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Q1. What exactly is Laparoscopy?
Laparoscopy is an alternative to 'Open' surgery wherein the abdomen is opened by tiny 'key hole' incisions and surgery is done. 'Scopy' means the use of an endoscope or telescope to see inside the abdomen. This is attached to a camera and a light source and the inside of the abdomen is projected on to a monitor. The surgeon performs surgery looking at this screen. The surgeon makes a total of 2-4 small cuts on the abdomen ranging from half to 1 cm through which the telescope and other thin surgical instruments are passed into the abdomen. When the uterus is removed , known as hysterectomy, there is also a cut at the top of the vagina where the uterus is attached.
Q2. What kind of gynaecological surgeries can be performed by Laparoscopy?
Most surgeries done in gynaecology can now be performed by Laparoscopy and do not require the large incision as for open surgery. Laparoscopy can be done sometimes only for diagnosis and is called Diagnostic Laparoscopy, as in checking whether the tubes are open or not and to look for any causes of infertility or pain outside the uterus. In women who are unable to conceive, Diagnostic Laparoscopy is often combined with Hysteroscopy (endoscope inside the uterus, inserted from below, via the vagina). When laparoscopy is done to perform some surgical procedure inside the abdomen it is called Operative Laparoscopy. This may be for simple procedures like sterilization, minor adhesions, drilling ovaries; or for intermediate or major reasons like fibroids, endometriosis, removal of ovaries or tubes or both or removal of uterus, for staging of cancers or radical surgeries for cancer. However, about 5% of all surgeries including those for cancer or very large tumours may benefit from open surgery.
Q3. Why does an expert surgeon recommend Laparoscopy over Open Surgery?
Laparoscopic surgery has many advantages above open surgery: the incisions are much smaller (open surgery incisions are 8-10 cms long), therefore pain is much less; requirement for pain killers (which can have side-effects like sleepiness, impaired judgement) is lesser; hospital stay is shorter; complications fewer; requirement for blood transfusions infrequent; recovery in terms of physical, emotional and mental state is much better and quicker; return to work is faster with consequent lesser loss of working and earning days. Surgery with laparoscope is more precise because it is magnified view. Further vision is much better because it's like having your eye behind the structure because you can see with the telescope at places where the surgeon's eye cannot reach.
Q4. If the cuts on the abdomen are so small in Laparoscopic surgery, how do you remove the uterus or a large tumour from inside the abdomen?
Quite often if the tumour is not malignant and contains fluid, it is punctured to collapse it into a smaller size. If it is solid, it can be cut into smaller pieces inside the abdomen using a special instrument. The collapsed or cut structures can be removed gently through the 1 cm cut on the abdomen which may be increased a bit if required. After hysterectomy, the uterus can be removed easily from below, through the vagina.
Q5. Will there be much pain or discomfort after Laparoscopic Surgery?
There may be some pain and discomfort in lower abdomen for one day to few days after Laparoscopic surgery but this is much less as compared to open surgery because the incisions on the abdomen are much smaller and there is much less tissue handling inside the abdomen by fine instruments instead of rough, big, gloved hands which can cause tissue injury in open surgery. There may be some pain in the shoulder following laparoscopy. This is not serious and is due to the gas used in the surgery to make space for instruments.
Q6. When can I be discharged from hospital?
Following Diagnostic Laparoscopy or with simple Operative Laparoscopy you can expect to be discharged from hospital latest by the morning after surgery. In most other cases of intermediate or even major surgery, discharge is generally 1-2 days following the surgery unless there is some health issues prior to the surgery or any complication during the surgery. The complication rates for Laparoscopic surgery are not more than for open surgery and depend upon patient factors like anaemia, diabetes, obesity and skill of the surgeon.
Q7. When can I perform routine household activities or return to work after Laparoscopic Surgery?
