Ultrasound - Treatment, Procedure And Side Effects

The liver is the engine of the human body. It is basically composed of 2 types of cells (a cell is the basic building block of the human body) – hepatocytes (liver cells) and cholangiocytes (bile duct cells). It also has other supporting tissue and their respective cells. The hepatocytes are by far the most numerous cell type, not surprisingly tumours (otherwise called mass or lump. “Tumor” means lump in Latin), of this cell form the majority of abnormal growths in the liver. Abnormal growths can be benign (that is, they do not grow rapidly, spread to other parts of the organ or to other parts of the body) or malignant (grow rapidly, spread to other parts of the organ and to other parts of the body, i.e. cancer). These abnormal growths from liver cells are Focal nodular hyperplasia (FNH), Adenomas (the benign variety) and hepatocellular cancer (otherwise called Hepatoma/HCC, the cancerous type). What we need to recognize is that certain adenomas can turn into HCC, over a period of time. The other type of growths in the liver are those that have originated elsewhere in the body and spread to the liver, for example a growth of the breast spreading to the liver. These are in fact the commonest tumours of the liver. I will discuss these at a later date.

Benign growths of the liver

Common benign growths are Haemangiomas, FNH and Adenoma. Most of these are identified when a scan is performed as investigation for some other problem. Accurate diagnosis of the nature of these lumps is important to determine the type of treatment needed. This can be ascertained by a carefully selected scan like an Ultrasound, CT scan or an MRI. The technology of these scans is continuing to evolve and get better year on year. There are different types of Ultrasound, CT and MRI scans with different applications, based on whether contrast is used or not, the different phases of scanning, the type of MRI scanning sequence etc. Therefore, these scans although commonly available and used very frequently, need to be performed under the supervision of a team involving Liver doctors and radiologist who is well versed in the diagnosis of liver lumps, for accurate diagnosis without the need for unnecessary tests (Box 1).

Haemangiomas are by far the commonest. It is estimated that 5% of the adult population harbor this lump in their livers! They occur in both sexes and at all ages but are commonest between 30 to 50 years in women. Most of them are small, less than 4-5 cms in diameter and are are identified on Ultrasound. MRI and its various applications is the scan of choice for accurate diagnosis. This is crucial as most of them do not need treatment.

Focal Nodular Hyperplasia (FNH) are the second most common liver lumps. They are usually single and small (less than 4 cms) and occur in women between 35 – 50 years of age. About 2.5-3% of population harbor this lump in their livers. Special MRI techniques using special contrast agents is diagnostic and the findings are quite distinct from haemangiomas. Again treatment is not recommended apart from selected circumstances. Assessment in a dedicated Liver team is recommended for accurate diagnosis and a proper management plan to be formulated.

Hepatic adenomas (Hepatocellular adenoma, HCA) are rare lumps and occur in 0.2 to 0.3% of the population, again occurring mostly in young women during their reproductive period. They are again solitary and most usually 3-4 ms in diameter.

There are a couple characteristics which make this lump different from the previous 2, there is a strong relation between hormones the development of HCA and some of these HCA can turn into the malignant Hepatocellular carcinoma (HCC). Therefore, accurate characterization and diagnosis of these HCA is essential. Sometimes biopsy of the lump, molecular and genetic tests maybe necessary to determine if the HCA has a high chance of progressing to HCC. Imaging tests are generally adequate, contrast MRI Liver and its different techniques is accurate in diagnosing HCA and sub-typing it, however CT and contrast-enhanced Ultrasound is sometimes necessary along with MRI.

Generally, a HCA in a male is recommended for surgical resection. While in women, discontinuation of the OCP pill/ any other such hormone is recommended for a period of 6 months, if the HCA does not have any worrying features and size is less than 5 cms. IF HCA is larger than 5 cms and has features suggestive of a high risk for change to HCC, surgery is advised. Again these decisions have to be made as a part of a Multi-disciplinary team (Box 1)

Malignant growths beginning within the Liver

As mentioned earlier, usually malignant growths which are seen in the liver spread to it from elsewhere in the body. Hepatocellular cancer/Hepatoma (HCC) is the commonest malignant tumour beginning within the liver, as apposed to those that spread to the liver from elsewhere. It occurs between 40-70 years of age and occurs commonly in men. It is estimated that 17000 new patients develop this tumour every year in India. The vast majority (> 80%) of these develop in patients who have chronic liver disease (cirrhosis). Importantly the number of HCC cases is increasing year on year as cirrhosis due to fatty liver disease, Hepatitis B (3% of Indian population carry this virus, ie nearly 40 million individuals) and alcohol are continuing to increase in India. Nearly overall it is the 4th or 5th most common cause of cancer and the second most common cause of cancer-related death. This is continuing to increase too. We do not have a national policy in India to screen and diagnose these lumps in the liver at an early stage. Most patients present at a late stage when effective treatment is not possible.

