Hand Microsurgery:
Surgery of the hand is a new speciality in our country. For the first time in the private sector, The Apollo Hospitals Group has developed a 24 hour state-of-the-art facility for comprehensive care of hand injuries at The National Institute in Hand Surgery, Microsurgery and Plastic Surgery. Apollo Hospitals, is one of the very few dedicated centers for treating hand injuries in the country.

Micro surgery is a sub-speciality performed with the aid of a microscope on structures that are barely visible to the naked eye. This sub-speciality mainly deals with ‘Replantations’ (reattaching severed parts of the limb). The department consists of senior consultants who have trained and worked at leading medical institutions in India and abroad.

Notable features of this department include:

A dedicated operating theatre, exclusively for hand and general trauma.Fully trained staff round the clockSenior consultants available on callLatest series of equipmentContinuity in management on individual basis
Apollo Hospitals offers surgical treatment for hand injuries and problems such as:

Congenital Abnormalities

The most common hand problems in infants are syndactyly (webbed fingers) and polydactyly (extra fingers). In all hand surgeries and especially pediatric hand surgeries at Apollo Hospitals, India atraumatic techniques (causing no tissue damage) are used.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome occurs most commonly due to the compression of the median nerve at the wrist where it passes through a narrow area called the carpal tunnel. The symptoms include numbness in the thumb, index, and middle fingers especially at night or upon waking up in the morning.

Carpal Tunnel Syndrome can be treated by releasing the constriction through endoscopic or minimal access surgery.

Arthritis

Reconstruction of painful arthritic deformities is performed routinely and includes tendon transfers, muscle release and joint displacement fusion.

Reconstructive Surgery (for tumors, nerve compression and arthritis)

Reconstructive hand surgery alleviates pain and helps correct deformities caused by tumors, nerve compression and arthritis. Many benign tumors of the hand and wrist don’t always cause pain and subside soon. However, when pain persists or limits necessary function, removal is recommended and is almost universally curative.

Microsurgery (for finger deformities)

Replantation of a single finger or multiple fingers can be done through microsurgery. Even if multiple finger amputation has been done, one or more fingers can be replanted in a position that will allow functioning of the hand. Replantation surgery will be followed by rehabilitative therapy for the hand.

Article by

Apollo hospitals

Cardiac emergencies are life threatening. They can arise due to various causes. Whatever may be the cause, the resulting damage is devastating. So the eponym “When the bolt strikes…” is indeed very appropriate to describe cardiac emergencies.

What is a Heart Attack?
“Heart Attack”, technically termed Myocardial Infarction, is a result of total blockage of the blood vessel (coronary artery) which supplies blood to the heart. The blockage is due to the formation of plug composed of cholesterol, blood cells, fibrin and calcium. The heart attack may manifest with a sudden onset of severe central chest pain described as heavy, compressing pain, which can radiate to the left hand, jaw or to the back. It is often associated with profuse sweating and weakness. The presentation can be so sudden that the patient suddenly collapses and becomes unresponsive with profuse sweating and cold peripheries.

A patient with the above mentioned symptoms has to be rushed to the nearest hospital equipped with ECG facilities and a physician / cardiologists on call. Emergency measures include supplemental oxygen through a face mask, pain relief with strong analgesics, intravenous access and initial dose of aspirin and statins (lipid lowering drug). Once the diagnosis of heart attack is confirmed, the treatment is initiated. The important aim of early institution of treatment is to save the heart muscle from damage following lack of blood supply. Blood thinning medications, drugs that improve demand-supply imbalance (beta blockers), drugs that reduce blood cholesterol (statins) and drugs that improve the remodeling of the heart after the attack (ACE inhibitors) form the mainstay of management of heart attacks.

However, the most important component of the treatment consists of Conventional Thrombolytic Therapy -Using clot dissolving medications like Streptokinase, Urokinase or Recombinant TPA to improve blood flow.

Primary Percutaneous Coronary Intervention or Primary Angioplasty (PCI)-An emergency coronary angiogram (to visualize the blockade) followed by balloon Angioplasty with stenting thereby improving the blood flow.

Both methods have got their own merits and demerits. Advantages of primary PCI are that the blockage is visualized, opened and stented, ensuring normal blood flow. The chances of recurrent heart attack, recurrent block and death are less when compared to the clot dissolving medications. Disadvantages include inadequate availability of cathlabs with trained professionals who could perform PCI, and the high cost of the procedure.

Thrombolysis with clot dissolving medications is a time-tested method of treatment. The chief advantage is its universal availability at affordable cost. The disadvantages are the lesser degree of blood flow improvement (54% success rate when compared to 93-98% success with primary PCI), bleeding complications and allergic reactions.

Whatever may be the modality of treatment, the earlier it is instituted the better will be the outcome for the patient. The first one hour is called “The Golden hour” and if treatment as described above is given, the complications and mortality are significantly reduced.

Complications of heart attack:
Cardiogenic shock

If even after thrombolysis the patient continues to have chest pain and develops low blood pressure he is said to be in “cardiogenic shock”. “Rescue PCI” is done for such patients to delineate the blood supply to the heart and open the occluded blood vessel. Such patients in cardiogenic shock will benefit from mechanical support to augment the blood pressure to ensure adequate blood supply to the heart and brain. This is done by inserting an intra aortic balloon pump (IABP) through an artery in the leg. IABP is a mechanical device in which a balloon is intermittently inflated by Helium from an external control, which will augment the patient’s blood pressure and improve the pumping of the heart. This offers temporary support and gives time for the heart to heal.

