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Dr. Madhu Aggarwal

Radiologist, Delhi

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Dr. Madhu Aggarwal Radiologist, Delhi
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To provide my patients with the highest quality healthcare, I'm dedicated to the newest advancements and keep up-to-date with the latest health care technologies....more
To provide my patients with the highest quality healthcare, I'm dedicated to the newest advancements and keep up-to-date with the latest health care technologies.
More about Dr. Madhu Aggarwal
Dr. Madhu Aggarwal is a trusted Radiologist in Gujranwala Town, Delhi. You can visit him at Vinayak Hospital- Derawal in Gujranwala Town, Delhi. Save your time and book an appointment online with Dr. Madhu Aggarwal on Lybrate.com.

Lybrate.com has an excellent community of Radiologists in India. You will find Radiologists with more than 41 years of experience on Lybrate.com. You can find Radiologists online in Delhi and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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Vinayak Hospital- Derawal

P No-2, Nr Gujranwala Town, Derawal Ngr, Model Town-2, Main Rd, Gujranwala Town. Landmark: Near Ashirwad Benquit Hall, DelhiDelhi Get Directions
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Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

MBBS, MD, FIMSA, FIPP
Pain Management Specialist, Delhi
Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

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 

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

Outcome 

  1. PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
  2. 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.
  3. PVP does augment height of VB but ideal would be kyphoplasty.
  4. Patient is either off medicine or on reduced doses.
  5. Patient feels so well that he almost forgets if he had VB

In case you have a concern or query you can always consult an expert & get answers to your questions!

4342 people found this helpful

Hello doctor, Can I play hardcore cricket after L4 L5 disc bulge recovery? Thanks in advance.

MD - Homeopathy, BHMS
Homeopath, Vadodara
Start gradually. Do proper exercise to strengthen the part.. Take homoeopathic treatment side by side.
1 person found this helpful
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Breast Cancer Symptoms In Hindi! - स्तन कैंसर के लक्षण

MBBS, M.Sc - Dietitics / Nutrition
Dietitian/Nutritionist, Delhi
Breast Cancer Symptoms In Hindi! - स्तन कैंसर के लक्षण

स्तन वसा, संयोजी ऊतक, और लोब में विभाजित ग्रंथि ऊतक से बना होता है। स्तन कैंसर तब शुरू होता है जब स्तन में कोशिकाएं नियंत्रण से बाहर निकलने लगती हैं। नलिकाएं का एक नेटवर्क लोब से निपल तक फैलता है। एक स्तन आमतौर पर दूसरे से छोटा होता है। महीने में अलग-अलग समय पर आपके स्तन अलग-अलग महसूस कर सकते हैं स्तनों के लिए आपकी अवधि के ठीक पहले लंपट महसूस करना आम बात है। आपके स्तन महीने में अलग-अलग समय पर अलग-अलग महसूस हो सकते हैं। स्तनों का आपकी अवधि के ठीक पहले लंपट महसूस होना आम बात है। 
स्तन कैंसर सामान्यतः कोशिकाओं जो स्तन के नलिकाएं होती हैं, में शुरू होता है। स्तन कैंसर तब शुरू होता है जब स्तन में कोशिकाएं नियंत्रण से बाहर बढ़ने लगती हैं। कोशिकाओं का यह उत्परिवर्तन एक ट्यूमर को जन्म देता है, जिसे एक गांठ के रूप में महसूस किया जा सकता है। अगर अनुपचारित छोड़ दिया जाता है, तो घातक कोशिका अंततः शरीर के अन्य भागों में फैल सकती हैं, एक प्रक्रिया जिसे मेटास्टैसिस कहा जाता है। 
स्तन कैंसर के लक्षण
स्तन में एक गांठ आमतौर पर स्तन कैंसर से जुड़ा है, लेकिन अधिकतर समय, स्तन में गांठ कैंसर नहीं होता। किशोरावस्था में हार्मोनल परिवर्तन से लेकर क्षतिग्रस्त वसा ऊतक तक, महिलाओं में शुरुआती 20 से लेकर शुरुआती 50 की उम्र तक सभी स्तन गांठों में से 90 प्रतिशत से ज्यादा गैर-कर्कश (सौम्य) हैं। 
स्तम्भों में लंप्स स्तन संक्रमण, फाइब्रोकाइसटिक स्तन रोग (ढेलेदार स्तन), फाइब्रोएडीनोमा (गैर-कन्सेसर ट्यूमर), वसा-परिगलन (क्षतिग्रस्त ऊतक) जैसे कई अन्य कारणों के कारण हो सकते हैं।
यद्यपि अधिकांश स्तन गांठ कम गंभीर स्थितियों के कारण होते हैं, नए, पीड़ारहित गांठें फिर भी स्तन कैंसर का सबसे आम लक्षण हैं। एक महिला अपने स्तन में बदलाव देख सकती है, और मामूली असामान्य दर्द जो दूर जाता प्रतीत नहीं होता। इन परिवर्तनों के लिए देखें:

1. स्तन या निपल का अलग महसूस होना:
- निपल कोमलता, या स्तन या अंडरआर्म क्षेत्र में या उसके पास एक गांठ या मोटा होना।
- त्वचा की बनावट में परिवर्तन या स्तन की त्वचा में छिद्रों का इज़ाफ़ा
- स्तन में एक गांठ

2. दिखने में बदलाव:
- स्तन के माप या आकार में कोई भी अस्पष्टीकृत परिवर्तन
- स्तन पर कहीं भी गढ़ा
- स्तन की अस्पष्ट सूजन (खासकर अगर यह केवल एक तरफ है)
- स्तन का अस्पष्ट संकुचन (खासकर अगर यह केवल एक तरफ है)
- निप्पल जो थोड़ा सा आवक हो जाता है, या उलटा हो गया है

3. निपल निर्वहन:
किसी भी प्रकार के निप्पल निर्वहन, विशेष रूप से साफ़ निर्वहन या खूनी निर्वहन स्तन कैंसर का संकेत हो सकता है। एक दूधिया निर्वहन जब महिला स्तनपान नहीं कर रही है, हालांकि स्तन कैंसर से जुड़ा नहीं है, लेकिन एक डॉक्टर द्वारा जांच कराया जाना चाहिए।
इन लक्षणों में से एक या अधिक होने का मतलब यह नहीं है कि आपको स्तन कैंसर है। यदि आप इन संकेत और लक्षणों में से किसी का अनुभव करते हैं, तो एक पूर्ण मूल्यांकन के लिए अपने चिकित्सक को देखें।

4115 people found this helpful

Doctor I have a compressed Disc that is L4 and l5 which is pressing my nerve and I find it very Difficult to stand straight or walk. And the pain is coming under the Thigh is there a cure either than Surgery Thanks expecting a Response soon thanks a lot. I am Diabetic and 55 years old.

MD Internal Medicine, MBBS
General Physician, Delhi
Doctor I have a compressed Disc that is L4 and l5 which is pressing my nerve and I find it very Difficult to stand st...
Being a diabetic, it's important to get your weight under control, for nerve compression you could try non surgical treatment, you need however to be aware that progression of the nerve pressure can result in paralysis of the legs.
1 person found this helpful
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How To Diagnose Breast Cancer ?

Dip In Gynae & Obs, Doctor of Medicine, MBBS Bachelor of Medicine and Bachelor of Surgery
Gynaecologist, Lucknow
How To Diagnose Breast Cancer ?

Breast cancer is a form of cancer which develops from the breast tissue. Breast cancer is indicated by signs such as a lump in the breast, changes in breast shape, fluid flowing from the nipple, dimpling of skin, or the development of red scaly patches. Breast cancer is a fatal form of cancer in women and immediate diagnosis is required on observing the symptoms.

Diagnosis of breast cancer
Other than the regular breast screening, the diagnosis of breast cancer involves the following steps and methods:

  1. Seeing your general practitioner (GP): It is very important to visit your GP soon after noticing the symptoms of breast cancer. Your GP will examine you properly and in case your symptoms need more assessment, he/she will refer you to a breast cancer clinic.
  2. Mammogram and breast ultrasoundYou will be required to have a mammogram, as recommended by a specialist breast unit. This is an X-ray of the breasts. An ultrasound scan may also be required. Breast ultrasound should be undertaken only if you are less than 35 years of age. This is because, young women have denser breasts and a mammogram is not as effective as ultrasound in the diagnosis of breast cancer. In ultrasound, high frequency sound waves are used for obtaining an image of your breasts. It is observed to notice any abnormality or lumps. A breast ultrasound is also important for determining whether a lump is solid or contains liquid.
  3. BiopsyIn this diagnosis process, a sample of the tissue cells is taken from the breasts and tested under a microscope to find out if it is cancerous. A scan and needle test for the lymph nodes present in your armpit is also done to check whether they have also been affected. A biopsy is undertaken in several ways, depending upon the condition and severity. A needle aspiration biopsy is used for testing a sample of your breast cells without the removal of the tissues. This is the most common form of biopsy and it is also used for draining a small fluid-filled lump or benign cyst. During the process, you will be given a local anesthetic. Usually, a needle biopsy is carried out guided by an X-ray, ultrasound and an MRI scan as well. This helps in distinguishing it from non-invasive changes such as ductal carcinoma in situ.