Recovery after surgery depends upon many factors: presence of health problems before surgery; why the surgery is required; what surgery is being done; problems or complications of surgery, anaesthesia or blood transfusions. If all is well, one can perform routine household activities by 1 week, provided one doesn't feel tired. Although there may not be any harm, it may be unwise to be normally active within 48 hours of procedure. Following Diagnostic Laparoscopy or Operative Laparoscopy for simple procedures, one can return to work in 1 week. For other procedures, a 2-3 week off from work is reasonable. It depends on the type of work you are returning to. Avoid too rapid return to work if it is manually hard or requires standing for long durations of time. Sometimes a surgical procedure brings on a well needed rest and break from a lifetime of work. Mostly, when you return to work depends upon your own body and its signals of tiredness. You need to listen to those signals.
I have a Acl tear in my left knee doctor advised for an operation should I go for it I am a athlete and 21 year old male.
Sir I am 62 l have got disc prolapse of my spine spine. Backpain- radiated toy right leg causing severe pain please give remedy.
Did you know barley water is good for kidney stones?
Barley (jau), a member of grass family, is a cereal that has been cultivated for over 13, 000 years. Packed with carbohydrates (78%), fat (1%), protein (10%) and water (10%), barley is a rich source of essential nutrients, dietary fiber, vitamins such as niacin, manganese, phosphorus and vitamin B6.
With several health benefits to its name, barley water is termed as the elixir to good health. It has been found to be beneficial in reducing chances of heart disease, soothing bowels, reducing blood cholesterol levels, improving blood sugar regulation in the body and acts as nutritive broth for fever, cold and cough. Additionally, studies support that barley water has also been found to play an integral role in maintaining renal health.
What is a renal stone?
A renal stone is a solid stony piece consisting of crystal forming substances in the urinary tract. They are usually formed when the urine is abundant in substances such as calcium, oxalate and uric acid and lack substances that inhibit their accumulation. While small kidney stones can pass through the urinary system without any symptoms, a stone larger than 5 mm can result in blockages in the urinary tract causing severe pain in the back and lower abdomen.
What causes renal stones?
- A family history for stones, lack of adequate water in the body, high BMI, excessive intake of diets rich in protein, sodium and sugar have been found to be some of the common causes for stone formation.
Try protein foods &amp; supplements
- Medical conditions such as hyperthyroidism, inflammatory bowel syndrome and renal tubular acidosis have also been found to alter the digestion of calcium.
How does barley water aid the dissolution of renal stones?
Studies show that regular use of barley water can dissolve and eliminate existing kidney stones and prevent the occurrence of stones and other kidney problems. Use of diuretics either natural or synthetic can help speed up the expulsion of the stone.
Diuretic in nature, barley water helps to flush toxins from the kidneys by creating bladder pressure and increasing the frequency of urination.
- It helps maintain the PH levels in the body, making it alkaline, preventing various urinary tract issues, including kidney stones.
- The vitamin B6 and magnesium in barley helps break down the masses of toxic calcium oxalate (primary cause for stones) in the kidney.
Dietary fiber in barley reduces the amount of calcium that is excreted by the body through urine, restoring renal health and cleansing the kidneys.
Ways to prepare barley water:
- Boil 1 litre of water with a tablespoon of barley pearls and boil on a low flame for about 30 minutes or until the water has reduced to half.
- Strain and cool this mix and drink it through the day.
- Add lemon juice or honey to make the mix tasty
Regular use of barley water ensures that the renal system is hydrated, healthy and free of depositions such as renal stones. So, go ahead and add this elixir to your diet to ensure a healthy renal system and a healthier you. Eat healthy, stay healthy!
Breast cancer is a type of cancer, which occurs due to the development of cancerous cells in breasts. Women are usually affected by breast cancer and breast cancer is one of the most common forms of cancer after skin cancer. Usually fatal if not diagnosed in its early stage, breast cancer is a very serious medical ailment. Read on more to find all about the different symptoms, causes, preventive measures and treatment of breast cancer.
