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Dr. Yogender Sharma

MBBS, DMRE, DRM

Radiologist, Ghaziabad

42 Years Experience  ·  200 at clinic
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Dr. Yogender Sharma MBBS, DMRE, DRM Radiologist, Ghaziabad
42 Years Experience  ·  200 at clinic
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Personal Statement

I'm a Senior Consultant Radiologist having professional experience of over 35 years....more
I'm a Senior Consultant Radiologist having professional experience of over 35 years.
More about Dr. Yogender Sharma
Dr. Yogender Sharma is one of the best Radiologists in Chander Nagar, Ghaziabad. He has over 42 years of experience as a Radiologist. He is a qualified MBBS, DMRE, DRM . You can visit him at Yogender X Ray House in Chander Nagar, Ghaziabad. Book an appointment online with Dr. Yogender Sharma and consult privately on Lybrate.com.

Lybrate.com has a nexus of the most experienced Radiologists in India. You will find Radiologists with more than 34 years of experience on Lybrate.com. You can find Radiologists online in Ghaziabad and from across India. View the profile of medical specialists and their reviews from other patients to make an informed decision.

Info

Specialty
Education
MBBS - BJ Medical Colleeg Ahemadabad - 1975
DMRE - BJ Medical Colleeg Ahemadabad - 1977
DRM - Mumbai University - 1978
Languages spoken
English
Hindi
Professional Memberships
Indian Radiological and Imaging Association
Indian Medical Association (IMA)

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Yogender X Ray House

D- 5 Chander Nagar Opposite Vivek Vihar Delhi UP Border GhaziabadGhaziabad Get Directions
200 at clinic
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Spine Surgery - Why It Is Must To Prepare Yourself?

MBBS, MS - Orthopaedics, M.Ch, FICS(USA)
Orthopedist, Delhi
Spine Surgery - Why It Is Must To Prepare Yourself?

The thought of going under the knife to treat your spine problem may give rise to a range of emotions; make you ponder over a number of things such as the recovery period, procedure and techniques involved and so on. Nonetheless, before opting for the surgery, there are certain points that you should go over and these are:

  • Be well aware of the cause of your painIdentifying the cause that is behind your pain is vital in order to decide whether the surgery is going to prove beneficial in the long run or not. If the cause is not identified as the right one, the surgery may prove futile and you may not get the pain relief that you're looking for.
  • Gather detailed information about your spine surgeon - Before visiting the spine surgeon, you should collect detailed information about the specialist so as to be able to come up with appropriate questions concerning the surgery. From questions concerning about the surgeon's success and complication rates, numbers of surgeries performed to qualifications of the surgeon, these and much more should be part of your evaluation process.
  • Prepare yourself before a consultation - It's good to prepare yourself before a medical consultation. Whether it's researching about the surgery and your condition or being well aware of your family's medical history, or details about the pain that you experience, or your expectations from the surgery, every aspect should be covered so that you derive the maximum benefit from your meeting.
  • Carry out your own research - Carrying out your own research on the alternatives before opting for the surgery can put you on a better footing. It's imperative to compare the opinion put forward by the surgeon from genuine sources so that you're better able to understand the merits and demerits of the treatment. If you wish to discuss about any specific problem, you can consult an Orthopedist.
4078 people found this helpful

I have back pain L4. L5 problem fast in 5 years. I want to reduce pain with out operation is possible. Please Inform

M.Ch, DNB (Orthopedics), MBBS
Orthopedist, Mohali
You should do a proper regime of medicaton and Exercises for 3 months. the kind of exercises depend on your x-ray and mri reports. Only of this fails completely then we think of other measures like injections to the spine, surgery etc. the basic principle of spine therapy is minimal intervention.
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My mother is suffering from DVT since one week. And is in the hospital by taking medicine. Doctor suggested to do surgery tomorrow. Please suggest what is correct to do?

