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!

Noncancerous growths of the muscle tissue surrounding the uterus are known as uterine fibroids. This is a common disease which about 70 to 80% of women contract by the time they are 50 years of age. The uterine fibroids can sometimes be very big and cause heavy periods as well as severe abdominal pain while at other times, uterine fibroids give no signs or symptoms whatsoever and go away on their own. This is why it is crucial to know what type of uterine fibroids you have and how to diagnose them. Here are the types of uterine fibroids and how to diagnose them;

Types
There are three main types of uterine fibroids. They are;

1. Intramural fibroids
The most common type of uterine fibroids are intramural fibroids. They typically appear in the endometrium and may grow larger which results in your womb getting stretched.

2. Subserosal fibroids
Subserosal fibroids are called so because they form on the serosa. The serosa is the outside of your uterus. Sometimes, Subserosal fibroids may grow so large that your uterus appears bigger on one side.

3. Pedunculated fibroids
Pedunculated fibroids tumors are basically Subserosal fibroids with a stem. A base which supports the tumor is called the stem.

Diagnosis
There are a number of tests done to diagnose uterine fibroids. They are;

1. Pelvic exam
A pelvic exam is a thorough inspection of a woman&#x2019;s pelvic area. The organs which are in the pelvic area include the cervix, ovaries, uterus and vagina. Normally, this and the next test in this article are enough to diagnose uterine fibroids.

2. Medical history
The history of your periods as well as the other symptoms you have will often be enough to diagnose the uterine fibroids. If your medical history is not enough, then you might need to undergo a pelvic exam.

3. Pelvic ultrasound
An ultrasound is when high-intensity sound waves are used to produce images of the pelvic area. This is only done when a pelvic exam and your medical history are not enough to diagnose uterine fibroids.

Types and Diagnosis of Uterine Fibroids

If you are concerned about liver cancer, you should know that most people do not experience signs and symptoms of the cancer in the early stages. Liver cancer is a form of cancer which occurs in the cells of the liver. There are various types of cancer which can develop in the liver. Hepatocellular carcinoma (HCC) is the most common liver cancer which begins in the hepatocyte, which is the main liver cell.

Symptoms-

Usually there are no specific primary stage symptoms of liver cancer. Some symptoms which may develop include the following:

Unusual weight loss is observed

Loss of appetite and developing food aversion

Pain in the upper abdomen

Nausea followed by vomiting

General weakness with intense fatigue

Swelling in the abdomen

The skin may become yellow

White and chalky stools are likely

Causes-

In most cases, the causes of liver cancer cannot be clearly determined. In some cases, the cause is known, such as chronic infection with the hepatitis virus, which may lead to liver cancer. Liver cancer occurs when the liver cells undergo changes or mutations in their DNA structure. DNA mutations lead to changes in instructions of chemical processes taking place in the body. The cells may grow out of control and develop into a cancerous tumour.

Risk Factors-

There are several factors which enhance the risk of liver cancer. They are as follows:

Chronic infection with hepatitis B or hepatitis C increases the risk of liver cancer.

A progressive and irreversible condition known as cirrhosis leads to scar tissue formation in the liver, increasing the risk of liver cancer.

Certain inherited liver diseases such as Wilson s disease and hemochromatosis also increase the chances of liver cancer.

People with diabetes are also at a greater risk of having liver cancer.

Non-alcoholic fatty liver disease (NAFLD), which is the accumulation of fat in the liver, also increases the chances of getting this condition.

Excessive alcohol consumption is another factor which causes irreversible damage to the liver and the chances of getting liver cancer get boosted.

Exposure to aflatoxins, which are poisons produced by molds growing on poorly stored crops, make you more likely to get liver cancer.

Several tests and procedures are carried out for the diagnosis of liver cancer. These include blood tests for diagnosing liver function problems, and imaging tests such as ultrasound, CT scan and MRI scan.

Top 4 Symptoms Of Liver Cancer

Cancer is the abnormal, uncontrolled growth of cells in a particular body part. With continued growth, pieces of this tissue travel through the blood to different body parts and continue to grow in the new area. This is known as metastases. Breast cancer is one of the most common forms of cancer and affects about 1 in 8 women in the USA. Read on to know more details of breast cancer   breast anatomy, causes, symptoms, risk factors, detection, prevention, and of course treatment.

