Bariatric Surgery

Bariatric surgery part-1

May lead to conditions that increase energy expenditure.Bariatric surgical procedures cause weight loss by restricting the amount of food the stomach can hold, causing malabsorption of nutrients, or by a combination of both gastric restriction and malabsorption. Bariatric procedures also often cause hormonal changes. Most weight loss surgeries today are performed using minimally invasive techniques (laparoscopic surgery).

The most common bariatric surgery procedures are a gastric bypass, sleeve gastrectomy, adjustable gastric band, and biliopancreatic diversion with duodenal switch.

  • Gastric Bypass
  • Sleeve Gastrectomy
  • Adjustable Gastric Band
  • Biliopancreatic Diversion with Duodenal Switch (BPD/DS)

Gastric Bypass

The Roux-en-Y Gastric Bypass – often called gastric bypass – is considered the ‘gold standard’ of weight loss surgery.

bariatric

The Procedure

There are two components to the procedure. First, a small stomach pouch, approximately one ounce or 30 milliliters in volume, is created by dividing the top of the stomach from the rest of the stomach. Next, the first portion of the small intestine is divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch. The procedure is completed by connecting the top portion of the divided small intestine to the small intestine further down so that the stomach acids and digestive enzymes from the bypassed stomach and first portion of small intestine will eventually mix with the food.

The gastric bypass works by several mechanisms. First, similar to most bariatric procedures, the newly created stomach pouch is considerably smaller and facilitates significantly smaller meals, which translates into less calories consumed.

Most importantly, the rerouting of the food stream produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.

Benefits

 

  1. Produces significant long-term weight loss (60 to 80 percent excess weight loss).
  2. Restricts the amount of food that can be consumed.
  3. May lead to conditions that increase energy expenditure.
  4. Produces favorable changes in gut hormones that reduce appetite and enhance satiety.
  5. Typical maintenance of >50% excess weight loss.

Sleeve Gastrectomy

The Laparoscopic Sleeve Gastrectomy – often called the sleeve – is performed by removing approximately 80 percent of the stomach. The remaining stomach is a tubular pouch that resembles a banana.

bairatical

The Procedure

This procedure works by several mechanisms. First, the new stomach pouch holds a considerably smaller volume than the normal stomach and helps to significantly reduce the amount of food  that can be consumed. The greater impact, however, seems to be the effect the surgery has on gut hormones that impact a number of factors including hunger, satiety, and blood sugar control.

Sleeve Gastrectomy

Short term studies show that the sleeve is as effective as the roux-en-Y gastric bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggest the sleeve, is effective in improving type 2 diabetes independent of the weight loss. The complication rates of the sleeve fall between those of the adjustable gastric band and the roux-en-y gastric bypass.

Benefits

  1. Restricts the amount of food the stomach can hold.
  2. Induces rapid and significant weight loss that comparative studies find similar to that of the Roux-en-Y gastric bypass. Weight loss of >50% for 3-5+ year data, and weight loss comparable to that of the bypass with the maintenance of >50%.
  3. Requires no foreign objects (AGB), and no bypass or re-routing of the food stream (RYGB).
  4. Involves a relatively short hospital stay of approximately 2 days.
  5. Causes favorable changes in gut hormones that suppress hunger, reduce appetite and improve satiety.

 Bariatric Surgery  continues in Part – 2   –  Click Here

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cancer-treatment

What Everyone Ought To Know About cancer – Part 2

Treatments for Cancer

Cancer treatment depends on the type of cancer, the stage of cancer , age, health status, and additional personal characteristics. There is no single treatment for cancer, and patients often receive a combination of therapies and palliative care. Treatments usually fall into one of the following categories: surgery, radiation, chemotherapy, immunotherapy, hormone therapy, or gene therapy.

Surgery

Surgery is the oldest known treatment for cancer. If cancer has not metastasized, it is possible to completely cure a patient by surgically removing cancer from the body. This is often seen in the removal of the prostate or a breast or testicle. After the disease has spread, however, it is nearly impossible to remove all of the cancer cells. Surgery may also be instrumental in helping to control symptoms such as bowel obstruction or spinal cord compression.

Innovations continue to be developed to aid the surgical process, such as the iKnife that “sniffs” out cancer. Currently, when a tumor is removed surgeons also take out a “margin” of healthy tissue to make sure no malignant cells are left behind. If there are no clear margins, the surgeon has to go back in and remove more tissue (if possible). Scientists from Imperial College London say the iKnife may remove the need for sending samples to the lab.

For surgeons to distinguish between cancerous and healthy tissue. Viewed through the glasses, cancer cells appear to glow blue under a special light, thanks to a fluorescent marker injected into the tumor that attaches only to cancerous and not to healthy cells. Also, the lighter the shade of blue, the more concentrated the cancer cells are.

