Lumpectomy is a surgical procedure that involves removing a suspected malignant (cancerous) tumor, or lump, and a small portion of the surrounding tissue from a woman’s breast. This tissue is then tested to determine if it contains cancerous cells. A number of lymph nodes may also be removed to test them for cancerous cells (sentinel lymph node biopsy or axillary dissection). If cancerous cells are discovered in the tissue sample or nodes, additional surgery or treatment may be necessary. Women who undergo a lumpectomy normally receive radiation therapy (RT) for about six weeks following the procedure to kill any cancer cells that may have been missed with the removal of the tumor. Lumpectomy is also referred to as partial mastectomy, wedge resection, breast conserving therapy, wide excision biopsy, tylectomy, segmental excision, and quadrantectomy.

A few decades ago, the standard surgical procedure to treat breast cancer was radical mastectomy, which involves the complete removal of the breast, muscles from the chest wall and all the lymph nodes in the armpit. Lumpectomy replaced radical mastectomy as the preferred surgical treatment because lumpectomy is designed to leave the natural appearance and cosmetic quality of the breast mostly intact while removing the malignancy. In addition, studies have shown that lumpectomy with radiation treatment is as effective as mastectomy in treating breast cancer.

The size and location of the lump determine how much of the breast is removed during a lumpectomy. A quadrantectomy, for example, involves removing a quarter of the breast. Before surgery, a woman should discuss with her doctor how much of the breast will be involved so that she can know what to expect.

The size of the cancer in relation to the size of the breast is the main factor that a woman’s doctor considers to determine if a lumpectomy is an appropriate treatment. Additionally, some of the features of the cancer (if it is confined to one area of the breast and does not involve the skin or chest wall) help the doctor determine if lumpectomy is appropriate. Most women who are diagnosed with breast cancer, especially those who are diagnosed early, are considered good candidates for lumpectomy. However, under some circumstances, lumpectomy is not a recommended surgery for some women. These factors include the following:

• Multiple cancers in separate locations of the same breast: This means that the potentially malignant tissue cannot all be removed from a single location, meaning that the breast may become drastically disfigured as a result of lumpectomy.
• Prior lumpectomy with radiation: Women who have had a lumpectomy with radiation therapy to remove cancer cannot have more radiation; therefore, they usually need a mastectomy if they experience cancer again in the same breast.
• Extensive cancer: Since a lumpectomy removes a specific area with malignancy, this surgery option would be inappropriate if the cancer has spread to other locations.
• Problematic tumors: A tumor that is rapidly growing or has attached itself to a nearby structure, such as the chest wall or skin, may require surgery that is more extensive to remove the tumor.
• Pregnancy: Radiation therapy, which usually follows the lumpectomy, can damage the woman’s fetus.
• Large tumors: Lumpectomy to remove a tumor that is larger than 5cm in diameter may drastically disfigure the breast. However, in some cases, the size of the tumor may be able to be reduced with chemotherapy, or endocrine therapy, to a size that is more manageable with lumpectomy. Small breasts, especially those that contain large lumps, may also be drastically disfigured after lumpectomy.
• Preexisting conditions that make radiation treatment more risky than usual: Radiation treatment may scar or damage connective tissue in women with collagen vascular diseases, such as scleroderma or lupus erythematosus.
• Prior radiation to the chest area, for instance, to treat Hodgkin’s disease.

Some women may prefer the idea of a mastectomy to lumpectomy in order to feel more confident that they will not develop breast cancer again. Other women may not feel comfortable with radiation therapy or be able to commit to a series of radiation treatments, which may involve an unacceptable time commitment or extensive travel. In most situations, though, women can safely choose between lumpectomy and mastectomy.

 

Endoscopic Retrograde Cholangiopancreatography (ERCP):

ERCP enables the physician to diagnose problems in the gallbladder, bile ducts, and pancreas. The liver is a large organ that makes a liquid called bile that helps with digestion. The gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. These ducts are called the biliary tree. The pancreas is a large gland that produces chemicals that help with digestion and also secretes hormones such as insulin.