Rhythm Disturbances

At times a patient presenting with a heart attack can present with heart rhythm disturbances. The heart rate can be fast or slow. If the heart rate is slow it is temporarily increased by implanting a temporary pacemaker within the heart. If the heart rate is very fast it is controlled either by medications or DC electric shock, which is given externally over the chest.

Heart Failure

The heart can fail to pump resulting in low oxygen levels in blood and fluid accumulation in lungs, which sometimes may require ventilatory assistance.

Septal Rupture

Occasionally the heart muscle gives way at the partition between two ventricles (septum) resulting in a communication between left and right ventricles. This is termed ventricular septal rupture and this affects the overall pumping function of the heart. The valve of the left side of heart can start leaking secondary to the attack and this can worsen the pump failure. Such patients require early intervention followed by emergency surgical correction of the problem. TA patient who is being taken up for an emergency angiogram with the aim to do PCI may even end up undergoing emergency bypass surgery if the blocks are multiple and present in all blood vessels.

In an occasional patient, the heart can rupture at its weakest point and blood collects within the pericardium (layer surrounding the heart). Such a complication almost always results in catastrophe.

How is a heart attack treated?
The routine management of a case of heart attack (with no complications) will require 5-7 days of hospitalization with initial CCU care for stabilization in the initial 48-72 hours. The patient is then subjected to further investigation by way of coronary angiogram, based on which the post heart attack treatment is decided. The treatment could be either medical, PTCA (Angioplasty) or CABG surgery (Bypass surgery).

Prior to discharge, counseling for the patient is mandatory regarding regular follow up (6 months to one year), continuation of medications, life style modification, smoking cessation, physical exercise, tight control of sugar and blood pressure levels and strict diet control.

Efficacy in timely management of a case of heart attack and its complication depends on a good Critical Care Unit and is a combined effort of the Cardiologist and Intensivist along with efficient nursing care. Good surgical back up with a competent cardiothoracic surgical team also contribute immensely to successful management of heart attack.

It is here that a centre like Apollo Hospitals has the edge over other facilities as it possesses every advantage for the successful management of a patient with heart attack, including world class cardiologist and cardiothoracic surgeons, state of the art Cath Labs and Operating Rooms, a highly efficient Critical Care Unit and a renowned Emergency care facility including timely and effective ambulance services, thus making it a one stop facility for successful outcomes after a heart attack

Why do some people get Heart Attacks? Can one prevent it?
When many lakhs of cars are moving on the roads only a few cars meet with accidents. Cars with defective brakes, gears or non-aligned tyres have increased chances of accidents. Likewise, extensive clinical and statistical studies have identified several factors that increase the risk of coronary heart disease and heart attack.

Major risk factors are those that research has shown significantly increase the risk of heart and blood vessel (cardiovascular) disease. Other factors are associated with increased risk of cardiovascular disease, but their significance and prevalence haven’t yet been precisely determined. They are called contributing risk factors.

The American Heart Association has identified several risk factors. Some of them can be modified, treated or controlled, and some can’t. The more risk factors you have, the greater your chance of developing coronary heart disease. Also, the greater the lever of each risk factor, the greater the risk. For example, a person with a total cholesterol of 300 mg/dL has a greater risk than someone with a total cholesterol of 245 mg/dL, even though everyone with a total cholesterol greater than 240 mg/dL is considered high-risk.

Non-modifiable Risk Factors:

Increasing age:

Over 83 percent of people who die of coronary heart disease are 65 or older. At older ages, women who have heart attacks are more likely than men are, to die from them within a few weeks.

Gender:

Men have a greater risk of heart attack than women do, and they have attacks earlier in life. Heredity (including Race): Children of parents with heart disease are more likely to develop it themselves. Just as you can’t control your age, sex and race, you can’t control your family history. Therefore, it’s even more important to treat and control any other risk factors you have.

Modifiable Risk Factors:

Smoking:

Smokers’ risk of developing coronary heart disease is 24 times that of nonsmokers. Cigarette smoking is a powerful independent risk factor for sudden cardiac death in patients with coronary heart disease. Exposure to other people’s smoke increases the risk of heart disease ever for nonsmokers.

People who stop smoking at 60 years gain 3 years extra life, at 50 years-6 years, at 40 years – 9 years and at 30 years – 10 years. Smoking also totally cancels the actions of Aspirin, a cardiovascular protecting drug and cancels 75% of the actions of Statins.

High blood cholesterol:

As blood cholesterol rises, so does risk of coronary heart disease. When other risk factors such as high blood pressure and tobacco smoke are present, this risk increases even more. A person’s cholesterol level is also affected by age, sex, heredity and diet.

High blood pressure:

High blood pressure increases the heart’s workload, causing the heart to thicken and become stiffer. It also increases your risk of stroke, heart attack, kidney failure and congestive heart failure. When high blood pressure exists with obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or stroke increases several times.

Physical inactivity:

An inactive lifestyle is a risk factor for coronary heart disease. The more vigorous your activity, the greater are your benefits. However, even moderate-intensity activities help if done regularly. Exercise can help control blood cholesterol, diabetes and obesity, as well as help lower blood pressure in some people. Doctors have liberalized the physical activity programmes as anywhere and at any time.

Obesity:

People who have excess body fat especially if a lot of it is at the waist are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight increases the heart’s work. It also raises blood pressure and blood cholesterol and triglyceride levels, and lowers HDL (“good”) cholesterol levels. It can also make Diabetes more likely to develop. Many obese and overweight people may have difficulty losing weight. But by losing even as few as 10 pounds, you can lower your heart disease risk.

