Even though brain aneurysms are becoming common these days, not all of them are required to be treated. In some cases, the physician may choose to observe an aneurysm closely before adopting any treatment measure. But in patients in whom an aneurysm has progressed to a severe level, there are two treatment options:

Open surgical clipping
Endovascular therapy or coiling
Open surgical clipping for brain aneurysms:
This procedure is typically performed by a neurosurgeon who makes an incision in the head. An opening in the bone is made, and then a clip is positioned by dissecting through the spaces of the brain. This aids in preventing the flow of blood into an aneurysm. In this procedure, the patient is required to stay in the hospital for two to three nights after which he or she is discharged.

Considerable modifications have been made in the open surgery techniques in the recent years. Neurosurgeons are now able to perform eye brow incisions or mini craniotomies for clipping an aneurysm. In these procedures, a small incision is cut out in the skin above the eyebrow for making a window. A tiny clip is placed across the mouth of an aneurysm to help it heal. But it is worthy of mention here that these are all invasive procedures and take relatively longer time to recover compared to the coiling process.

Endovascular coiling:

This treatment is also performed by a neurosurgeon, and it has been proved that this process is exceptionally suitable for patients with a ruptured aneurysm. Endovascular coiling is often done in coalesce with an angiogram, where a catheter is inserted into the vessel over the hip, which is then gradually carried to the vessels of the brain and finally to an aneurysm.
Then the coils are packed to the point where it rises from the blood vessel, which prevents the blood from flowing intothe blood vessel. Most patients undergoing this minimally invasive procedure can go home the day following the surgery. The success rate of this process is very high, and over 125,000 patients have been treated all across the globe with the help of detachable platinum coils.
Over the last few years, a substantial amount of advancements have taken place in the endovascular techniques. Recent developments show the use of flow diverting embolization devices, which are similar to a stent and are placed in the primary vessel, adjacent to an aneurysm. It diverts the flow away from an aneurysm and therefore, allows the neurosurgeons to treat the brain aneurysms, which were previously considered inaccessible and untreatable.
Both the procedures are quite efficient in treating a brain aneurysm. The most suitable option is dependent on a host of factors such as size, shape, location and overall health condition of the patient.

Brain Aneurysms - Treatment Options Available For It!

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?

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!

If you are concerned about breast cancer, you should know about the steps you can take to prevent the condition. Breast cancer is a type of cancer developing from the breast tissue. Symptoms such as a lump in the breast, fluid flowing from the nipple, changes in the shape of the breast and occurrence of red scaly patches on the breast denote breast cancer.

You need to make certain lifestyle changes in order to prevent breast cancer. The ways you should adopt include the following:

Limit your alcohol intake: The more you consume alcohol, the more you put yourself at the risk of getting breast cancer. It is recommended for you not to drink more than one drink per day. Small amounts of alcohol increase the risk of breast cancer as well.

Abstain from smoking: There is a direct link between tobacco smoking and breast cancer, and the risk is even more in premenopausal women. You should quit smoking to reduce the risk of breast cancer along with many other conditions, which can develop because of the ill-effects of smoking.

Control your weight: Obese women are more prone to breast cancer when compared with women with a healthy weight. This is especially true when obesity occurs at a later stage in life, after menopause.

Keep physically active: Regular physical activity is essential for you to maintain a healthy weight, which is important for preventing breast cancer. 150 minutes of moderate aerobic exercises or 75 minutes of vigorous exercises are recommended along with strength training.

Breastfeed: Breastfeeding plays an important role in preventing breast cancer. The more you breastfeed your baby, the more protected you are from breast cancer.

Limit the dosage and duration of hormone therapy: If you undertake combination hormone therapy for more than three to five years, you are at a higher risk of developing breast cancer. In case you are taking hormone therapy for menopausal symptoms, you should talk to your doctor about alternative options such as non-hormonal therapy and medications. If you still require hormonal therapy, you must use the lowest dose that will be effective.

Avoid exposure to radiation and pollution: Certain medical imaging procedures like computerized tomography involves radiation of high doses. There is a link between breast cancer and radiation exposure. Thus, you should abstain from getting exposed to radiation and avoid taking such tests if it is not very urgent.

