Month: May 2009

Categories
Diagnonistic Test

Hysteroscopy

[amazon_link asins=’9386150492,B0040SYP22,0781755328,1842142593,076376437X,B01FIZYZQQ,B00GNOSDOC,B00EN61JAM,B0756NT213′ template=’ProductCarousel’ store=’finmeacur-20′ marketplace=’US’ link_id=’c88420a9-dcf5-11e7-886a-db8f021aa1b7′]

Definition:
Hysteroscopy is the inspection of the uterine cavity by endoscopy. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention (operative hysteroscopy).
……………....CLICK & SEE
The hysteroscope is a long tube, about the size of a straw, which has a built-in viewing device. Hysteroscopy is useful for diagnosing and treating some problems that cause infertility, miscarriages, and abnormal menstrual bleeding. Sometimes other procedures, such as laparoscopy, are done at the same time as hysteroscopy.

Method:-
The hysteroscope is an optical instrument connected to a video unit with a fiber optic light source, and to the channels for delivery and removal of a distention medium. The uterine cavity is a potential cavity and needs to be distended to allow for inspection. Thus during hysteroscopy either fluids or CO2 gas is introduced to expand the cavity. The choice is dependent on the procedure and the patient’s condition. Fluids can be used for both diagnostic and operative procedures. However, CO2 gas does not allow the clearing of blood and endometrial debris during the procedure, which could make the imaging visualization difficult. Gas embolism may also arise as a complication. Since the success of the procedure is totally depending on the quality of the high-resolution video images in front of surgeon’s eyes, CO2 gas is not commonly used as the distention medium. Electrolytic solutions include normal saline and lactated Ringer’s. Current recommendation is to use the electrolytic fluids in diagnostic cases, and in operative cases in which mechanical, laser, or bipolar energy is used. Since they are conducting electricity, these fluids should not be used with monopolar electrosurgical devices. Non-electrolytic fluids eliminate problems with electrical conductivity, but can increase the risk of hyponatremia. These solutions include glucose, glycine, dextran (Hyskon), mannitol, sorbitol and a mannitol/sorbital mixture (Purisol). Water was once used routinely, however, problems with water intoxication and hemolysis discontinued its use by 1990. Each of these distention fluids is associated with unique physiological changes that should be considered when selecting a distention fluid. Glucose is contraindicated in patients with glucose intolerance. Sorbitol metabolizes to fructose in the liver and is contraindicated if patients has fructose intolerance. High-viscous Dextran also has potential complications which can be physiological and mechanical. It may crystallize on instruments and obstruct the valves and channels. Coagulation abnormalities and adult respiratory distress syndrome (ARDS) have been reported. Glycine metabolizes into ammonia and can cross the blood brain barrier, causing agitation, vomiting and coma. Mannitol 5% should be used instead of glycine or sorbitol when using monopolar electrosurgical devices. Mannitol 5% has a diuretic effect and can also cause hypotension and circulatory collapse. The mannitol/sorbitol mixture (Purisol) should be avoided in fructose intolerant patients.

A hysteroscope is in fact a modification of the traditional resectoscope, which is used for transurethral resection of the prostate. It has a double-channeled sheath allowing for continuous flow of fluid or gas media into the uterus through the larger channel, while allowing for less outflow through the smaller channel. This results in the distention of the uterine cavity. With modern optical technologies, hysteroscopes are getting smaller in diameter yet able to provide larger and brighter images for surgeons’ convenience.

After cervical dilation, the hysteroscope is guided into the uterine cavity and an inspection is performed. If abnormalities are found, an operative hysteroscope with a channel to allow specialized instruments to enter the cavity is used to perform the surgery. Typical procedures include endometrial ablation, submucosal fibroid resection, and endometrial polypectomy. Typically hysteroscopic intervention is done under general endotracheal anesthesia or Monitored Anesthesia Care (MAC), but a short diagnostic procedure can be performed in a gynecologist‘s office with just a paracervical block using the Lidocaine injection in the upper part of the cervix.