Applications

ERCP is primarily used as a therapeutic procedure for treatment of diseases of

• Bile duct

  • extraction of bile duct stones by balloon/basket (balloon/basket extraction)
  • by crushing large bile stones and retrieving them (mechanical lithotripsy)
  • relieving jaundice due to bile duct narrowing by dilating passage with balloon (balloon dilation)
  • treatment of bile duct infection (cholangitis) by draining pus by cutting open bile duct opening (biliary sphincterotomy) and placing stents /catheter in bile duct for free drainage of bile into duodenum ( plastic stent/ENBD placement)
  • stopping leakage of bile in bile duct injuries as a result of trauma and surgery
  • metallic stent placement for relief of itcing and jaundice in bile duct, pancreatic, gallbladder cancers (metallic stent placement)

• Pancreas

  • relief of pain in chronic pancreatitis
  • by removal of pancreatic duct stones
  • dilating the narrowed pancreatic duct
  • placing of stents to facilitate drainage of infected fluid collection in pancreatitis (Pseudocyst drainage)

How is ERCP performed?

ERCP combines the use of X-rays and an endoscope, which is a long, flexible, lighted tube. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on X-rays.

For the procedure, you will lie on your left side on an examining table in an X-ray room. You will be given medication to help numb the back of your throat and a sedative to help you relax during the examination. You will swallow the endoscope, and the physician will then guide the scope through your oesophagus, stomach, and duodenum until it reaches the spot where the ducts of the biliary tree and pancreas open into the duodenum. At this time, you will be turned to lie flat on your stomach, and the physician will pass a small plastic tube through the scope. Through the tube, the physician will inject a dye into the ducts to make them show up clearly on X-rays. X-rays are taken as soon as the dye is injected.

Radiation therapy uses high-energy radiation to kill cancer cells by damaging their DNA directly or create charged particles (free radicals) within the cells that can in turn damage the DNA. X-rays, gamma rays, and charged particles are types of radiation used for cancer treatment. The radiation used for cancer treatment may come from a machine outside the body (external radiotherapy), or it may come from radioactive material placed in the body near Tumour cells (brachytherapy) or injected into the bloodstream (I131 for thyroid cancers). A patient may receive radiation therapy before, during, or after surgery, depending on the type of cancer being treated. The type of radiation therapy may vary of the size of the Tumour, and location of the Tumour.

Intensity Modulated Radiotherapy uses hundreds of tiny radiation beam-shaping devices, called collimators, to deliver a single dose of radiation and modulating different doses to different areas of the Tumour. Intensity guided Radiotherapy using repeat imaging CT and PET scans to reduce dose to normal tissues and enhance dose to specific areas of Tumour. Stereotactic radiosurgery (SRS) can deliver one or more high doses of radiation to a small Tumour by using accurate image-guided Tumour targeting and patient positioning systems. Therefore, a high dose of radiation can be given without excess damage to normal tissue. Electron beams are also used to irradiate superficial tumors such as on skin while protons beams are shown to have fewer side effects than normal photons in treating deeper tissues. Hyperthermia has also been used in conjunction with radiation to improve the treatment outcomes in several cancers.

What is liver cancer ?
Liver cancer is the uncontrolled growth and spread of unhealthy cells in the liver. Cancer that starts in the liver is primary liver cancer. Cancer that spreads to the liver from another organ (such as bowel or breast) is known as secondary or metastatic liver cancer.

What is the difference between liver tumor and liver cancer ? 
Any mass or nodule in the liver is known as a liver tumor. Liver tumors can be non-cancerous (benign) or cancerous (malignant). The most common type of cancer that originates in the liver is hepatocellular carcinoma (HCC).

What are the causes of primary liver cancer ?
There is no one cause of primary liver cancer. Several factors increase a person’s likelihood of developing liver cancer. Some risk factors for liver cancer include:
Viral hepatitis – Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections are an important cause for the development of liver cancer. It is estimated that about 5-10 percent of people with HBV or HCV will develop liver cancer.

• Cirrhosis is a progressive disorder that leads to scarring of the liver. Cirrhosis is the end result of all forms of long standing liver damage. Cirrhosis is caused by Hepatitis B, Hepatitis C, alcohol abuse, fatty liver and certain genetic disorders.  5-10 percent of patients with cirrhosis will develop liver cancer.
• Toxins such as Arsenic – Drinking water (usually well water) contaminated with arsenic also increase risk for developing liver cancer. Obesity may increase the risk of liver cancer.
• Diabetes can increase the risk of liver cancer, especially in those who drink alcohol heavily or have chronic viral hepatitis B or C infection.