Hepatitis B is a vaccine-preventable disease, there are good drugs to treat it and decrease the risk of cirrhosis and HCC in HBV patients, therefore it is important to test for this virus infection. The fatty liver disease can cause chronic liver damage and HCC, regular exercise and consuming a balanced diet can reduce the risk of fatty liver disease.

The usual mode of detection of these growths is when a scan is done for some other reason. Occasionally patients can develop pain in the abdomen or jaundice which leads to an investigation. The treatment of HCC depends on the extent of tumour, the extent of the chronic liver disease (the stage of cirrhosis) and the overall condition of the patient. These patients are best seen, assessed and treated in a team (Box 1) which specializes in the treatment of Liver disease.

The best treatment for HCC is surgery. However, this is suitable only for certain carefully selected patients. This can take the form of liver resection (where a portion of the liver with tumour is removed) or liver transplantation (where the whole liver is removed and a donated liver (full or partial) is replaced into the patient. Indeed surgical has excellent survival rates; more than 75% of patients survive for more than 5 years after resection or transplantation making treatment for these cancers one of the most satisfactory.

Other treatments which can be combined with surgery in selected patients or can be combined with patients not suitable for surgery are different types of Interventional radiological therapy – chemotherapy or radiotherapy delivered through fine catheters introduced into the blood vessels of the liver (TACE: Transarterial chemotherapy, TARE: Transarterial radiotherapy) and or heat energy delivered to the tumour area by means of carefully placed needles/probes (RFA: radiofrequency ablation, MWA: microwave ablation).

HCC is unique cancer as its treatment should be tailored to the patient, the treatments are varied and range from catheter-based non-invasive treatment to major surgery and transplantation. This necessitates that HCC patients are best managed in a multidisciplinary team which is highly skilled in and specializes in the management of liver diseases.

Box 1: A liver tumour multidisciplinary team – Integrated Liver Care team

• The team should be one with expertise in the management of benign liver lesions and should include a Hepatologist, a Hepatobiliary & Transplant surgeon, Diagnostic and Interventional radiologists, Medical oncologist and a Pathologist.

• Each member of the team must hold specific and relevant training, expertise and experience relevant to the management of benign liver lesions.

• The team should be one with the skills required not only to appropriately manage these patients but also to manage the rare but known complications of diagnostic or therapeutic interventions.

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

Orthopaedic stem cell treatment is an advanced branch of medicine, which can only be performed by a handful of physicians across the planet. If you are considering the surgery and the treatment, you should first know the important factors that can have an impact on the same. 

Outlined below are 5 things you should know about the treatment before you schedule the surgery. 

1. Source of the stem cell: The source from which the stem cells have been extracted play a huge part in determining how successful the surgery would be. In case of orthopaedic stem cell treatment, the best place to extract the cells from is the bone marrow. However, in some cases, these cells may be taken from fatty regions of the body and not the bone marrow. This will eventually have an impact on the outcome of the surgery. Bone marrow cells are much more proficient at repairing damages of the bones than stem cells from any other source. 
2. The technique for extracting stem cells: A procedure called the bone marrow aspiration or BMA is used to harvest the stem cells from the bone marrow. However, there is a correct way of doing it and a not so correct way of doing it. For instance, the stem cells need to be harvested using special needles and from several high density spots inside the bone. 
3. Placing the stem cells in the right spot: Just extracting the stem cell properly is not enough. It also needs to be injected at the right place through the correct procedure. The surgeon will use advanced machineries to conduct the surgery, which are essential for the success of the treatment. These could include the use of c-arm fluoroscope, other one is called the ultrasound or may be even an arthroscope. 
4. The correct dosage: This is a gray area, as knowledge needs to be further refined about the precise dosage required for the treatment. Specialised instruments and digital centrifugation systems help in  acquiring and concentrating the necessary amounts of stem cells for the procedure. 
5. Understanding that the treatment works: Since stem cell treatment of any kind is a fairly new concept, most people feel that it may not work as advertised. However, if you go to a reliable facility where such surgeries are performed, you will get to know that not only does the treatment work but there have been several patients whose quality of life has improved greatly. Joint preservation surgery is the field which specialises in management of various conditions by these procedures.

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

First-trimester screening is a prenatal test. It is conducted to get early information about a baby's risk of certain chromosomal conditions. It can detect conditions like Down syndrome (trisomy 21) and extra sequences of chromosome 18 (Trisomy 18).

It is usually conducted in two steps:

1. Blood test
2. Followed by USG

Initially, a blood test is conducted to ascertain the levels of two pregnancy specific substances in the mother's blood. The blood is tested for pregnancy associated plasma protein and human chorionic gonadotropin (HCG). Thereafter, a USG is done to find out the size of the clear space in the tissue that is present at the back of the foetus’s neck.

The screening is done between weeks 11 and 14 of pregnancy. The doctor is able to gauge the risk of your baby having Down syndrome or Trisomy 18 by using your age and results of the test. This screening is quite helpful and can guard you against deadly consequences in the future. Down syndrome is known to cause impairments in the mental and social development of the child. Trisomy 18 gets often fatal by age 1. However, first screening doesn’t find out the risk of neural tube defects.