Anatomy: The main function of the breast is lactation through its milk-producing tissue that are connected to the nipple by narrow ducts. In addition, there is surrounding connective tissue, fibrous material, fat, nerves, blood vessels and lymphatic channels which complete the structure. This is essential to know as most breast cancers develop as small calcifications (hardened particles) in the ducts or as small lumps in the breast tissue which then continues to grow into cancer. The spread can happen through lymphatic or blood flow to other organs.

Warning signs/symptoms: The following are some symptoms that need to be watched out for if you have a predisposition to breast cancer.

    A lump in either of the breasts or armpits
    Change in size, shape, or contour of either breast
    Redness of your breast or nipple
    Discharge of clear or bloody fluid
    Thickening of breast tissue or skin that lasts through a period
    Altered look or feel of the skin on the breast or the nipple (dimpled, inflamed, scaly, or puckered)
    One area on the breast that looks very different from the other areas
    Hardened area under the breast skin

Either one or a combination of these should be an indication to get a detailed checkup done. Early diagnosis results in controlling the disease with minimal treatment and reduced complications.

Causes and risk factors: The exact cause for breast cancer is yet to be pinned down. However, risk factors are clearly identified, and women with risk factors need to watch out for warning signs.

    Family history: Of all the risk factors, the family history is the most important. Breast cancer runs in families, and if there is a first-degree relative with the breast cancer, the chances of developing it are almost double. Two genes BRCA1 and BRCA2 are the carriers of the disease, and this testing can be done in women to identify if they are at risk.
    Family history of other cancers: Even if there is no breast cancer, if there are other cancers that run in the family, watch out.
    Age: Women over 50 are at higher risk of developing breast cancer.
    Race: Caucasian and Jewish women are at higher risk of breast cancer than African-American women.
    Hormones: Greater exposure to the female hormone estrogen increases the chances of developing breast cancer. Women who use birth control pills for contraception and hormone replacement after menopause are at a higher risk of developing breast cancer.
    Gynecologic milestones: Women who have abnormal menstrual milestones need to watch out. These include those who attain menarche before 12 years of age, get pregnant after 30, attain menopause after 55, and have menstrual cycles shorter than 26 days or longer than 29 days.
    Obesity and alcohol abuse are also likely to increase a woman s chances of developing breast cancer.

Stages: Starting from stage 0, higher stages indicate advanced disease.

    Stage 0: The growth which has begun in the milk-producing tissue or the ducts has remained there (in situ) and not spread to any other area, including the rest of the breast.
    Stage I: The tissue slowly becomes invasive and has begun to affect the surrounding healthy tissue. It could have spread to the fatty breast tissue and some breast tissue may be found in the nearby lymph nodes.
    Stage II: The cancer at this stage grows considerably or spreads to other parts. There are chances that cancer may grow and also spread.
    Stage III: It may have spread to the bones or other organs but small amounts are present in up to 9 to 10 of the lymph nodes in the armpits and collar bones which makes it is difficult to fight.
    Stage IV: The cancer is widespread to far-flung areas like the liver, lungs, bones, and even the brain.

Screening: This is one of the most effective ways to identify the disease in its early stages. This will help in controlling cancer from spreading with minimal treatment.

    Self-examination: A thorough self-examination to look for changes in terms of shape, size, colour, contour, and firmness should be learned by all women. Watch for any discharge, sores, rashes, or swelling in the breasts, surrounding skin, and nipple. Examine them while standing and when lying down.
    In most women, annual screening mammograms are advised after the age of 40. However, in women who have a strong family history or genetic makeup, it is advisable to have screening mammograms starting at age 20 every 3 years and then annually from the age of 40.
    Women in high-risk categories should have screening mammograms every year and typically start at an earlier age.
    Ultrasound screening can also be given in addition to mammograms.
    Breast MRI is another way to screen for breast cancer if the risk is greater.

Breast Cancer Prevention: Now that there is so much awareness about causes and risk factors, there are definitely ways to prevent or delay the onset of the disease.

    Exercise and a healthy diet with reduced amount of alcohol are definitely effective in minimising the chances of developing cancer.
    Tamoxifen is used in women who are at high risk for breast cancer.
    Evista (raloxifene) which is used to treat osteoporosis after menopause. It is also widely used in preventing breast cancer.
    In high-risk women, breasts are surgically removed to prevent the development of cancer (preventive mastectomy).

