What is Uncemented / Cementless Total Hip Replacement

Total hip replacement is a surgical procedure for replacing the hip joint. This joint is composed of two parts – the hip socket (acetabulum, a cup-shaped bone in the pelvis) and the “ball” or head of the thighbone (femur). During the surgical procedure, these two parts of the hip joint are removed and replaced with smooth artificial surfaces. The artificial socket is made of high-density plastic, while the artificial ball with its stem is made of a strong stainless metal. These artificial pieces are implanted into healthy portions of the pelvis and thighbones and affixed with a bone cement (methyl methacrylate).

An alternative hip prosthesis called a “cementless” total hip replacement has the potential to allow bone to grow into it, and therefore may last longer than the cemented hip. This is an important consideration for the younger patient. In some cases, only one of the two components (socket or stem) may be fixed with cement and the other is cementless and would be called a “hybrid” hip prosthesis.

When is total hip replacement considered ?

Total hip replacements are usually performed for severe arthritic conditions. The operation is sometimes performed for other problems such as hip fractures or avascular necrosis (a condition in which the bone of the hip ball dies). Most patients who have artificial hips are over 55 years of age, but the operation is occasionally performed on younger persons.

Circumstances vary, but generally, patients are considered for total hip replacements if : –

Your pain is severe enough to restrict work, recreation, and the ordinary activities of daily living.
Your pain is not relieved by anti-inflammatory medicine, the use of a cane or walker and restricting activities.
You have significant stiffness of the hip.
Your x-rays show advanced arthritis, or other problems.

The orthopaedic surgeon must be very precise in preparing the femur for a cementless impact. The implant channel must match the shape of the implant itself very closely. New bone growth cannot bridge gaps larger than 1 mm to 2 mm. Your surgeon may recommend a period of protected weight-bearing (using crutches or a walker) to give the bone time to attach itself to the implant. This protected weight bearing helps to ensure there is no movement between the implant and bone so a durable connection can be established.

Cementless femoral components tend to be much larger at the top, with more of a wedge shape. This design enables the strong surface (cortex) of the bone and the dense, hard spongy (cancellous) bone just below it to provide support.

The acetabular component of a cementless total hip replacement also has a coated or textured surface to encourage bone growth into the surface. Depending on the design, these components may also use screws through the cup or spikes, pegs, or fins around the rim to help hold the implant in place until the new bone forms. Usually these components have a metal outer shell and a polyethylene liner.

The pelvis is prepared for a cementless acetabular component using a process similar to that used in a cemented total hip replacement procedure. The intimate contact between the component and bone is crucial to permit bone ingrowth.

Initially, it was hoped that cementless total hip replacement would eliminate the problem of bone resorption or stem loosening caused by cement failure. Although certain cementless stem designs have excellent long-term outcomes, cementless stems can loosen if a strong bond between bone and stem is not achieved.

Patients with large cementless stems may also experience a higher incidence of mild thigh pain. Likewise, polyethylene wear, particulate debris, and the resulting osteolysis (dissolution of bone) remain problems in both cemented and uncemented designs. Improvements in the wear characteristics of newer polyethylene and the advent of hard bearings (metal-on-metal or ceramic) may help resolve some of these problems in the future.

Although some orthopaedic surgeons are now using cementless devices for all patients, cementless total hip replacement is most often recommended for younger, more active patients and patients with good bone quality where bone ingrowth into the components can be predictably achieved. Individuals with juvenile inflammatory arthritis may also be candidates, even though the disease may restrict their activities.

What Is Esophageal Cancer?

Signs and symptoms of pancreatic cancer:

The cervix is a tubelike channel that connects the uterus to the vagina. Cervical polyps are growths that usually appear on the cervix where it opens into the vagina. Polyps are usually cherry-red to reddish-purple or grayish-white. They vary in size and often look like bulbs on thin stems. Cervical polyps are usually not cancerous (benign) and can occur alone or in groups. Most polyps are small, about 1 centimeter to 2 centimeters long. Because rare types of cancerous conditions can look like polyps, all polyps should be removed and examined for signs of cancer.