Symptoms: Breast cancer has few distinct characteristics and if you have a few or all the following symptoms you could be more likely to suffer from breast cancer.
- The formation of a lump in your breast, which is different from the surrounding tissue and usually more thickened.
- The discharge of bloody fluid material from the nipples.
- Sudden change of the size, shape and appearance of the breast.
- Certain distinct changes to the skin over the breast for example an indentation in the skin similar to that of a dimple.
- Appearance of an extra nipple which is inverted.
- If the darkened area around the nipples known as the areola is flaking or peeling off.
Causes: Studies and researches remain inconclusive on what causes breast cancer. Breast cancer occurs due to abnormal division of the cells located in the breast, which over time accumulate and form lumps. They
might spread to other parts of the body. Breast cancer is caused mainly due to a complex interaction of personal genetics, environment and lifestyle choices. Breast cancer can also be caused due to genetics as about 5% to 10% of cases are due to gene mutations which pass onto generations.
Risk factors: There are certain factors, which increase the probability of contracting breast cancer. Increasing age, personal and family history of breast cancer, obesity, radiation exposure, pregnancy at an older age, postmenopausal hormone therapy are some of the factors that increase the chances of breast cancer.
Treatment: Several forms of surgical methods exist to treat breast cancer. Depending on the condition and spread of the disease a suitable surgery is performed. These include mastectomy, lumpectomy, axillary lymph node dissection and removal of both breasts. Other forms of treatment include chemotherapy or the use of high doses of drugs to destroy cancerous cells. Radiation therapy where X-rays are used to destroy the cancer cells is also effective.
I am having problem in l4 and I5. This problem is from around 3 years. But the condition is improved now. Can you please suggest some exercises?
Also known as slipped disc, herniated disc or sciatica. The discs are the shock absorbers of your spine. When they are injured the inner soft part of the disc can protrude out through a tear in the outer lining of the disc. This disc material can press on the nerves in the spinal column, injuring them through direct pressure and causing inflammation.
The most common age to develop a disc prolapse is between the ages of 30-50 years., twice as many men as women are affected. Prolpased discs occur mainly in the low back (lumbar) spine. Less than I in 20 cases of back pain are due to a disc prolapse, most are due to mechanical back pain. (see section back pain).
A slipped disc is characterised by sudden, severe back pain that is often made worse by movement and which can usually be eased by lying down flat.
Nerve root pain (sciatica) can also occur because a nerve is trapped or irritated by a prolapsed disc. Although the problem is in the back, patients experience pain along the course of the nerve, for example, down a leg to the calf or foot.
With a prolapsed disc, the sciatic nerve is most commonly affected. The sciatic nerve is a large nerve that is made up from several smaller nerves that come out from the spinal cord in the lower back and travels down each leg. The irritation or pressure on the nerve may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot.
In rare cases, cauda equina syndrome can occur. This is a disorder where the nerves at the very bottom of the spinal cord are trapped. It can cause low back pain as well as problems with bowel and bladder function and weakness in one or both legs. These symptoms need urgent medical treatment to prevent permanent damage to the nerves that supply the bladder and bowel.
A large number of people can have a prolapsed disc without any symptoms if it doesn’t trap or irritate the nerve.
A doctor will normally be able to diagnose a prolapsed disc from the symptoms and by examining the patient.
In most cases, no tests are needed, as the symptoms often settle within a few weeks.
Tests such as x-rays or scans may be advised if symptoms persist. In particular, an MRI scan can show the site and size of a prolapsed disc. This information is needed if surgery is being considered
I have a back disc doctor has advised to take complete bed rest for 3 months but I am preparing for competitive exam which is not possible. is there any way so that I will be ok?
