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Cosmetic Surgery

Cosmetic Surgery: Definition

The goal of cosmetic surgery is to improve a person’s appearance and, thus, self-esteem by changing the way she or he looks. Cosmetic surgery can be performed on any part of the face and body.

Types

The Face

The Body

Critical Care Unit

critical care unit (CCU):

It is a specially equipped hospital area designed for the treatment of patients with sudden life-threatening conditions. CCUs contain resuscitation and monitoring equipment and are staffed by personnel specially trained and skilled in recognizing and immediately responding to cardiac and other emergencies. See also intensive care unit.

About Critical Care Nursing

Definition of Critical Care Nursing:

Critical care nursing is that specialty within nursing that deals specifically with human responses to life-threatening problems. A critical care nurse is a licensed professional nurse who is responsible for ensuring that acutely and critically ill patients and their families receive optimal care.

Definition of a Critically Ill Patient:

Critically ill patients are defined as those patients who are at high risk for actual or potential life-threatening health problems. The more critically ill the patient is, the more likely he or she is to be highly vulnerable, unstable and complex, thereby requiring intense and vigilant nursing care.

Where Critical Care Nurses Work:

According to “The Registered Nurse Population” study, 56.2% of all nurses work in a hospital setting, and critical care nurses work wherever critically ill patients are found — intensive care units, pediatric ICUs, neonatal ICUs, cardiac care units, cardiac catheter labs, telemetry units, progressive care units, emergency departments and recovery rooms.

Increasingly, critical care nurses work in home healthcare, managed care organizations, nursing schools, outpatient surgery centers and clinics.

What Critical Care Nurses Do:

Critical care nurses practice in settings where patients require complex assessment, high-intensity therapies and interventions and continuous nursing vigilance. Critical care nurses rely upon a specialized body of knowledge, skills and experience to provide care to patients and families and create environments that are healing, humane and caring.

Foremost, the critical care nurse is a patient advocate. AACN defines advocacy as respecting and supporting the basic values, rights and beliefs of the critically ill patient. In this role, critical care nurses:

Respect and support the right of the patient or the patient’s designated surrogate to autonomous informed decision making.
Intervene when the best interest of the patient is in question.
Help the patient obtain necessary care.
Respect the values, beliefs and rights of the patient.
Provide education and support to help the patient or the patient’s designated surrogate make decisions.
Represent the patient in accordance with the patient’s choices.
Support the decisions of the patient or designated surrogate, or transfer care to an equally qualified critical care nurse.
Intercede for patients who cannot speak for themselves in situations that require immediate action.
Monitor and safeguard the quality of care the patient receives.
Act as a liaison between the patient, the patient’s family and other healthcare professionals.

The Roles of Critical Care Nurses

Critical care nurses work in a wide variety of settings, filling many roles including bedside clinicians, nurse educators, nurse researchers, nurse managers, clinical nurse specialists and nurse practitioners. With the onset of managed care and the resulting migration of patients to alternative settings, critical care nurses are caring for patients who are more ill than ever before.

Managed care has also fueled a growing demand for advanced practice nurses in the acute care setting. Advanced practice nurses are those who have received advanced education at the master’s or doctoral level. In the critical care setting, they are most frequently clinical nurse specialists (CNS) or acute care nurse practitioners (ACNP).

A CNS is an expert clinician in a particular specialty — critical care in this case. The CNS is responsible for the identification, intervention and management of clinical problems to improve care for patients and families. They provide direct patient care, including assessing, diagnosing, planning and prescribing pharmacological and nonpharmacological treatment of health problems.

ACNPs in the critical care setting focus on making clinical decisions related to complex patient care. Their activities include risk appraisal, interpretation of diagnostic tests and providing treatment, which may include prescribing medication

Cataracts

What are the different types of cataracts?

Age-related cataract: Most cataracts are related to aging.

Congenital cataract: Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may not affect vision. If they do, they may need to be removed.

Secondary cataract: Cataracts are more likely to develop in people who have certain other health problems, such as diabetes. Also, cataracts are sometimes linked to steroid use.

Traumatic cataract: Cataracts can develop soon after an eye injury, or years later.