Why it is Done:
Hysteroscopy is useful in a number of uterine conditions:

Asherman’s syndrome (ie. intrauterine adhesions). Hysteroscopic adhesiolysis is the technique of lysing adhesions in the
*uterus using either microscissors (recommended) or thermal energy modalities. Hysteroscopy can be used in conjunction with laparascopy or other methods to reduce the risk of perforation during the procedure.
*Endometrial polyp. Polypectomy.
*Gynecologic bleeding
*Uterine fibroids. Myomectomy.
*Congenital Uterine malformations (also known as Mullerian malformations). Eg.septum,
*Evacuation of retained products of conception in selected cases.

Hysteroscopy has the benefit of allowing direct visualization of the uterus, thereby avoiding or reducing iatrogenic trauma to delicate reproductive tissue which may result in Asherman’s syndrome.
How do you prepare for the test
The time that you schedule this test can be important. Your gynecologist is able to get the best view of the uterine lining during the week that follows your period. If you have regular cycles, it is helpful for you to anticipate the timing of your next period and plan to have the hysteroscopy done in the following week.

Tell your doctor ahead of time if you have ever had an allergic reaction to lidocaine or the numbing medicine used at the dentist’s office. Discuss different options for anesthesia with your doctor in advance.

If your doctor plans on giving you any anti-anxiety medicines before the procedure, or if you are going to have other tests done at the same time as hysteroscopy, you might be told not to eat or drink for eighthours or more before the test. Just before the test, you should empty your bladder.

Risk Factors:

After the procedure, you may have slight vaginal bleeding and cramps for one or two days. Sometimes a small amount of the gas used to expand the uterus can float up to the top of the abdomen and remain there for a day or two before it dissolves away. This can cause some shoulder pain. Some patients experience nausea from medicines used for anesthesia or anxiety.

Some of the procedures that are done along with hysteroscopy have risks of their own. You should ask your doctor about special risks that might come along with additional procedures planned for you.

A common problem is the uterine perforation when the instrument breaches the wall of the uterus. This can lead to bleeding and damage to other organs. A life-threatening condition is the bowel perforation by the instruments after the uterine perforation, resulting in acute peritonitis which can be fatal. Furthermore, cervical laceration, intrauterine infection (especially in prolonged procedures), electrical and laser injuries, and complications caused by the distention media described above are also not uncommon. The overall complication rate for diagnostic and operative hysteroscopy is 2% with serious complications occurring in less then 1% of cases.

How long is it before the result of the test is known
Your doctor can tell you what was seen through the hysteroscope right away. If a biopsy sample is removed, the analysis might take several days.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/hysteroscopy.shtml
http://en.wikipedia.org/wiki/Hysteroscopy

Reblog this post [with Zemanta]
Related articles
Categories
News on Health & Science

New Methods for Curbing Nausea of Chemotherapy

Ginger, a home remedy for helping an upset stomach, and a cocktail of anti-nausea drugs both reduced vomiting and sickness in cancer patients.

Chemotherapy could soon become less grueling.

Simply adding about half a teaspoon of ginger to food in the days before, during and after chemotherapy can reduce the often-debilitating side effects of nausea and vomiting, a large, randomized clinical trial has found. And a newer type of anti-nausea drug, when added to standard medications, can help prevent such side effects as well.

The ginger results will be presented this month at the American Society of Clinical Oncology annual meeting; the drug study was published this week in the Lancet Oncology journal.

The findings are significant, cancer experts say, because about 70% of chemotherapy patients experience nausea and vomiting — often severe — during treatment.

“Chemotherapy has come to be the thing cancer patients fear the most,” said Dr. Steven Grunberg, a professor of medicine at the University of Vermont and lead author of the study in the Lancet Oncology. “We’ve made a huge amount of progress, but we haven’t completely solved the problem.”

