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.

Developmental Dysplasia of the hip (DDH)

What is Developmental hip dysplasia?

Developmental hip dysplasia or DDH is a term used to describe a spectrum of conditions where the hip joint fails to develop properly in childhood. In the past terms such as congenital hip dislocation or CDH were used, though the current preferred term is DDH. The term Hip dysplasia is also commonly used. All of the above terms refer to the same condition.

Before we can understand what DDH is, it is perhaps useful to know a little bit about the hip joint itself. The hip is the largest joint in the body and consists of a ball (femoral head) and a socket (acetabulum). The bones are held together by strong ligaments. Being a ball and socket joint, the hip is freely mobile in all directions. There are numerous muscle groups around the hip that provide stability and movement.

As mentioned above, DDH represents a spectrum. On the less severe end of the spectrum is a slightly shallow acetabulum (or socket) but with the femoral head (ball) still inside the socket. This is a dysplastic hip which typically goes unnoticed during childhood but sooner or later will cause arthritis in the hip because of the poor articulation between the ball and socket. Patients with mild dysplasia present for the first time as adults with end-stage hip arthritis and need a hip replacement. These cases are however rare (no more than 10% of cases).

The more common scenario is where the hip is shallow at birth and during the first few months to years of life the hip joint gradually dislocates out of place. In developed countries (UK, USA and Europe) where babies are screened by clinical examination or ultrasound scanning, DDH may be diagnosed at birth or in the first few weeks of life. Diagnosis at an early age makes treatment much easier and the use of strapping around the hip (called a Pavlik Harness) cures the problem in most babies.

In India, there is no uniform protocol amongst obstetricians or paediatricians to screen for hip dysplasia in the neonatal period (first 4 weeks of life). DDH therefore goes unnoticed and the child presents at a much older age when surgery is the only option to treat the problem.

On the most severe end of the spectrum are the so-called Teratologic hip dislocations. Such dislocations occur when the baby is still developing in the womb. They are usually associated with genetic conditions such as Arthrogryposis (multiple joint contractures). Teratologic hips are difficult to treat and typically need surgery even at an early age.

What causes DDH?

There is no specific cause for DDH that happens in every child with the condition. However, there are many known risk factors that increase the statistical probability of a baby having DDH. These include

• First born female child
• Twins
• Oligohydramnios (where the amount of fluid around the baby is less than normal)
• Family history of DDH in first degree relatives
• Breech presentation
• Postural foot deformities (such as metatarsus adductus and calcaneovalgus feet)
• “Moulded baby syndrome” refers to a combination of DDH, Torticollis (Wry neck), foot deformity and plagiocephaly (flattened appearance to the back of the head). This is thought to result from abnormal pressure on the baby (moulding) within the womb.

A child with DDH may not have any of the above risk factors and the first indication may be a limp that is noticed when the child starts to walk. In India, we routinely see children as old as 10 years with dislocated hips, largely due to a failure to diagnose the problem at an early stage.

A significant number of all babies have shallow hips at birth (probably the result of developing in a cramped space within the womb) but the hips spontaneously become normal within the first 6 weeks of life as the baby starts to move the legs freely. In a small proportion of children, this process fails to occur and these hips gradually dislocate over a period of time.

What are the symptoms of DDH?

There are a wide variety of symptoms that vary with age of the child at diagnosis.

0 – 1 year:

• No symptoms are apparent, though observant parents sometimes notice that the legs are different lengths.
• In severe dislocations, it may be difficult to open the legs (called hip abduction) to change nappies. At this age, DDH is diagnosed by doctors during examination or by ultrasound scanning.

Walking age (1 – 16 years):

• Limping is the commonest symptom. It is typically a painless limp and can be difficult to spot.
• Pain is a relatively late symptom and indicates the onset of damage to the hip (tear of a cartilage ring in the hip joint called the labrum) or early arthritis. The pain may be sharp and worse with certain hip movements or just a “dull ache” after activity. Clicking or “giving way” of the hip can also occur.