The cause of cervical polyps is not well understood, but they are associated with inflammation of the cervix. They also may result from an abnormal response to the female hormone estrogen.

Cervical polyps are relatively common, especially in women older than 20 who have had at least one child. They are rare in girls who have not started menstruating. There are two types of cervical polyps:

• Ectocervical polyps can develop from the outer surface layer cells of the cervix. They are more common in postmenopausal women.
• Endocervical polyps develop from cervical glands inside the cervical canal. Most cervical polyps are endocervical polyps, and are more common in premenopausal women.

Symptoms

Cervical polyps may not cause any symptoms. However, you may experience:

• Discharge, which can be foul-smelling if there is an infection
• Bleeding between periods
• Heavier bleeding during periods
• Bleeding after intercourse

Diagnosis

If you have a cervical polyp, you probably won’t be able to feel it or see it. Cervical polyps are discovered during routine pelvic exams or evaluations for bleeding or while getting a Pap test.

Expected Duration

Sometimes a polyp will come off on its own during sexual intercourse or menstruation. However, most polyps need to be removed to treat any symptoms and to evaluate the tissue for signs of cancer, which is rare.

Prevention

Visit your doctor for an annual Pap test and for regular pelvic exams. A direct examination is the best way to identify cervical polyps.

Treatment

Cervical polyps are removed surgically, usually in a doctor’s office. The doctor will use a special instrument, called a polyp forceps, to grasp the base of the polyp stem and then gently pluck the polyp with a gentle, twisting motion. Bleeding is usually brief and limited. Nonprescription, mild pain medication such as acetaminophen (Tylenol and others) or ibuprofen (Advil, Motrin and others) can help to relieve discomfort or cramping during or after the procedure.

The polyp or polyps are sent to a laboratory for examination. You may receive antibiotics if the polyp shows signs of infection. If the polyp is cancerous, treatment will depend on the extent and type of cancer.

Large polyps and polyp stems that are very broad usually need to be removed in an operating room using local, regional or general anesthesia. You will not need to stay in the hospital overnight. Cervical polyps may grow in the future from different areas of the cervix, usually not from the original site. Regular pelvic examination will help to identify and treat polyps before they cause symptoms.

When To Call a Professional

If you experience vaginal discharge, bleeding after intercourse, or bleeding between periods, make an appointment to see your doctor as soon as possible for a pelvic exam.

Prognosis

The outlook is excellent. The vast majority of cervical polyps are not cancerous. Once removed, polyps usually don’t come back.

Humans are the most advanced in the order of creation, they have been gifted with the intellect which they have been using in different fields and helping mankind make his life easier and simpler. With the advance in technology medicine was not far behind. The so called “incurable diseases” started finding a cure, psychiatric patients were unshackled after the discovery of neurotransmitters responsible for psychiatric illnesses. Antibiotics and vaccines started curing and preventing serious infectious diseases.

However the neuro-degenerative diseases such as dementia, MNDs, spinal cord injury, parkinsonism, cerebral palsy etc., still are in search of that elusive drug. But with the discovery of stem cell therapy the hitherto “elusive drug” the magic remedy has been found which has come to salvage scores of patients suffering from these debilitating illnesses.

What is stem cell?
Stem cells can be called as the ‘mother cells’. They originate from the developing embryo and differentiate into different types of cells for example the heart muscle, the liver, brain, skin, bone etc. Etc., They are known as progenitors cells since they lead to creation of new cells.

When these stem cells are transplanted into the body they migrate to the injured areas in the body , get attached there and transform themselves into the tissue desired and replace the damaged one.
This is the theory behind the use of stem cells in most of the neuro-degenerative and autoimmune disorders.