I have been diagonosed for Lumber region disc displacement/compression in L1-L2-L3-L4.Though I have been taking homeo medicine for past 8-9 months, the pain subsidise for some days but comes back again at lower back and down the right leg thighs,knee and calf muscles. Sometimes it is also on left leg side. Can I restart tretment again. Prescribe some medicines and other preventive treatment to correct this defect
I am 63 year old male, having- (1) a sciatica on right side (2) herniation between in lumber, as a result suffering from leg and lower back pain. I want your valued answer of treatment.
I want to know about disk pain. i am suffering from this pain from very long . please suggest me good treatment
I am male 39 I have a problem of obesity combined with disk problem. If to reduce tummy I go for walk the backache develops. If I take rest for improving disk problem then tummy gets large. Suggest solution.
Breast cancer awareness
October is breast cancer awareness month and a great time to highlight the importance of maintaining healthy habits to support breast health. One disease that most women fear these days, you would probably reply" breast cancer.
Understand what you can do to reduce your breast cancer risk. So follow these guidelines and know that you are doing all that you possibly can to protect yourself from developing breast cancer. Be thankful every day that your breasts are healthy.
Check your own breasts regularly. Do monthly self-breast examinations after your period is over. If you find any lumps or tenderness that concerns you, have it checked out right away. Fortunately, 80% of breast lumps are benign. When you examine your breasts, remember that lumps which are soft, movable, and change with your menstrual cycle are much less likely to be cancerous. Any discharge from the nipple other than breast milk should be checked out by your health professional.
Get regular mammograms. In a woman without breast symptoms and with no significant risk of breast cancer, I recommend mammograms beginning age 35 or 40 every two years. For women without breast symptoms who are at higher risk of breast cancer, I recommend yearly mammograms beginning at age 35. Beginning at age 50, the rate of breast cancer goes up, so yearly mammograms are advised.
Limit alcohol intake. The more alcohol you drink, the greater your risk of developing breast cancer.
Get to and maintain a healthy weight - if your bmi is out of the healthy range, find a program and tools to help you get to a healthy weight, which is important for maintaining health in general, including breast health. Obesity, particularly after menopause, can greatly increase your risk of breast cancer. Aim for gradual weight loss by choosing minimally processed foods and eating smaller portions.
Don't smoke - accumulating evidence suggests a link between smoking and breast cancer risk, particularly in pre -menopausal women.
Exercise regularly - physical activity can help you maintain a healthy weight, which, in turn, helps prevent breast cancer.
Limit dose and duration of hormone therapy - if you're taking hormone therapy for menopausal symptoms, ask your doctor about other options. You might be able to manage your symptoms with non-hormonal therapies and medications.
Choose the right supplements - filling in nutrition gaps with supplements can help you support breast health. Look for options that contain vitamin d and omega-3 fatty acids, as they have both been associated with maintaining breast health.
Breast-feed your babies for as long as possible - women who breast-feed their babies for at least a year in total have a reduced risk of developing breast cancer later.
Cancer is the abnormal, uncontrolled growth of cells in a particular body part. With continued growth, pieces of this tissue travel through the blood to different body parts and continue to grow in the new area. This is known as metastases. Breast cancer is one of the most common forms of cancer and affects about 1 in 8 women in the USA. Read on to know more details of breast cancer – breast anatomy, causes, symptoms, risk factors, detection, prevention, and of course treatment.
Anatomy: The main function of the breast is lactation through its milk-producing tissue that are connected to the nipple by narrow ducts. In addition, there is surrounding connective tissue, fibrous material, fat, nerves, blood vessels and lymphatic channels which complete the structure. This is essential to know as most breast cancers develop as small calcifications (hardened particles) in the ducts or as small lumps in the breast tissue which then continues to grow into cancer. The spread can happen through lymphatic or blood flow to other organs.
Warning signs/symptoms: The following are some symptoms that need to be watched out for if you have a predisposition to breast cancer.