In the ginger study, 644 patients, most of them female, from 23 oncology practices nationwide received two standard anti-emetic medications at the time of chemotherapy. They also were given a capsule containing either 0.5 gram, 1 gram or 1.5 grams of ginger, or a placebo capsule. The patients took the capsules containing the placebo or ginger for three days before chemotherapy and three days after the treatment.

All of the patients receiving ginger experienced less nausea for four days after chemotherapy, said lead study author Julie L. Ryan of the University of Rochester Medical Center. Doses of 0.5 gram and 1 gram were most effective, reducing nausea by 40% compared with the patients on the placebo.

The study is the largest to examine the effect of ginger, already widely used as a home remedy for an upset stomach. One gram of ground ginger is equivalent to about 1/2 teaspoon. Ryan cautioned that some foods labeled as ginger, such as ginger ale or ginger cookies, may contain only ginger flavoring.

Researchers don’t know why ginger seems to help, Ryan said. But, she added: “There is other research showing it has a potent anti-inflammatory effect in the gut.”

In the study led by Grunberg, 810 patients were given two standard anti-nausea drugs, dexamethasone and ondansetron, that work by blocking a neural pathway in the brain that controls nausea. This two-drug regimen is most effective in preventing nausea and vomiting in the first 24 hours after chemotherapy.

One-third of the patients also received a one-day dose of the new drug, casopitant mesylate, while one-third received a three-day dose and one-third received a placebo.

Adding casopitant mesylate, the authors found, helped control symptoms in the so-called delayed phase of nausea that occurs beyond the first day after chemotherapy. Of patients receiving the standard two-drug regimen, 66% experienced no nausea or vomiting in the five days after chemotherapy, compared with 86% of patients taking a single dose of casopitant mesylate.

Casopitant mesylate probably adds extra relief from nausea because it acts on different nerve systems than the standard drugs, Grunberg said. Dexamethasone and ondansetron are in a class of drugs known as serotonin receptor antagonists; casopitant mesylate blocks the so-called NK1 pathway in the brain.

“NK1 antagonists work better for that later period,” Grunberg said. “This study reinforces the value of this family of anti-nausea agents.”

It also appears that the three-drug combination can be given on the day of chemotherapy without the need for additional doses, he said.

“That is a huge convenience for the patient, if we can give them all the drugs they will need for this period on the day they come to the clinic for chemotherapy,” Grunberg said. “Our whole goal is maintain the highest quality of life during chemotherapy.”

Sources: Los Angeles Times

Related articles by Zemanta
Reblog this post [with Zemanta]
Categories
News on Health & Science

Chinese Mind-Body Training Reduces Stress

Researchers have unravelled how an emerging mind-body technique, adapted from traditional Chinese medicine and practised by thousands in  China, cuts down stress levels in just five days.
………………………………………
The integrative body-mind training (IBMT) is now being taught to undergraduates involved in research on the method at the University of Oregon (UO).

In October 2007, researchers led by visiting UO professor Yi-Yuan Tang and UO psychologist Michael Posner documented that doing IBMT prior to a mental math test led to low levels of the stress hormone cortisol among Chinese students.

The experimental group also showed lower levels of anxiety, depression, anger and fatigue than students in a relaxation control group.

“The previous paper indicated that IBMT subjects showed a reduced response to stress.” Tang said. “Why did it work so fast?”

The new findings point to how IBMT alters blood flow and electrical activity in the brain, breathing quality and even skin conductance, allowing for “a state of ah, much like in the morning opening your eyes, looking outside the grass and sunshine, you feel relaxed, calm and refresh without any stress, this is the meditation state,” he said.

Data were drawn from several technologies in two experiments involving 86 undergraduate students at Dalian University of Technology, where Tang is a professor, said an UO release.

The data were analysed and prepared for publication at the UO with help from Posner and psychology professor Mary K. Rothbart, who are not co-authors of the paper.

