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!

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. It occurs in both women and men, although breast cancer in men is rare.

Risk factors:

Lack of physical activity
Alcohol consumption
Advancing age
No childbirth or no breastfeeding
Family history of breast cancer
Early menarche (< 12 years of age) or late menopause ( > 55 years of age)
History of ovarian cancer or endometrial cancer
History of benign breast conditions (e.g. atypical hyperplasia) or lobular carcinoma in situ
Receiving hormonal replacement therapy (HRT)
History of receiving radiation therapy to the chest before age of 30
More importantly, you can lower your risk of having breast cancer by the following measures:

 Have regular physical activities, do at least 150 minutes of moderate-intensity aerobic physical activities per week (e.g. climbing stairs or brisk walking)
Avoid alcohol drinking;
Maintain a healthy body weight and waist circumference - aim for a body mass index (BMI) between 18.5 and 22.9, and a waist circumference of not more than 80cm for women; and
Have childbirth at an earlier age and breastfeed each child for longer duration factors include:
What are the common symptoms of breast cancer?

The symptoms of breast cancer may not be easily noticed at an early stage. Any of the following changes in the breast can be a symptom of breast cancer:

  Breast lump;

  A change in the size or shape of the breast;

  A change in skin texture of the breast or nipple (e.g. red, scaly, thickened or  orange-skin  appearance);

  Rash around the nipple;

  In-drawing of the nipple;

  Discharge from one or both nipples;

  New and persistent discomfort or pain in the breast or armpit; and

  A new lump or thickening in the armpit

What is breast cancer screening? Should I screen for breast cancer if I do not have any symptom?

Screening means examining people without symptoms in order to detect disease or fi nd people at increased risk of disease. It is often the fi rst step in making a defi nitive diagnosis. For breast cancer screening, its purpose is to fi nd women who have breast cancer, before they have any symptom, in order to offer them earlier treatment.

Mammography is widely used as a screening tool. It is an X-ray examination of the breasts. During mammography, the breast is pressed between 2 plates to flatten and spread the breast tissue, in order to obtain a clear image. Some women may find it uncomfortable or painful but the discomfort is usually short lasting. Mammography screening is safe in general and only a very small dose of radiation is used in the procedure. One in 5 female breast cancer patients may be missed by mammography.

Prevention and Screening for Breast Cancer: Information for women and their families

Hydrocephalus is a condition that is also called  water on the brains . This condition is triggered in children when the cerebrospinal fluid (CPF) isn t drained completely from the brain. This fluid surrounds and protects the brain and the spinal cord and when it doesn t find an outlet, it accumulates in the brain.

Very young children with hydrocephalus have enlarged heads to accommodate all the excess water. But older children whose skull bones have solidified and cannot expand suffer terrible headaches. This condition requires immediate treatment or it could lead to damage to the brain.

What triggers Hydrocephalus? 

If there is an obstruction in the ventricles (the passages through which the CPF flows), the circulation of this fluid is affected. And this triggers hydrocephalus.

Hydrocephalus can be of two types-

Congenital Hydrocephalus:

This is a congenital condition, which means the baby is born with this ailment. It could be because there are abnormalities in the spine or it did not develop the way it should have or because the aqueduct that connects the ventricles of the brain is narrowed.

Acquired Hydrocephalus:

This condition can develop at any age. It is triggered by bleeding in the brain. It may happen if babies are born before the due date. Or a brain injury may prompt it. A tumour could also be behind hydrocephalus.

What are the Symptoms of Hydrocephalus?

Among babies, the biggest sign is the swollen head. Other symptoms may include-

Bulges along with the skull

The gap along with the bone plates of the skull

Swollen veins on the head

Eyes may bulge

Vomiting, nausea and loss of appetite.

Seizures

Drowsiness

squinting

Treatment of Hydrocephalus -

This condition requires immediate treatment or it might trigger problems of the nervous system. Here are some treatments that a child might have to undergo-

Shunt procedure -

A catheter is inserted into the brain to drain away the excess fluid. It is passed through the abdominal cavity and the bloodstream absorbs it.

