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Overview

Hynidase 1500Iu Injection

Manufacturer: Shreya Life Sciences Pvt Ltd
Medicine composition: Hyaluronidase
Prescription vs.OTC: Prescription by Doctor required

Hynidase 1500Iu Injection is an enzyme solution that can be injected and helps in enhancing the natural degradation of hyaluronic acid. It being a spreading substance is combined with other medicines and injected under the skin to improvise their absorption by the body when the drug cannot be injected into the vein. It also improves the absorption of radioactive substances during subcutaneous urography.

The first dose of Hynidase 1500Iu Injection must be given after a skin test to check whether the person is allergic to it or not. It should not be directly applied in the eye or injected into infected skin or vein. It should not be used to catalyse the absorption of dopamine or alpha agonist medicines. The physician should be contacted if a dose is missed.

Hynidase 1500Iu Injection is available in the form of solution or powder for solution in strength(s) of 150 units/ml, 200 units/ml, 150 units, 1500 units and 6200 units. For proper dosage a physician or pharmacist should be consulted.

Side effects of Hynidase 1500Iu Injection include skin rashes and redness, itching, unusual weakness, difficulty in swallowing, dizziness, tightness in the chest, swelling of eyelids, lips, tongue or face, fast heartbeat, cough.

In addition to its intended effect, Hynidase 1500Iu Injection may cause some unwanted effects too. In such cases, you must seek medical attention immediately. This is not an exhaustive list of side effects. Please inform your doctor if you experience any adverse reaction to the medication.
Acute urticaria
Hormone imbalance
Slow growth in children and teenagers
Angioedema (swelling of deeper layers of skin)
Injection site reaction
Edema.
Is It safe with alcohol?
Interaction with alcohol is unknown. Please consult your doctor.
Are there any pregnancy warnings?
Hynidase 1500iu injection may be unsafe to use during pregnancy.
Animal studies have shown adverse effects on the foetus, however, there are limited human studies. The benefits from use in pregnant women may be acceptable despite the risk. Please consult your doctor.
Are there any breast-feeding warnings?
Hynidase 1500iu injection is probably safe to use during breastfeeding. Please consult your doctor.
Is it safe to drive while on this medicine?
There is no interaction between driving and consuming this drug. So dose alteration is not needed.
Does this affect kidney function?
There is no data available. Please consult doctor before consuming the drug.
Does this affect liver function?
There is no data available. Please consult doctor before consuming the drug.
Below is the list of medicines, which have the same composition, strength and form as Hynidase 1500Iu Injection, and hence can be used as its substitute.
Ajanta Pharma Ltd
Sunways India Pvt Ltd
Are there any missed dose instructions?
If you miss a dose of Hyaluronidase, skip it and continue with your normal schedule. Do not double the dose.
Whenever you take more than one medicine, or mix it with certain foods or beverages, you're at risk of a drug interaction.
What are you using Hynidase 1500Iu Injection for?
Other
preservation of the medicinal products
How much was the improvement?
Excellent
Average
Poor
How long did it take before seeing improvement?
Within 2 hours
How frequently did you take this medicine?
Once a day
How did you take this medicine?
With Food
What were the side effects of this medicine?
Slow growth in children and teenagers
Disclaimer: The information produced here is best of our knowledge and experience and we have tried our best to make it as accurate and up-to-date as possible, but we would like to request that it should not be treated as a substitute for professional advice, diagnosis or treatment.

Lybrate is a medium to provide our audience with the common information on medicines and does not guarantee its accuracy or exhaustiveness. Even if there is no mention of a warning for any drug or combination, it never means that we are claiming that the drug or combination is safe for consumption without any proper consultation with an expert.

Lybrate does not take responsibility for any aspect of medicines or treatments. If you have any doubts about your medication, we strongly recommend you to see a doctor immediately.

