Squint or strabismus surgery is performed on extra ocular muscles to correct eye misalignment.

A squint or Strabismus, which affects one in 20 children, is a common eye condition in which the eyes are pointing in different directions, instead of moving and focusing together in the same direction. Squints typically develop before the patient reaches five years old, but there are also cases when the condition develops later in life.

 

Symptoms of a squint can easily be observed. One of the patient’s eyes might turn outwards, inwards, downwards, or upwards, while the other eye looks forward. However, it is important to note that not all squints are constant—there might be instances when the eyes look normal. Minor squints are not obvious and might be misdiagnosed as another condition.

Specialized testings such as forced ductions, force generation, and saccadic velocities can distinguish excessive scarring, lost or slipped muscles, and fat adherence. Pupillary reactions are also assessed and a dilated exam performed to determine the presence of other retinal or vitreal problems that may require additional treatment. Based on the diagnosis, the condition can be managed with optical treatments, (such as a change in refraction), medical treatment (which may involve the use of corticosteroids and anti-inflammatory medications) and surgical treatment (which may involve the release of scar tissue, excisional biopsies, and treatment of retinovitreal disorders).

Possible Risks and Complications

Squint surgery has various risks and complications although most of them rarely occur. These include:

• Double vision, which usually goes away a week after the procedure
• Eye infection
• Excessive bleeding
• Perforation of the eye and nearby structures
• Change in refraction, which is managed through optical therapy
• Allergic reaction to the anaesthetic, suture material, or post-operative medications
• Conjunctival scarring
• Anterior segment ischemia, which occurs when the procedure resulted in impaired blood flow to the anterior segment
• Ptosis on the vertical rectus muscles

 

Neuromuscular scoliosis is one of three main types of scoliosis that cause an irregular curvature of the spine. It is the second most common form of scoliosis and is associated with disorders of the nerve or muscular systems such as cerebral palsy, spina bifida and spinal cord injury.

These types of neuromuscular conditions cause muscles to become weak, spastic, or paralyzed. Without full support from the muscles of the back, the spine can develop an abnormal curve as it grows.

Symptoms:

The most common symptom of scoliosis is an abnormal curve of the spine. Often this is a mild change and may be first noticed by a friend or family member or physician doing routine screening of children for school or sports. The change in the curve of the spine typically occurs very slowly so it is easy to miss until it becomes a more severe physical deformity. It can also be found on a routine school screening examination for scoliosis. Those affected may notice that their clothes do not fit as they did previously, they may notice an uneven waist, or that pant legs are longer on one side than the other.

 

 

Treatment:

Non-surgical treatments

Non-surgical treatments such as bracing, wheelchair modification, physical therapy, and environmental adaptation can help your child adapt to everyday environments and improve their mobility. Bracing can prevent your child’s spinal curvature from getting worse during periods of growth, but bracing will not correct the curve. Depends on curves below treatment options

1. Observation(curves less than 20 degree)

2. Braces (between 25 degree & 45 degree)

3. Surgery(greater than 45 degree)

Spinal fusion surgery

Stabilizing the spine with spinal fusion surgery is the most common treatment for neuromuscular scoliosis. Using metal rods, hooks, screws, and wires, known as instrumentation, the procedure straightens the spine and solidifies the bone so it will no longer curve abnormally. For 6 to 12 months after surgery, the spine fuses in much the same way that a broken bone heals. The child will need to wear a brace during this time. The instrumentation typically remains in the back without causing any problems.

 

Clubfoot is a birth defect that causes a child’s foot to point inward instead of forward. The condition is normally identified after birth, but doctors can also tell if an unborn baby has clubfoot during an ultrasound. Although the condition usually affects only one foot, it’s possible for both feet to be affected. Clubfoot can sometimes be corrected through stretching and bracing, but surgery may be necessary in severe cases.

Optic neuritis occurs when swelling (inflammation) damages the covering (myelin) of the optic nerve. The optic nerve is a bundle of nerve fibers that transmits visual information from your eye to your brain. Common symptoms of optic neuritis include pain with eye movement and temporary vision loss in one eye.

Causes:

The exact cause of optic neuritis is unknown. It’s believed to develop when the immune system mistakenly targets the substance covering your optic nerve, resulting in inflammation and damage to the myelin. Normally, the myelin helps electrical impulses travel quickly from the eye to the brain, where they’re converted into visual information. Optic neuritis disrupts this process, affecting vision.