What are the symptoms of liver cancer ?
Liver cancer usually has no obvious symptoms, and people at risk should be followed regularly to detect cancer at an early stage. The following symptoms might be caused by liver cancer:
Unexplained weight loss
Anorexia (persistent lack of appetite)
Early satiety (feeling very full after a small meal)
Persistent abdominal pain
Increasing abdominal girth (swelling of the “stomach” area) with or without breathing difficulty
Sudden jaundice (yellowness of the skin and eyes)
Sudden deterioration in the overall condition of a patient with cirrhosis
Liver enlargement or a mass that can be felt in the area of the liver

What tests will I have to detect liver cancer ?
If liver cancer is suspected, the doctor will conduct a physical examination and order special tests. Further tests may include alpha-fetoprotein (AFP) blood test, ultrasound scan, computed tomography (CT), magnetic resonance imaging (MRI), angiography, laparoscopy and biopsy. It is important to detect liver cancers early because small cancers in a patient who has minimal symptoms can be treated effectively.

What is liver cancer screening ?
Liver cancer screening is the best way to detect liver cancer early in its course. It is performed to detect small cancers that do not produce any symptoms. Small cancers can be treated more effectively. Patients who have a liver disease that puts them at a high risk of developing liver cancer (such as hepatitis B, any form of cirrhosis) should undergo periodic screening tests. It usually involves a blood test to look for a cancer marker (alpha-feto-protein) and an ultrasound scan of the liver to look for actual cancer. You must understand that screening tests are not 100 percent accurate and your doctor may advise you additional tests if he suspects that you may have a liver cancer.

How is liver cancer treated ?
Liver cancer treatment depends on:
The liver’s condition
The size, location, and number of tumors
If the cancer has spread outside the liver
The person’s age and overall health

Different ways of treating liver cancer are:
Surgery: If the cancer has been found early and the rest of the liver is healthy, doctors may perform surgery to remove the tumor from the liver.
Cryosurgery: Cryosurgery uses a metal probe to freeze and destroy cancer cells.
Radiofrequency Ablation: Radio frequency ablation uses a special probe to destroy cancer cells with heat using special needle. The procedure is performed under ultrasound or laparoscopic guidance.
Chemotherapy or chemoembolization: Chemotherapy uses anti-cancer drugs to destroy cancer cells. In some cases, the chemotherapy can be directly injected into the liver tumor.
Radiation Therapy: Radiation therapy uses radiation (high-energy x-rays) to destroy cancer cells.
Oral chemotherapy drugs : Sorafenib is an oral medication for use in advanced cases of liver cancer.

Can a liver transplant be done for liver cancer ?
Surgery is the most effective therapy for most types of liver cancer, but doctors will usually combine different methods to treat the cancer most effectively. When surgery to remove the cancer itself cannot be performed, your doctor may suggest a liver transplantation in which the cancer along with the entire liver is replaced thus curing the patient.

Pancreatitis

Pancreatitis is serious disease in which there is a swelling in pancreas. The pancreas is a large gland behind the stomach and close to the duodenum. The function of pancreas is to secrete digestive enzymes into the small intestine through a tube called the pancreatic duct. These enzymes help digest fats, proteins, and carbohydrates in food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body use the glucose it takes from food for energy. Pancreatic disease occurs when the digestive enzymes are activated and begin attacking the pancreas. In very severe cases, pancreatitis can result in bleeding into the gland itself; serious tissue damage, infection and fluid collections may occur. Severe pancreatitis can result in damage to other very important organs such as the heart, lung and kidneys. In approximately 70% of the cases, pancreatitis occurs when person consumes excessive, alcohol for longer period of time. It may happen due to metabolic disorders. It’s rare that patients have chronic pancreatitis that tends to run in families (hereditary pancreatitis). Alcohol damages the pancreas but patient may not show symptoms for many years. It occurs suddenly and patient show severe pancreatitis symptoms, including severe pain and loss of pancreatic function, resulting in digestion and blood sugar abnormalities.
There are two types of pancreatitis. The first category is acute pancreatitis which occurs suddenly and may result in critical complications. According medical data, the majority of patients get well completely from this type of pancreatitis. Chronic pancreatitis is usually the result of longstanding harm to the pancreas from alcohol intake. In chronic pancreatitis, patient complains severe pain and there is loss of pancreatic function.