Procedures:

Essentially there are two types of stem cell therapy:

• Autologous therapy where the patient is given stem cells derived from his own bone marrow, or adipose (fat) tissue.
• Allogenic therapy where the donor cells are used ( not the patient himself but some other persons cells are transplanted)

Keloids are raised overgrowths of scar tissue that occur at the site of a skin injury. They occur where trauma, surgery, blisters, vaccinations, acne or body piercing have injured the skin. Less commonly, keloids may form in places where the skin has not had a visible injury. Keloids differ from normal mature scars in composition and size. Some people are prone to keloid formation and may develop them in several places.

Keloids are more common in African-Americans. They are seen most commonly on the shoulders, upper back and chest, but they can occur anywhere. When a keloid is associated with a skin incision or injury, the keloid scar tissue continues to grow for a time after the original wound has closed, becoming larger and more visible until it reaches a final size. They generally occur between 10 and 30 years of age and affect both sexes equally, although they may be more common among young women with pierced ears. Keloids may form over the breastbone in people who have had open heart surgery.

Symptoms:

Keloids usually appear in areas of previous trauma but may extend beyond the injured area. They are shiny, smooth and rounded skin elevations that may be pink, purple, or brown. They can be doughy or firm and rubbery to the touch, and they often feel itchy, tender or uncomfortable. They may be unsightly. A large keloid in the skin over a joint may interfere with joint function.

Expected Duration:

Keloids may continue to grow slowly for weeks, months or years. They eventually stop growing but do not disappear on their own. Once a keloid develops, it is permanent unless removed or treated successfully. It is common for keloids that have been removed or treated to return.

Prevention

People who are prone to keloids should avoid cosmetic surgery. When surgery is necessary in such people, doctors can take special precautions to minimize the formation of keloids at the site of the incision. Examples of techniques that might be used to minimize keloid formation include covering the healing wound with hypoallergenic paper tape for several weeks after surgery, covering the wound with small sheets made of a silicone gel after the surgery, or using corticosteroid injections or radiation treatments at the site of the surgical wound at the beginning of the healing period.

Treatment

There is no single treatment for keloids, and most treatments do not give completely satisfying results. Two or more treatments may be combined. If you decide to pursue treatment for a keloid scar, you will have the best results if you start treatment soon after the keloid appears. Available treatments include:

• Removal with conventional surgery — This unreliable technique requires great care, and keloids that return after being removed may be larger than the original. Keloids return in more than 45% of people when they are removed surgically. Keloids are less likely to return if surgical removal is combined with other treatments.
• Dressings — Moist wound coverings made of silicone gel sheets have been shown in studies to sometimes reduce the size of keloids over time. This treatment is safe and painless.
• Corticosteroid injections — Injections with triamcinolone acetonide or another corticosteroid medicine typically are repeated at intervals of four to six weeks. This treatment can often reduce keloid size and irritation, but injections are uncomfortable.
• Compression — This involves using a bandage or tape to apply continuous pressure 24 hours a day for a period of six to 12 months. Such compression can cause a keloid to become smaller. For keloids that form at the site of an ear piercing, a clip known as a “Zimmer splint” usually reduces keloid size by at least 50% after one year of compression. Zimmer splints that resemble earrings are available.
• Cryosurgery — This freezing treatment with liquid nitrogen is repeated every 20 to 30 days. It can cause a side effect of lightening the skin color, which limits this treatment’s usefulness.
• Radiation therapy — This therapy is controversial because radiation increases the risk of cancer. Radiation treatments may reduce scar formation if they are used soon after a surgery, during the time a surgical wound is healing.
• Laser therapy — This is an alternative to conventional surgery for keloid removal. There is no good evidence that keloids are less likely to return after laser therapy than after regular surgery.
• Experimental treatments — One treatment showing promise is injecting keloid scars with medicines that were developed to treat autoimmune illnesses or cancers. Treatments with these medicines (various types of interferon and the chemotherapy agents 5-fluorouracil and bleomycin) will need to be evaluated further before they are appropriate for use outside of research studies.

Cirrhosis:

An echocardiogram uses sound waves to produce images of your heart. This commonly used test allows your doctor to see how your heart is beating and pumping blood. Your doctor can use the images from an echocardiogram to identify various abnormalities in the heart muscle and valves.