Popular Questions & Answers

Gutkha khane se Mera mouth dhire dhire band horaha hai INJ .Tricort -10 mg+INJ. Hynidase ye inj 4 week se (week me 1 bar) le raha hi but koi improve nahi hai Kya karu inj continue karu ya kuch aur karu? Ghutkha xora huwa 3 month hogaya hai.

BDS
Dentist, Allahabad
Gutkha khane se Mera mouth dhire dhire band horaha hai INJ .Tricort -10 mg+INJ. Hynidase ye inj 4 week se (week me 1 ...
Go for laser treatment for opening of mouth after 3 weeks blow air into large balloon inflate it and deflate it repeat this five times a day
1 person found this helpful

My Dad Ganesh Mal Chowdhury age: 57, consuming pain (Betel) with jada (Masala) from the age of 15. Now from last few days he is suffering from wound in mouth. He can not able to take any food cause any food feel him irritated in mouth. Please advice me any medicine can help him.

BDS
Dentist, Gurgaon
My Dad Ganesh Mal Chowdhury age: 57, consuming pain (Betel) with jada (Masala) from the age of 15. Now from last few ...
Medical Care The treatment of patients with oral submucous fibrosis depends on the degree of clinical involvement. If the disease is detected at a very early stage, cessation of the habit is sufficient. Most patients with oral submucous fibrosis present with moderate-to-severe disease. Moderate-to-severe oral submucous fibrosis is irreversible. Medical treatment is symptomatic and predominantly aimed at improving mouth movements. Treatment strategies are described below. [4] The role of these treatments is still evolving. The US Food and Drug Administration has not yet approved these drugs for the treatment of oral submucous fibrosis. Steroids In patients with moderate oral submucous fibrosis, weekly submucosal intralesional injections or topical application of steroids may help prevent further damage. Placental extracts The rationale for using placental extract in patients with oral submucous fibrosis derives from its proposed anti-inflammatory effect, [58] hence, preventing or inhibiting mucosal damage. Cessation of areca nut chewing and submucosal administration of aqueous extract of healthy human placental extract (Placentrex) has shown marked improvement of the condition. [45] Hyaluronidase The use of topical hyaluronidase has been shown to improve symptoms more quickly than steroids alone. Hyaluronidase can also be added to intralesional steroid preparations. The combination of steroids and topical hyaluronidase shows better long-term results than either agent used alone. [59] IFN-gamma This plays a role in the treatment of patients with oral submucous fibrosis because of its immunoregulatory effect. IFN-gamma is a known antifibrotic cytokine. IFN-gamma, through its effect of altering collagen synthesis, appears to be a key factor to the treatment of patients with oral submucous fibrosis, and intralesional injections of the cytokine may have a significant therapeutic effect on oral submucous fibrosis. [60] Lycopene Newer studies highlight the benefit of this oral nutritional supplement at a daily dose of 16 mg. Mouth opening in 2 treatment arms (40 patients total) was statistically improved in patients with oral submucous fibrosis. This effect was slightly enhanced with the injection of intralesional betamethasone (two 1-mL ampules of 4 mg each) twice weekly, but the onset of effect was slightly delayed. [61] Pentoxifylline In a pilot study, 14 test subjects with advanced oral submucous fibrosis given pentoxifylline at 400 mg 3 times daily were compared to 15 age- and sex-matched diseased control subjects. Statistical improvement was noted in all measures of objective (mouth opening, tongue protrusion, and relief from fibrotic bands) and subjective (intolerance to spices, burning sensation of mouth, tinnitus, difficulty in swallowing, and difficulty in speech) symptoms over a 7-month period. [62] Further studies are needed, but this could be used in conjunction with other therapies. Surgical Care Surgical treatment is indicated in patients with severe trismus and/or biopsy results revealing dysplastic or neoplastic changes. Surgical modalities that have been used include the following: Simple excision of the fibrous bands: Excision can result in contracture of the tissue and exacerbation of the condition. Split-thickness skin grafting following bilateral temporalis myotomy or coronoidectomy: Trismus associated with oral submucous fibrosis may be due to changes in the temporalis tendon secondary to oral submucous fibrosis; therefore, skin grafts may relieve symptoms. [33] Nasolabial flaps and lingual pedicle flaps: Surgery to create flaps is performed only in patients with oral submucous fibrosis in whom the tongue is not involved. [63] KTP-532 laser: Use of a KTP-532 laser release procedure was found to increase mouth opening range in 9 patients over a 12-month follow-up period in one study. [64] ErCr: YSGG laser fibrotomy, performed under a local anesthesia: This may be a useful adjunct in managing oral submucous fibrosis. [65] Consult an ear, nose, and throat specialist for evaluation of dysplasia and close follow-up monitoring for the development of oral cancer. Consult a plastic surgeon for patients with severe trismus, in whom reconstructive surgery may be possible. Dietary focus should be on reducing exposure to the risk factors, especially the use of betel quid, and correcting any nutritional deficiencies, such as iron and vitamin B complex deficiencies. [3] Physical therapy using muscle-stretching exercises for the mouth may be helpful in preventing further limitation of mouth movements. This is often combined with medical and surgical therapy. [66] Regular physical examinations, biopsy specimen analysis, and cytologic smear testing should be scheduled to detect oral dysplasia or carcinoma, especially in patients with severe oral submucous fibrosis. Patients with surface leukoplakias require close follow-up monitoring and repeat biopsies. Patients with dysplasias and carcinomas should receive routine treatment for these entities. [67] Watch for signs that indicate malignant change, which include the following: An unhealing ulcer in the lesion Lesion undergoing red changes (erythroplakia) A burning sensation in the mouth An exophytic mass A lump in the neck Difficulty in chewing, swallowing, or speaking.