Causes:

Acute pancreatitis is more common in men than women. Chronic pancreatitis may be due to metabolic, hereditary, or simply the causes are unidentified. Pregnancy can also cause ancreatitis, but in some cases the development of pancreatitis is most likely just a reflection of the hyper triglyceridemia which often occurs in pregnant women. Pancreas divisum, a common congenital deformity of the pancreas may cause some cases of frequent pancreatitis. Gallstones in the gallbladder which is another organ in the abdomen may be a cause of pancreatitis because a gallstone can block the pancreatic duct, trapping digestive juices inside the pancreas. Pancreatitis due to gallstones occurs most often in women who are above 50 years. Other causes are usually due to medications and very rarely, infections, trauma or surgery of the abdomen. Types of trauma can cause acute pancreatitis in rare cases. Trauma can be postoperative trauma (due to surgery), hyperlipidemia (or excessive amounts of fat and fatty substances in the blood), hypercalcemia (or an abnormally large amount of calcium in the blood), Ductal obstruction, Infectious Agents. Other causes, including Tropical pancreatitis, hereditary pancreatitis, hyperparathyroidism, cystic Fibrosis, pancreas Divisum.

Symptoms:

Pancreatitis patient complains pain in the upper abdomen that may last for a few days. The pain may be severe and may become constant just in the abdomen or it may reach to the back and other areas. It may be sudden and severe or start as a mild pain that gets worse when food is eaten. Acute pancreatitis may be a symptom of gallstone disease. The relation between gallstones and acute pancreatitis is the anatomical union of the ducts that drain the gallbladder and pancreas, called the ampulla or major papilla of the duodenum. In mild cases, a person is having problem in eating for 3 or 4 days and he has to receive fluids and pain relievers through an intravenous line. The pain occurs more often and lasts longer. Patient loses weight as the time passes and show symptoms of diabetes, including increased thirst, appetite, urination, fatigue, and weight loss. General symptoms of chronic pancreatitis include Pain, malabsorption of food leading to weight loss or diarrhea, diabetes, nausea, vomiting, fever and increased heart rate.
Patients must seek medical advice when they have intense, persistent abdominal pain, consult doctor to determine whether it is a symptom of pancreatitis or some other medical condition is the cause. It’s important to diagnose pancreatitis early in order to avoid severe and permanent damage to pancreas.

Complications:

Numerous complications may develop in severe cases of acute pancreatitis. A damaged pancreas may become infected with bacteria that spread from the small intestine into the pancreas. Signs of infection include fever, an elevated white blood cell count and, in severe cases, organ failure. Pancreatic infections can be deadly without thorough treatment, including drainage or surgery to remove the infected tissue. Sometimes doctor perform multiple operations. Another complication is pseudocysts. These are collections of pancreatic fluid and sometimes tissue debris that form within pancreas or in an obstructed duct. If the cyst is small, no particular care may be needed, but large, infected or bleeding pseudocysts need instant treatment. Abscess is a collection of pus in or near pancreas that may develop after the inception of acute pancreatitis. Treatment involves drainage of the abscess by catheter or surgery. There may be respiratory failure. Chemical changes in patient’s body can affect his lung function, causing the level of oxygen in blood to fall to severely low levels. Shock usually occurs when blood pressure is very low so that patient’s organs can not carry out their normal functions. Severe shock can cause death within minutes if treatment is not given immediately. Chronic pancreatitis can lead to bleeding because constant inflammation and damage to the blood vessels surrounding the pancreas cause potentially fatal bleeding. Patient may be drug addict. It is due to medical treatments for severe pancreatic pain is not always effectual. Pancreatic cancer. Long-term inflammation of the pancreas increases your risk of pancreatic cancer, one of the most serious of all malignancies.