What are the different treatments available?

Choose No needle – No stitch – No patch Cataract surgeries by Phacoemulsification with Foldable IOL implantation ,
State of the Art Technology includes;

* Latest Whitestar Signature Phaco system
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WHITESTAR COLD PHACO Technology of Signature system is clinically proven to produce clearer corneas on post-op day 1. This is one of its types as it can perform Phacoemulsification and Posterior Vitrectomy with the same system.

10 MEDICAL BREAKTHROUGHS

Nobody knows if innovation is infectious, or can be learnt. But the year 2009 saw a wave of creative, inspired approaches from the nation’s medical fraternity. No, not big bang innovations, but more the Tata Nano variety. With government expenditure on health as a percentage of total health expenditure at 17.9 per cent, one hardly expects the Indian state to play a major role. Nor so much the booming drug companies, who spend 12 to 15 per cent of their outlays on research and 30 per cent on marketing. The true leaders of innovation this year have been the nation’s surgeons.

Technology has been their driving force, minimally invasive the gold standard and precision the mantra. And armed with new machines and new skills, surgeons have accessed parts of a patient’s body as never before, used tools and techniques in a whole new way, changed how some types of surgery are performed, hastened the healing process for many and practically created new milestones for the range of patients they can help.

“Modern surgery might not yet feature Star Trek-ian techniques and equipment, but in some regards, they are on their way,” says Dr Naresh Trehan, the cardiologist who pioneered robotic surgery of the heart in the country. But that’s not all. From discovering new drugs and genes, new business models, new use of technology to designing hospital furniture keeping the Indian reality in mind-simple innovations have been the flavour of the season. “The knowledge economy is an innovation economy,” they say. Our doctors and researchers this year have certainly provided a roadmap for turning new ideas into long-term successes.

1. Sizing up the brain

Gene behind brain disorder found

This is what happens when the best brains come together to size up the brain. Geneticist Arun Kumar of the Indian Institute of Science (IISC) and psychiatrist Satish Girimaji of the National Institute of Mental Health and Neuro Sciences (NIMHANS) in Bangalore worked together for nine years. The outcome? Finding a key gene that causes microcephaly-a disorder marked by smaller-than-normal brain size and mental retardation. Until now only four genes were known to cause this hereditary disorder that develops in the foetal stage. This is the first time a fifth gene, named STIL, has been detected. The new gene is particularly valid for India, where one in every 50,000 to 1,00,000 live births ends up with microcephaly.

2. Beating cancer

Research and technology bring new hope

Medics link the HPV virus to cervical cancer, especially in sexually active women. In India, it kills about 76,000 each year. This year, biochemists, microbiologists and gynaecologists at the All India Institute of Medical Sciences sent a message of hope by detecting the most common HPV types that cause havoc in India. More good news: the Apollo Speciality Cancer Hospital in Chennai launched the CyberKnife technology, a first in India. A pocket-pincher, but it promises precise radiation to cancer cells, avoiding healthy tissue. A noninvasive option that caters to the quality of life of a cancer patient.

3. Gumming the eye

Using glue in eye surgery

For the first time, the entire front part of a patient’s eye-cornea, sclera, iris, pupil and lens-was transplanted at Dr Agarwal’s Eye Hospital & Eye Research Centre, Chennai. It followed the technique that was used here in 2007 to fix intraocular lens with fibrin glue (generally used to arrest bleeding and seal tissues in surgery) in a patient’s eye where lenses could not be implanted by normal procedures. “Earlier, the treatment of damaged IOL was a challenge for ophthalmologists and in most cases nothing could be done,” says Agarwal. “With this glue technology, we can now treat patients where intraocular lens capsules are missing.”

4. Lend me a hand, robot

Milestone robotic surgeries of chest and stomach

It was the year of surgeons using third-generation robots to reach a range of organs. The first such surgery on the thorax was done by Dr Arvind Kumar of AIIMS, Delhi, in June. Last month,Dr Jaydeep Palep did the first stomach surgery at Care Hospital, Hyderabad.”It’s almost like shrinking one’s hands and putting them in places they would never fit,”says Kumar.

