Shrink your fibroids
Posted by on Wednesday, 22nd May 2013
Please visit my website www.irtreatments.com for further details. mobile +919320182803
Fibroids Treatment – Shrink your fibroids by angiography methods (Uterine Fibroid Embolisation) - No Surgery, Quick Recovery and Affordable Treatment.
Fibroids in uterus with symptoms can be treated without surgery by procedure called Uterine Fibroid Embolisation (UFE).
Advantages of Uterine Fibroid Embolisation (UFE)
1. It is performed under Local anaesthesia. Not General anaesthesia.
2. Requires only a needle puncture in skin (No surgical incision of abdomen).
3. Recovery is much shorter than from hysterectomy or open myomectomy.
4. You can walk after rest for 4 hrs. Within 3 days you can carry out routine activities.
5. No complications associated with surgical opening.
6. All fibroids are treated at once, which is not the case with myomectomy.
7. Uterine fibroid embolization involves virtually no blood loss or risk of blood transfusion.
8. Many women resume light activities in a few days and the majority of women are able to return to normal activities (including exercise) within a week. If the presenting complaint was excess vaginal bleeding, 87-90% of cases experience resolution within 24hours.
9. Emotionally, financially and physically benign procedure -embolization can have an overall advantage over other procedures as the uterus is not removed.
FAQ's
Q. What are the conditions that can be treated?
A.
1. Single / multiple Uterine Fibroids with symptoms.
Q. What are typical symptoms?
A.
1. Heavy, prolonged menstrual periods and unusual bleeding, sometime with clots.
2 .Lower abdomen pressure or heaviness
Q. Who is most likely to have uterine fibroids?
A. Uterine fibroids are very common, although, often they are very small and cause no problem. From 20% to 40 % of women aged 35 and older have uterine fibroids of a significant size.
Q. How are uterine fibroids diagnosed?
A. Sonography
Q. What is fibroid embolization?
A. UFE is performed by an interventional radiologist, a physician who is specially trained to perform this and other minimally invasive procedures. The doctor makes a needle puncture in the groin and inserts a catheter into an artery. The catheter is guided through the artery to the uterus while the interventional radiologist guide’s the progress of the procedure using X-ray. The interventional radiologist injects tiny particles the size of grains of sand into the artery that is supplying blood to the fibroid tumor. This cut off the blood flow and causes the fibroid to shrink. The artery on the other side of the uterus is then treated. This procedure is available at few hospitals.
Q. Which patient can go for fibroid embolization?
A. Patients who have single / multiple fibroids which are causing symptoms
Q. How successful is the fibroid embolization procedure?
A. Studies show that up to 94% of women who have the procedure experience significant or total relief of heavy bleeding, pain and other symptoms. The procedure also is effective for multiple fibroids. No re-growth of treated fibroids is observed.
Q. Are there risks associated with the treatment of fibroid tumors?
A. There are some associated risks, as there are with almost any medical procedure. Most women experience moderate pain and cramping in the first several hours following the fibroid embolization procedure. Some experience nausea and fever. These symptoms are controlled with antibiotics and pain medication. Less than 1% of the patients need myomectomy or hysterectomy to complete the removal of a persisting fibroid.
Q. What are the risks of Surgery for fibroids
A. Hysterectomy and myomectomy carry risks, including infection, bleeding leads to blood transfusion. Patients who undergo myomectomy may develop adhesions causing tissue and organs in abdomen to fuse together, which can lead to other problems. In addition, the recovery time is much longer generally one to two month.
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deep vein thrombosis
Posted by on Tuesday, 14th May 2013
DEEP VEIN THROMBOSIS
What is deep vein thrombosis (DVT)?
The blood circulation system in our body has arteries and veins. The arteries carry pure blood and veins carry impure blood. The vein system in our legs has two groups of veins; superficial veins and deep veins. The superficial veins are ones which we can see under our skin on legs; while deep veins our hidden in the muscles. The thrombosis means blockage of veins by blood clots. So when deep veins forms clot inside it is called “deep vein thrombosis”. This usually happens in the legs. When that happens suddenly; patient develops pain, catch in the muscles and swelling of the leg; depending on the extent of blockage. If the extent of blockage is large you will have pain, swelling, stiffness. If the extent of block is less you may complain only of cramp or stiffness with pain.
In a few cases these pieces of blood clots in veins can break away and deposit into the blood vessels of lungs. When that happens; person may suffer from breathlessness, chest pain, heart failure and sometimes results in death.
Causes of deep vein thrombosis
There are various causes of deep vein thrombosis. It can be due to slowing of blood due to various reasons like prolonged bed rest, long hours of sitting, dehydration, trauma, recent surgery. The “economy class syndrome” is the formation of blood clots in veins deep within the legs occurring during or just after a long airplane flight, especially in economy class due to prolonged immbolisation and lack of space.