Another form of biopsy used for the diagnosis of breast cancer is called vacuum assisted biopsy or mammotome biopsy. In this process, a needle gets attached to a suction tube, which helps in obtaining the sample and for clearing the bleeding. In case you have a concern or query you can always consult an expert & get answers to your questions!

2520 people found this helpful

Uterine Cancer And Its Ayurvedic Managment

MD- Ayurvedic Pathology
Ayurveda, Amritsar

Ayurveda is a form of medicine that has been practiced for thousands of years and has many effective cure for some of the most complex diseases. Cancer, in this day and age, is one such complex disease and its incidence is increasing rapidly. It is always recommended to consult a ayurveda specialist for severe cancer. Some of the common ingredients for treatment of uterine cancer through ayurveda are mentioned here.

Turmeric: Already a staple spice in many indian dishes, turmeric as a herb in raw form and as a spice in powdered form, is touted the new wonder herb all across the world. It has been used as a traditional healing herb in india since ages. It has also been seen to be a very effective anti-inflammatory agent and thus it is very effective in stopping the growth of cancer cells.
Green tea from the camellia sinensis plant: green tea has been known to be effective in treating multiple types of cancer, aid in weight loss and also facilitate detoxification. Regular consumption of green tea from the camellia sinensis plant is known to fight the growth of cancer cells within the body; thus is a very effective in treating uterine cancer as well.
Ashwagandha: this herb is not only used in ayurveda, but has also been adopted by homeopathy as conventional medicine to make extracts. Ashwagandha is an adaptogen, which means it can adapt to the requirements of the body and then make the changes to provide support to the necessary areas. It is also very good at preventing the growth of cancer cells.
Garlic: This spice is known to be good for multiple forms of cancer as it contains allicin, which is being hailed as one of the best fighters of inflammatory diseases. It also contains other types of phytochemicals and thus helps in detoxifying the body. It is very effective in fighting cancer cells and can arrest the growth of cancer within the body.
Ginger: Ginger is extremely effective in the treatment of many ailments, if consumed regularly in controlled amounts. It has been known to be very effective in the treatment of colon cancer. Due to its properties, it is also known to be effective in the prevention of uterine and many other forms of cancer.

Ayurvedic thrapies:

Ayurveda, an enigmatic yet enthralling science offers numerous treatment methods for uterine cancer. Here are a few: 

Matra basti: Matra basti is a special treatment in traditional ayurveda for chronic constipation, low back pain, rheumatoid arthritis, obesity, and various neurological disorders like multiple sclerosis, epilepsy, dystrophy and atrophy of nerves and muscle. In this treatment, certain herbal oils and herbal extracts are applied through the rectum on a daily basis. Matra vasti has a lubricating, balancing, nourishing, strengthening and pacifying effect. It also works as rejuvenator, immune-modulator and nutrient and subdues elevated vata dosha. The treatment lasts for a period of 3 to 7 days.

Pichu dharanam for soothing at advance stages of uterine cancer: it is a special treatment modality in ayurveda where sterile medicated cotton swab is kept inside the vagina for a specific period of time. This comes under local treatment modalities specific to gynaecological diseases in females and is also done in ante natal care. Pichu means cotton ball. Yoni pichu is the application of a sterile cotton swab soaked in medicated oil or ghee in the vagina.
Abhyangam: Abhyangam is a form of ayurvedic medicine that involves massage of the body with large amounts of warm oil. It s a complete body massage and really effective. The abhyangam massage therapy is very beneficial and prevents degeneration and ceases the aging process. This therapy needs more positions to massage and comparing to other massage therapy, abhyangam is very special. It usually involves oils prepared with specialized ayurvedic herbs and essential oils for lymph drainage, detox, and relaxation. It has seven positions and it treats the whole body. It assures new healthy physical changes. 
Nasyam: Nasyam or errhine therapy is an ayurvedic treatment excellent remedy for chronic sinusuitis, headache, throat diseases, epilepsy, catarrh, migraine, voice constraint, eye diseases and cervical spondylitis. In ayurveda, the application of medical oils or powders through the nostrils is called nasya. It is said in classical texts that the nostrils are the doorway to the brain. Nasya is an important method of treatment for illnesses of the cranial region. Nasya treatment - the forehead and neck regions of the patient are gently massaged with a suitable oil to induce sweating. Thereafter the patient is made to lie down on his back with his head bent slightly back. Warm oil is then dripped into both nostrils which the patient draws in.

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Know More About Uterus Removal

MBBS, DGO, F.I.C.O.G., Dipl.Endo. Surgery (USA)
Gynaecologist, Delhi
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I am Dr. Malvika Sabharwal from jeevan mala hospital and apolo spectral hospital in Karol Bagh, New Delhi India.