5. The sweet switch

A rare surgery for diabetes

Surgery for diabetes? That’s exactly what Dr Surendra Ugale of Kirloskar Hospital in Hyderabad and Dr Ramen Goel of Bombay Hospital tried out through the Ileal Transposition (or small intestinal switch). The procedure shortens the intestinal tract between the stomach and terminal ileum, shifts it into an upper area and puts it in line again. The fallout? A biochemical process that facilitates insulin secretion in the presence of undigested food and controls Type II diabetes-a metabolic disorder that is marked by the failure to absorb sugar and starch due to lack of the hormone insulin.

6. Sing a different tune

iPhone used to stave off blindness

Who would have thought that the pricey Apple iPhone could help India’s rural masses? But doctors at the Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, are doing precisely that to diagnose vision loss in infants from remote areas. Over 8 per cent of India’s 27 million infants each year weigh less than 2 kg and run the risk of Retinopathy of Prematurity. So long just a handful of city doctors had the know-how. Now with the iPhone and a software developed by the i2i TeleSolutions, the good doctors are busy saving lives across the country.

7. Business unusual

A low-cost luxury hospital

Free market mantra to tackle poverty? Think LifeSpring maternity hospital,Hyderabad. The no-frills chain of small hospitals offering world-class care to low-income clients at 30-50 per cent of market rates is winning kudos for its business model.Set up as a joint venture of Hindustan Latex Ltd and Acumen,US, last year, six hospitals have rolled out, with 30 more on the cards by 2010. Success mantra?With over 1,500 customers a month, optimising resources and leveraging economies of scale.

8. Propped up in style

A homespun hospital bed addresses Indian needs

Between the hand-cranking metal beds and super-expensive motorised ones, Indian hospitals had little choice. Then came Onio, the design firm in Pune set up by two ex-NID-ians, whose unique design won them the Design Brilliance Award. “Indian beds imitated Western designs,” says Prakash Khanzode, who mentored the project. “We spoke to hundreds of doctors, nurses and patients to come up with a design suitable for India.” Plastic on all exposed surfaces, quick-shifting, totally adjustable, the Vita Bed is ready for ICUs. Godrej is about to market it.

9. At your finger tips

Ancient medical skills online

Thousands of years of accumulated medical knowledge at the click of a mouse. Thanks to the Council of Scientific & Industrial Research and the Department of AYUSH, Ministry of Health, the world’s first traditional knowledge digital library took shape this year. With over 200,000 ayurveda, siddha and unani formulations across 30 million pages in five international languages, it will hopefully put an end to the rampant misappropriation of time-honoured medical knowledge and practices-a growing concern.

10. Power-packed pill

A five-in-one capsule for the heart

Lifestyle moderation is the key to prevent chronic diseases. Yes, we all know that. But in this age of lifestyle excesses, those who forget to look after their cardiovascular health, a preventive pill is about to come handy. It’s a five-in-one drug combo meant to keep blood singing through your veins and simmer down raging cholesterol and blood pressure. Designed by a team of doctors from Bangalore’s St. John’s Medical College and McMaster University, Canada, the polypill-a first in the world-is likely to reduce coronary heart disease by 62 per cent and stroke by 48 per cent.

Successful Twin Hand Transplant at Aims, Kochi, Kerala

Successful Twin Hand Transplant at Aims

Abdul Rahim, who successfully underwent the twin hand transplant surgery at the Amrita Hospital, Kochi, with the wife and children of Joseph, the donor, and Dr Subramania Iyer of the AIMS

KOCHI: The Amrita Institute of Medical Sciences and Research Centre (AIMS) has set yet another milestone in organ transplant, with the second successful twin hand transplant.

Recipient of the second twin hand transplant is 30-year-old Abdul Rahim, a former army captain from Kandahar in Afghanistan who lost both his hands during de-mining operations in Kandahar three years ago.

This is the first case of twin-hand transplant on an Afghan citizen. The donor was Joseph, a 54-year-old accident victim from Kerala, who was declared brain dead. Manu, 30, the recipient of the first hand transplant, which was performed four months ago, is recovering well and is doing almost all the routine activities.