Diabetes mellitus:

Diabetes seriously increases your risk of developing cardiovascular disease. Even when glucose (blood sugar) levels are under control, Diabetes increases the risk of heart disease and stroke, but the risks are even greater if blood sugar is not well controlled. About three-quarters of people with Diabetes die of some form of heart or blood vessel disease. If you have Diabetes, it’s extremely important to work with your healthcare provider to manage it and control any other risk factors you can.

Stress:

Individual response to stress may be a contributing factor. Some scientists have noted a relationship between coronary heart disease risk and stress in a person’s life, their health behaviors and socioeconomic status. These factors may also affect established risk factors. For example, people under stress may overeat, start smoking or smoke more than they otherwise would. Alcohol: Drinking too much alcohol can raise blood pressure, cause heart failure and lead to stroke. It can contribute to high triglycerides, cancer and other diseases, and produce irregular heartbeats. It also contributes to obesity, alcoholism, suicide and accidents.

Article by
Apollo Hospitals

COMPREHENSIVE HEALTH CHECK FOR FEMALE

Women should get regular health checkup every year or as per recommended by the doctor. Regular checkups can help pick up early signs of any health disorder. With increasing prevalence of cardiac diseases, diabetes and cancer in women, it is very important to keep an update of the health to discover the disease earlier when the treatment is often effective.

Benefits of the Package:

• Designed to suit basic needs of a woman for a health checkup

• Consultations with our medical experts

• Early disease detection for complete protection

• Use of latest technology for perfect assessment of the health

INVESTIGATIONS

• CBC

• ESR

• Blood grouping & RH typing

• Urine routine & microscopy

• Stool routine

• Peripheral Smear

• Audiometry

• Pap Smear

• Chest X ray

• Ultrasound abdomen & pelvis

• Sonomammogram(Less than 40 yrs)/Mammogram (Above 40yrs)

DIABETES EVALUATION

• Fasting Blood Sugar

• Post Prandial Blood Sugar

Lipid Profile

• Total Cholesterol

• HDL

• LDL

• VLDL

• Triglycerides

Liver Function Test

• Alkaline Phosphatase

• SGOT

• SGPT

• GGPT

• Albumin

• Globulin

• Total Protein

• Total & Direct Bilirubin

KIDNEY PROFILE

• SR CREATININE

• SR Uric Acid

• Calcium

• Phosphorus

• BUN

Thyroid Profile

• T3

• T4

• TSH

CARDIAC RISK EVALUATION

• ECG

• ECHO Screening/Tread Mill Test

CONSULTATIONS

• Physical examination

• Opthalmology Consultation

• Dental

• Diet Consultation

• Physician Consultation

• Gynecology Consultation

Medical Reports

Instructions

• Please be fasting from 10:00 p.m. the previous night and report to Manipal Hospitals at 08:00 a.m. on the day of the Health Check.

Article by
Manipal Hospitals

The implants themselves are tiny titanium posts, which are inserted into the jawbone where teeth are missing. These metal anchors act as tooth root substitutes. They are surgically placed into the jawbone. The bone bonds with the titanium, creating a strong foundation for artificial teeth. Small posts are then attached to the implant, which protrude through the gums. These posts provide stable anchors for artificial replacement teeth.

Implants also help preserve facial structure, preventing the bone deterioration that occurs when teeth are missing.

The Surgical Procedure

For most patients, the placement of dental implants involves two surgical procedures. First, implants are placed within your jawbone. For the first three to six months following surgery, the implants are beneath the surface of the gums gradually bonding with the jawbone. You should be able to wear temporary dentures and eat a soft diet during this time. At the same time, your dentist is forming new replacement teeth.

After the implant has bonded to the jawbone, the second phase begins. Our doctors will uncover the implants and attach small posts, which will act as anchors for the artificial teeth. These posts protrude through the gums. When the artificial teeth are placed these posts will not be seen. The entire procedure usually takes six to eight months. Most patients experience minimal disruption in their daily life.

Surgical Advances

Using the most recent advances in dental implant technology, our doctors are able to place single stage implants. These implants do not require a second procedure to uncover them but do require a minimum of six weeks of healing time before placing artificial teeth on them. There are even situations where the implants can be placed at the same time as a tooth extraction further minimizing the number of surgical procedures. Advances in dental implant technology have made it possible in select cases, to extract teeth, and place implants with crowns at one visit. This process, called “immediate loading” greatly simplifies the surgical process.

Who actually performs the implant placement?

Implants are a team effort between an Oral and Maxillofacial Surgeon and a prosthodontist. While our doctor performs the actual implant surgery, and initial tooth extractions and bone grafting if necessary, the prosthodontist fits and makes the permanent prosthesis.

What types of prostheses are available?

A single prosthesis (crown) is used to replace one missing tooth – each prosthetic tooth attaches to its own implant. A partial prosthesis (fixed bridge) can replace two or more teeth and may require only two or three implants. A complete dental prosthesis (fixed bridge) replaces all the teeth in your upper or lower jaw. The number of implants varies depending upon which type of complete prosthesis (removable or fixed) is recommended. A removable prosthesis (over denture) attaches to a bar or ball in socket attachments, whereas a fixed one is permanent and removable only by the dentist.

Our doctors perform in-office implant surgery in a hospital-style operating suite, thus optimizing the level of sterility. Inpatient hospital implant surgery is for patients who have special medical or anesthetic needs or for those who need extensive bone grafting from the jaw, hip or tibia.

Why dental implants?

Once you learn about dental implants, you finally realize there is a way to improve your life. When you lose several teeth – whether it’s a new situation or something you have lived with for years – chances are you have never become fully accustomed to losing such a vital part of yourself.
Dental implants can be your doorway to renewed self-confidence and peace of mind.

Why would you select dental implants over more traditional types of restorations?