The study was published online in the Proceeding of the National Academy of Sciences.
You may click to see:->

Mind/Body Medicine for the 21st Century.

History of Meditation as a Clinical Intervention

Do Mind/Body Techniques Work?

Healing through Bodymind technique

Sources: The Times Of India

Reblog this post [with Zemanta]
Categories
News on Health & Science

Eat Indian Curry to Lose Weight

Eating lots of curry may help you lose weight, research suggests.

Click & see

Scientists believe that haldi, or turmeric, which is used in most Indian meals, has an active ingredient that can help fight obesity.

A meal that includes haldi will lead to less weight gain than one without the yellow powder.

This is because haldi contains a plant-based chemical called curcumin which suppresses the growth of fat tissue in mice and human cell cultures, according to a study by Tufts University in Boston, published in the Journal of Nutrition.

Curcumin is also easily absorbed by the body, the researchers said, after experiments on mice.

“Weight gain is the result of the growth and expansion of fat tissue, which cannot happen unless new blood vessels form, a process known as angiogenesis,” said senior study author Mohsen Meydani of the Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts.

“Based on our data, curcumin appears to suppress angiogenic activity in the fat tissue of mice fed high fat diets,” he said in a statement.

In particular, turmeric is effective when added to a high-fat meal, suggesting it could help fight obesity.

Researchers gave one set of mice high-fat diets and another set the same food with 500mg of curcumin added to each meal.

After 12 weeks, the mice which were fed curcumin weighed less than those which did not eat it.

The next step will be to perform clinical trials on humans, said the researchers.

Sources: The Times Of India

Related articles by Zemanta
Enhanced by Zemanta
Categories
News on Health & Science

Excess Cola Can Paralyze Muscles

Think twice before you take a sip from that cola bottle this summer. Experts are warning that excessive cola consumption can lead to anything from  mild weakness to profound muscle paralysis.
…………………………….
This is because the cola drinks can cause blood potassium to drop dangerously low, they report in the International Journal of Clinical Practice.

They tell of the curious case of an Australian ostrich farmer who needed emergency care for lung paralysis after drinking 4-10 litres of cola a day.

He made a full recovery and was advised to curtail his cola intake, BBC News portal reported on Tuesday.
Another example included a pregnant woman who regularly consumed up to three litres a day for the last six years and complained of tiredness, appetite loss and persistent vomiting.

A heart trace revealed she had an irregular heartbeat, most likely caused by her low blood potassium levels.
Once she stopped drinking such quantity of cola, she made a full and uneventful recovery.

The investigators believe these cases are not atypical and that many people risk problems due to their intake. Manufacturers insist the products are safe when consumed in moderation.

In a commentary, Clifford Packer from the Louis Stokes Cleveland VA Medical Centre in Ohio said: “We have every reason to think that it is not rare. With aggressive mass marketing, super-sizing of soft drinks, and the effects of caffeine tolerance and dependence, there is very little doubt that tens of millions of people in industrialised countries drink at least 2-3 litres of cola per day. “It follows that the serum potassium levels of these heavy cola drinkers are dropping, in some cases, to dangerous low levels.”

The author of the study, Moses Elisaf from the University of Ioannina in Greece, said it appeared that hypokalaemia can be caused by excessive consumption of three of the most common ingredients in cola drinks – glucose, fructose and caffeine. “The individual role of each of these ingredients in the pathophysiology of cola-induced hypokalaemia has not been determined and may vary in different patients. However in most of cases we looked at for our review, caffeine intoxication was thought to play the most important role.

“This has been borne out by case studies that focus on other products that contain high levels of caffeine but no glucose or fructose.”

Despite this, he warned that caffeine free cola products could also cause hypokalaemia because the fructose they contain can cause diarrhoea. “We believe that further studies are needed to establish how much is too much when it comes to the daily consumption of cola drinks.”

Sources: The Times Of India

Reblog this post [with Zemanta]
css.php