I am 30 year old my mouth was not fully open how can I do and how solution this problem pls give me true medicine and fast result open my mouth and recovery send me the ans and solution pls.

BHMS
Homeopath, Hooghly
Difficulty in opening mouth hv so mny reasons. Like chewing tobaco. Problem in tempero-mendibular articulation. Angular stomatitis etc. It's need proper diagnosis and treatment. I think you should consult with oro-dental surgeon. Sometime surgical intervention needed also.

Popular Health Tips

Back Pain Management

BPTh/BPT
Physiotherapist, Pune
Back Pain Management

Spondylitis includes swelling of the vertebra. It happens because of wear and tear of the ligament and bones found in your cervical spine, which is in your neck. While it is to a great extent because of age, it can be brought on by other reasons too. Side effects incorporate pain and stiffness starting from the neck to the lower back. The spine's bones (vertebrae) get fused, bringing about an unbending spine. These changes might be mellow or extreme, and may prompt a stooped-over posture. Some of the non-surgical methods to treat spondylitis are as follows-

Exercise based recovery/physiotherapy: your specialist may send you to a physiotherapist for treatment. Non-intrusive treatment helps you extend your neck and shoulder muscles. This makes them more grounded and at last, relieves pain. You may neck traction, which includes using weights to build the space between the cervical joints and decreasing pressure on the cervical disc and nerve roots.