Abdul Rahim approached Amrita Institute of Medical Sciences four months ago, after scouting for hand transplant in several countries. The transplant was performed in a ‘marathon’ surgical procedure that lasted for around 15 hours, involving more than 20 surgeons and eight anaesthetics.

“Rahim has regained functioning of both his hands significantly, and is using them for day-to-day activities. He will need intensive physiotherapy for another nine-ten months, for which he will have to stay back in Kochi,” said Dr Subramania Iyer, professor and head of the plastic surgery department at Amrita. “Each hand required connecting of two bones, two arteries, four veins and about 14 tendons each. Immune suppressant drugs, which were started before the commencement of the surgery, are continuing,” said Amrita medical director Dr Prem Nair

The family members of the donor agreed to donate the hands after they were given counselling and were assured that the hands would be replaced with prosthetic limbs to reduce deformity.

The Amrita Institute of Medical Sciences, which has been in the forefront of organ transplant in the country, has already conducted 885 transplants, including two liver transplants, bowel transplants, two twin hand transplants, and a rare pancreas transplant.

“The hospital has been getting requests from across the country and abroad, especially in the Gulf, for hand transplant. We have been highly selective, even in providing counselling, as our experience is very limited,” Dr Iyer added.

Pancreatic Cancer, Symptoms, Treatments

Pancreatic Cancer Treatment (PDQ®)

Sections

General Information About Pancreatic Cancer
Stages of Pancreatic Cancer
Recurrent Pancreatic Cancer
Treatment Option Overview
Treatment Options by Stage
Treatment Options for Recurrent Pancreatic Cancer
To Learn More About Pancreatic Cancer
Changes to This Summary (04/​02/​2015)
About This PDQ Summary
Get More Information From NCI
View All Sections

General Information About Pancreatic Cancer
Key Points

Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas.
Smoking and health history can affect the risk of pancreatic cancer.
Signs and symptoms of pancreatic cancer include jaundice, pain, and weight loss.
Pancreatic cancer is difficult to detect (find) and diagnose early.
Tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.

Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas.

The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. The pancreas lies between the stomach and the spine.
Enlarge
Anatomy of the pancreas; drawing shows the pancreas, stomach, spleen, liver, gallbladder, bile ducts, colon, and small intestine. An inset shows the head, body, and tail of the pancreas. The bile duct and pancreatic duct are also shown.
Anatomy of the pancreas. The pancreas has three areas: head, body, and tail. It is found in the abdomen near the stomach, intestines, and other organs.

The pancreas has two main jobs in the body:

To make juices that help digest (break down) food.
To make hormones, such as insulin and glucagon, that help control blood sugar levels. Both of these hormones help the body use and store the energy it gets from food.

The digestive juices are made by exocrine pancreas cells and the hormones are made by endocrine pancreas cells. About 95% of pancreatic cancers begin in exocrine cells.

This summary is about exocrine pancreatic cancer. For information on endocrine pancreatic cancer, see the PDQ summary on Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment.

For information on pancreatic cancer in children, see the PDQ summary on Unusual Cancers of Childhood Treatment.
Smoking and health history can affect the risk of pancreatic cancer.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk.

Risk factors for pancreatic cancer include the following:

Smoking.
Being very overweight.
Having a personal history of diabetes or chronic pancreatitis.
Having a family history of pancreatic cancer or pancreatitis.
Having certain hereditary conditions, such as:
Multiple endocrine neoplasia type 1 (MEN1) syndrome.
Hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome).
von Hippel-Lindau syndrome.
Peutz-Jeghers syndrome.
Hereditary breast and ovarian cancer syndrome.
Familial atypical multiple mole melanoma (FAMMM) syndrome.

Signs and symptoms of pancreatic cancer include jaundice, pain, and weight loss.

Pancreatic cancer may not cause early signs or symptoms. Signs and symptoms may be caused by pancreatic cancer or by other conditions. Check with your doctor if you have any of the following:

Jaundice (yellowing of the skin and whites of the eyes).
Light-colored stools.
Dark urine.
Pain in the upper or middle abdomen and back.
Weight loss for no known reason.
Loss of appetite.
Feeling very tired.