Treatment: As with all cancers, treatment would depend on the stage at which it is identified and include a combination of chemotherapy, radiation, and surgery. As noted earlier, if you are at risk, look out for warning signs as early diagnosis is the key to maximum recovery.

Breast Cancer - Know More to Say 'No' More!

The human body has 206 bones and bone cancer can affect any of these bones. This condition starts when healthy bone marrow cells mutate and grow out of control to form a tumor. There are many different types of bone cancer. Treatment of bone cancer varies from case to case and depends on factors such as, type of cancer, stage at which it is diagnosed and the patient s overall health amongst other factors.

Surgery, chemotherapy, and radiation are the three most common types of treatments favored for bone cancer. Surgery is usually used for low-grade tumors. This involves the removal of tumor and the surrounding healthy cells and tissues to ensure that that cancer does not recur. For high-grade tumors, surgery may be accompanied by chemotherapy, radiation or a combination of the two. 

Chemotherapy involves the delivery of medication to destroy cancer cells orally or intravenously. Radiation involves the use of high energy X rays to kill cancer cells. This is often used to treat patients with a tumor that cannot be surgically removed.

Apart from these standard forms of treatment, bone cancer patients are often advised to take part in clinical trials for their treatment. This can be described as a research study to test the efficiency of new approaches to the treatment of bone cancer. A clinical trial can be used to treat the safety and efficacy of a new drug, the new dosage of standard drugs or a new combination of treatment types. As a member of a clinical trial, you may be one of the first few people to benefit from treatment even before it is available to the general public. 

Some of the new options available through clinical trials are:

Immunotherapy: This is also known as biologic therapy. It is designed to boost the patient s immune system to fight cancer cells. Mifamurtidesi one of the types of immunotherapy being tested. Immune checkpoint inhibitors such as monoclonal antibodies are also being tested for their ability to block specific molecules.
Targeted therapy: This type of therapy targets the genes and proteins that contribute towards the growth and survival of cancer cells. Targeted therapy limits the damage caused to healthy cells and tissues and only blocks the growth of cancer cells.
Myeloablative therapy: This involves an intense regimen of chemotherapy. High doses of chemotherapy aim at destroying all the cancer cells. Unfortunately, in the process, healthy cells may also be killed. This may be followed by introducing stem cells through a bone marrow transplant to the patient s body to renew blood cells.
Intraoperative radiation therapy: These trials evaluate the use of radiation given inside the patient s body during a surgery. In cases where tumor is in a distant location of the body, stereotactic body radiotherapy and radiofrequency ablation may be used.


Bone Cancer - Understanding The New Approaches For Treatment!

The symptoms caused due to herniated disc can be very severe and can also cause a bit of disability. The disc of the spine is like a cushion and separates the set of bones on the backside. The discs are shock absorbers of the spine and are mainly composed of 2 parts, a soft jelly centre called the nucleus and a tough outer covering called the annulus.

Effects of Herniated Disk
A herniated or cracked disc is a severe condition and it seems to happen most commonly in the lower back.  It happens when a fraction of the soft centre gets pushed through the destabilized area due to degeneration, trauma or by putting pressure on the spinal cord. 

Nerves are located precisely at the back of every disc and are responsible for controlling everything in our body. While a disc gets herniated, the external covering of the disc tears and creates a bulge. The soft jelly gets shifted from the centre of the disk to the region where the damage has occurred on the disc. Most commonly, the bulge occurs in areas where the nerve is located and it causes strain on the affected nerve. It has been observed that individuals do not feel any painful sensations even if their disc gets damaged.

When is Surgery Recommended for Herniated Disc?
Surgery for herniated disc is recommended only after options like steroid injections, pain relievers, exercise and non-steroid anti-inflammatory drugs do not work. If the pain persists even after these options, then it becomes important to go for surgery. There are certain risks involved in this surgery like infection, bleeding or nerve damage. 

There are chances that the disc may get ruptured again if it is not removed. If you are a patient suffering from degenerative disc disease, then there are chances that problem occurs in other discs. It is very important that a patient maintains healthy weight to prevent any further complications.

The main factor that increases the risk of herniated disc is excess body weight, which causes a lot of stress on the lower back. A few people become heir to a tendency of developing this condition. Even individuals with physically demanding jobs are prone to this condition. 

Activities like bending sideways, pushing, twisting, repetitive lifting can increase the risk of a herniated disk. At times, emergency surgery is also required to avoid paralysis in a patient.

Herniated Disc - What are the Risks Involved in it?

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