  • Medications: your specialist may prescribe you certain medicines if over-the-counter medications do not work. These include:
  • Muscle relaxants, for example, cyclobenzaprine, to treat muscle fits
  • Opiates, for example, hydrocodone, for pain relief
  • Epileptic medications, for example, gabapentin, to ease pain created by nerve damage
  • Steroid infusions, for example, prednisone, to decrease tissue irritation and diminish pain
  • Home treatment: in case your condition is less severe, you can attempt a couple of things at home to treat it:
  • Take an over-the-ounter pain reliever, for example, acetaminophen or a calming medication, for example, advil or aleve.
  • Use a warming cushion or an ice pack on your neck to give pain alleviation to sore muscles.
  • Exercise routinely to help you recover quickly.
  • Wear a delicate neck prop or neckline to get transitory help. In any case, you shouldn't wear a neck brace for temporary pain relief.
  • Acupuncture: acupuncture is a highly effective treatment used to mitigate back and neck pain. Little needles, about the extent of a human hair, are embedded into particular points on the back. Every needle might be whirled electrically or warmed to improve the impact of the treatment. Acupuncture works by prompting the body to deliver chemicals that decrease pain.
  • Bed rest: severe instances of spondylitis may require bed rest for close to 1-3 days. Long-term bed rest is avoided as it puts the patient at danger for profound vein thrombosis (dvt, blood clots in the legs).
  • Support/brace use: temporary bracing (1 week) may help get rid of the symptoms, however, long-term use is not encouraged. Supports worn for a long time weaken the spinal muscles and can increase pain if not continually worn. Exercise based recovery is more beneficial as it reinforces the muscles.
  • Lifestyle: losing weight and eating nutritious food with consistent workouts can help. Quitting smoking is essential healthy habits to help the spine function properly at any age.

Once the conservative treatment fails:

Early aggressive treatment plan of back leg pain has to be implemented to prevent peripherally induced cns changes that may intensify or prolong pain making it a complex pain syndrome. Only approx 5% of total lbp patients would need surgery approx 20% of discal rupture or herniation with neurologically impending damage like cauda equina syndrome would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then. Depending upon the diagnosis one can perform combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon patient`s pathology response to treatment. Using precision diagnostic therapeutic blocks in chronic lbp, isolated facet joint pain in 40%, discogenic pain in 25% (95% in l4-5 l5-s1), segmental dural or nerve root pain in 14% sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of lbp after conservative treatment has failed.

Need for non-surgical options: outcome studies of lumber disc surgeries documents, a success rate between 49% to 95% and re-operation after lumber disc surgeries ranging from 4% to 15%, have been noted. “in case of surgery, the chance of recurrence of pain is nearly 15%. In fbss or failed back surgery the subsequent open surgeries are unlikely to succeed. Reasons for the failures of conventional surgeries are:

  • Dural fibrosis
  • Arachnoidal adhesions
  • Muscles and fascial fibrosis
  • Mechanical instability resulting from the partial removal of bony ligamentous structures required for surgical exposure decompression
  • Presence of neuropathy.
  • Multifactorial aetiologies of back leg pain, some left unaddressed surgically.

Epidural adenolysis or percutaneous decompressive neuroplasty is done for epidural fibrosis or adhesions in failed back surgery syndromes (fbss). A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ l. A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope sciatica gets complicated by pivd with disco-radicular conflict causing radicular pain sometimes disabling. In this era of minimally invasive surgery lot many interventional techniques have evolved to address the disc pathology. We are still working for the ideal, safe effective technique to tackle disco- radicular interphase. Here now we have devised a mechanical neuroplasty or foraminoplasty technique using an inflatable balloon tip catheter with guide wire via targeted transforaminal or interlaminar route aided by drugs instillation. Selected patients are procedured fluoroscopic guided with local anesthesia under prescribed sedation aseptically via preselected route depending upon location type of pivd causing root insult. First a suitable size needle is placed at desired site confirming with radiolucent dye through which hyaluronidase with saline or la was injected. A flexible guide wire is passed at selected location direction on which the inflatable balloon is threaded to the area of interest.

Adhesiolysis is achieved mechanically with inflating balloon for 10 seconds at a time location. We inflated the balloon with contrast agent to have visualization of adhesiolysis opening up of adhesions or root route. Here the balloon pressure time has to be kept in minimum to avoid neurological damage, for which we inflate balloon for 10 seconds at a time. Close observation is made to balloon shape, pressure patient`s response. Once dilatation is done the drug mixture of steroid with la or hynidase/ hypertonic saline is instilled over nerve in epidural space. We have logically used same approach for our balloon neuroplasty foraminoplasty as it is safe targets exactly the area of disco-radicular interphase or conflict. We can manage to address both the exiting and traversing nerve roots with single entry just by manipulating our guide wire to the place of offence. The procedure can be done via transforaminal route at level or level above or below, especially via s1 foramen. Now we are employing this technique for fresh cases coupling with intradiscal decompression aided by instant disc retrieval by epidural balloon inflation with good results. The idd is done by coblation/ laser/ dekompressor or rf biacuplasty. There is scope of coupling this technique with endoscopic spine surgery. By adding “balloon neuroplasty” to the armamentarium of the interventional pain management many patients can be benefited relieved of previously interventionally unmanageable disco-radicular pain including fbss sufferers.