Pancreatic cancer is difficult to detect (find) and diagnose early.

Pancreatic cancer is difficult to detect and diagnose for the following reasons:

There aren’t any noticeable signs or symptoms in the early stages of pancreatic cancer.
The signs and symptoms of pancreatic cancer, when present, are like the signs and symptoms of many other illnesses.
The pancreas is hidden behind other organs such as the stomach, small intestine, liver, gallbladder, spleen, and bile ducts.

Tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer.

Pancreatic cancer is usually diagnosed with tests and procedures that make pictures of the pancreas and the area around it. The process used to find out if cancer cells have spread within and around the pancreas is called staging. Tests and procedures to detect, diagnose, and stage pancreatic cancer are usually done at the same time. In order to plan treatment, it is important to know the stage of the disease and whether or not the pancreatic cancer can be removed by surgery.

The following tests and procedures may be used:

Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances, such as bilirubin, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
Tumor marker test : A procedure in which a sample of blood, urine, or tissue is checked to measure the amounts of certain substances, such as CA 19-9, and carcinoembryonic antigen (CEA), made by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the body. These are called tumor markers.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.
PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan may be done at the same time. This is called a PET-CT.
Abdominal ultrasound : An ultrasound exam used to make pictures of the inside of the abdomen. The ultrasound transducer is pressed against the skin of the abdomen and directs high-energy sound waves (ultrasound) into the abdomen. The sound waves bounce off the internal tissues and organs and make echoes. The transducer receives the echoes and sends them to a computer, which uses the echoes to make pictures called sonograms. The picture can be printed to be looked at later.
Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
Endoscopic retrograde cholangiopancreatography (ERCP): A procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken.
Percutaneous transhepatic cholangiography (PTC): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body. This test is done only if ERCP cannot be done.
Laparoscopy : A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. The laparoscope may have an ultrasound probe at the end in order to bounce high-energy sound waves off internal organs, such as the pancreas. This is called laparoscopic ultrasound. Other instruments may be inserted through the same or other incisions to perform procedures such as taking tissue samples from the pancreas or a sample of fluid from the abdomen to check for cancer.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. There are several ways to do a biopsy for pancreatic cancer. A fine needle or a core needle may be inserted into the pancreas during an x-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

Whether or not the tumor can be removed by surgery.
The stage of the cancer (the size of the tumor and whether the cancer has spread outside the pancreas to nearby tissues or lymph nodes or to other places in the body).
The patient’s general health.
Whether the cancer has just been diagnosed or has recurred (come back).

Pancreatic cancer can be controlled only if it is found before it has spread, when it can be completely removed by surgery. If the cancer has spread, palliative treatment can improve the patient’s quality of life by controlling the symptoms and complications of this disease.

Dysphagia- under gastroenterology

What is dysphagia?

Dysphagia is the medical term for the symptom of difficulty swallowing, derived from the Latin and Greek words meaning difficulty eating.
Mechanism of swallowing

Swallowing is a complex action.

Food is first chewed well in the mouth and mixed with saliva.
The tongue then propels the chewed food into the throat (pharynx).
The soft palate elevates to prevent the food from entering the posterior end of the nasal passages, and the upper pharynx contracts, pushing the food (referred to as a bolus) into the lower pharynx. At the same time, the voice box (larynx) is pulled upwards by muscles in the neck, and, as a result, the epiglottis bends downwards. This dual action closes off the opening to the larynx and windpipe (trachea) and prevents passing food from entering the larynx and trachea.
The contraction of the muscular pharynx continues as a progressing, circumferential wave into the lower pharynx pushing the food along.
A ring of muscle that encircles the upper end of the esophagus, known as the upper esophageal sphincter, relaxes, allowing the wave of contraction to push the food from the lower pharynx on into the esophagus. (When there is no swallow, the muscle of the upper sphincter is continuously contracted, closing off the esophagus from the pharynx and preventing anything within the esophagus from regurgitating back up into the pharynx.)
The wave of contraction, referred to as a peristaltic wave, progresses from the pharynx down the entire length of the esophagus.
Shortly after the bolus enters the upper esophagus, a specialized ring of muscle encircling the lower end of the esophagus where it meets the stomach, known as the lower esophageal sphincter, relaxes so that when it arrives the bolus can pass on into the stomach. (When there is no swallow the muscle of the lower sphincter is continuously contracted, closing off the esophagus from the stomach and preventing contents of the stomach from regurgitating back up into the esophagus.)
After the bolus passes, the lower sphincter tightens again to prevent contents of the stomach from regurgitating back up into the esophagus. It remains tight until the next bolus comes along.