There are several reasons: Why sacrifice the structure of surrounding good teeth to bridge a space? In addition, removing a denture or a “partial” at night may be inconvenient, not to mention that dentures that slip can be uncomfortable and rather embarrassing.

Are you a candidate for implants?

If you are considering implants, your mouth must be examined thoroughly and your medical and dental history reviewed. If your mouth is not ideal for implants, ways of improving outcome, such as bone grafting, may be recommended.

What type of anaesthesia is used?

The majority of dental implants and one graft can be performed in the office under local anaesthesia, with or without general anesthesia.

Do Implants need special care?

Once the implants are in place, they will serve you well for many years if you take care of them and keep your mouth healthy. This means taking the time for good oral hygiene (brushing and flossing) and keeping regular appointments with your dental specialists.

Article by
sparsh hospitals

Orthodontic Treatment – Correction of Irregular Teeth

What is Orthodontic Treatment?

You might have seen kids wearing braces or wires on their teeth. They are in fact going through this treatment called “orthodontic treatment”. This treatment corrects the irregularities of your teeth. For example, if you have a bad bite because of crowed or crooked teeth. Teeth in irregular position lead to an undesirable appearance, and smile. To correct such problems, one has to go through this treatment. Wires and brackets help to move teeth from their current position to the correct position. Orthodontic treatment helps in improving the oral health condition and facial bone development too.
Orthodontic treatment not only improves the look of your teeth, it may prevent bigger dental problems from developing later in life.

What are the benefits of orthodontic treatment?
Improvements to the bite can be made, making it easier to bite, chew and speak
Appearance get improved as the treatment align the teeth in their correct position.
What type of problem can be corrected by orthodontic treatment?
Not everyone has a good smile. Many people have either overcrowded teeth or too spacing making their personality poor. You can also improve that if you have such problems with the orthodontic treatment.
Crooked or crowded teeth may cause uneven wear of tooth surfaces or jaw problems that may lead to complications later in life. They can also be difficult to clean properly, which makes them prone to tooth decay and gum disease. Orthodontic treatment helps to improve your oral health that can get worsen if not treated.

Are orthodontic appliances always fixed?
No. There are two types of appliances. One is fixed known as braces or brackets. Another type is a removable type. Removable type is a traditional method of treating bad bite.

What are the benefits of fixed procedure over traditional removable type?
Only minor irregularities can be corrected by the removable orthodontic treatment where as major problems can be treated by the fixed orthodontic treatment.
There are high chances of relapse with removable type of treatment.
Fixed orthodontic treatment is always better with uncooperative kids who tend to remove their appliance if they do not like it.
The final outcome is always better with fixed orthodontic treatment procedure.
How long will be the treatment period?
Treatment times vary, but it may take from 12 to 30 months to complete. For adults, treatment may take a little longer because the facial bones have stopped growing. But whatever your age, keeping your teeth and gums healthy during orthodontic treatment will help keep treatment time on track.

What are braces made from?
They are made up of various materials. They can be made of metal, ceramic, plastic or a combination of these materials.

Are there any tooth colored brackets available?
Yes, there are some clear or tooth colored braces available.

When should treatment begin?
Irregularities of teeth often become noticeable when permanent teeth start to erupt. Child’s permanent teeth start to erupt from the age of 6 till 12. While teeth are erupting, we can notice irregularities of their teeth and suggest if they need this treatment during their regular dental visits. Treatment often begins between ages 8 to 14. Treatment that starts at an early age produces optimal results.

How about adults wearing braces?
It’s never too late to improve your dental health and beautify your smile. If you’re an adult, you can still improve your bad bite such as crooked or crowded teeth, overbites, under bites, incorrect jaw position, or jaw-joint disorders. Usually, adult treatment takes a little longer than a child’s treatment. No matter your age.

Article by

Manipal hospitals
Bangalore

Myomectomy:

Myomectomy is that the surgical elimination of fibroids from the female internal reproductive organ. It permits the female internal reproductive organ to be left in the same place and, for a few females, makes gestation a lot of probably than before. Myomectomy is that the most popular fibroid treatment for ladiesMyomectomy

Before myomectomy, decreases the fibroids with gonadotropin-releasing secretion analogue (GnRH-a) medical aid might scale back blood loss from the surgery. GnRH-a medical aid lowers the number of oestrogen your body makes. If you are bleeding from a fibroid, GnRH-a medical aid can even improve anaemia before surgery by stopping female internal reproductive organ harm for many months.

Below are the surgical methods:

Hysteroscopy- this surgical method involves injecting a instrument to the vagina and to the uterus
Laparoscopy- this surgical method involves using an instrument with one or more small cuts in the abdomen
Laparotomy- this method uses a bigger incision in the abdomen
These surgical method uses depends on the location, size and number of fibroids.

Hysteroscopy is used for removing fibroids, which is present on the inner wall of the uterus. These fibroids can be removed if it is not deep routed into the uterine wall
Laparoscopy usually used for removing two or three fibroids, up to about 2.1 in. (5.2 cm), which are grown outside the uterus
Laparotomy used to remove la fibroids that have grown deep routed into the uterine wall or large fibroids and many fibroids
The time in hospital after surgery depends on each surgery

Hysteroscopy is a casualty procedure
Laparoscopy is a casualty procedure or may need a stay of 1 day
Laparotomy has to stay for an average of 1 day to 5 days
Retrieval time depends on the technique used for the myomectomy:

Hysteroscopy requires from a 3 days to 3 weeks to recover.
Laparoscopy needs 2 to 3weeks.
Laparotomy needs 3 to 6 weeks.
Why Myomectomy is done?