Promising results of an early small trial at Duke University Medical Center in Durham, NC have suggested a new injectable agent that makes cancer cells in a tumor fluoresce. Tests continue to be carried out.

Radiation Radio Therapy

Radiation treatment, also known as radiotherapy, destroys cancer by focusing high-energy rays on the cancer cells. This causes damage to the molecules that make up the cancer cells and leads them to commit suicide.

Radiotherapy utilizes high-energy gamma-rays that are emitted from metals such as radium or high-energy x-rays that are created in a special machine. Early radiation treatments caused severe side-effects because the energy beams would damage normal, healthy tissue, but technologies have improved so that beams can be more accurately targeted. Radiotherapy is used as a standalone treatment to shrink a tumor or destroy cancer cells.

Chemotherapy

Chemotherapy utilizes chemicals that interfere with the cell division process – damaging proteins or DNA – so that cancer cells will commit suicide. These treatments target any rapidly dividing cells, but normal cells usually can recover from any chemical-induced damage while cancer cells cannot. Chemotherapy is generally used to treat cancer that has spread or metastasized because the medicines travel throughout the entire body. It is a necessary treatment for some forms of leukemia and lymphoma. Chemotherapy treatment occurs in cycles so the body has time to heal between doses. However, there are still common side effects such as hair loss, nausea, fatigue, and vomiting.  Combination therapies often include multiple types of chemotherapy or chemotherapy combined with other treatment options

Immunotherapy

Immunotherapy aims to get the body’s immune system to fight the tumor. Local immunotherapy injects a treatment into an affected area, for example, to cause inflammation that causes a tumor to shrink. Systemic immunotherapy treats the whole body by administering an agent such as the protein interferon alpha that can shrink tumors. Immunotherapy can also be considered non-specific if it improves cancer-fighting abilities by stimulating the entire immune system, and it can be considered targeted if the treatment specifically tells the immune system to destroy cancer cells. These therapies are relatively young, but researchers have had success with treatments that introduce antibodies to the body that inhibit the growth of breast cancer cells. Bone marrow transplantation can also be considered immunotherapy because the donor’s immune cells will often attack the tumor or cancer cells that are present in the host.

Hormone Therapy

Several cancers have been linked to some types of hormones, most notably breast and prostate cancer. Hormone therapy is designed to alter hormone production in the body so that cancer cells stop growing or are killed completely. Breast cancer hormone therapies often focus on reducing estrogen levels and prostate cancer hormone therapies often focus on reducing testosterone levels. In addition, some leukemia and lymphoma cases can be treated with the hormone cortisone

Gene Therapy

The goal of gene therapy is to replace damaged genes with ones that work to address a root cause of cancer: damage to DNA. For example, researchers are trying to replace the damaged gene that signals cells to stop dividing (the p53 gene) with a copy of a working gene. Other gene-based therapies focus on further damaging cancer cell DNA to the point where the cell commits suicide. Gene therapy is a very young field and has not yet resulted in any successful treatments.

Targeting Cancers For New Drug Therapies

Researchers at The Institute of Cancer Research reported in the journal Nature Reviews Drug Discovery that they have found a new way of rapidly prioritizing the best druggable targets online. They managed to identify 46 previously overlooked targets.

The researchers used the database together with a tool and were able to compare up to 500 drug targets in a matter of minutes. With this method, it is possible to analyze huge volumes of data to discover new drug targets, which can lead to the development of effective cancer medications.

The scientists analyzed 479 cancer genes to determine which ones were potential targets for medications. Their approach was effective – they found 46 new potentially “druggable” cancer proteins.

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Cancer treatment

What Everyone Ought To Know About cancer – Part 1

Cancer is a class of diseases characterized by out-of-control cell growth. There are over 100 different types of cancer, and each is classified by the type of cell that is initially affected.

cancer

Cancer harms the body when altered cells divide uncontrollably to form lumps or masses of tissue called tumors (except in the case of leukemia where cancer prohibits normal blood function by abnormal cell division in the blood stream). Tumors can grow and interfere with the digestive, nervous, and circulatory systems, and they can release hormones that alter body function. Tumors that stay in one spot and demonstrate limited growth are generally considered to be benign.

More dangerous, or malignant, tumors form when two things occur:

  • a cancerous cell manages to move throughout the body using the blood or lymphatic systems, destroying healthy tissue in a process called invasion
  • that cell manages to divide and grow, making new blood vessels to feed itself in a process called angiogenesis.

When a tumor successfully spreads to other parts of the body and grows, invading and destroying other healthy tissues, it is said to have metastasized. This process itself is called metastasis, and the result is a serious condition that is very difficult to treat.