Intradiscal procedures:

Provocative discography: coupled with ct a diagnostic procedure prognostic indicator for surgical outcome is necessary in the evaluation of patients with suspected discogenic pain, its ability to reproduce pain (even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options in assessing previously operated spines.

Percutaneous disc decompression (pdd): after diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed.

Ozone-chemoneucleoplasty: ozone discectomy a least invasive safe effective alternative to spine surgery is the treatment of choice for prolapsed disc (pivd) done under local anaesthesia in a day care setting. This procedure is ideally suited for cervical and lumbar disc herniation with radiculopathy. Total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at european countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no post operative discomfort or morbidity and low cost. If despite the ozone therapy the symptoms persist, percutaneous intradiscal decompression can be done via transforaminal route with drill discectomy/ laser or coblation nucleoplasty/ biacuplasty/ disc-fx / endoscopic discectomy are good alternatives before opting for open surgerical discectomy; which has to be contemplated in those true emergencies, as mentioned above as the first choice. In biacuplasty radiofrequency energy is used in bipolar manner heating shrinking the disc  making it harder as well for weight bearing. It also seals the annular defect ablates annular nerves relievingback pain. In laser or coblation nucleoplasty energy is used to evaporate the disc thereby debulking it to create space for disc to remodel itself assisted by exercises. 

Dekompressor: a mechanical percutaneous nucleotome cuts drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression. A mechanical device cuts drills out the disc material debulking the disc reducing nerve compression curing sciatica brachialgia. It comes in needle size of 17g for lumbar discs 19 g for cervical discs. In lumbar region postero-lateral approach is used  in cervical discs anterolateral approach is used. 

Disc-fx : endoscopic discectomy: in this novel technique a wide bore needle is inserted placed sub-annular in post disc just under the disc protrusion. Disc is then mechanically extracted with biopsy forceps to empty the annular defect. This painful sensitive annular defect supplied be sinuvertebral nerve is thermo-ablated with radiofrequency which also seals the defect to prevent decrease recurrences. Next higher procedure, endoscopic discectomy is done with endoscope put through sheath inserted via posterolateral transforaminal or posterior interlaminar approach. Mostly done under local anaesthesia its fast becoming standard of care for disc protrusion extrusions causing spinal canal stenosis with root or cord compression with leg pain.

Laser discectomy done for closed bulging discs is an outpatient procedure with one-step insertion of a needle into the disc space. Disc material is not removed; instead, nucleus pulposus is debulked by evaporating it by the laser energy. Laser discectomy is minimally invasive, cost-effective, and free of postoperative pain syndromes, and it is starting to be more widely used at various centers. 

Seld: epiduroscopic laser neural decompression is considered an effective treatment alternative for chronic refractory low back and/or lower extremity pain, including lumbar disc herniation, lumbar spinal stenosis, failed back surgery syndrome with morbid adhesion neuritis that cannot be alleviated with existing noninvasive conservative treatment. This procedure is done under vision via an epiduroscope inserted via caudal canal or transforaminally employing front or side firing laser fibers /or fine instruments. If you wish to discuss about any specific problem, you can consult a pain management specialist.

2 people found this helpful

Non-surgical Treatment for Cervical Spondylosis - Tips!

MBBS, MD, FIMSA, FIPP
Pain Management Specialist, Delhi
Non-surgical Treatment for Cervical Spondylosis - Tips!