Myomectomy reserves the uterus while treating fibroids. It may be a sensible treatment option if:

Anaemia cannot be treated with medicine
Pressure or pain cannot be relieved through any medicine
Fibroid which changes the wall of the uterus

Article by
BGS Global Hospitals

Bangalore

Laparoscopic & Hysteroscopic Surgeries:

Well trained Hysteroscopic and laparoscopic gynaecologists with years of experience in India and abroad individually tailor almost all gynaecological operations to needs using modern modality of surgery. Some of the common laparoscopic surgeries performed are for:

• Laparoscopy

• Ectopic pregnancies

• Ovarian cysts

• Hysterectomies (laparoscopic assisted vaginal hysterectomy)

• Myomectomy for fibroid

• Laparoscopic treatment for infertility

• Endometriosis etc.

• Chronic pelvic pain

• Hysteroscopy

• Fibroid removal

• Removal of Polyps

• Menstrual problems

• Infertility

• Uterine septum

Know More
Natural Access Scar less Surgery

This implies vaginal surgery operations like: Hysterectomy Prolapse Myomectomy Polypectomy Post operative recovery is maximum with this approach and results in less pain since it is a totally scarless method much like a normal vaginal delivery.

Article by
Apollo Hospitals
Bangalore

Classification:

Carcinoid tumors generally are classified based on the location in the primitive gut (ie, foregut, midgut, hindgut) that gives rise to the tumor. Foregut carcinoid tumors are divided into sporadic primary tumors and tumors secondary to achlorhydria. The term sporadic primary foregut tumor encompasses carcinoids of the bronchus, stomach, proximal duodenum, and pancreas. Midgut tumors are derived from the second portion of the duodenum, the jejunum, the ileum, and the right colon. These account for 60-80% of all carcinoid tumors (especially those of the appendix and distal ileum) in adults and are also seen in children
Diagnosis and Treatment:

A number of imaging modalities have been used to detect carcinoid tumors. These modalities include plain radiography, upper- and lower-GI radiography with the use of oral contrast agents, CT, MRI, angiography, positron emission tomography (PET), scintigraphy with metaiodobenzylguanidine (MIBG) and octreotide (Monsieurs, 2001; Shi, 1998), radionuclide imaging with somatostatin analogs attached to the radioactive tracer, and technetium-99m bone scanning. Depending on the location of the tumor and metastasis, a combination of these may be used.
GI series, CT, and MRI may be helpful in some situations.
For the diagnosis of chest tumors, CT combined with scintigraphy with octreotide is preferred.
In the large bowel, the disease is often detected with colonoscopy and does not provide an imaging challenge. Imaging diagnosis of small-bowel carcinoids is relatively difficult. Small tumors in this location are difficult to detect on upper-GI series and CT scans, and other techniques are required.
Mesenteric invasion and liver metastasis are often detected on CT scans. MRI can also be helpful in the diagnosis of hepatic disease but is less sensitive than CT in detection of extrahepatic lesions.
With advances in imaging studies, angiography is rarely used and is reserved for equivocal situations.
PET scanning can be helpful and is increasingly used for diagnosis and follow-up of the tumors.
Scintigraphy with MIBG and octreotide scanning have been used to successfully detect carcinoid tumors (Kaltsas, 2001). Octreotide scanning appears to be more sensitive than MIBG imaging.
Radionuclide imaging with somatostatin analogs attached to radioactive tracer can be used to advantage for diagnosis of carcinoid tumors.
Radiotracers currently used include indium-111 diethylenetriamine pentaacetic acid (111 In-DTPA) and yttrium. Most neuroendocrine tumors have receptors for somatostatins. Five somatostatin receptor subtypes, designated SSTR-1 to SSTR-5, are identified. Binding affinity of somatostatin analogs to these subtypes may vary, with highest affinity for SSTR-2, medium affinity for SSTR-2 and SSTR-5, and lowest affinity for SSTR-1 and SSTR-4. Carcinoid tumors often express SSTR-1 to SSTR-3 and, infrequently, SSTR-2. Nevertheless, for tumors that measure less than 1 cm in diameter, the sensitivity of111 In-DTPA octreotide imaging reaches 80-90%.
This technique can be used to identify primary and metastatic disease and is approved for radionuclide scanning of carcinoid tumors. An advantage is that, if the result is positive, this technique can be used as a treatment modality.
In a study of 40 patients, somatostatin-receptor scintigraphy (SRS) helped in detecting localized tumors in 78% of patients versus 82% with CT scanning. However, SRS helped in identifying primary tumors in 2 patients missed on CT scanning. In 16% of patients, SRS depicted lesions not found with other modalities. No false-positive results were observed.
Overall, SRS appears to be the imaging method of choice for localizing and evaluating the extent of carcinoid tumor.
Bone metastasis is not uncommon in carcinoid tumors. In a study of 12 patients, 11 of whom had liver metastasis, 8 had bone involvement, as detected on SRS.
Technetium-99m bone scanning can aid in the detection of metastases.

Procedures:
Endoscopy, including bronchoscopy, esophagogastroscopy, gastroscopy, and colonoscopy, can be used for biopsy and diagnosis.

Medical Care
If metastases occur and surgical excision is not suitable, consider treatment with currently recommended chemotherapy.

Chemotherapeutic agents currently used in clinical trials to palliate metastatic carcinoid disease include the following:
Alkylating agents
Doxorubicin
5-Fluorouracil
Dacarbazine
Actinomycin D
Cisplatin
Etoposide
Streptozotocin
Interferon alfa
Somatostatin analogs with a radioactive load
A combination of the agents listed above is typically used.
In one study, 8 adults with carcinoid tumor metastatic to liver were treated with intra-arterial 5-fluorouracil and embolization of hepatic tumors with bovine collagen fiber admixed with iohexol, cisplatin, mitomycin C, and doxorubicin. This treatment resulted in symptomatic relief and tumor regression in 4 patients and stabilized the disease in the rest of the patients.
Octreotide, a somatostatin analog, is highly effective in reducing symptoms; however, in the pediatric age group, stunted linear growth is of concern.