General Surgeon, Mumbai
To guide you better, pls upload your investigation reports. Dvt surgery is done to avoid complications like embolism, mi, stroke. Or ischemia, increasing limb edema. Etc pls discuss with your doctor in detail. If you do not get required answers. Consult me online.
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Common Causes and Symptoms of Uterine Prolapse

MS - Obstetrics and Gynaecology
Gynaecologist, Chennai
Common Causes and Symptoms of Uterine Prolapse

The uterus is a muscular structure held in place inside your pelvis with the help of muscles, ligaments, and tissues. These muscles weaken in women due to pregnancy, childbirth or delivery complications and can lead to severe complications. One such complication is a uterine prolapse. Uterine prolapse occurs when the uterus sags or slips from its normal position into the vaginal canal.

The causes of uterine prolapse are varied and include:

- Delivering a large baby
- Pregnancy
- Difficulty in labor and delivery
- Reduction in estrogen levels post menopause
- Traumatic childbirth
- Loss or weakening of the pelvic muscle
- Conditions which lead to increased pressure in the abdominal area such as a chronic cough, straining, pelvic tumors or accumulation of fluid in the abdomen
- Loss of external support due to major surgery in pelvic area

Uterine prolapse can be complete or incomplete depending on how far the uterus sags into the vagina. Women who have minor uterine prolapse may not have any visible symptoms. However, if the condition worsens, it manifests itself in visible signs.

Symptoms of moderate or severe prolapse are:

1. A feeling of fullness or pressure in your pelvis when you sit
2. Seeing the uterus or cervix coming out of the vagina
3. Vaginal bleeding or increased discharge
4. Painful sexual intercourse
5. Recurrent bladder infections
6. Continuing back pain with difficulty in walking, urinating and moving your bowels

Without proper attention, the condition can cause impairments in the bowel, and can also affect bladder and sexual function.

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

 

1 person found this helpful

Hi doctor, What are the chances of me getting breast cancer if my mom has got it during her menopause? I am getting married soon and this has raised a concern in my fiance's mind.

MS - General Surgery
General Surgeon, Kanpur
yes there is 2 to 5 times more risk than general population of developing breast cancer if 1 or 2 member of 1st degree relatives are suffering from breast cancer, do routine self examination of your breast.
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I am having ls S1 disk bulge problems if I am having physiotherapist it will cure or not?

DNB (Radiodiagnosis), DMRD, MBBS
Radiologist, Bangalore
Hi, thanks for your query a l 5 - s 1 disc bulge might respond to physical therapy. It cannot be cured completely like before but with precautions and medicine you will feel much better and have a normal life. Please take care not to involve yourself in any activity which might stress your lower back. This will delay recovery and might also cause complications and the pain and discomfort to increase. Avoid doing sudden movement involving lower back and lifting weight more than 5 kg. This will help you recover quickly. For mild pain you should use ointments with muscle relaxant and pain relief. In severe pain plase adk your doctor for oral ner pain reluef medicine and non steroidal anti inflammatory pills. Use of heat pack is also recommended. Regards.
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Ultrasound - How it is Beneficial over Other Imaging Techniques?

DNB (Radio Diagnosis), MBBS
Radiologist, Hyderabad
Ultrasound - How it is Beneficial over Other Imaging Techniques?

Ultra sound is commonly known as sonography. It is a process of reproducing ultrasound images of soft tissues of a particular body part and other organs on the computer screen with the help of the echoes of the sound waves produced by the transducer, a high-frequency generating instrument.
Ultra sound is commonly used during the different stages of pregnancy to denote the foetal health, date of delivery, birth defects etc. However, in recent times, the ultra sound has also been associated with the diagnosis of other body parts such as the eyes, heart, gall bladder, liver, ovary, uterus, kidney, uterus, testicles, and ovaries. Ultra sound has also been useful in conducting biopsies for suspecting cancer patients, although not all of the cancers are detected by this imaging process. 3D & 4D ultrasound imaging are useful for looking at a particular body portion with much more precision and in slow motion respectively.