- A lump in either of the breasts or armpits
- Change in size, shape, or contour of either breast
- Redness of your breast or nipple
- Discharge of clear or bloody fluid
- Thickening of breast tissue or skin that lasts through a period
- Altered look or feel of the skin on the breast or the nipple (dimpled, inflamed, scaly, or puckered)
- One area on the breast that looks very different from the other areas
- Hardened area under the breast skin
Either one or a combination of these should be an indication to get a detailed checkup done. Early diagnosis results in controlling the disease with minimal treatment and reduced complications.
Causes and risk factors: The exact cause for breast cancer is yet to be pinned down. However, risk factors are clearly identified, and women with risk factors need to watch out for warning signs.
- Family history: Of all the risk factors, the family history is the most important. Breast cancer runs in families, and if there is a first-degree relative with the breast cancer, the chances of developing it are almost double. Two genes BRCA1 and BRCA2 are the carriers of the disease, and this testing can be done in women to identify if they are at risk.
- Family history of other cancers: Even if there is no breast cancer, if there are other cancers that run in the family, watch out.
- Age: Women over 50 are at higher risk of developing breast cancer.
- Race: Caucasian and Jewish women are at higher risk of breast cancer than African-American women.
- Hormones: Greater exposure to the female hormone estrogen increases the chances of developing breast cancer. Women who use birth control pills for contraception and hormone replacement after menopause are at a higher risk of developing breast cancer.
- Gynecologic milestones: Women who have abnormal menstrual milestones need to watch out. These include those who attain menarche before 12 years of age, get pregnant after 30, attain menopause after 55, and have menstrual cycles shorter than 26 days or longer than 29 days.
- Obesity and alcohol abuse are also likely to increase a woman’s chances of developing breast cancer.
Stages: Starting from stage 0, higher stages indicate advanced disease.
- Stage 0: The growth which has begun in the milk-producing tissue or the ducts has remained there (in situ) and not spread to any other area, including the rest of the breast.
- Stage I: The tissue slowly becomes invasive and has begun to affect the surrounding healthy tissue. It could have spread to the fatty breast tissue and some breast tissue may be found in the nearby lymph nodes.
- Stage II: The cancer at this stage grows considerably or spreads to other parts. There are chances that cancer may grow and also spread.
- Stage III: It may have spread to the bones or other organs but small amounts are present in up to 9 to 10 of the lymph nodes in the armpits and collar bones which makes it is difficult to fight.
- Stage IV: The cancer is widespread to far-flung areas like the liver, lungs, bones, and even the brain.
Screening: This is one of the most effective ways to identify the disease in its early stages. This will help in controlling cancer from spreading with minimal treatment.
- Self-examination: A thorough self-examination to look for changes in terms of shape, size, colour, contour, and firmness should be learned by all women. Watch for any discharge, sores, rashes, or swelling in the breasts, surrounding skin, and nipple. Examine them while standing and when lying down.
- In most women, annual screening mammograms are advised after the age of 40. However, in women who have a strong family history or genetic makeup, it is advisable to have screening mammograms starting at age 20 every 3 years and then annually from the age of 40.
- Women in high-risk categories should have screening mammograms every year and typically start at an earlier age.
- Ultrasound screening can also be given in addition to mammograms.
- Breast MRI is another way to screen for breast cancer if the risk is greater.
Breast Cancer Prevention: Now that there is so much awareness about causes and risk factors, there are definitely ways to prevent or delay the onset of the disease.
- Exercise and a healthy diet with reduced amount of alcohol are definitely effective in minimising the chances of developing cancer.
- Tamoxifen is used in women who are at high risk for breast cancer.
- Evista (raloxifene) which is used to treat osteoporosis after menopause. It is also widely used in preventing breast cancer.
- In high-risk women, breasts are surgically removed to prevent the development of cancer (preventive mastectomy).
Treatment: As with all cancers, treatment would depend on the stage at which it is identified and include a combination of chemotherapy, radiation, and surgery. As noted earlier, if you are at risk, look out for warning signs as early diagnosis is the key to maximum recovery.