Considering the complexity of swallowing, it is no wonder that swallowing, beginning with the contraction of the upper pharynx, has been “automated,” meaning that no thought is required for swallowing once swallowing is initiated. Swallowing is controlled by automatic reflexes that involve nerves within the pharynx and esophagus as well as a swallowing center in the brain that is connected to the pharynx and esophagus by nerves. (A reflex is a mechanism that is used to control many organs. Reflexes require nerves within an organ such as the esophagus to sense what is happening in that organ and to send the information to other nerves in the wall of the organ or outside the organ. The information is processed in these other nerves, and appropriate responses to conditions in the organ are determined. Then, still other nerves send messages from the processing nerves back to the organ to control the function of the organ, for example, the contraction of the muscles of the organ. In the case of swallowing, processing of reflexes primarily occurs in nerves within the wall of the pharynx and esophagus as well as the brain.)

The complexity of swallowing also explains why there are so many causes of dysphagia. Problems can occur with:

the conscious initiation of swallowing,
propulsion of food into the pharynx,
closing of the nasal passages or larynx,
opening of the upper or lower esophageal sphincters,
physical blockage to the passage of food, and
transit of the bolus by peristalsis through the body of the esophagus.

The problems may lie within the pharynx or esophagus, for example, with the physical narrowing of the pharynx or esophagus. They also may be due to diseases of the muscles or the nerves that control the muscles of the pharynx and esophagus or damage to the swallowing center in the brain. Finally, the pharynx and the upper third of the esophagus contain muscle that is the same as the muscles that we use voluntarily (such as our arm muscles) called skeletal muscle. The lower two-thirds of the esophagus is composed of a different type of muscle known as smooth muscle. Thus, diseases that affect primarily skeletal muscle or smooth muscle in the body can affect the pharynx and esophagus, adding additional possibilities to the causes of dysphagia.
Odynophagia and globus sensation

There are two symptoms that are often thought of as problems with swallowing (dysphagia) that probably are not. These symptoms are odynophagia and globus sensation.
Odynophagia

Odynophagia means painful swallowing. Sometimes it is not easy for individuals to distinguish between odynophagia and dysphagia. For example, food that sticks in the esophagus often is painful. Is this dysphagia or odynophagia or both? Technically it is dysphagia, but individuals may describe it as painful swallowing (i.e., odynophagia). Moreover, patients with gastroesophageal reflux disease (GERD) may describe dysphagia when what they really have is odynophagia. The pain that they feel after swallowing resolves when the inflammation of GERD is treated and disappears and is presumably due to pain caused by food passing through the inflamed portion of the esophagus.

Odynophagia also may occur with other conditions associated with inflammation of the esophagus, for example, viral and fungal infections. It is important to distinguish between dysphagia and odynophagia because the causes of each may be quite different.
Globus sensation

A globus sensation refers to a sensation that there is a lump in the throat. The lump may be present continuously or only when swallowing. The causes of a globus sensation are varied, and frequently no cause is found. Globus sensation has been attributed variously to abnormal function of the nerves or muscles of the pharynx and GERD. The globus sensation usually is described clearly by individuals and infrequently causes confusion with true dysphagia.

Cardiac Treatment

Heart Disease: Symptoms, Diagnosis, Treatment

Most heart attacks happen when a clot in the coronary artery blocks the supply of blood and oxygen to the heart. A blockage that is not treated within a few hours causes the affected heart muscle to die.
Image: National Heart, Lung, and Blood Institute, Diseases and Conditions Index
Click to view a larger version of the image
Symptoms

It is very important to learn the signs of a heart attack. Fast action can save lives—maybe your own.