The advantages of ultra sound are:
1. The process of ultrasound imaging is a painless and a fast one. It does not require any insertion of needles or similar objects to denote the problems of the concerned body part.
2. The process is more convenient as compared to other similar imaging processes like MRI, mammogram and x-rays as they can capture images of the soft tissues, blood flow & cysts more clearly than the other processes.
3. The process is free of any harmful effects as there are no chances of exposure to radiation as compared to similar processes such as CT scans or X-rays. If you wish to discuss about any specific problem, you can consult a doctor and ask a free question.

4891 people found this helpful

Uterine Cancer - Causes, Diagnosis and Treatment

DGO, MBBS
Gynaecologist, Chennai
Uterine Cancer - Causes, Diagnosis and Treatment

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.

3753 people found this helpful

Brain Aneurysms - Key Treatments That Can Help With It!

MCh - Neurosurgery, MBBS
Neurosurgeon, Chennai
Brain Aneurysms - Key Treatments That Can Help With It!

Are you experiencing excruciating headache? you probably didn't know but you could be suffering from brain aneurysms. It is described as bulge formation in the blood vessel in the brain. It is a totally asymptomatic condition as one does not display any symptoms until the bulge vessel ruptures which may result in blood releasing in the skull which may further lead to a stroke. The bulge is often formed in the gaps between the tissues covering the brain and brain itself.

Most common treatment options for ruptured aneurysm
There are two common treatment options for a ruptured brain aneurysm endovascular coiling and surgical clipping. Both these procedures have certain risk factors, therefore it is best to discuss the details with a neurologist. The endovascular coiling is a less invasive process where the surgeon inserts a hollow tube or catheter into an artery and threads it through the body to reach an aneurysm. Then a guide wire is sent to push a soft platinum wire through the catheter. This coils up and disrupts the flow of blood into the aneurysm and leads to blood clotting. The clotting is essential in sealing off the aneurysm from the artery.

The surgical clipping is a process used for closing off the aneurysm, and a section of the skull is required to be removed for assessing the affected part. It also helps in locating the blood vessel that is responsible for the problem. Finally, a metal clip is placed on the neck of the aneurysm to stop the flow of blood. Though endovascular coiling is less invasive and said to be safer, adequate post-treatment care is necessary to minimize risks.
To treat larger aneurysms, a treatment called flow diverters may be useful. Since, the treatment is decided based on the size, location, apperance and your health condition, your doctor will be the best person to take the final call.

Other procedures to treat symptoms
Other than the surgical procedures several treatments might be prescribed to treat the symptoms and to manage complications. A few commonly advised treatments are:

  1. Pain relievers: To manage headaches
  2. Calcium channel blockers: One of the most common complications that may arise with an aneurysm is calcium entering the walls of blood vessels which may result in narrowing of walls. Calcium channel blockers are medications may be prescribed by the doctors to deal with the complication
  3. Anti seizure medications: Medications such as levetiracetam, phenytoin, valproic acid, and others are prescribed to treat seizures associated with aneurysms
  4. Procedures to prevent stroke: An insufficient blood flow may result in a stroke and to prevent it, the drug vasopressor is injected intravenously, or angioplasty is performed.
  5. Rehabilitative therapy: Damage to the brain may require the patient to undergo several physical and occupational therapy.

If you suffer from the condition, it is advised to keep a check on the blood pressure and quit smoking as they can help in reducing the risks associated with aneurysms. 

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

3671 people found this helpful

I have slip disc l4, l5 Should I avoid carrying weights. More over what are the exercise I must follow?

MBBS, MS, DNB, FNB (SPINE SURGERY)
Orthopedist, Chennai
Hi. You should avoid forward bending activities, especially while lifting weights. Learn spinal and core strengthening exercises from a physiotherapist and do them regularly. You should also learn about proper posture and follow it during daily routine activities.
1 person found this helpful

Tips to Prevent Herniated Discs

M.Ch. orthopaedics, M.S. (Orth)
Orthopedist, Ludhiana
Tips to Prevent Herniated Discs

Our spinal disk resembles a jelly donut, wherein the softer insides are protected by the hard exterior. Sometimes, as a result of some injury or an accident the jelly slips out, leading to an extremely painful condition which in medical parlance is known as herniated disc. The pain that you are subjected to, during herniated disc, occurs as the nerves nearby are damaged due to the concussion.