Some patients has increased tendency to form clots. It may due to certain deficiency of blood components. These patients tend to form blood clots more than others. Such individuals have repeated attacks of deep vein thrombosis. In certain diseases persons have more frequency of deep vein thrombosis like cancer, obesity and kidney diseases. Pregnancy is one state where chances of deep vein thrombosis are high due to pressure from uterus and hormonal changes. Women who are taking contraceptive pills are again more prone to DVT due to hormonal changes. Old age, persons with severe infections and patients on chemotherapy are also more prone to DVT.
Treatment of deep vein thrombosis
Deep vein thrombosis can be detected by blood test called “D-dimer”. To know the extent of disease sonography of veins (Color Doppler) is done. This Sonography test will confirm the diagnosis and also it will tell us the extent of disease. In some cases MRI scan will be required.
Once detected one should start treatment early to get best results. If your disease is mild, you can be treated as OPD patient. Doctor will give you blood thinning injections two times daily for 5-7 days and start blood thinning medications. You will also need blood tests to see the appropriate level of medication required for blood thinning. It is better to take rest from your work. If your disease is significant doctor will admit and treat you. This would include blockage of veins in pelvis, migration of blood clot into lungs, old age, and other medical diseases.
If there is considerable disease involving major veins in thigh and pelvis; the blood clots can be melted with blood thinning medicines injected directly into affected veins and clots can be aspirated out of the veins. This treatment is called “catheter directed thrombolysis”. This procedure has to be done within two weeks of start of disease. This is a new method of treatment which has significantly improved the results of treatment. If there is increased risk of blood clot migrating into lungs then doctor can put a filter in inferior vena cava (the large vein in lower trunk formed by joining of both leg veins).
Your blood thinning tablet will continue for six months. You will also be investigated to find out if you have certain deficiency of blood components. Besides this you will be required to wear compression stockings in affected leg. These stockings you will have to wear for two years or more.
Discussion will not be complete without long term effects of deep vein thrombosis. In medical term it is called ‘post thrombotic syndrome (PTS)’. Up to half of the patients who had DVT will suffer from PTS. The symptoms of PTS includes swelling of leg, pain, heaviness, itching, discoloration of skin, varicose veins and even ulcer on legs. It is to avoid these symptoms patients are advised to wear compression stockings for two years or more.
Deep vein thrombosis should be detected early and treated appropriately for early recovery, prevention of complications and decrease chances of long term effects.
Dr Sunil Bhargava MD, DNB, MNAMS
Consultant Interventional Radiology and Vascular Sciences
SevenHills Hospital, Andheri (E), Mumbai 400059
E mail drsunil.b@sevenhillshospital.com ,Mobile +919320182803
Dr Sunil Bhargava is an Interventional Radiologist with experience of over 17 years. He is an expert in endovascular treatment of vascular diseases. His areas of interest include venous ailments like varicose veins, deep vein thrombosis and congenital venous malformations.
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spider veins
Posted by on Saturday, 11th May 2013
SPIDER VEINS
What are spider veins?
Spider veins are tiny prominent blood vessels seen on the skin of legs. These are 0.5-1mm in size. Veins 1-3mm in size are called reticular veins. These veins occur in patches. Usually they do not cause any problems. Sometimes these veins can bleed, cause pain and irritation.
What investigations are done?
If you have too many spider veins doctor may do sonography of veins
What are the reasons for seeking treatment?
1. Bleeding from spider veins.
2. Pain and irritation
3. Itching
4. For cosmetic reasons if they are prominent
What is done for treatment?
Treatment is called “Sclerotherapy”. It is done on OPD basis. Doctor can give injections into these veins. They veins will swell up after treatment and then collapse over few days and then disappear.
What are the side effects of treatment?
The common side effect is pigmentation along the treated veins. This will fade away with creams most of the times.
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backache -laser treatment for disc problems
Posted by on Saturday, 11th May 2013
LASER treatment for disc disease
laser treatment for disc problems is called Percutaneous Laser Disc Decompression(PLDD). This treatment is now available in India.
PLDD is the minimally-invasive medical procedure developed by Dr. Daniel S.J. Choy in 1986 that uses a laser beam to treat back and neck pain caused by a herniated disc.
A herniated disc is like a balloon with a weak spot. Inflating it will cause a bulge (herniation). Pain results from the bulge pressing against nerves in the spinal column. The patients who have contained intervertebral disc on imaging and has not responded to medication for one month are suitable candidates for this treatment.
The PLDD treatment is performed using only local anesthesia. During the procedure, a thin needle is inserted into the herniated disc under x-ray guidance. SevenHills hospital has cathlab with CT scan capability by which we can precisely place the needle and check results after laser therapy. An optical fiber is inserted through the needle and laser energy is sent through the fiber, vaporizing a tiny portion of the disc nucleus. This creates a partial vacuum which draws the herniation away from the nerve root, thereby relieving the pain. The effect usually is immediate, but pain relief may be seen after a week or upto 2 months. In carefully selected cases 80% patients are benefitted.