Endoscopic surgery -

This surgery is performed on older children. A lighted stick with a camera is inserted by drilling a tiny hole into the third ventricle. This allows the accumulated fluids to flow out and past the blockages. This is a minimally invasive procedure.

The child is kept under meticulous observation after the surgery. Hydrocephalus is a dangerous ailment but with timely intervention, it can be cured completely.

What Triggers Hydrocephalus In Children?

In case you have a diseased uterus, which makes you infertile, you can undergo a procedure known as uterus transplant or uterine transplant to get pregnant. In the process of sexual reproduction, a diseased uterus does not allow embryonic implantation. This factor is referred to as uterine factor infertility or UFI. As a result, you will not be able to get pregnant.

Who requires a uterus transplant?
This procedure involves women who have UFI and women who had their uterus removed by hysterectomy. Women who have a damaged uterus on account of an injury or infection, which does not function anymore, can also undergo a uterus transplant procedure. Women from the age of 21 to 45 are eligible for this procedure. Many women are born without having a uterus. This condition is called Mayer-Rokitansky-K ster-Hauser syndrome.

Procedure
Uterus transplantation begins with undertaking a uterus retrieval surgery on the uterus donor. The uterus, which is recovered has to be stored and transported to the location of the patient undergoing the transplant. An ischemic tolerance may last over 24 hours. Three major surgeries have to be carried out with the recipient. Firstly, a transplantation surgery is required in which the donor s uterus gets transplanted. In case pregnancy develops, a caesarean section surgery has to be performed. The patient is given immune suppressive therapy. After childbirth, a hysterectomy is done in order to terminate the immune suppressive therapy.

Will the women be able to get pregnant after having sex?
Women receiving a uterus transplant will not be capable of becoming pregnant without undergoing fertility treatments. The transplanted uterus is not connected with the fallopian tubes, which is the location of the normal fertilisation process. The women will require to carry out IVF or in vitro fertilisation to become pregnant after a uterus transplant. IVF is a process in which the eggs are removed from the ovaries and get fertilised in a laboratory. Then, they are implanted in the uterus. After undergoing the uterus transplant procedure, a woman has to wait for a period of one year. The uterus requires time for healing and after recovery, the embryo may be implanted for pregnancy. After giving birth successfully, a woman will be able to keep the transplanted uterus.

She has the option to get pregnant again. However, after giving birth twice, a hysterectomy must be carried out for the removal of the uterus. This is done so that the woman can stop using the immune suppressant drugs, which are associated with major risks. Uterus transplant is a relatively new technology. In October 2014, the first healthy baby was born to a woman who had undergone a uterus transplant. This surgery is kind of experimental in nature and is usually the last option for getting pregnant. 

Diseased Uterus - Can it be Replaced?

It is very common for women to have heavy and painful periods or have a feeling of fullness in the lower abdomen. Although, it may not sound very alarming these could be the symptoms of uterine fibroids. These are the most common types of benign tumours found in women. The fibroids are basically some tissues and muscle cells that grow within the uterus, outside the uterus, or along the wall of the uterus. The fibroids are usually benign and asymptomatic and do not require any treatment unless they cause problems. 

Know the causes 

Though the exact cause of fibroid formation is not known, it is believed that the female hormones estrogen and progesterone have a role to play in their formation. Fibroids are formed only when a woman is producing these hormones and they are not seen in women in non-reproductive age i.e. before starting of menses or after stoppage of menses (menopause). If fibroids are persisting even after menopause or especially if increasing in size then it is an alarming sign. Such a fibroid needs to be taken care of immediately. 

What are the symptoms? 