Diagnosis:

Physicians diagnose pancreatitis by checking the blood for levels of digestive enzymes such as amylase and lipase helps. If the level of these two enzymes is high in the blood then it is diagnosed as acute pancreatitis. As the patient recovers, the digestive enzyme levels will decrease to normal. Chronic pancreatitis generally is assumed when the patient has symptoms and risk factors such as heavy alcohol intake. Diagnosis can be complicated. Doctors use new techniques, including pancreatic function tests and x-ray imaging of the pancreas gland with a CT scan or retrograde pancreatography (ERCP) to diagnose it.

Treatment:

Treatment plan for acute pancreatitis is supportive management in the hospital. Generally, patients are given intravenous fluids and pain medication. Medical records, represent that approximately 20 percent of patients, the pancreatitis can be severe. The patient may need to be admitted in the intensive care unit because of damage that has occurred to other important organs such as the heart, lungs or kidneys. In some severe cases, surgery is done to remove permanently damaged parts of the gland. Chronic pancreatitis can be very difficult to treat. Medical doctors try to alleviate pain and improve nutritional and metabolic problems that result from pancreatic function loss. Patients are generally given pancreatic enzymes and insulin to supplement as it is not being secreted or released by the pancreas. In some instances, obstruction of the pancreatic duct would need a surgical drainage procedure.

Prevention:

It is a fact that pancreatitis occurs all of sudden and can not be prevented but patients can some precautions to reduce risk. They must not consume excessive alcohol. Smoking is also risk factor for this disease. Excessive fat intake must be avoided. Eating a high-fat diet can raise blood-fat levels and increase risk of gallstones which can lead to pancreatitis. A healthy diet comprises fresh fruits and vegetables, whole grains, and lean protein, and limits fats, especially saturated fats such as butter. Person must have to develop good habits and modify Lifestyle to avoid this disease. Chronic pancreatitis may have bad consequences such as pain and malabsorption of certain nutrients. It is better to avoid alcohol. Person must eat meals at short intervals. fat intake should be limited in diet. It will help reduce weight and oily stools that result from a lack of pancreatic enzymes. Diet should be rich in carbohydrates. Carbohydrates provide energy to help fight tiredness. Person must obtain most of daily calories from complex carbohydrates found in grains, vegetables and legumes. If he has diabetes, he must consult a dietitian. Dietician can make appropriate diet plan. It is always recommended to drink plenty of liquids.

Patients of pancreatitis may suffer from cause emotional stress. In order to deal with such problems, person must maintain normal daily activities as best he can. He must be in touch with friends and family and continue to do activities that he enjoys. It is to understand that physical health can impact directly on mental health. Denial, anger and frustration are common with chronic illnesses. In this crisis period, person must seek help of professionals such as therapists or behavioral psychologists. They can provide good advice to resolve emotional problems. They can also educate patient how to develop coping skills which include relaxation techniques that may help patient to live better life. If patient is suffering from a chronic illness, he is at greater risk of depression. At this time, it is better for patient to discuss with family, friends and doctor to come out with depression. These strategies will help to fight with disease and patient will relax.

 

 

Signs and symptoms of ovarian cancer:

Ovarian cancer may cause several signs and symptoms. Women are more likely to have symptoms if the disease has spread beyond the ovaries, but even early- stage ovarian cancer can cause them. The most common symptoms include:
a.Bloating
b.Pelvic or abdominal pain
c.Trouble eating or feeling full quickly
d.Urinary symptoms such as urgency (always feeling like you have to go) or frequency (having to go often)

These symptoms are also commonly caused by benign (non-cancerous) diseases and by cancers of other organs. When they are caused by ovarian cancer, they tend to be persistent and represent a change from normal− for example, they occur more often or are more severe. If a woman has these symptoms more than 12 times a month, she should see her doctor, preferably a gynecologist.

Others symptoms of ovarian cancer can include:

1. Fatigue
2. Upset stomach
3. Back pain
4. Pain during sex
5. Constipation
6. Menstrual changes
7. Abdominal swelling with weight loss.

However, these symptoms are more likely to be caused by other conditions, and most of them occur just about as often in women who don’t have ovarian cancer.

Treatments for Ovarian Cancer:

a. Surgery for ovarian cancer

Surgery is the main treatment for most ovarian cancers. How much surgery you have depends on how far your cancer has spread and on your general health. For women of childbearing age who have certain kinds of tumors and whose cancer is in the earliest stage, it may be possible to treat the disease without removing both ovaries and the uterus.