Octreotide reduces the amount of the growth factor produced and, thus, theoretically impairs growth.
Intermittent and continuous infusions of octreotide have been reported, with superior results obtained with the latter.
Such treatment can result in near-normalization of the plasma insulinlike growth factor I and partial suppression of plasma growth hormone–releasing hormone (GHRH) (Lefebvre, 1995).
The availability of a long-acting somatostatin analog that can be given once a month has eliminated the need for injections 2-3 times per day, with equal efficacy (Rubin, 1999).
In metastatic carcinoid tumors, long-term use of octreotide is reported. However, receptor alteration induced during the use of this agent requires consecutive drug dosage increase to control the symptoms (Corleto, 2000).
At present, no formal, well-designed study has been performed to systematically measure the effects of this modality of therapy. Although experience is limited, adverse effects in children have been similar to those in adults. Adverse effects include gallstones and steatorrhea, which may sometimes require pancreatic enzyme replacement. Local irritation at the injection site is a common complaint. These adverse effects must be weighted against the potential benefits.

In situ targeted therapy with somatostatin analogs (eg, octreotide attached to a radioactive load using yttrium-90 or111 Indium-labeling agents) provides promise for patients with unresectable tumors. This therapy is currently used on an experimental basis in adults and children.

Surgical Care:
The treatment of choice is surgical excision, if feasible. The surgical technique may vary according to the type or location of the tumor.

In most appendiceal tumors, simple appendectomy is sufficient for treatment. In intestinal carcinoids, block resection of the tumor with adjacent lymph nodes must be attempted. In the bronchial location, aggressive surgical resection, and not bronchoscopic removal, is recommended (Fink, 2001; Fauroux, 2005).
In localized tumors, surgical resection can result in cure, with 70-90% survival rate.
When total resection is not possible, debulking may provide symptomatic relief.
For hepatic tumors, surgical ligation of the hepatic artery can potentially deprive blood supply to the tumor cells and cause necrosis while preserving most of the normal live cells. However, new blood vessels develop over time and restore circulation.
Intra-arterial infusion of chemotherapeutic agents with chemoembolization of the hepatic artery may also provide effective, albeit short term, relief of symptoms due to hepatic metastasis in cases of carcinoid tumors.
If hepatic metastasis is present but resectable, surgical resection is preferred
Article by
HCG Cancer centre

Treatment and Diagnosis:

Types of Hodgkin Lymphoma:

If you have swollen lymph nodes or another symptom that suggests Hodgkin lymphoma, your doctor will try to find out what’s causing the problem. Your doctor may ask about your personal and family medical history.

You may have some of the following exams and tests:

Physical exam: Your doctor checks for swollen lymph nodes in your neck, underarms, and groin. Your doctor also checks for a swollen spleen or liver.
Blood tests: The lab does a complete blood count to check the number of white blood cells and other cells and substances.
Chest x-rays: X-ray pictures may show swollen lymph nodes or other signs of disease in your chest.
Biopsy:A biopsy is the only sure way to diagnose Hodgkin lymphoma. Your doctor may remove an entire lymph node (excisional biopsy) or only part of a lymph node (incisional biopsy). A thin needle (fine needle aspiration) usually cannot remove a large enough sample for the pathologist to diagnose Hodgkin lymphoma. Removing an entire lymph node is best.

The pathologist uses a microscope to check the tissue for Hodgkin lymphoma cells. A person with Hodgkin lymphoma usually has large, abnormal cells known as Reed-Sternberg cells. They are not found in people with non-Hodgkin lymphoma. See the photo of a Reed-Sternberg cell.

You may want to ask your doctor these questions before having a biopsy:

How will the biopsy be done?
Will I have to stay in the hospital?
Will I have to do anything to prepare for it?
How long will it take? Will I be awake? Will it hurt?
Are there any risks? What are the chances of swelling, infection, or bleeding after the procedure?
How long will it take me to recover?
How soon will I know the results? Who will explain them to me?
If I do have cancer, who will talk to me about next steps? When?

Types of Hodgkin Lymphoma

When Hodgkin lymphoma is found, the pathologist reports the type. There are two major types of Hodgkin lymphoma:

Classical Hodgkin lymphoma: Most people with Hodgkin lymphoma have the classical type. The Reed-Sternberg cell looks like the photo.
Nodular lymphocyte-predominant Hodgkin lymphoma: This is a rare type of Hodgkin lymphoma. The abnormal cell is called a popcorn cell. It may be treated differently from the classical type.

Staging

Your doctor needs to know the extent (stage) of Hodgkin lymphoma to plan the best treatment. Staging is a careful attempt to find out what parts of the body are affected by the disease.

Hodgkin lymphoma tends to spread from one group of lymph nodes to the next group. For example, Hodgkin lymphoma that starts in the lymph nodes in the neck may spread first to the lymph nodes above the collarbones, and then to the lymph nodes under the arms and within the chest.

In time, the Hodgkin lymphoma cells can invade blood vessels and spread to almost any other part of the body. For example, it can spread to the liver, lungs, bone, and bone marrow.