1. Multiple sclerosis.
2. Neuromyelitis optica.
3. Infections. Bacterial infections, including Lyme disease, cat-scratch fever and syphilis, or viruses, such as measles, mumps and herpes, can cause optic neuritis.Other diseases. Diseases such as sarcoidosis, Behcet’s disease and lupus can cause recurrent optic neuritis.
4. Drugs and toxins.

Treatments:

Optic neuritis usually improves on its own. In some cases, steroid medications are used to reduce inflammation in the optic nerve. Possible side effects from steroid treatment include weight gain, mood changes, facial flushing, stomach upset and insomnia.

Steroid treatment is usually given by vein (intravenously). Intravenous steroid therapy might speed vision recovery, but it doesn’t appear to affect the amount of vision you’ll recover. Steroid treatment is also used to reduce the risk of developing multiple sclerosis or slow its development.

Kidney removal or nephrectomy is a major surgery that removes a part of the entire kidney. Donor nephrectomy removes a healthy kidney from a donor to be placed in another person whose both kidneys have failed (end-stage renal disease), a procedure known as kidney transplantation.

Those considering donating one of their kidneys to a loved one can read about the criteria involved in selecting the right donor, surgical procedure involved, and what one can expect after the surgery. These will help in understanding if it is really safe to donate a kidney to a loved one.

The Right Donor

There are two types of donors for a kidney transplant:

1. Living (related or unrelated)
2. Deceased

For someone to be considered as a potential donor, s/he must meet a number of criteria:

• Be 18 years of age or above
• Be in good health and free of chronic illnesses like heart disease, cancer or diabetes
• Have two normal functioning kidneys
• Compatible blood and tissue type with the recipient
• Pass all physical tests before the surgery
• Be of stable mental health

It is suggested that a kidney transplant from a living donor has better survival rates than a transplant from a deceased donor. Further, transplantation results are best if the donor is related to the loved one (as parent, child, sibling, or relative).

Relative as a donor: A transplant from a related donor greatly increases the chances of the kidney being accepted by the recipient because body tissues and blood groups are more likely to be matched. The donor will be tested for similarity in the white blood cell HLA antigen and blood group antigen on red blood cells with the loved one. The compatibility pattern within the family is as follows:

1. Parent and child: 50 % (because a child carries half of each parent’s genes)
2. Siblings: 25 %

However, in case a person is not genetically related, he can still donate his kidney if their tissue type and blood groups match and they pass the required criteria for donors.

What One Needs To Know About The Surgery

Surgical advances have made it possible to perform nephrectomy as a hand-assisted laparoscopic procedure, in which a surgeon will create two to three small puncture sites and a small incision of about seven centimeters (compared to 25 centimeters in open surgery). It will take about three hours for the entire procedure that is performed under general anesthesia.

The donor will require a hospital stay for two to three days. Some pain will be experienced but can be tackled with medication. The person will be encouraged to resume light activities as soon as s/he feels comfortable but must refrain from strenuous activities for several weeks post surgery.

The doctor will ask the prospective donor to visit for frequent check ups initially, but only annual tests will be needed gradually. The following will be checked:

• Blood pressure
• Urine protein level
• Kidney waste filtration rate

Are There Risks Involved?

Research studies have not shown any long-term risk involved in kidney donation, as long as the candidate screening was thorough and matched well with their loved one.

As far as the surgery is concerned, the donor might be affected by some complications like bleeding or infection that may occur in any major surgery. Adequate recovery time, initially in the hospital and later at home, is required to allow the other kidney to expand in order to take upon additional blood supply and filter wastes in the absence of the other one.

Regular check ups at the hospital will monitor blood pressure and kidney function. Kidney donation will not change the donor’s quality of life, risk to kidney failure in the future, and survival rate in the long-term any more than that for a non-donor.

Care After Surgery

Donors will need to take care of their remaining kidney for its normal functioning through:

• A balanced diet.
• Following doctor’s prescription of medicines (if any) carefully.
• Avoiding foods rich in proteins that may overwork the kidney.
• Drinking alcohol and caffeinated drinks moderately.
• Limiting salt intake.
• Following an exercise routine.

Any concerns a person may have regarding kidney donation must be discussed with a Nephrologist and one should go ahead with the procedure only when all the necessary criteria for kidney transplant are met.