Depending on what information your doctor needs, you may have one of several types of echocardiograms. Each type of echocardiogram has few risks involved.

Why it’s Done:

• Transthoracic echocardiogram. This is a standard, noninvasive echocardiogram. A technician (sonographer) spreads gel on your chest and then presses a device known as a transducer firmly against your skin, aiming an ultrasound beam through your chest to your heart. The transducer records the sound wave echoes your heart produces. A computer converts the echoes into moving images on a monitor. If your lungs or ribs block the view, a small amount of intravenous dye may be used to improve the images.

• Transesophageal echocardiogram. If it’s difficult to get a clear picture of your heart with a standard echocardiogram, your doctor may recommend a transesophageal echocardiogram. In this procedure, a flexible tube containing a transducer is guided down your throat and into your esophagus, which connects your mouth to your stomach. From there, the transducer can obtain more-detailed images of your heart. Your throat will be numbed, and you’ll have medications to help you relax during a transesophageal echocardiogram.

• Doppler echocardiogram. When sound waves bounce off blood cells moving through your heart and blood vessels, they change pitch. These changes (Doppler signals) can help your doctor measure the speed and direction of the blood flow in your heart. Doppler techniques are used in most transthoracic and transesophageal echocardiograms, and they can check blood flow problems and blood pressures in the arteries of your heart that traditional ultrasound might not detect. Sometimes, the blood flow shown on the monitor is colorized to help your doctor pinpoint any problems (color flow echocardiogram).

• Stress echocardiogram. Some heart problems — particularly those involving the coronary arteries that supply blood to your heart muscle — occur only during physical activity. For a stress echocardiogram, ultrasound images of your heart are taken before and immediately after walking on a treadmill or riding a stationary bike. If you’re unable to exercise, you may get an injection of a medication to make your heart work as hard as if you were exercising.

Results:

Your doctor will look for healthy heart valves and chambers, as well as normal heartbeats. Information from the echocardiogram may show:

• Heart size. Weakened or damaged heart valves, high blood pressure or other diseases can cause the chambers of your heart to enlarge. Your doctor can use an echocardiogram to evaluate the need for treatment or monitor treatment effectiveness.
• Pumping strength. An echocardiogram can help your doctor determine your heart’s pumping strength. Specific measurements may include the percentage of blood that’s pumped out of a filled ventricle with each heartbeat (ejection fraction) or the volume of blood pumped by the heart in one minute (cardiac output). If your heart isn’t pumping enough blood to meet your body’s needs, heart failure may be a concern.
• Damage to the heart muscle. During an echocardiogram, your doctor can determine whether all parts of the heart wall are contributing normally to your heart’s pumping activity. Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions.
• Valve problems. An echocardiogram shows how your heart valves move as your heart beats. Your doctor can determine if the valves open wide enough for adequate blood flow or close fully to prevent blood leakage. Abnormal blood flow patterns and certain conditions, such as aortic valve stenosis — when the heart’s aortic valve is narrowed — can be detected as well.
• Heart defects. Many heart defects can be detected with an echocardiogram, including problems with the heart chambers, abnormal connections between the heart and major blood vessels, and complex heart defects that are present at birth. Echocardiograms can even be used to monitor a baby’s heart development before birth.

Risks:

There are few risks involved in a standard transthoracic echocardiogram. You may feel some discomfort similar to pulling off an adhesive bandage when the technician removes the electrodes placed on your chest during the procedure.

If you have a transesophageal echocardiogram, your throat may be sore for a few hours afterward. Rarely, the tube may scrape the inside of your throat. Your oxygen level will be monitored during the exam to check for any breathing problems caused by sedation medication.

During a stress echocardiogram, exercise or medication — not the echocardiogram itself — may temporarily cause an irregular heartbeat. Serious complications, such as a heart attack, are rare.

Dyslexia is a specific reading disability due to a defect in the brain’s processing of graphic symbols.

It is a learning disability that alters the way the brain processes written material and is typically characterized by difficulties in word recognition, spelling, and decoding.