For epithelial ovarian cancer, surgery has 2 main goals:ovarian-cancer-staging and debulking (this is discussed in detail further on). It’s important that this surgery is done by someone who’s experienced in ovarian cancer surgery.

Experts recommend that patients see a gynecologic oncologist for surgery. Gynecologic oncologists are specialists who have training and experience in treating, staging, and debulking ovarian cancer. If your cancer isn’t properly staged and debulked, you may need to have more surgery later. It has been shown that gynecologic oncologists are more likely than general surgeons and gynecologists to stage and debulk ovarian cancer optimally (see below).

For other types of ovarian cancer (germ cell tumors and stromal tumors), the main goal of surgery is to remove the cancer.

Staging epithelial ovarian cancer

Surgery for ovarian cancer has 2 main goals. The first goal is to the cancer − to see how far the cancer has spread from the ovary. Usually this means removing the uterus (this operation is called a hysterectomy), along with both ovaries and fallopian tubes (this is called a bilateral salpingo-oophorectomy or BSO). In addition, the omentum is also removed (an omentectomy). The omentum is a layer of fatty tissue that covers the abdominal contents like an apron, and ovarian cancer sometimes spreads to this tissue. Some lymph nodes in the pelvis and abdomen are biopsied (taken out to see if the cancer has spread from the ovary).

If there is fluid in the pelvis or abdominal cavity, it will also be removed for analysis. The surgeon may “wash” the abdominal cavity with salt water (saline) and send that fluid for analysis. He or she may also remove tissue samples from different areas inside the abdomen and pelvis. All the tissue and fluid samples taken during the operation are sent to a lab to be examined for cancer cells. ovarian-cancer-staging is very important because ovarian cancers at different stages are treated differently. If the staging isn’t done correctly, the doctor may not be able to decide on the best treatment.

Debulking epithelial ovarian cancer

The other important goal of surgery is to remove as much of the tumor as possible − this is called debulking.Debulking is very important in any patient with ovarian cancer that has already spread widely throughout the abdomen at the time of surgery. The aim of debulking surgery is to leave behind no tumors larger than 1 cm. This is calledoptimally debulked. Patients whose tumors have been optimally debulked, have a better outlook than those left with larger tumors after surgery (called sub-optimally debulked).

Sometimes the surgeon will need to remove a piece of colon to debulk the cancer properly. In some cases, a piece of colon is removed and then the 2 ends that remain are sewn back together. In other cases, though, the ends can’t be sewn back together right away. Instead, the top end of the colon is attached to an opening (stoma) in the skin of the abdomen to allow body wastes to get out. This is known as a colostomy. Most often, this is only temporary, and the ends of the colon can be reattached later in another operation.

Debulking surgery might also mean removing a piece of the bladder. If this occurs, a catheter (to empty the bladder) will be placed during surgery. This will be left in place until the bladder recovers enough to be able to empty on its own. Then, the catheter can be removed.

Debulking may also require removing the spleen and/or the gallbladder, as well as part of the stomach, liver, and/or pancreas.

If both ovaries and/or the uterus are removed, you will not be able to become pregnant. It also means that you will go into menopause if you haven’t done so already. Most women will stay in the hospital for 3 to 7 days after the operation and can resume their usual activities within 4 to 6 weeks.

Surgery for ovarian germ cell tumors and ovarian stromal tumors

Most ovarian germ cell tumors are treated with a hysterectomy and bilateral salpingo-oophorectomy. If the cancer is in only one ovary and the patient still wants to be able to have children, only the ovary containing the cancer and the fallopian tube on the same side are removed (leaving behind the other ovary and fallopian tube and the uterus).

Ovarian stromal tumors are often confined to just one ovary, so surgery may just remove that ovary. If the cancer has spread, more tissue may need to be removed. This could mean a hysterectomy and bilateral salpingo-oophorectomy and even debulking surgery.

b. Chemotherapy for ovarian cancer

The General Medicine deals with the prevention, diagnosis and non-surgical treatment of various diseases. It serves as the first point of contact whenever a patient visits the hospital. A general physician conducts a physical examination of the patient and then recommends necessary tests and diagnostic procedures. The results of these tests, the general physical examination and symptoms are then correlated to arrive at a final diagnosis. Depending on the final diagnosis, the general physician gives the necessary treatment (usually medication) to the patient or refers to a specialty department for further treatment.