The uterine transplant is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased. As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile. This phenomenon is known as absolute uterine factor infertility (AUFI). Uterine transplant is a potential treatment for this form of infertility.

The first uterine transplant performed in India took place on 18 May 2017 at the Galaxy Care Hospital in Pune, Maharashtra. The 26-year-old patient had been born without a uterus, and received her mother’s womb in the transplant. India’s first uterine transplant baby, weighing 1.45 kg, was delivered through a Caesarean section at Galaxy Care Hospital in Pune on Thursday. The surgery was performed by a team of doctors at Pune’s Galaxy Care Hospital and led by the hospital’s medical director, Dr. Shailesh Puntambekar.

The transplant is intended to be temporary – the recipient will undergo a hysterectomy after one or two successful pregnancies. This is to avoid the need for her to take immunosuppressive drugs for life with a consequent increased risk of infection.

The procedure remains the last resort: it is a relatively new and somewhat experimental procedure, performed only by certain specialist surgeons in select centres, it is expensive and unlikely to be covered by insurance, and it involves risk of infection and organ rejection. Some ethics specialists consider the risks to a live donor too great, and some find the entire procedure ethically questionable, especially since the transplant is not a life-saving procedure

One of the most important structures in your inner ear is the mastoid bone. Although it’s called a bone, the mastoid doesn’t have the typical structure associated with other bones in the human body. It’s made of air sacs and resembles a sponge, rather than being solid and rigid like most bones.

Mastoiditis is a serious infection in the mastoid process, which is the hard, prominent bone just behind and under the ear. Ear infections that people fail to treat cause most cases of mastoiditis. The condition is rare but can become life-threatening without treatment.

Symptoms:

• drainage from the affected ear
• ear pain
• fever
• headache
• hearing loss in the affected ear
• redness, swelling, and tenderness behind the affected ear

Mastoiditis is a potentially life-threatening condition. Initial treatment for a severe infection may include hospitalization. You will receive antibiotic medication through a vein in your arm, or intravenously, while at the hospital. You will need to take oral antibiotics at home for several days after leaving the hospital.

If the infection doesn’t clear up after treatment with antibiotics, surgery may be necessary. Surgery may involve removing part of your mastoid bone to drain the infection. Doctors may also need to drain your middle ear of infected fluid to successfully treat the infection.

Idiopathic pulmonary fibrosis (IPF) is a type of lung disease that results in scarring (fibrosis) of the lungs for an unknown reason. Over time, the scarring gets worse and it becomes hard to take in a deep breath and the lungs cannot take in enough oxygen. The lung damage caused by pulmonary fibrosis can’t be repaired, but medications and therapies can sometimes help ease symptoms and improve quality of life. For some people, a lung transplant might be appropriate.

fig— IPF bronchial Tube

Symptoms

• Shortness of breath (dyspnea)
• A dry cough
• Fatigue
• Unexplained weight loss
• Aching muscles and joints
• Widening and rounding of the tips of the fingers or toes (clubbing)

Causes: Occupational and environmental factors

Long-term exposure to a number of toxins and pollutants can damage your lungs. These include:

• Silica dust, tobacco smoke, viruses
• Asbestos fibers
• Hard metal dusts
• Coal dust
• Grain dust
• Bird and animal droppings

Radiation treatments

Some people who receive radiation therapy for lung or breast cancer show signs of lung damage months or sometimes years after the initial treatment. The severity of the damage may depend on:

• How much of the lung was exposed to radiation
• The total amount of radiation administered
• Whether chemotherapy also was used
• The presence of underlying lung disease

Medications

Many drugs can damage your lungs, especially medications such as:

• Chemotherapy drugs. Drugs designed to kill cancer cells, such as methotrexate (Trexall, Otrexup, others) and cyclophosphamide, can also damage lung tissue.
• Heart medications. Some drugs used to treat irregular heartbeats, such as amiodarone (Cordarone, Nexterone, Pacerone), may harm lung tissue.
• Some antibiotics. Antibiotics such as nitrofurantoin (Macrobid, Macrodantin, others) or ethambutol can cause lung damage.
• Anti-inflammatory drugs. Certain anti-inflammatory drugs such as rituximab (Rituxan) or sulfasalazine (Azulfidine) can cause lung damage.