Patients get off the table with just a small adhesive bandage. 24 hours of bed rest is advised. Then patients begin progressive ambulation and most return to work in four to five days.
Because only a thin needle is used, there is no cutting and no scarring; hence a very low risk procedure. Since only a tiny amount of disc is vaporized, there is no subsequent spinal instability. PLDD is different from open lumbar disc surgery because there is no damage to the back muscle, no bone removal or large skin incision. Most of the complications that may occur with open surgery are eliminated with the PLDD procedure. please visit my website www.irtreatments.com for further details
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ROLE OF INTERVENTIONAL RADIOLOGY IN CANCER
Posted by on Friday, 9th March 2012
ROLE OF INTERVENTIONAL RADIOLOGY IN CANCER
Interventional radiology has a great supportive role in diagnosis and management of malignancy. It adds new dimension to the facilities that can be offered to the patient in an institution.
Diagnosis- various deep-seated biopsies can be done under US and CT guidance. These would other wise need laprotomy. This small procedure can reduce morbidity and facilitate speedy treatment.
Various malignancies where interventional procedures can play a role are following:
1. Liver malignancies-primary and secondaries.
2. Malignant Biliary obstruction
3. Renal malignancies
4. Cervical and other pelvic malignancies.
5. Ca lung
6. GI bleeds.
7. Epistaxis- Secondary, Nasopharyngeal angiofibroma.
8. SVC Thrombosis- thrombolytic therapy.
Liver malignancies-primary small HCC (hepatocellular carcinoma) when detected can be treated with PEIT (percutaneous ethanol injection treatment) or Radiofrequency ablation(RFA) or TACE (transarterial chemoembolisation).
In large inoperable HCC TACE can be done. This procedure involves embolisation of the selective feeding artery. The chemotherapeutic agent is epirubicin and the dose is calculated on body surface area. The epirubicin is mixed in 5-15ml of lipidol. The mixture is well shaken and injected into the feeding artery. The chemotherapeutic agent-lipidol mixture gets concentrated in the tumor tissue and washed off from the normal liver. At end of the injection, the artery is occluded with gelfoam.
Liver malignancies-Secondaries. – If there are few secondaries in the liver and primary lesion has been resected, then lesions less than 30mm can be treated with percutaneous ethanol injection treatment or high frequency thermal treatment.
Malignant Biliary obstruction
Inoperable patients of malignant biliary obstruction need palliation to reduce itching and jaundice to improve the quality of life and well-being. Procedures that can be performed are external drainage, external internal drainage, and biliary stenting. Metallic stents are preferred over plastic stents due to low profile and long patency of 6mths to one year. In case the lesion cannot be crossed then external biliary drainage is done.
Renal malignancy- Inoperable renal malignancies can have life-threatening hematuria. For this renal artery embolisation can be done. .
Alcohol ablation of the kidney can be performed using absolute alcohol. This procedure gives severe pain in there loin due to infarction. Also patient can suffer from nausea, vomiting, fever and leucocytosis. This needs symptomatic treatment for few days.
GI malignancies- The lesion that are causing excessive GI bleeding and the lesion is not amenable to immediate surgical treatment then embolisation of the visceral arteries can be done.
Cervical and other pelvic malignancies. Patients with carcinoma cervix can suffer from uncontrolled bleeding per vagina spontaneously or following radiotherapy. Here the uterine artery can be embolised. Similarly bladder malignancies with hematuria can be treated with embolisation of vesical arteries. In pelvis arteries of both sides are embolised, as rich anastomosis exists between two sides.
Lung malignancies patients with primary lung malignancies can suffer from massive hemoptysis. Embolisation of bronchial arteries can control such episodes.Radiofrequency ablation can also be offered in selected cases.
SVC(superior vena cava) syndrome. - Patients with carcinoma bronchus can invade mediastinum and obstruct SVC resulting in uncomfortable clinical features of SVC syndrome. Metallic stents can be placed to relieve such symptoms.
Also patients can develop SVC thrombosis. Here thrombolytic therapy can be done. This involves infusion of urokinase in the thrombus at the rate of 50,000-100,000 units/hour.
Head and neck malignancies- secondaries in nose or Nasopharyngeal angiofibroma, which is a highly vascular tumor, can be embolised. This results less bleeding at the time of surgery and also complete removal of the tumor is possible.
There are large numbers of interventional procedures that can be helpful in diagnosis, treatment and palliation. These procedures save patients from a life threatening hemorrhage in malignancies. It helps in improving the level of medicare provided to the cancer patients in a given institution.
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