People with dyslexia have problems with reading comprehension.

The National Center for Learning Disabilities says that dyslexia is a neurological and often genetic condition, and not the result of poor teaching, instruction, or upbringing.

Dyslexia is not linked to intelligence.

Symptoms of dyslexia

The most common signs and symptoms associated with dyslexia are:

• Learning to read – the child, despite having normal intelligence and receiving proper teaching and parental support, has difficulty learning to read.
• Milestones reached later – the child learns to crawl, walk, talk, and ride a bicycle later than the majority of other kids.
• Speech – apart from being slow to learn to speak, the child commonly mispronounces words, finds rhyming extremely challenging, and does not appear to distinguish between different word sounds.
• Slow at learning sets of data – at school, the child takes much longer than the other children to learn the letters of the alphabet and how they are pronounced. There may also be problems remembering the days of the week, months of the year, colors, and some arithmetic tables.
• Coordination – the child may seem clumsier than their peers. Catching a ball may be difficult.
• Left and right – the child commonly gets “left” and “right” mixed up.
• Reversal – numbers and letters may be reversed without realizing.
• Spelling – might not follow a pattern of progression seen in other children. The child may learn how to spell a word today and completely forget the next day.
• Phonology problems – phonology refers to the speech sounds in a language. If a word has more than two syllables, phonology processing becomes much more difficult. For example, with the word “unfortunately” a person with dyslexia may be able to process the sounds “un” and “ly,” but not the ones in between.
• Concentration span – children with dyslexia commonly find it hard to concentrate. Many adults with dyslexia say this is because, after a few minutes of non-stop struggling, the child is mentally exhausted. A higher number of children with dyslexia also have ADHD (attention deficit hyperactivity disorder), compared with the rest of the population.
• Sequencing ideas – when a person with dyslexia expresses a sequence of ideas, they may seem illogical.
• Autoimmune conditions – people with dyslexia are more likely to develop immunological problems, such as hay fever, asthma, eczema, and other allergies.

 

Causes of dyslexia

A child with dyslexia may have more difficulty than usual in reading, spelling, and concentrating.

Specialist doctors and researchers are not sure what causes a person to develop dyslexia.

Some evidence points to the possibility that the condition is inherited, as dyslexia often runs in families.

Genetic causes of dyslexia

A team at the Yale School of Medicine found that defects in a gene, known as DCDC2, were associated with problems in reading performance.

Parkinson’s disease is a movement disorder that progresses slowly. Some people will first notice a sense of weakness, difficulty walking, and stiff muscles. Others may notice a tremor of the head or hands. Parkinson’s is a progressive disorder and the symptoms gradually worsen. The general symptoms of Parkinson’s disease include:

• Slowness of voluntary movements, especially in the initiation of such movements as walking or rolling over in bed
• Decreased facial expression, monotonous speech, and decreased eye blinking
• A shuffling gait with poor arm swing and stooped posture
• Unsteady balance; difficulty rising from a sitting position
• Continuous “pill-rolling” motion of the thumb and forefinger
• Abnormal tone or stiffness in the trunk and extremities
• Swallowing problems in later stages
• Lightheadedness or fainting when standing (orthostatic hypotension).

Treatments:

What Is Pallidotomy?

It is thought that the part of the brain called the globus pallidus becomes overactive in Parkinson’s disease. This overactivity acts like a brake and slows or diminishes bodily movement. Pallidotomy surgery permanently destroys the overactive globus pallidus to lessen the symptoms of Parkinson’s disease. This treatment can eliminate rigidity and significantly reduce tremor, bradykinesia, and balance problems. Pallidotomy can also enhance the effect of medication in people with an advanced form of the disease.

What Is Thalamotomy?

It is thought that the abnormal brain activity that causes tremor is processed through the thalamus. Thalamotomy destroys part of the thalamus to block the abnormal brain activity from reaching the muscles and causing tremor. Because thalamotomy is used only to control tremors, it is not generally recommended as a treatment for Parkinson’s disease.