The department of general medicine provides treatment for the following:

1. All types of fevers
2. Infections affecting different organs of the body
3. All metabolic diseases and endocrine diseases such as diabetes, thyroid, cholesterol, obesity.
4. Blood pressure
5. Tummy aches, infections like vomiting, diarrhea and jaundice
6. Infectious diseases
7. Respiratory diseases like asthma, allergies, lung infection, cough, sinusitis, pneumonia & TB
8. Disease of the joints and limbs, backache
9. Problems like headache, muscular weakness, epilepsy.

There are many different factors that can affect the fertility of both women and men. Even if you are not currently trying for a baby you may be wondering, or have concerns about your fertility health. There are various screening tests that can be done to evaluate fertility for both women and men

TMJ disorders:

TMJ disorders are a family of problems related to your complex jaw joint. If you have had symptoms like pain or a “clicking” sound, you’ll be glad to know that these problems are more easily diagnosed and treated than they were in the past. These symptoms occur when the joints of the jaw and the chewing muscles (muscles of mastication) do not work together correctly. TMJ stands for Temporomandibular Joint, which is the name for each joint (right and left) that connects your jaw to your skull. Since some types of TMJ problems can lead to more serious conditions, early detection and treatment are important.

No one treatment can resolve TMJ disorders completely and treatment takes time to become effective. Our doctors can help you have a healthier and more comfortable jaw.

Trouble with Your Jaw?

TMJ disorders develop for many reasons. You might clench or grind your teeth, tightening your jaw muscles and stressing your TM joint. You may have a damaged jaw joint due to injury or disease. Injuries and arthritis can damage the joint directly or stretch or tear the muscle ligaments. As a result, the disk, which is made of cartilage and functions as the “cushion” of the jaw joint, can slip out of position. Whatever the cause, the results may include a misaligned bite, pain, clicking or grating noise when you open your mouth or trouble opening your mouth wide.

Do You Have a TMJ Disorder?

• Are you aware of grinding or clenching your teeth?
• Do you wake up with sore, stiff muscles around your jaws?
• Do you have frequent headaches or neck aches?
• Does the pain get worse when you clench your teeth?
• Does stress make your clenching and pain worse?
• Does your jaw click, pop, grate, catch, or lock when you open your mouth?
• Is it difficult or painful to open your mouth, eat or yawn?
• Have you ever injured your neck, head or jaws?
• Have you had problems (such as arthritis) with other joints?
• Do you have teeth that no longer touch when you bite?
• Do your teeth meet differently from time to time?
• Is it hard to use your front teeth to bite or tear food?
• Are your teeth sensitive, loose, broken or worn?

The more times you answered “yes,” the more likely it is that you have a TMJ disorder. Understanding TMJ disorders will also help you understand how they are treated.

Treatment

There are various treatment options that our doctors can utilize to improve the harmony and function of your jaw. Once an evaluation confirms a diagnosis of TMJ disorder, our doctors will determine the proper course of treatment. It is important to note that treatment always works best with a team approach of self-care joined with professional care.
The initial goals are to relieve the muscle spasm and joint pain. This is usually accomplished with a pain reliever, anti-inflammatory or muscle relaxant. Steroids can be injected directly into the joints to reduce pain and inflammation. Self-care treatments can often be effective as well and include:

• Resting your jaw
• Keeping your teeth apart when you are not swallowing or eating
• Eating soft foods
• Applying ice & heat
• Exercising your jaw
• Practicing good posture

Stress management techniques such as biofeedback or physical therapy may also be recommended, as well as a temporary, clear plastic appliance known as a splint. A splint or nightguard fits over your top or bottom teeth and helps keep your teeth apart, thereby relaxing the muscles and reducing pain. There are different types of appliances used for different purposes. A nightguard helps you stop clenching or grinding your teeth and reduces muscle tension at night and helps to protect the cartilage and joint surfaces. An anterior positioning appliance moves your jaw forward, relives pressure on parts of your jaw and aids in disk repositioning. It may be worn 24 hours/day to help your jaw heal. An orthotic stabilization appliance is worn 24 hours or just at night to move your jaw into proper position. Appliances also help to protect from tooth wear.