It is the first screening done in pregnancy. It can be done before any other screening. Thus, the results are known at an early stage. You will get time to think about the future consequences can help you in deciding your course of action and the decision to either continue or terminate the pregnancy. You will be ready to know and decide whether you will be able to live and take care of a baby with special needs. You can conduct other screenings later in pregnancy. You must know that first-trimester screening is treated as being optional. It can detect the risk and cannot tell you whether your baby has the problems in real or not.

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

When your doctor suspects of the presence of extra fluid in your lungs, you might be advised for a thoracic ultrasound. What is a thoracic ultrasound and why do you need it? With a thoracic ultrasound, your doctor will be able to look at everything in the thoracic cavity and can know if your lungs, heart, and other structures in the chest are working fine. The pulmonologists can efficiently determine the lung condition even in critically ill patients using a non-invasive ultrasound technique.

And, since the method is based on sound, there is no risk of exposure to potentially harmful ionizing radiation or nephron-toxic contrast dye in this case. Hence, a thoracic ultrasound has become the most preferred technique for conducting a preliminary examination or to further check and confirm a finding noted using other imaging techniques for thoracic diseases.

Reasons to have a chest ultrasound

• The doctor usually refer an ultrasound when he or she can feel that there is some extra amount of fluid in your chest. The ultrasound can tell the physician the reason behind the deposition of excess liquid.
• The ultrasound would help detect the type of fluid that is present in the chest, whether it is exudate that is caused due to inflammation, an infection, or lung cancer, or whether it is transudate that is a leakage from the lymph nodes or the blood vessel. It determines the movement of the diaphragm.
• Chest ultrasound can be done in conjunction with other examinations like CT scan, MRI to evaluate the condition of the chest.
• It has to be noted that, in certain circumstances such as severe obesity and barium in your esophagus, the procedure can give an inaccurate result. Hence, it is always advisable to talk with the health care provider and share your complete medical history before undergoing this procedure to prevent such occurrences.

After a Thoracic Ultrasound

• After the results of the ultrasound are received, the doctor can detect what the condition of your chest is at the moment. Your doctor will also confirm if the lungs have collapsed or if there is water in the lungs, or excess fluid has deposited into the lungs.
• Ultrasound can also reveal if you have pneumonia. A diagnosis like this does not take a long duration, and thus the ultrasound plays a significant role in expediting the treatment process.
• There are no hard and fast regulations to follow after the ultrasound. The physician may recommend few instructions depending on your situation. In typical cases, there is no special preparation like fasting is required and you need not be sedated during the ultrasound as well.
• A safe and painless method to detect the condition of the chest and the respiratory organs and the blood flow through the organs in your chest, a thoracic ultrasound is a preferred procedure that can help your doctor to diagnose your condition and decide upon the treatment method.

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

Today, prenatal testing can help pinpoint your unborn child’s risk to a number of genetic conditions. NIPT or non-invasive prenatal testing is a modern form of prenatal testing that does not harm the mother or child. NIPT involves a simple blood test that can be performed as an outpatient procedure in any doctor’s office. Blood for this test is collected from a vein in the mother’s arm. The DNA from this blood sample is then studied in a laboratory to look for signs of abnormalities. These results are them compared to your first trimester ultrasound results to determine if further testing is required.

There are a number of advantages to this form of testing

1. Highly Accurate: NIPT results are said to be accurate in 99% cases. This clears doubts about chromosomal abnormalities and helps parents to be deal with problems in their unborn children. For example, NIPT testing can be used to diagnose problems like Down syndrome. NIPT also decreases the need for other forms of invasive prenatal testing.
2. Safe: NIPT is noninvasive and does not harm the health of the baby or the mother. Since it involves only a simple blood test, it does not cause pain or discomfort either. It also has no connection to miscarriages. Pregnant woman above the age of 35 and those who have had an ultrasound showing an increased risk of aneuploidy or those who have a history of trisomy can benefit from this form of pre-natal testing. The only known alternative to this form of testing involves withdrawing DNA samples from the amniotic sac with the help of a needle. This form of testing can result in a miscarriage in rare cases.
3. Comfortable: Unlike prenatal tests that require precision while withdrawing DNA from the amniotic sac, the NIPT requires far less expertise. This makes women much more comfortable undergoing this form of testing as compared to the other.
4. Early Diagnosis: With prenatal testing parents do not have to wait till a baby is born to find out if he or she suffers from any genetic complications. NIPT can be scheduled as early as 10 weeks into the pregnancy and hence gives the parents enough time to prepare themselves to deal with the issue if any.

However, you should remember that NIPT cannot be used to replace diagnostic tests such as amniocentesis. Also, it does not detect all chromosomal abnormalities. If you wish to discuss about any specific problem, you can consult an IVF Specialist.