Spondylitis includes swelling of the vertebra. It happens because of wear and tear of the ligament and bones found in your cervical spine, which is in your neck. While it is to a great extent because of age, it can be brought on by other reasons too. Side effects incorporate pain and stiffness starting from the neck to the lower back. The spine's bones (vertebrae) get fused, bringing about an unbending spine. These changes might be mellow or extreme, and may prompt a stooped-over posture. Some of the non-surgical methods to treat spondylitis are as follows-

  1. Exercise based recovery/physiotherapy: Your specialist may send you to a physiotherapist for treatment. Non-intrusive treatment helps you extend your neck and shoulder muscles. This makes them more grounded and at last, relieves pain. You may neck traction, which includes using weights to build the space between the cervical joints and decreasing pressure on the cervical disc and nerve roots.
  2. Medications: Your specialist may prescribe you certain medicines if over-the-counter medications do not work. These include:
    1. Muscle relaxants, for example, cyclobenzaprine, to treat muscle fits
    2. Opiates, for example, hydrocodone, for pain relief
    3. Epileptic medications, for example, gabapentin, to ease pain created by nerve damage
    4. Steroid infusions, for example, prednisone, to decrease tissue irritation and diminish pain
  3. Home treatment: In case your condition is less severe, you can attempt a couple of things at home to treat it:
    1. Take an over-the-counter pain reliever, for example, acetaminophen or a calming medication, for example, Advil or Aleve.
    2. Use a warming cushion or an ice pack on your neck to give pain alleviation to sore muscles.
    3. Exercise routinely to help you recover quickly.
    4. Wear a delicate neck prop or neckline to get transitory help. In any case, you shouldn't wear a neck brace for temporary pain relief.
  4. Acupuncture: Acupuncture is a highly effective treatment used to mitigate back and neck pain. Little needles, about the extent of a human hair, are embedded into particular points on the back. Every needle might be whirled electrically or warmed to improve the impact of the treatment. Acupuncture works by prompting the body to deliver chemicals that decrease pain.
  5. Bed Rest: Severe instances of spondylitis may require bed rest for close to 1-3 days. Long-term bed rest is avoided as it puts the patient at danger for profound vein thrombosis (DVT, blood clots in the legs).
  6. Support/brace use: Temporary bracing (1 week) may help get rid of the symptoms, however, long-term use is not encouraged. Supports worn for a long time weaken the spinal muscles and can increase pain if not continually worn. Exercise based recovery is more beneficial as it reinforces the muscles.
  7. Lifestyle: Losing weight and eating nutritious food with consistent workouts can help. Quitting smoking is essential healthy habits to help the spine function properly at any age.

ONCE THE CONSERVATIVE TREATMENT FAILS:

Early aggressive treatment plan of back & leg pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only approx 5% of total LBP patients would need surgery & approx 20% of discal rupture or herniation with Neurologically impending damage like cauda equina syndrome would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then. Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon patient`s pathology & response to treatment. Using precision diagnostic & therapeutic blocks in chronic LBP , isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5-S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed. 

NEED FOR NON-SURGICAL OPTIONS: Outcome studies of lumber disc surgeries documents, a success rate between 49% to 95% and re-operation after lumber disc surgeries ranging from 4% to 15%, have been noted. “In case of surgery, the chance of recurrence of pain is nearly 15%. In FBSS or failed back surgery the subsequent open surgeries are unlikely to succeed. Reasons for the failures of conventional surgeries are:

  1. Dural fibrosis
  2. Arachnoidal adhesions
  3. Muscles and fascial fibrosis
  4. Mechanical instability resulting from the partial removal of bony & ligamentous structures required for surgical exposure & decompression
  5. Presence of Neuropathy.
  6. Multifactorial aetiologies of back & leg pain, some left unaddressed surgically. 