Apart from pain, herniated disc is preceded by other symptoms, some of them are:

  1. Pain in the arm or the leg: Depending on which part of the body you have suffered the herniated disc, in the neck or in your lower back, this condition is succeeded by intense pain either near the buttocks or near the shoulders. It goes without saying that this pain increases sharply with movement.
  2. Numbness: That part of the body where the nerves are damaged due to herniated disc often becomes numb and has no sensation whatsoever.
  3. Weakness: Due to herniated disc, the muscles become weak that considerably impairs and curbs mobility.

However, there are various ways by which you can prevent a herniated disc. Some of them are:

  1. Exercise: Exercise in any form and even for a short while yields several benefits. Your body invariably gains momentum and agility. If you exercise daily, your spine becomes more stable and strong, thereby preventing a possible herniated disc.
  2. Maintaining the right and good posture: A lot depends on the way you sit and walk, in fact more than you can imagine. If you sit badly, it exerts a pressure on the spine and the discs. Subsequently, a good posture does the very reverse and curbs chances of a herniated disc in the future.
  3. Keep a tab on the weight: It is always healthy to maintain the right weight, the one that keeps you away from the onset of various diseases. If you are overweight, it puts more pressure on the spine disk, thereby increasing the risk of developing a herniated disc.
3045 people found this helpful

Abnormal Uterine Bleeding - 3 Ways to Treat it!

MD, MBBS
Gynaecologist, Vadodara
Abnormal Uterine Bleeding - 3 Ways to Treat it!

Any kind of bleeding from the uterus, which is not normal, can be termed as abnormal uterine bleeding. This refers to bleeding between periods or before periods, bleeding after having sex, spotting, abnormally heavy bleeding or bleeding after attaining menopause. If you are suffering from any of these issues, you need to consult with the doctor

Diagnosis
It is very important to diagnose abnormal uterine bleeding. There are several examinations and tests that have to be carried out, depending on age. For irregular spotting, a pregnancy test can be undertaken in case you think you could be pregnant. If your uterine bleeding is very heavy, a test has to be performed to check blood count. This is done to observe whether you have anemia. An ultrasound test of the pelvic region will also be advised by your doctor to know the cause of the bleeding. Several hormonal tests and thyroid function tests are required as well.

Other diagnostic tests include:

  1. Sonohysterography: When fluid is placed within the uterus and ultrasound images of the uterus are taken. An image of the pelvic organs is obtained.
  2. Hysteroscopy: It can be carried out when a device is inserted via the vagina and enables the doctor to examine the uterus internally.
  3. Magnetic resonance imaging: This is also used to get images of the organs.
  4. Endometrial biopsy:  It involves insertion of a catheter to take out a tissue which is microscopically observed. 

Treatment
There are different types of treatment for abnormal uterine bleeding depending upon factors such as the cause of bleeding and the age of the patient.

  1. Medications: Several medicines are used to treat abnormal uterine bleeding. Sometimes hormonal medicines are used. Birth control pills are also used to improve the regularity of periods. Hormonal infections, vaginal creams and an IUD device releasing hormone can be used. Non steroidal anti-inflammatory drugs are also used to control bleeding. Several antibiotics may also be prescribed.
  2. Surgery: In some cases of abnormal uterine bleeding, a woman has to undergo a surgery for the removal of growth such as polyps and fibroids, which results in bleeding. While some fibroids can be removed via hysteroscopy, others require different techniques for treatment.
  3. Endometrial ablation: It can be undertaken to control bleeding. This mode of treatment aims at reducing the bleeding permanently. In case all treatment methods fail, hysterectomy has to be carried out. This is a serious surgery and after it is performed, a woman does not have periods anymore and will not be able to conceive a child.