What about bite correction or surgery?

If your TMJ disorder has caused problems with how your teeth fit together, you may need treatment such as bite adjustment (equilibration), orthodontics with or without jaw reconstruction, or restorative dental work. Surgical options such as arthroscopy and open joint repair restructuring are sometimes needed but are reserved for severe cases.

Our doctors do not consider TMJ surgery unless the jaw can’t open, is dislocated and nonreducible, has severe degeneration, or the patient has undergone appliance treatment unsuccessfully.

TMJ Ankylosis

The temporomandibular joint (TMJ) is the joint that allows mastication and speech. It is a synovial joint formed between the mandibular condyle below and the articular fossa of the temporal bone above. The joint is liable to suffer from a number of diseases,(commonly fractures of the mandible), some of which predispose to TMJ ankylosis. Ankylosis is defined as loss of joint movement resulting from fusion of bones within the joint or calcification of the ligaments around it.

Typically calcification of the ligaments around the joint is not painful, but the mouth can open only about 1 inch or less. Fusion of bones within the joint causes pain and more severely limits jaw movement. Occasionally, stretching exercises help people with calcification, but people with calcification or bone fusion usually need surgery to restore jaw movement.

TMJ ankylosis may be post- traumatic or post-surgery for TMJ disease in a majority of cases. More unusual causes include Rheumatoid Arthritis, Sickle Cell Anaemia and Fibrodysplasia Ossificans Progressiva. Surgical options for treatment include Gap Arthroplasty which is still preferred by some and Interpositional Surgery which is the standard procedure.

The nasopharynx is located behind the nose and above the back of the throat. On each side of the nasopharynx are the Eustachian tubes which connect to the ears. Nasopharyngeal cancer typically arises in the thin lining of the nasopharynx in the space behind the Eustachian tubes. It is more common in Southern China and most often found in men.

Symptoms
Since the tumour grows within air-filled spaces, it may not exhibit symptoms until it is large enough to block passage of air or smell or vision. They include:

• A lump in the neck caused by a swollen lymph node

• A sensation of fullness or pressure in the ear

• Popping noises, hearing loss, and ear infection

• Nasal regurgitation of food and liquids

• Impaired (hypernasal) speech

Tumours of the Pituitary Gland and Skull Base

• Headaches

In advanced cases, infiltration of NPC into the spine can cause

• Stiff neck

• Pain

• Neck instability

The preferred surgical treatment for NPC is the Endoscopic Endonasal Approach ODONTOID PANNUS (Rheumatoid Pannus, Odontoid Synovial Cyst) Odontoid pannus is abnormal tissue that grows in the region of the odontoid process – a toothlike projection at the back of the second cervical vertebra which serves as the pivot for the turning of the head.

This membrane of granulated tissue forms most often as a result of rheumatoid arthritis, in which the condition is called a rheumatoid pannus. Odontoid pannus may also develop due to severe trauma to the neck at the second cervical vertebra.

A similar (although rarely diagnosed) condition which has similar symptoms and treatment is the odontoid synovial cyst.

Rheumatoid pannus
Rheumatoid arthritis (RA) is a progressive auto-immune disease that causes chronic inflammation of the joints. When it attacks, it usually begins in the synovium – a kind of tissue that lines the joint capsule. Cells in the synovium begin to grow and divide abnormally (synovitis) causing a thickening of the synovium resulting in an inflamed and swollen joint.

As it progresses, the synovium can grow larger and form an inflamed, granulated sheet of tissue called rheumatoid pannus. This tissue will spread from the synovial membrane, causing considerable destruction as it invades the subchondral bone.

Symptoms of cervical–spinal abnormalities develop in approximately 60% to 80% of patients with rheumatoid arthritis. When RA invades the cervical spine, the resulting extension of pannus into the spinal canal may compress the brain stem, spinal cord and vertebral arteries causing severe pain and disability.

Left untreated rheumatoid pannus can even result in sudden death.

Treatment
An instability of the joints results in progressive deformity. Generally, in order to stabilise the joints, cranio-cervical fusion is recommended.

If the patient suffers from compression of the spinal cord or brainstem, surgery to decompress them is recommended. In these cases, the Endoscopic Endonasal Approach is best.