Staging may involve one or more of the following tests:

CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your chest, abdomen, and pelvis. You may receive an injection of contrast material. Also, you may be asked to drink another type of contrast material. The contrast material makes it easier for the doctor to see swollen lymph nodes and other abnormal areas on the x-ray.
MRI: A powerful magnet linked to a computer is used to make detailed pictures of your bones, brain, or other tissues. Your doctor can view these pictures on a monitor and can print them on film.
PET scan: You receive an injection of a small amount of radioactive sugar. A machine makes computerized pictures of the sugar being used by cells in your body. Lymphoma cells use sugar faster than normal cells, and areas with lymphoma look brighter on the pictures.
Bone marrow biopsy: The doctor uses a thick needle to remove a small sample of bone and bone marrow from your hipbone or another large bone. Local anesthesia can help control pain. A pathologist looks for Hodgkin lymphoma cells in the sample.

Other staging procedures may include biopsies of other lymph nodes, the liver, or other tissue.
The doctor considers the following to determine the stage of Hodgkin lymphoma:

The number of lymph nodes that have Hodgkin lymphoma cells
Whether these lymph nodes are on one or both sides of the diaphragm (see picture)
Whether the disease has spread to the bone marrow, spleen, liver, or lung.

The stages of Hodgkin lymphoma are as follows:

Stage I: The lymphoma cells are in one lymph node group (such as in the neck or underarm). Or, if the lymphoma cells are not in the lymph nodes, they are in only one part of a tissue or an organ (such as the lung).
Stage II: The lymphoma cells are in at least two lymph node groups on the same side of (either above or below) the diaphragm. Or, the lymphoma cells are in one part of a tissue or an organ and the lymph nodes near that organ (on the same side of the diaphragm). There may be lymphoma cells in other lymph node groups on the same side of the diaphragm.
Stage III: The lymphoma cells are in lymph nodes above and below the diaphragm. Lymphoma also may be found in one part of a tissue or an organ (such as the liver, lung, or bone) near these lymph node groups. It may also be found in the spleen.
Stage IV: Lymphoma cells are found in several parts of one or more organs or tissues. Or, the lymphoma is in an organ (such as the liver, lung, or bone) and in distant lymph nodes.
Recurrent: The disease returns after treatment.

In addition to these stage numbers, your doctor may also describe the stage as A or B:

A: You have not had weight loss, drenching night sweats, or fevers.
B: You have had weight loss, drenching night sweats, or fevers.

Treatment

Chemotherapy
Radiation Therapy
Stem Cell Transplantation

Your doctor can describe your treatment choices and the expected results. You and your doctor can work together to develop a treatment plan that meets your needs.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat Hodgkin lymphoma include hematologists, medical oncologists, and radiation oncologists . Your doctor may suggest that you choose an oncologist who specializes in the treatment of Hodgkin lymphoma. Often, such doctors are associated with major academic centers. Your health care team may also include an oncology nurse and a registered dietitian.

The choice of treatment depends mainly on the following:

The type of your Hodgkin lymphoma (most people have classical Hodgkin lymphoma)
Its stage (where the lymphoma is found)
Whether you have a tumor that is more than 4 inches (10 centimeters) wide
Your age
Whether you’ve had weight loss, drenching night sweats, or fevers.

People with Hodgkin lymphoma may be treated with chemotherapy, radiation therapy, or both.

If Hodgkin lymphoma comes back after treatment, doctors call this a relapse or recurrence. People with Hodgkin lymphoma that comes back after treatment may receive high doses of chemotherapy, radiation therapy, or both, followed by stem cell transplantation.

You may want to know about side effects and how treatment may change your normal activities. Because chemotherapy and radiation therapy often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next. Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them. The younger a person is, the easier it may be to cope with treatment and its side effects.

You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods. See the Taking Part in Cancer Research section.
You may want to ask your doctor these questions before you begin treatment:

What type of Hodgkin lymphoma do I have? May I have a copy of the report from the pathologist?
What is the stage of my disease? Where are the tumors?
What are my treatment choices? Which do you recommend for me? Why?
Will I have more than one kind of treatment?
What are the expected benefits of each kind of treatment?
What are the risks and possible side effects of each treatment? What can we do to control the side effects?
How long will the treatment last?
What can I do to prepare for treatment?
Will I need to stay in the hospital? If so, for how long?
What is the treatment likely to cost? Will my insurance cover the cost?
How will treatment affect my normal activities?
Would a clinical trial be right for me?
How often should I have checkups after treatment?

Chemotherapy

Chemotherapy for Hodgkin lymphoma uses drugs to kill lymphoma cells. It is called systemic therapy because the drugs travel through the bloodstream. The drugs can reach lymphoma cells in almost all parts of the body.

Usually, more than one drug is given. Most drugs for Hodgkin lymphoma are given through a vein (intravenous), but some are taken by mouth.

Chemotherapy is given in cycles. You have a treatment period followed by a rest period. The length of the rest period and the number of treatment cycles depend on the stage of your disease and on the anticancer drugs used.

You may have your treatment in a clinic, at the doctor’s office, or at home. Some people may need to stay in the hospital for treatment.

The side effects depend mainly on which drugs are given and how much. The drugs can harm normal cells that divide rapidly:

Blood cells: When chemotherapy lowers the levels of healthy blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team gives you blood tests to check for low levels of blood cells. If levels are low, there are medicines that can help your body make new blood cells.
Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back, but it may be somewhat different in color and texture.
Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Ask your health care team about medicines and other ways to help you cope with these problems.

Some types of chemotherapy can cause infertility:

Men: Chemotherapy may damage sperm cells. Because these changes to sperm may be permanent, some men have their sperm frozen and stored before treatment (sperm banking).
Women: Chemotherapy may damage the ovaries. Women who may want to get pregnant in the future should ask their health care team about ways to preserve their eggs before treatment starts.