How is DDH diagnosed?

The investigation of choice depends on age of the child.

0 – 4 months of age: Ultrasound scanning of the hips using the Graf method. Alpha and Beta angles have to be calculated and these angles guide treatment. The Graf method is precise and has been standardised to a high degree. Specific training in ultrasound scanning for hip dysplasia is necessary in order to obtain good quality ultrasound scans.

Children older than 4 months: A good quality AP pelvis x-ray will clearly demonstrate the problem. Various lines are drawn on the x-ray by orthopaedic surgeons but these are probably of little interest to parents.

Arthrogram: This is a dye test which requires a general anaesthetic. In babies and young children up to the age of 18 months, a large part of the ball of the hip joint is made of cartilage not bone. The cartilage is not visible on x-rays and some contrast agent on the outside is required to outline the entire ball (cartilage + bone). An arthrogram also provides useful information to the surgeon about whether the hip can be put back in place without the need for open surgery.

CT Scans: are obtained post-operatively after a body cast (Hip spica) has been applied. X-rays performed through a spica are difficult to interpret. A CT scan clearly shows whether the operation to reduce the hip has been successful. Most good paediatric orthopaedic centres would insist on a CT scan prior to discharging the patient from hospital.

A CT scan is also sometimes obtained to visualise the hip in 3-D where the anatomy is abnormal or unusual. It is a good investigation in cases where previous surgery has been performed.

MR scans/ MR arthrograms: These tests are of use in teenagers or adults with symptoms suggestive of damage to acetabular labrum. Labral tears can be quite painful and restrict activities particularly sports.

In most cases, a simple x-ray of the hips is sufficient to confirm DDH.

What are the treatment options?

Treatment of DDH is entirely dependent on the age of the child. The younger the child at diagnosis, the less the intervention required. It is therefore important that the diagnosis is made soon after birth.

A proportion of babies have dislocated or dislocatable hips at birth. In most modern hospitals, paediatricians or obstetricians will examine babies for DDH. In certain developed countries, all babies have a hip ultrasound scan a few weeks after birth to rule out DDH. This system is obviously ideal in picking up all cases of DDH but it is expensive, difficult to implement and “over-treats” the problem. Remember that a proportion of babies with shallow hips get better by themselves. If the hip remains abnormally shallow at 3 months of age or if the hip is frankly dislocates, treatment is mandatory.

If your child has any of the risk factors mentioned previously, the safest course of action is to obtain an ultrasound scan of the both hips performed in accordance with the Graf method.

Pavlik Harness:

This is the least invasive method and therefore the most preferred by parents (and surgeons!). The harness can be used from birth to the age of approximately 4 months, though it can be difficult in children older than 3 months. It is a system of straps that is applied to both legs and keeps the legs opened (called hip abduction). The baby can kick both legs freely within the harness and it does not interfere with normal growth of the baby.

Once the baby has been placed in a harness, ultrasound scans must be repeated every week until the hip is anatomically located back in the hip joint. This may take 2 – 4 weeks. A further 6 weeks in the harness is necessary. If the baby grows out of the initial harness, it can be changed easily for a larger size. Average time in the harness is likely to be between 10 and 12 weeks.

In the vast majority of babies under 3 months (90% or more), treatment with the Pavlik harness is the only treatment that is necessary. There is good evidence to suggest that the hips become entirely normal when assessed at 5 years of age.

In summary, early diagnosis (soon after birth) and Pavlik harness treatment should be considered as the gold standard in managing hip dysplasia. Complications are minimal and it is effective.

Please click here for instructions on how to look after your baby in a Pavlik harness.

Closed Reduction and hip spica application:

If the child is older than 3 months at diagnosis, Pavlik harness is not appropriate. In this group (3 months to 12 months), an arthrogram will be necessary.  A short general anaesthetic is given. The hip is examined when the child is fully relaxed. A radio-opaque dye is also instilled into the hip joint to provide contrast. If the hip can be put back in place without undue force, a hip spica is applied. The term closed reduction refers to reducing a dislocated joint without the need for an incision. This is in contrast to an open reduction where an incision is necessary.