EPIDURAL ADENOLYSIS OR PERCUTANEOUS DECOMPRESSIVE NEUROPLASTY is done for epidural fibrosis or adhesions in failed back surgery syndromes (FBSS). A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with EPIDUROSCOPE Sciatica gets complicated by PIVD with disco-radicular conflict causing radicular pain sometimes disabling. In this era of minimally invasive surgery lot many interventional techniques have evolved to address the disc pathology. We are still working for the ideal, safe & effective technique to tackle disco- radicular interphase. Here now we have devised a mechanical neuroplasty or foraminoplasty technique using an inflatable balloon tip catheter with guide wire via targeted transforaminal or interlaminar route aided by drugs instillation. Selected patients are procedured fluoroscopic guided with local anesthesia under prescribed sedation aseptically via preselected route depending upon location & type of PIVD causing root insult. First a suitable size needle is placed at desired site confirming with radiolucent dye through which hyaluronidase with saline or LA was injected. A flexible guide wire is passed at selected location & direction on which the inflatable balloon is threaded to the area of interest.

Adhesiolysis is achieved mechanically with inflating balloon for 10 seconds at a time & location. We inflated the balloon with contrast agent to have visualization of adhesiolysis & opening up of adhesions or root route. Here the balloon pressure & time has to be kept in minimum to avoid neurological damage, for which we inflate balloon for 10 seconds at a time. Close observation is made to balloon shape, pressure & patient`s response. Once dilatation is done the drug mixture of steroid with LA & or hynidase/ hypertonic saline is instilled over nerve in epidural space. We have logically used same approach for our Balloon Neuroplasty & foraminoplasty as it is safe & targets exactly the area of disco-radicular interphase or conflict. We can manage to address both the exiting and traversing nerve roots with single entry just by manipulating our guide wire to the place of offence. The procedure can be done via transforaminal route at level or level above or below, especially via S1 foramen. Now we are employing this technique for fresh cases coupling with Intradiscal decompression aided by instant disc retrieval by epidural balloon inflation with good results. The IDD is done by Coblation/ Laser/ DeKompressor or RF Biacuplasty. There is scope of coupling this technique with endoscopic spine surgery. By adding “Balloon Neuroplasty” to the armamentarium of the interventional pain management many patients can be benefited & relieved of previously interventionally unmanageable disco-radicular pain including FBSS sufferers. 

INTRADISCAL PROCEDURES:

PROVOCATIVE DISCOGRAPHY: coupled with CT A diagnostic procedure & prognostic indicator for surgical outcome is necessary in the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines. 

PERCUTANEOUS DISC DECOMPRESSION (PDD): After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed.

OZONE-CHEMONEUCLEOPLASTY: Ozone Discectomy a least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a day care setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. Total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no post operative discomfort or morbidity and low cost. If despite the ozone therapy the symptoms persist, Percutaneous intradiscal decompression can be done via Transforaminal route with Drill Discectomy/ Laser or Coblation Nucleoplasty/ Biacuplasty/ Disc-FX / Endoscopic Discectomy are good alternatives before opting for open surgerical Discectomy; which has to be contemplated in those true emergencies, as mentioned above as the first choice. In Biacuplasty radiofrequency energy is used in bipolar manner heating & shrinking the disc & making it harder as well for weight bearing. It also seals the annular defect & ablates annular nerves relieving back pain. In Laser or Coblation Nucleoplasty energy is used to evaporate the disc thereby debulking it to create space for disc to remodel itself assisted by exercises. 

DEKOMPRESSOR: A mechanical percutaneous nucleotome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression. A mechanical device cuts & drills out the disc material debulking the disc reducing nerve compression curing Sciatica & Brachialgia. It comes in needle size of 17G for lumbar discs & 19 G for cervical discs. In lumbar region postero-lateral approach is used & in cervical discs anterolateral approach is used. 