Abnormal uterine bleeding is a serious health condition, which may lead to severe complications. Immediate diagnosis and appropriate treatment methods should be undertaken in case of any abnormal uterine bleeding.

2639 people found this helpful

MRI SCAn report. There is a partial fusion of C5 C6 VERTEBRAL BODIES. C6 C7 BROAD BASED LEFT posture LATERAL DISC PROTRUSION is noted INDENTING the THECAL SAC CAUSING LEFT NEURAL forminal & impinging LEFT C7 Existing NERVE ROOT. What's the cure for this. Will physical therapy help?

BPTh/BPT, MPTh/MPT
Physiotherapist, Noida
Hot fomentation x twice daily. Neck Exercises. Neck Stretching. Postural Correction. Shoulder Shrugs . Core Strengthening Exercises. Take frequent Breaks at work Use cervical pillow. Use Back Support. Self Massage the back of neck
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I am a 25 years old male, I have been suffering from bulging disk at l5-s1. I have been resting for 2 months, now my neck has started paining too and left pelvic joint is making popping sound everytime it is bend. So I got my blood acid checked. And its been 8 for last two months, I have been drinking like 6 lts water everyday. Is uric acid main reason of pain? And how can I get it down as I don't want to start the medicine so early in life and drinking water is not working. Please suggest, my career is suffering a lot.

MBBS, MS - Orthopaedics
Orthopedist, Delhi
Requires detailed examination and investigation. Preliminary investigations suggested: hb, tlc, dlc, esr, blood sugar fasting & pp, uric acid vit d urine r/e x-ray of the affected part. Anyway it may be tried sleep on a hard bed with soft bedding on it. Spring beds, folding beds or thick mattress are harmful use no pillow under the head. Do hot fomantation paracetamol 250mg od & sos x 5days. Caldikind plus 1tab od x10. Do neck, back, knee & general exercises. It may have to be further investigated. Do not ignore it. Let it not become beginning of a bigger problem. Make sure that patient is not allergic to any of the medicines that he/she is going to take. If it does not give relief in 4-5days, inform.
5 people found this helpful
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Main 22 ki women hun or main memography karwana chahti hun. Memography karwane ka right time konsa hai? Period se pehle ya period ke baad ya phir period ke time?

BHMS, MD - Homeopathy
Homeopath, Mohali
you can get it done anytime in month. if there is lump pain during before or after periods then get it done during that time
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Herniated Disc - Effects And Diagnosis

M Ch. Ortho, MS - Orthopaedics, MBBS
Orthopedist, Delhi
Herniated Disc - Effects And Diagnosis

A Herniated disc also known as a slip disc or prolapsed disc and it refers to the problem where one of the discs located in between the bones of the vertebrae(backbone) gets damaged and stacks itself upon the nerves. The tender inner portion of the disc gets protruded over the outer ring. Herniated disc causes severe neck pain and back pain. It occurs when the outer ring gets weak and tears down. The most common symptoms include pain and numbness, especially on one side of the body. The pain extends down to the arms and legs. It worsens during nighttime. The muscles become weak. Overweight people are likely to have this disease, as the discs carry extra weight. Old people are vulnerable to a slip disc.

Effects of Herniated Disc:

  1. An untreated case of Herniated disc may cause permanent damage to the nerves.
  2. In certain cases, a Herniated disc is capable of cutting off nerve impulses to the "caudal equine"nerves, present in the lower back and legs. This leads to loss of bladder control or bowel control.
  3. Saddle anaesthesia is another long-term effect. Nerves are compressed by the slip disc, causing loss of sensation in the inner portions of your thighs, the back of your legs and surrounding the rectum region.
  4. Symptoms may improve or worsen.

Diagnosis of Herniated Disc:
Treatment or diagnosis of Herniated disc or slipped disc can be either conservative or surgical in nature. The nature of treatment is determined according to your discomfort level and the kind of pain you are experiencing, or how much the disc has slipped out.