A post-operative CT scan is necessary to confirm that the hip is concentrically reduced, meaning that the ball is sitting in the centre of the socket. Sometimes the ball can appear on x-rays to be sitting well but the CT scan shows otherwise. Some centres use an ultrasound scan rather than a CT.

The hip spica is changed at 3 months under general anaesthesia. The total period in the spica is 6 months. This may seem a long time to some parents but children have not started walking at this age and there are no long-term adverse effects that result from hip spica treatment.

When the ball of the hip joint is dislocated, the socket also becomes quite shallow. Keeping the hip joint well reduced in a spica promotes development of the socket (remodelling) and improves stability of the hip. Children less than 1 year of age possess considerable remodelling capacity and it is important to harness this potential.

Medial open reduction:

This is a minimally invasive procedure undertaken in children under 18 months of age. There are numerous advantages with this procedure compared to a traditional “anterior open reduction”. The operation is performed through a small incision in the groin and therefore not visible to the outside. There is minimal blood loss and less postop pain.

The medial open reduction is also referred to as “assisted closed reduction” or “relaxed closed reduction”. This term is used because a forcible closed reduction causes damage to the blood supply of the femoral head and poor long-term results.

Medial open reduction is followed by immobilisation in a hip spica cast for 4 – 6 months. This will depend on a number of factors including ease of reduction, age of the child and progress of hip development within the spica.

Long-term results of medial open reduction have proven that this is a minimally invasive procedure that is safe and effective.

Anterior Open Reduction with femoral and pelvic osteotomy:

This procedure is typically used in children older than 18 months who have been walking for a period of time on the dislocated hip. A thick membrane called the capsule surrounds all joints of the body. When a child walks on a dislocated hip, the capsule enlarges and becomes quite lax. This enlarged capsule needs to be tightened up in order to prevent the hip from re-dislocating after surgery. The anterior open reduction procedure is designed to address this particular problem of a capacious and redundant capsule.

The anterior open reduction is performed through a “Bikini” incision. There are several tight structures (muscles, tendons and ligaments) that are divided or lengthened. The hip joint is relocated and the capsule repaired to keep the joint in place. Typically, the shallow socket (acetabulum) is also corrected by means of a pelvic osteotomy wherein the socket is divided and reset in the correct alignment. In addition to the pelvic osteotomy, the thigh bone may also need to be divided and reset, called a femoral osteotomy. Pelvic osteotomies sometimes need to be stabilised with a pin. Femoral osteotomies require plate and screws to maintain the bone in place during the healing process.

The child is placed in a hip spica for a period of 10 weeks after surgery. During this time, the hip joint stabilises and the osteotomies heal. On removal of the spica in the out-patients, the child is referred for a course of physiotherapy to improve hip movements and to encourage progressive weight-bearing. It may be up to 3 months from surgery before the child is able to walk normally.

If pins or metal plates have been used to secure an osteotomy, these require removal approximately 6 – 12 months later.

Who is at risk of DDH? How can DDH be prevented?

There is no way to prevent DDH from occurring but if your child has any of the risk factors mentioned above, obtaining an ultrasound scan of the hips by a trained sonologist and consulting a paediatric orthopaedic surgeon as soon as possible after birth will facilitate early treatment of the condition, typically without the need for any surgery.

 

What is a Spinal Fracture?

The spine is composed of blocks of bone called vertebrae stacked one above the other with an intervening soft shock-absorber like tissue called a disc lying between each pair of vertebrae.

What causes it?

Normal vertebrae can fracture due to falls from a height, road traffic accidents and other high velocity accidents. Vertebrae can lose their strength due to osteoporosis and these osteoporotic vertebrae are susceptible to fractures from low velocity injuries. Massive injuries to the spine can result in a loss of the normal alignment of the spine – dislocations. Depending on the extent of the initial damage to the spinal cord, some spinal cord injuries are permanent whereas others recover over time.