DISC-FX & ENDOSCOPIC DISCECTOMY: In this novel technique A wide bore needle is inserted & placed sub-annular in post disc just under the disc protrusion. Disc is then mechanically extracted with biopsy forceps to empty the annular defect. This painful & sensitive annular defect supplied be sinuvertebral nerve is thermo-ablated with radiofrequency which also seals the defect to prevent & decrease recurrences. Next Higher procedure, Endoscopic Discectomy is done with endoscope put through sheath inserted via posterolateral transforaminal or posterior interlaminar approach. Mostly done under local anaesthesia its fast becoming standard of care for disc protrusion & extrusions causing spinal canal stenosis with root or cord compression with leg pain.

LASER DISCECTOMY done for closed bulging discs is an outpatient procedure with one-step insertion of a needle into the disc space. Disc material is not removed; instead, nucleus pulposus is debulked by evaporating it by the laser energy. Laser discectomy is minimally invasive, cost-effective, and free of postoperative pain syndromes, and it is starting to be more widely used at various centers. 

SELD: Epiduroscopic laser neural decompression is considered an effective treatment alternative for chronic refractory low back and/or lower extremity pain, including lumbar disc herniation, lumbar spinal stenosis, failed back surgery syndrome with morbid adhesion neuritis that cannot be alleviated with existing noninvasive conservative treatment. This Procedure is done under vision via an epiduroscope inserted via Caudal canal or Transforaminally employing front or side firing Laser fibers &/or fine instruments. If you wish to discuss about any specific problem, you can consult a Pain Management Specialist.

3722 people found this helpful

Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) - To Help You Live Your Dream!

MD - Obstetrtics & Gynaecology, DGO
IVF Specialist, Mumbai
Intracytoplasmic Morphologically Selected Sperm Injection (IMSI) - To Help You Live Your Dream!

Of a million sperms released in one ejaculation, a single sperm manages to fertilize the egg, which grows into an embryo and then a baby. Due to various reasons, when this does not happen, it is termed as infertility and is currently on the rise.

With In-vitro fertilization (IVF), couples sometimes go through multiple sessions to ensure fertilization. ICSI or intracytoplasmic sperm injection improved this chance of fertilization. It is where a single sperm is used to fertilize an egg in an artificially controlled environment and then injected into the uterus where it grows further.

The next step in this technique is IMSI, where the chances of successful pregnancy are further enhanced and also promises improved quality of the embryo. IMSI, as it stands for, has “morphologically selected” which means under a highly powerful microscope, the best sperms are selected and then used to fertilize the egg. Morphology stands for shape, and the shape of the sperm is a direct indicator of the sperm quality. This not just ensures good success rate but also ensures the sperm which is used produces a high-quality embryo.

Features

  1. High success rate of fertility
  2. Reliable and efficient method of ART (assisted reproductive technology)
  3. More expensive than traditional IVF methods or ICSI
  4. Requires complex equipment, training, and set-up

Indications:

  1. Useful in couples who have failed IVF previously
  2. Male infertility with unidentifiable cause
  3. Poor sperm quality

What to expect?

Both partners are prepared both physically and mentally prior to IMSI.

Before the procedure - men:

  1. A screening is first done to decide if the sperms can be used directly
  2. In case of hereditary diseases, a donor is preferred
  3. The first technical step involves sperm collection, either directly or through a donor
  4. Sperms are collected either through masturbation or through a small incision in the testicles
  5. Sperms used could be fresh or frozen; fresh ones may be stored for later use also

Before the procedure – women:

  1. The woman is put on some ovulation therapy to ensure the release of multiple eggs, so a good one is picked. These high doses of hormones ensure multiple eggs are released.
  2. Egg release is monitored through blood and urine tests
  3. They are collected within after 36 hours of release

During the IMSI procedure:

  1. A healthy egg is chosen and placed in a glass container containing hyaluronidase
  2. Sperms are placed in a medium which will slow their movement, which enables picking a good sperm for fertilization
  3. The dual advantage of this is that in addition to a high success rate of fertilization, the quality of the embryo is also assured 

    If you wish to discuss about any specific problem, you can consult a gynaecologist.

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