Medical conditions

Lung damage can also result from a number of conditions, including:

• Dermatomyositis
• Polymyositis
• Mixed connective tissue disease
• Systemic lupus erythematosus
• Rheumatoid arthritis
• Sarcoidosis
• Scleroderma
• Pneumonia

Many people with idiopathic pulmonary fibrosis may also have gastroesophageal reflux disease (GERD) — a condition that occurs when acid from your stomach flows back into your esophagus.

 

Rheumatic fever can lead to a condition known as rheumatic heart disease. This is usually a thickening and stenosis of one or more of the heart valves and often requires surgery to repair or replace the involved valve(s). Rheumatic valve disease is a thickening and stenosis of one or more of the heart valves and often requires surgery to repair or replace the affected valve(s). The valve could become leaky instead of stenotic as well.

Symptoms:

The symptoms of rheumatic heart disease vary and damage to the heart often is not readily noticeable. When symptoms do appear, they may depend on the extent and location of the heart damage. Typically, symptoms of rheumatic fever appear about two weeks after the onset of an untreated strep throat infection. Apart from the sore throat caused by the strep infection, children have a fever and feel ill. Commonly, the child will have a very painful, swollen and red joint — usually a large joint like a knee, ankle, elbow or shoulder — that goes away after a day or two only to be replaced by the same problem in another joint. Short-lived skin rashes may occur, but are not common. Even if the heart is affected, it is usually not severe enough to cause symptoms, although occasionally the child may be short of breath.

Treatments

Although having rheumatic fever leaves a child more susceptible to heart damage, it does not always permanently damage the heart. However, when the inflammation caused by rheumatic fever leaves one or more of the heart valves scarred, the result is rheumatic heart disease. The mitral valve and the aortic valve are usually the ones damaged by the disease. Years later, the mitral valve may become narrowed, a condition known as mitral stenosis.

Treatment of acute rheumatic fever includes antibiotics to treat the strep infection and additional medications to ease the inflammation of the heart and other symptoms. Usually aspirin is given in large doses until the joint inflammation goes away; rarely, steroids are needed. Once the acute illness has gone away, patients need to take penicillin, or an equivalent antibiotic, for many years to prevent recurrences. This is a very important treatment because the risk of heart valve damage increases if rheumatic fever recurs.

Most often the valve leak caused by the disease is mild and does not need treatment. If the leak is severe enough to strain and enlarge the heart, surgery may be needed to eliminate the leak. This surgery may involve repair of the damaged valve. Sometimes the valve is too badly damaged to repair, in which case it must be replaced by an artificial valve.

Watermelon stomach, which is also known as gastric antral vascular ectasis or GAVE, is where the lining of the stomach bleeds, causing it to look like the characteristic stripes of a watermelon when viewed by endoscopy. Watermelon stomach occurs most commonly in older women (over age 70 years), although it can develop in men and women of any age. Signs and symptoms of watermelon stomach include blood in the stool, haematemesis (vomiting blood) and anaemia. It is a genetics disorder also.

The exact cause of watermelon stomach is not known, however, it is often diagnosed in people with other chronic (long-term) conditions such as cirrhosis (scarring of the liver and poor liver function) and systemic sclerosis.

Endoscopy CT scan looks like watermelon

Diagnosis

Diagnosis can be challenging as gastric bleeding is more commonly caused by other conditions, such as stomach ulcers and abnormal, enlarged vessels in the throat and stomach (esophageal varices) and some medications that can irritate the stomach lining such as aspirin or NSAIDs. Tests for watermelon stomach include:

• an endoscopy
• a biopsy of the stomach lining
• an endoscopic ultrasound (ultrasound probe on the tip of an endoscope) computed tomography (CT) scan
• a tagged red blood cell scan may be used to confirm the diagnosis.

Treatment

Treatment can be surgery and/or medications to stop or control the bleeding. Watermelon stomach is usually treated with endoscopic laser surgery or argon plasma coagulation. Both of these procedures are performed by endoscopy. Endoscopic laser surgery uses a laser light to treat bleeding blood vessels, while argon plasma coagulation uses argon gas and electrical current to seal irregular or bleeding tissue. In some cases, people may be treated with certain medications that help stop or control the gastrointestinal bleeding. Corticosteriods, tranexamic acid and hormone therapy (with oestrogen and progesterone) have been used to treat watermelon stomach with some success. If the bleeding is severe, blood transfusions may also be necessary at the time of diagnosis to control the bleeding. Additional transfusions may be recommended if gastrointestinal bleeding cannot be stopped or controlled