Maintaining a healthy diet also helps in reducing your risk of developing breast cancer. You should include food items which are plant based in your regular diet, such as fruits, vegetables, nuts, whole grains and legumes. Also, consume healthy fats such as olive oil instead of red meat and butter.

How Can You Prevent Breast Cancer?

Cancer of the kidneys is amongst the ten most common types of Cancer. There are many types of renal cancer with Renal cell carcinoma being the most common amongst them. Renal cancer is said to be triggered by a genetic mutation but the cause for this mutation is yet unknown. While kidney cancer appears suddenly in some cases, in others it is inherited from the parents. Here are 4 things you should know about cancer of the kidneys.

Risk Factors
Along with a mutation of the genes which is beyond our control, some lifestyle factors can also increase a person s risk of suffering from renal cancer. Some of these factors are:

Smoking
Obesity
High blood pressure
Symptoms
An early diagnosis can make the treatment of renal cancer much easier than if it is left undiagnosed. Hence, it becomes important to recognise the symptoms of this disease. Common renal cancer symptoms include:

Blood in the urine
A lump on either side of the abdomen
Persistent pain on one side of the abdomen
Tiredness
Unexplained weight loss
Fever
These symptoms are common to a number of other diseases as well and hence if you experience them, it is best to get yourself checked out by a doctor. In order to confirm a diagnosis, your doctor is likely to ask for blood tests, urine tests, an ultrasound and a CT scan or an MRI. In most cases, your doctor will also schedule a biopsy to check for cancer cells in the kidney tissue.

Stages of kidney cancer
Once cancer has been diagnosed, your doctor will need to determine the extent of damage caused in order to find the best form of treatment for the disease. Stages of kidney cancer are determined by the size of the tumour and on how much it has spread from the original location. There are four stages of kidney cancer.
Stage I   When the cancer cells are restricted to the kidneys and the tumour is no bigger than 3  in diameter
Stage II   The tumour has grown bigger in size but is still restricted to the kidney
Stage III   The tumour may be big or small but has spread to at least one lymph node or has affected the blood vessels
Stage IV   The cancerous cells have spread to nearby lymph nodes or other organs or the tumour has grown through the fatty layer and outer fibrous layer of the kidney.

Treatment
Kidney cancer can be cured easily if detected in the early stages by removing the tumour and adjacent tissue or the entire kidney if need be. Removing one kidney is not fatal as a person can live a healthy life with a single kidney.

Kidney Cancer - How Its Stages Can Affect The Treatment?

A set of cartilage discs present between the vertebrae, ensures that the spinal column can withstand the weight of the upper body. If these discs tear or get injured, the condition is commonly known as slipped disc. In medical terms the same condition is known as prolapsed intervertebral disc. Here is a look at the causes, symptoms and treatment for this painful condition.

Causes for Prolapsed Disc
Intervertebral cartilage discs undergo normal wear and tear with age. However, there are other underlying causes for a slipped disc.

Sitting for prolonged period of time may lead to the disorder
Repeatedly lifting weight in such a manner that all the pressure is exerted on the vertebrae may also lead to a prolapsed intervertebral disc. Example   Exercising with incorrect posture
Alcohol consumption and smoking
Sedentary lifestyle and lack of exercise
Accidental trauma to the spinal region
Diet not consisting of all the essential nutrition
Family history of the same condition
Tweaking one s lifestyle is generally enough to ensure that people are not affected by the condition.

Symptoms of prolapsed intervertebral disc

Patients claim to feel pain radiating from their spinal region to the calves of their feet. This sciatic nerve may get compressed due to the disorder, leading to such a pain.
Tingling sensation in the lower and upper back regions. This sensation may also spread to the arms and legs.
Patients complain of a weakness or numbness in the buttock area, feet and legs.
Treatment for prolapsed intervertebral disc

Limited activity is advised after diagnosis, but complete bed rest is not recommended.
Ice packs should be applied at first. After the pain resides, heat should be applied on the region.
Physical therapy and certain exercises are prescribed by the physician
Anti inflammatory drugs can help control the condition and relieve some of the pain.
Surgery is considered only if the condition does not subside after 4-6 weeks. However, such a surgery is risky and may cause permanent nerve damage.
If you feel that you are at risk of prolapsed intervertebral disc, consult a physician immediately. Follow the recommendations of the doctor, so that you do not have to go through the pain associated with the condition.

Prolapsed Disc - What Causes It?

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