Some of the drugs used for Hodgkin lymphoma may cause heart disease or cancer later on. See the Follow-up Care section for information about checkups after treatment.
You may want to ask your doctor these questions before having chemotherapy:

Which drugs will I have? What are the expected benefits?
When will treatment start? When will it end? How often will I have treatments?
Where will I go for treatment? Will I be able to drive home afterward?
What can I do to take care of myself during treatment?
How will we know the treatment is working?
What side effects should I tell you about? Can I prevent or treat any of these side effects?
Will there be lasting side effects?

Radiation Therapy

Radiation therapy (also called radiotherapy) for Hodgkin lymphoma uses high-energy rays to kill lymphoma cells. It can shrink tumors and help control pain.

A large machine aims the rays at the lymph node areas affected by lymphoma. This is local therapy because it affects cells in the treated area only. Most people go to a hospital or clinic for treatment 5 days a week for several weeks.

The side effects of radiation therapy depend mainly on the dose of radiation and the part of the body that is treated. For example, radiation to your abdomen can cause nausea, vomiting, and diarrhea. When your chest and neck are treated, you may have a dry, sore throat and some trouble swallowing.

In addition, your skin in the area being treated may become red, dry, and tender. You also may lose your hair in the treated area.

Many people become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise people to try to stay as active as they can.

Although the side effects of radiation therapy can be distressing, they can usually be treated or controlled. You can talk with your doctor about ways to ease these problems.

It may also help to know that, in most cases, the side effects are not permanent. However, you may want to discuss with your doctor the possible long-term effects of radiation treatment. After treatment is over, you may have an increased chance of developing a second cancer. Also, radiation therapy aimed at the chest may cause heart disease or lung damage.

Radiation therapy aimed at the pelvis can cause infertility. Loss of fertility may be temporary or permanent, depending on your age:

Men: If radiation therapy is aimed at the pelvic area, the testes may be harmed. Sperm banking before treatment may be a choice.
Women: Radiation aimed at the pelvic area can harm the ovaries. Menstrual periods may stop, and women may have hot flashes and vaginal dryness. Menstrual periods are more likely to return for younger women. Women who may want to get pregnant after radiation therapy should ask their health care team about ways to preserve their eggs before treatment starts.

You may want to ask your doctor these questions before having radiation therapy:

Why do I need this treatment?
When will the treatments begin? When will they end?
How will I feel during treatment?
How will we know if the radiation treatment is working?
Are there any lasting side effects?

Stem Cell Transplantation

If Hodgkin lymphoma returns after treatment, you may receive stem cell transplantation. A transplant of your own blood-forming stem cells (autologous stem cell transplantation) allows you to receive high doses of chemotherapy, radiation therapy, or both. The high doses destroy both Hodgkin lymphoma cells and healthy blood cells in the bone marrow.

Stem cell transplants take place in the hospital. Before you receive high-dose treatment, your stem cells are removed and may be treated to kill lymphoma cells that may be present. Your stem cells are frozen and stored. After you receive high-dose treatment to kill Hodgkin lymphoma cells, your stored stem cells are thawed and given back to you through a flexible tube placed in a large vein in your neck or chest area. New blood cells develop from the transplanted stem cells.

Article by
HCG cancer centre

Cartilage Injury Treatments

In some cases arthroscopy can be used to ‘smooth’ the cartilage. Although new cartilage cannot grow to take its place, scar tissue appears.
It is also possible to transplant some cartilage from an uninjured part of the knee. Another option is to remove some normal cartilage cells, reproduce them in a lab and then later reimplant them into the damaged area so that new cartilage will grow.

Know More

Detached Cartilage of Bone in the Knee Joint

If the injury is fairly recent, it is possible to put the piece back in place. More commonly, the loose body may be removed by arthroscopy.
Cartilage Restoration

Cartilage Restoration is a procedure where a patient’s knee is resurfaced, realigned and stabilized thereby avoiding a joint replacement. Cartilage restoration is especially effective in patients who are under 50 and active.

Articular cartilage is a firm, smooth and slippery covering on the ends of bones that protects and cushions the bone joint. Injuries to this cartilage can cause pain and swelling. If partially or fully detached injured cartilage can cause mechanical symptoms such as “locking up or “catching.” If various non-operative treatments fail, surgery may be required. One of the surgical options is cartilage restoration.

There are two types of cartilage restoration:
ACI (Autologous Chondrocyte Implantation)

ACI is indicated for larger areas of full thickness cartilage loss, and requires two surgeries. First we arthroscopically harvest normal cartilage cells from one area of the knee not needed. The second surgery is an open surgery where we implant the cartilage cells back into knee to repair the damaged area.The cells in a gel form which solidify when placed in the cartilage defect area within 10 minutes.
Microfracturing

Microfracturing is a technique in which arthroscopically multiple small holes are put in the sub chondylar bone so that bone marrow can bring in blood supply and bent the cartilage defect with fibro cartilage.
Visscosupplementation

In order to provide optimum environment for cartilage to heal Visscosupplementation is injecting a solution of hyaluronic acid. It is used in association with Microfracturing.
Osteochondral Transplant

Cartilage and bone transplants are indicated when the damaged area is very large, if there is failure of one of the other techniques, or if bone is also injured along with the cartilage. This is when cartilage and bone plugs are harvested from either an uninjured non-weight bearing area of the knee, or from a donor (cadaver), and then transplanted to cover the injured area of bone and cartilage.

Cartilage restoration surgery can take 1-4 hours depending on the injury.

Recovery varies but can take 2-3 months before weight-bearing activities can be pursued

Article by
Apollo Hospitals