I am gonna tell you about uterus removal. Uterus removal is a very common operation. Bht commonly isko kara jata hai k patient ata hai apko bolta hai k ji hamary ko flah flah flah problem hai or ap hamara uterus nikal dijiye. Sb sy phly to main apko btaungi kya indications hain. Chahye wo fibroid k hn, ya bleeding zyada ho rai ho. Koi fibroid nai hai per bleeding bht zyada ho rai hai ya koi changes a rhy hain. Jaisa k agr mouth of the uterus main agr koi peps pal krty hain routinely jo k karna chahye, her ek marez k liye. Ap regular apasnaol kar ry hain us main koi changes any lag jaty hain ya aisi koi bhi problem ho to patient ata hai or wo bara clear mind sy kehta hai k ji mje uterus remove krwana hai. Kbhi kbhi wo refered cases hoty hain. Ya marez ko kahein kaha jata hai or hamary pas aty hain. Q k hamary pas jo uterus removal ka tareka hai wo hai durbeen sy or ek pait khol k. pait khol kr jo karty hain, ek bara 8 centimeter, 8 inches k kareeb ek insection hota hai pait k upper or us k through hm uterus ko, us ko pakar k baher nikal k us ki puri surgery kr k as pas disconnect kr k us ko nikal dety hain. Or abdomen ko stitch kr dety hain. Laparoscopic surgery jb sy hm ny shuru kari hai. Year was 92. I think ye sb sy bara bone hai. Doctor k lye bhi, patient k lye bhi. Ek to patient friendly surgery hai. Or doctor k liye offcourse, doctor ko sekhny main thora samain zaror lgta hai,but once you have commanded the technique of Laparoscopic surgery, it is the best. It is the best for the patient and for you it’s a very affective way of taking out the uterus without any problems. Ap us ko Laparoscopicly nikalty ho or Laparoscopicly jb nikalty ho 1 din ka stay rehta hai hospital main. 1 din main mareez back to normal work hota hai. Wo ghr ja kr k, serhioyon sy charhta hai. Serhiyon par jaye, upper rahy, ghar k khanay bnaye, baheer ghumny jaye, hr roz piture dekhy, us py koi issue nai hai. Bht minimal unko btaya jata hai do’s and don’t’s. unka upper charhny main koi problem nai ati. Sirf halki phulki jo problem, sirf 2 chezain ki hm log btaty hain which Is hardly any issue. So patient is back to normal routine. Ap apny ffice dubara ja skty hain itni jaldi. Loss of working days is very less. To loss of working days jaisy e kam oty hain, aj kal apko pta hi hai, mostly ladies are working, most of the women are working today. Chahy wo ghr py, ghr ka bhi kam itna hota hai. Bachon k aj kal kitny kam hoty hain, us k ilawa office girls bht hoti hain. Jo k office ko bhi sambhalti hain or ghr ko bhi sambalti hain. Let me tell you hamary bht patients hain un ko kbhi ye problem nai I k hum uterus nikalny k bad hm ghr ka kam nai kar paye. Ya office ka kam nai kar paye. Hamary pas doctors aty hain. Dur dur sy aty hain, in fact patients are coming from dubai, London, America, Canada all over. Wo aty hain apna operation krwaty hain or 2 din k bad they are ready to go home. Because this surgery has really picked up so much k jb o dekhty hain k kitny aram sy ye kam ota hai to unko aisa koi hesitancy nai lagti. Un k roz mara ki zindagi main koi change nai ata. Unko minimalistic thory sy do’s and don’ts hoty hain which is hardly anything. And aam tor per jb hum uterus nikalty hain, jaisa k main apko dekhati hn. This is one uterus. Two tubes and two ovaries. Aj agr main uterus nikal rai hn, lady ka age hai 45, I will tell her definetly ovary tubes to ap nikal hi lijye. Ovaries jo hain, wo apko hormones deti hain. Hormones ek lady ko femerity bna k rakhti hai. Femariti sy ye bhi matlab hai, tubes ka koi aisa role nai hai per ovaries apko hormones dy k, hormones k karan apka skin, hair, heart, sb k upper us ka zor hai. So ovaries ko hum bina puchy bilkul nai nikalty. Us k lye permission lety hain tabhi nikali jati hai. Per agr uterus nikal ry hain to aam tor per hum tubes ko bhi nikal dety hain.

Thank you very much.

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Please suggest. What should be done for slip disk problem along with allopathic treatment?

MBBS, D'Ortho, DNB (Orthopedics)
Orthopedist, Mumbai
Hello lybrate-user slip disc common at this age, as you already taking medication would suggest to start physiotherapy core stabilising exercises.
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