Fibroids often remain quiet for long periods of time. They cause nonspecific symptoms in the pelvis and abdomen including: 

Fullness in the abdomen 
Low back pain 
Irregular menstruation 
Cramping with menstruation 
Painful sex 
Increased urgency to urinate 
Anemia, leading to tiredness and weakness 
Infertility Diagnosing the fibroids 
When these symptoms are recurrent, it is good to confirm the diagnosis. This can happen with a pelvic exam followed by ultrasound scanning to confirm the size and location of the fibroids. A blood test also may be done to confirm anemia, which is common due to heavy periods.

Treatment Options 

Management of fibroids can range from doing nothing to periodic monitoring to surgical removal. 

If pain and heavy bleeding are the only symptoms, then pain killers like ibuprofen should suffice for symptomatic relief. Anemia, if severe, may require iron supplementation. 
Embolization is an option which shrinks the fibroid, at the same time preserving the uterus. The blood flow to the fibroid is cut off, thereby preventing its further growth. It takes about 1 to 3 hours and requires some bed rest after the procedure. There could be some pelvic pain and vaginal bleeding, which will gradually subside. The fibroids may grow back, but the benefits of keeping the uterus are definitely there. This is suitable in case of single fibroid with specific blood supply. 
The next surgical option is myomectomy, where the portion of the uterus which contains the fibroid alone is removed. This is done in women who still wish to get pregnant and in women who would like to retain the uterus. This can also be achieved laparoscopically( key hole surgery). In such cases, fibroids are cut into small pieces and then removed from the body. This procedure should be done by a doctor specialised in advanced gynecological endoscopy as all this cutting should be done in a bag to avoid any spillage of cells inside the abdominal cavity. This procedure is known as Laparoscopic Myomectomy with In-bag Moecellation. 
In women who have crossed their pregnancy phase, hysterectomy or complete removal of the uterus is advised. In these women, the bleeding and pain may not have subsided even after years of treatment with hormones. The growing fibroids could be pressing on the adjacent organs, causing pressure. This is the only definitive treatment and should be done in women have completed their family and don t desire to be pregnant. 
Myomectomy and hysterectomy may be done laparoscopically or with an open method depending on the overall health, the size and location of the fibroids in the uterus.

Uterine Fibroid - How Removing Them Will Help You?

When cells divide abnormally and uncontrollably, they can form a mass or lump of tissue. This lump is called a tumor. Bone tumors form in your bones. As the tumor grows, abnormal tissue can displace healthy tissue.

Some tumors are benign, meaning they aren t cancerous. While benign bone tumors won t spread to other parts of the body and are unlikely to be fatal, they can still be dangerous and may require treatment. Benign tumors can grow and could compress your healthy bone tissue. Other tumors are malignant, meaning they re cancerous. Malignant bone tumors can cause cancer to spread throughout the body.

Causes of bone tumor:

The cause of bone tumors is unknown. They often occur in areas of the bone that grow rapidly. Possible causes include:

Genetic defects passed down through families
Radiation
Injury
In most cases, no specific cause is found.
Symptoms of bone tumor:

Symptoms of bone tumor may include any of the following:

Bone fracture, especially fracture from slight injury (trauma)
Bone pain, may be worse at night
Occasionally a mass and swelling can be felt at the tumor site
Some benign tumors have no symptoms.
Diagnosing a bone tumor:

There are some common conditions like fractures, infections and other conditions that may resemble tumors. But, to be sure some physical examination to be performed which will check the tenderness in the bone and also the range of motion. Blood or Urine test may be performed to detect different proteins that may indicate the presence of tumor. Doctor may go with X-rays and depending on the X-ray results other imaging tests might be necessary i.e. CT scan, MRI PET scan. In some cases biopsy is also performed. In this test. a sample of the tissue that makes up the tumor is removed.

Treating bone tumor:

Bone cancer is generally treated with Surgery in which the entire tumor is removed. The surgeon carefully examines the margins of your tumor to make sure no cancer cells are left. Surgical techniques have improved greatly. Other ways to treat is radiation therapy which is used in conjunction with surgery. Still if the doctor feels that cancer cells are likely to spread or already spread then Chemotherapy is recommended.

Bone Tumor - How It Can Be Diagnosed?

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