What are the symptoms/effects?

Fractures and dislocations of the spine can lead to spinal cord and nerve root injury causing varying degrees of muscle paralysis, sensory alterations and loss of bladder and bowel control.

How are they diagnosed?

Fractures and dislocations are diagnosed by a thorough clinical examination, followed by x-rays, CT scans and MRI scans. The CT scan reveals the extent of the bony injury whereas the MRI scan provides information regarding spinal cord compression and ligamentous injury.

What are the treatment options?

There are two issues here – a) bone and ligamentous injury and b) neural injury. Many spinal fractures can be managed without surgery as bony injuries heal over time. However, in the presence of a massive ligamentous injury (e.g. fracture dislocations) operative stabilisation is advisable.

Complete damage to the spinal cord results in permanent paralysis and surgery does not alter the neurological outcome. However, surgical stabilisation in this instance may permit early institution of rehabilitation. Incomplete injuries may recover over time and there is a role for surgical decompression and stabilisation in this instance.

Who is at risk?/How can I prevent it?

Adhering to occupational health and safety rules and regulations, following traffic laws and avoiding excessive speed while travelling on the road will reduce the incidence of spinal cord injuries.

Following a Myocardial infraction or heart attack, the area of infraction often leaves behind by a nonfunctional scar. This can leads to a dilatation of the heart over a period of time and change its shape from a normal elliptical one to a globular one resulting in reduction of heart function and can lead to heart failure. By an operation called Linear Endoventricular Patch Plasty or commonly called Modified Dor’s Procedure, the elliptical shape of heart is restored, thus restoring its normal pump function. The procedure is done in isolation or along with the routine CABG.

Capsule Endoscopy: – Evaluates small intestine which cannot be assessed by Gastoscope and Colonoscope.

Man has been fascinated since long to view the milieu interior of gastrointestinal tract. We have advanced video endoscopes, which can permit viewing of esophagus, stomach, and duodenum with a traditional gastroscope. Likewise the entire large intestine and part of terminal ileum can be scanned to a great detail by using colonoscope. Detection and treatment of various upper GI and lower GI lesions including tumors, ulcers and bleeding lesions has been simplified with endoscopic methods.

However, the small intestine is difficult to study by endoscopic methods due to the enormous length (14 feet) and anatomic feature (loosely supported and looped structure on the mesentery). Push enteroscopy can examine part of jejunum and a double balloon technique can examine almost the entire small bowel. However endoscopic examination with these techniques is very cumbersome (can take up to 4 hrs), with inadequate information and is not patient friendly. These difficulties with traditional flexible instruments propelled the development of a technological marvel; an endoscope that could make its way through the 14 feet of small bowel. A pill sized camera with sufficient battery life to image the entire small intestine- Capsule endoscopy.

This unique video capsule is 11×26 mm n size and weighs less than 4 grams. The device captures two images per second and has a battery half-life of 8 hours.

After a overnight fasting, patient swallows the capsule which travels through the GI trace by means of peristalsis. Images are transmitted by digital radio frequency communication channel to an external data recorder unit. The data recorder is tied around patient like a Holter monitor. Patient can continue normal activities during the entire procedure, which can be done as a ambulatory procedure. The data recorder is then connected to a dedicated computer for analysis. The non-invasive nature of capsule endoscopy makes it an attractive option over traditional endoscopy, as it requires little preparation, with no need for sedation. The procedure does not cause any discomfort to the patient and provides a more physiologic view of small intestine
Capsule endoscopy has been found to be superior to CT scan or MRI, for detection of small bowel lesions like tumors, ulcerations secondary to NSAIDs, vascular malformations, diverticulae etc. In patients with bleeding from small intestine, capsule endoscopy has been shown to be as accurate as intraoperative enteroscopy and superior to angiogram and tagged RBC nuclear scan. Capsule endoscopy has been shown to change patient management in up to 75% of cases with GI hemorrhage from small bowel. Now the last frontier in luminal endoscopy (visualization of small bowel) has also been conquered with this mega invention.