  1. The pain caused by Herniated disc can be relieved by undertaking an exercise schedule, which includes stretching and strengthening the spine and its surrounding muscles.
  2. A physiotherapist should be appointed for recommending the types of exercises.
  3. Taking pain relievers also soothes the pain.
  4. Stronger medicines prescribed by doctors include-muscle relaxants, narcotics to deal with the pain, medicines for nerve pain such as "gabapentin"  or "duloxetine".
  5. In case of the symptoms not subsiding within a span of six weeks, a surgery may be recommended by your doctor. The surgeon may have to remove the damaged part of the disc. This surgery is called a microdiscectomy. If you wish to discuss about any specific problem, you can consult an orthopedist.
2585 people found this helpful

I have noticed that the space between c5 and c6 of my spine have increased and as a result my neck and shoulder are very painful. I have also little tmj. What will I do now? Please Please help me.

PG Diploma in Emergency Medicine Services (PGDEMS), Bachelor of Ayurveda, Medicine and Surgery (BAMS), MD - Alternate Medicine
Ayurveda, Ghaziabad
Hello Lybrate user according to Ayurveda Vata vikriti is the main factor for pain. Treatment- 1-apply prasarini oil or pranacharya restopain oil on your affected part and give hot water fomentation. 2-take yograj guggul and agni tundi vati after lunch and dinner with warm water. 3-Take maha rasnadi kwath 2-2 tsf twice a day. 4-Take pranacharya vatari capsule and syrup twice a day. Diet- Avoid fermented food. Junk food. Potato rice. Sleep well.
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Please tell me what can I do in slip disk problem please explain preventive & treatment methods without using drugs because I need not anymore drugs because I already taken lots of drugs.

Fellowship of the Royal College of Surgeons (FRCS), Membership of the Royal College of Surgeons (MRCS)
Orthopedist, Trichy
you have to avoid lifting heavy weight and doing strenuous activities. Core muscle strengthening exercises helps. weight reduction is necessary.
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Brain Exercises - Know More About It!

MD - Psychiatry, MBBS
Psychiatrist, Chennai
Brain Exercises - Know More About It!

The brain is not a stagnant realm fed with a granted quota of intelligence and memory at birth. It is always in a state of flux. Exercising your brain in various ways accelerates its ability to perform better. It is in your hands to have a sharper take on situations and occurrences. Playing games that require brainstorming, solving quizzes, crosswords or playing chess makes you feel rejuvenated and tired at the same time; the reason being activated brain cells. A healthy brain will affect your life decisions positively and you probably will think rightly before you leap.

Tips to exercise those brain cells:

1. Meditate and calm your mind: Ten minutes of meditation each day can help you get over anxiety. When your mind is at peace you think out pros and cons with enhanced insight. This composure reflects in each of your actions. Meditation demands your brain to be quiet when it is accustomed to work; you therefore have greater control over it.
     
2. Music can improve your brain abilities: Music is the best antidote for a sloppy brain. Music excites the neurons healing a bruised memory. It gifts you with clarity of thought. Apart from listening to music one must try to play a musical instrument. Teaching yourself things puts your mind through a strict regimen of constructive activities.
   
3. Take out time to learn a new language: We are paralyzed the minute our brain gives up. Due to several external and internal reasons each one of us is likely to suffer from cognitive disorders on being subjected to extreme pressure or shock. Trying to learn a new language motivate your brain cells to have a wider vocabulary, which further restricts your chances of brain damage.   

4. Mental mathematics could better your intelligence: Calculators, computers and phones are ridding us of our ability to compute individual data. Computation and consolidation of data helps your mind to work faster with precision. So, you now know those lessons on mental mathematics in childhood were actually the key to a well-rounded brain. 

5. Think of something novel: The more the number of neurons the merrier is your brain. Take pains to direct your mind on a novel track. Thinking beyond what is given and expected helps your brain grow new neurons. It builds up your creativity letting you discover more of your capabilities. If you wish to discuss about any specific problem, you can consult a psychiatrist.

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