Chest pain or discomfort—it may feel like pressure or a squeezing pain in your chest. It may feel like indigestion. You may also feel pain in your shoulders, arms, neck, jaw, or back.
Shortness of breath—often comes along with chest discomfort but can also occur before.
Other symptoms—breaking out in a cold sweat, nausea, or light-headedness, upper body discomfort in one or both arms, the neck, jaw, or stomach.

Diagnosis

Key heart tests include:

Electrocardiogram (ECG or EKG)—This records the electrical activity of the heart as it contracts and relaxes. The ECG can detect abnormal heartbeats, some areas of damage, inadequate blood flow, and heart enlargement.
Blood test—Checks for enzymes or other substances released when cells begin to die. They are “markers” of the amount of damage to your heart.
Nuclear scan—Reveals the damaged areas of the heart that lack blood flow. It also can show problems with the heart’s pumping action. The test uses radioactive tracers to study how blood flows in your heart.
Coronary angiography (or arteriography)—A test that uses dye and special X-rays to show the inside of your coronary arteries.

Treatment

You will need to change your lifestyle to help prevent or control coronary heart disease (CHD) and so reduce the risk of a first or repeat heart attack. Sometimes, though, you may need medicines.

Antiplatelet drugs, such as aspirin, keep blood clots from forming. These drugs help to keep arteries open in those who have had a previous heart bypass or other artery-opening procedure, such as coronary angioplasty.
Anticoagulants (blood thinners) prevent blood from clotting or prevent existing clots from getting larger. They can keep harmful clots from forming in your heart, veins, or arteries. Clots can block blood flow and cause a heart attack or stroke. Common names for anticoagulants are “warfarin” and “heparin.”
Digitalis makes the heart contract harder when the heart’s pumping function has been weakened. It also slows some fast heart rhythms.
ACE (angiotensin converting enzyme) inhibitors stop production of a chemical that narrows blood vessels. They help control high blood pressure. You may also take an ACE inhibitor after a heart attack to help the heart pump blood better. People with heart failure, a condition in which the heart is unable to pump enough blood to supply the body’s needs, may also take them.
Beta blockers slow the heart and make it beat with less contracting force, so blood pressure drops and the heart works less hard. They are used for high blood pressure, chest pain, and to prevent repeat attacks.
Nitrates (nitroglycerin) relax blood vessels and stop chest pain.
Calcium channel blockers relax blood vessels. They are used to treat high blood pressure and chest pain.
Diuretics decrease fluid in the body. They treat high blood pressure. Diuretics are sometimes referred to as “water pills.”
Blood cholesterol-lowering agents decrease LDL (“bad”) cholesterol levels in the blood.
Thrombolytic agents (clot busting drugs) are given during a heart attack to break up a blood clot in a coronary artery and restore blood flow.

What Is Acute Coronary Syndrome (ACS)?

Many people hear the term “acute coronary syndrome” related to heart attack. But just what is it? Acute coronary syndrome (ACS) is a life-threatening form of coronary heart disease (CHD) that occurs when the heart muscle does not receive enough oxygenrich blood. ACS includes myocardial infarction (MI), also known as a heart attack, and unstable angina, or sudden, severe chest pain that typically occurs when a person is at rest.

Every year, ACS affects an estimated 1.4 million people in the United States and another 1.4 million people in Europe. Even though patients receive intense ACS management while in the hospital, new treatments are needed to reduce the risk of acute heart attack, stroke, and cardiovascular death. ACS patients receive anticoagulant drugs but this treatment is limited to the hospital.

Orthopedics Treatment

Orthopedics Definition

Orthopedics is the field of medicine concerned with the study and treatment of the musculosketetal system, particularly the spine, joints, and muscles. Orthopedics mainly deals with correction of disorders and deformities related to the musculosketal system; hence, orthopedics is central to the treatment of back pain.

Orthopedic care can employ various pain management techniques, manual treatment, physical therapy, and bracing to treat a variety of spinal dysfunctions including chronic back pain, scoliosis, and sacrioiliac joint dysfunction.