestyle and deteriorate the curvature of the spine- which leads to the deterioration of the intervertebral discs.
Asthi (the bony tissue) is affected due to the muscles.
Majja (the disc and the neural tissue- spine) is compressed due to the pressure and all effects.
So, we need to treat the condition, wisely and in a wholesome manner, rather just to removal of the protruded tissues (Laminotomy) and this is the basic reason- there are risks associated with the surgery of the spine and in almost more than 45% cases patients had to go for a second surgery to stay pain free. Why Surgery for spine doesn t succeed. Secondly, this is a mechanical problem so medicines alone can give you temporary relief rather than the cure-  So better you save your money and invest it on complete cure for the problem, rather than just taking the pain killers and medicines which were indicated in epilepsy to just reduce the signs and symptoms.



Slipped Disc - How Can Ayurveda Avert It?

Bone cancer is a cancerous tumour in the bone, destroying the normal bone tissues. Tumours on bone tissues are not always cancerous or malignant, they are mostly benign. Primary bone cancer is when the malignant tumour begins to form in the tissues of the bones, but when these cancerous cells spread to other body parts like breasts, prostate or lungs, it is called metastatic cancer. Primary bone cancer is less common than metastatic cancer.

Bone cancer can be of three different types:

Osteosarcoma: In this case, the malignant tumour arises from the osteoid bone tissue. This occurs mainly in the upper arm and knee areas.

Chondrosarcoma: In this case the cancerous cells form in the cartilaginous tissues, causing a lot of pain. This occurs mostly in the pelvic area.

The Ewing sarcoma generally arises in the bone but it can also form in the soft tissues. Other kinds of soft tissues affecting cancerous cells are known as soft tissue sarcomas.

Causes-

There aren t many clear defined causes; however, several factors have been identified by researchers.

Osteosarcoma is seen to occur more frequently in people who have been through a high external radiation therapy dose.

In people who have frequently been treated with anticancer medications, children tend to be most affected.

Heredity may be an adding cause, although the percentage of hereditary transfer of cancer cells is very low.



People with hereditary bone defects or implants have a higher chance of acquiring bone cancer.

Symptoms-

The most common and saddening symptom of bone cancer is painful, although not all bone cancers cause pain. Unusual or persistent swelling or pain around a bone maybe a red flag for bone cancer. In case of a situation like this, immediate doctor s opinion is required.

Diagnosis-

Usually, diagnosis of a bone cancer can be made using X-rays; for example, a bone scan, a computed tomography scan, a magnetic imaging procedure positron emission tomography, and an angiogram. Biopsy and blood tests are also helpful in bone cancer diagnosis.

Treatment-

The size, location and stage of cancer, age, and health of the person decide the kind of treatment that should be given to the patient. Various treatment options include chemotherapy, radiation therapy and cryosurgery.

Survival-

The combined survival rate of all sorts of bone cancers is 70%. This percentage may vary with the type of bone cancer and also its stage.

An Overview Of Bone Cancer

Kidney cancer or renal cancer is when kidney cells grow uncontrollably and form a tumour. Kidney cancer often begins in the tubules (tiny tubes in the kidneys). The prognosis may depend on the stage of the kidney cancer.

Different Stages of Kidney Cancer
The TNM system helps to categorize each stage of the kidney cancer.
Tumour (T)   Describes the size and location of the tumour.
Node (N)   Describes the spread of cancer to lymph nodes.
Metastatis (M)   Describes the spread of cancer to other body parts.

These results combined with the five stages (0 and 1 to 4) can help to identify the right treatment option for every patient. Zero stage describes no cancer presence. For instance  
Stage 1   Here the tumour is confined to kidneys and its size is smaller than 7 centimetres. (T1 or T1, N0, M0)
Stage 2   Here the tumour is confined to kidneys and its size is more than 7 centimetres. (T2)
Stage 3   Here the tumour is in kidneys or blood vessels or fatty tissues but also a lymph node; cancer spreads to major veins but doesn t extend beyond renal or Gerota s fascia (connective tissues surrounding adrenal glands and kidneys). (T3)
Stage 4   Here the cancer is in the fatty tissues surrounding kidneys and adjacent lymph nodes; has spread to other nearby organs and beyond renal fascia. (T4)

Treatment and management of kidney cancer
Once your doctor has determined the staging of your kidney cancer, a treatment plan can be formulated for you.

Surgery
Simple nephrectomy removes the affected kidney.
Radical nephrectomy is a common surgery for kidney cancer. It removes all affected parts such as the kidneys, adrenal gland, lymph nodes and surrounding tissues.
Partial nephrectomy is for small tumours and removes the kidneys and the surrounding tissues.
Interventional radiology: This is a surgery aided by real-time images. An advanced surgery using a nano knife is minimally-invasive and is effective for inoperable kidney tumours.
Targeted therapy: Drugs target specific tumour cells and destroy them.
Immunotherapy: Used for kidney cancer that has spread to other organs, this therapy may use different types of drugs to either help immune cells find cancer growth or regulate the immune system activity to stop or slow cancer growth.
Arterial embolization: It is a procedure to stop blood supply to the kidney tumour, in order to shrink it in size prior to surgery.
Cryotherapy: This procedure involves using extreme cold to kill cancer cells.
Chemotherapy is not very effective for treating kidney cancer. Talk to your doctor about all possible treatment options for your cancer. You can lower your risk of kidney cancer by eating healthy, maintaining your ideal body weight and managing your blood pressure.

Stages Of Kidney Cancer - How They Can Be Managed?

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

Uterine cancer is also known as endometrial cancer. It is a cancer which begins in the lining of the uterus. The uterus is the part of a woman's body where the fetus develops. Uterine cancer is one of those rare cancers in India, which can be diagnosed in its early stages. This is because excessive vaginal bleeding occurs, thus making it a very serious and an apparent symptom. It is also one of the few forms of cancer which can be cured as removing the uterus is often more than enough to cure the patient of uterine cancer.

Here are the causes, diagnosis and treatment of uterine cancer:

Causes

The exact cause of uterine cancer is not yet known, however, there is a theory on what causes uterine cancer. Hormones in a woman's body have been thought to increase the chances of getting uterine cancer. This is because it has long been thought that having high levels of estrogen is the cause of uterine cancer. Increased estrogen thickens the endometrium and thus, increases the likelihood of uterine cancer.

Diagnosis

There are several tests used to diagnose whether you have uterine cancer including:

1. Pelvic exam: This is an examination in which the vagina, bladder, rectum and uterus are scanned for lumps. If they are found, it might be due to uterine cancer.
2. Pap test: A pap test is a special test designed to scan for uterine cancer.
3. Transvaginal ultrasound: A transvaginal ultrasound uses high-intensity sound waves so that pictures of the uterus can be taken.
4. Biopsy: During a biopsy, the doctor will remove tissue from the endometrium and it will then be analyzed for cancerous growths.

Treatment

1. Surgery: This is the most common treatment as it removes the entire uterus and prevents the spreading of the cancer.
2. Chemotherapy: Chemotherapy involves giving drugs which kill cancerous cells. They are given through either an intravenous line or even in pill form.
3. Hormone therapy: This is a therapy in which either progesterone levels are increased or estrogen levels are decreased.
4. Radiation therapy: In this treatment, high energy laser beams are used to destroy cancerous cells.

Uterine Cancer - Causes, Diagnosis and Treatment

Don't wait any longer, manage your Radiologist online with a Lybrate doctor today

Consult for Radiologist - Online and Easy!

FilterClear All

COMMON SPECIALITIES

COMMON ISSUES