According to the Cancer Society, Cancer is the second most common cause of death and accounts for nearly 1 of every 4 deaths. The World Health Organisation estimates that, worldwide, there were 14 million new cancer cases and 8.2 million cancer-related deaths in 2012 (their most recent data).

Individual Types of Cancer

Breast

There are said to be over 200 different types of cancer. We have the following common cancer types covered in individual Knowledge Center articles:

  • Anal cancer
  • Bladder cancer
  • Bone cancer
  • Breast cancer
  • Cervical cancer
  • Colon cancer
  • Colorectal cancer
  • Endometrial cancer
  • Kidney cancer
  • Leukemia
  • Liver cancer
  • Lymphoma
  • Ovarian cancer
  • Pancreatic cancer
  • Prostate cancer
  • Stomach cancer
  • Testicular cancer
  • Thyroid cancer
  • Vaginal cancer
  • Vulvar cancer

The rest of this article will focus on what cancer is, what causes cancer, the symptoms, diagnosis and available treatments.

Fast Facts on Cancer

tobacco

Here are some key points about cancer. More detail and supporting information is in the main article.

  1. Cancer is considered to be one of the leading causes of morbidity and mortality worldwide.
  2. It is believed that cancer risk can be reduced by avoiding tobacco, limiting alcohol intake, limiting UV ray exposure from the sun and tanning beds and maintaining a healthy diet, level of fitness and seeking regular medical care.
  3. Screening can locate cervical cancer, colorectal cancer and breast cancer at an early, treatable stage.
  4. Vaccines such as the human papillomavirus (HPV) vaccine assist in preventing some cervical, vaginal, vulvar, and oral cancers. A vaccine for hepatitis B can reduce liver cancer risk.
  5. According to the World Health Organization (WHO), the numbers of new cancer cases is expected to rise by about 70% over the next 20 years.
  6. The most common sites of cancer among men are lung, prostate, colon, rectum, stomach and liver.
  7. The most common sites of cancer among women are breast, colon, rectum, lung, cervix and stomach.

Symptoms of Cancer

Cancer symptoms are quite varied and depend on where the cancer is located, where it has spread, and how big the tumor is. Some cancers can be felt or seen through the skin – a lump on the breast or testicle can be an indicator of cancer in those locations. Skin cancer (melanoma) is often noted by a change in a wart or mole on the skin. Some oral cancers present white patches inside the mouth or white spots on the tongue.

lymphadenitis

Other cancers have symptoms that are less physically apparent. Some brain tumors tend to present symptoms early in the disease as they affect important cognitive functions. Pancreas cancers are usually too small to cause symptoms until they cause pain by pushing against nearby nerves or interfere with liver function to cause a yellowing of the skin and eyes called jaundice. Symptoms also can be created as a tumor grows and pushes against organs and blood vessels. For example, colon cancers lead to symptoms such as constipation, diarrhea, and changes in stool size. Bladder or prostate cancers cause changes in bladder function such as more frequent urination or infrequent urination.

Lymph Nodes

Swollen or enlarged lymph nodes can be a symptom, although lymph nodes can also become swollen when fighting infection (cold or flu).

lymph nodes

As cancer cells use the body’s energy and interfere with normal hormone function, it is possible to present symptoms such as fever, fatigue, excessive sweating, anemia, and unexplained weight loss. However, these symptoms are common in several other maladies as well. For example, coughing and hoarseness can point to lung or throat cancer as well as several other conditions.

When cancer spreads, or metastasizes, additional symptoms can present themselves in the newly affected area. Swollen or enlarged lymph nodes are common and likely to be present when the cancer starts to spread.

If cancer spreads to the brain, patients may experience vertigo, headaches, or seizures. Spreading to the lungs may cause coughing and shortness of breath. In addition, the liver may become enlarged and cause jaundice and bones can become painful, brittle, and break easily. Symptoms of metastasis ultimately depend on the location to which the cancer has spread.

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Cosmetic Dentistry

Cosmetic Dentistry – Part 3

Dental Bonding

Dental Bonding

Tooth Bonding is a process wherein your dentist applies a composite resin to one or more teeth that have become discolored or physically damaged. The plastic resin will be tooth-colored to blend in, and your teeth can be bonded for numerous reasons. If they’re chipped, fractured, discolored or simply decaying, this cosmetic solution may be a great supplement to an improved oral care routine.

Veneer Bonding

Veneer Bonding

An alternative to a composite resin bond is a veneer, made from either porcelain or composite. Porcelain is the stronger of the two and requires a moulding to be taken before it’s sent to a laboratory for manufacturing. Composites are therefore a less-costly alternative to porcelain. Whether you receive porcelain or composite, the veneer is then bonded to the tooth using a specific dental instrument.

Tooth Extractions

Tooth Extractions

Gum disease can loosen or severely damage a tooth. A tooth may need to be removed that is severely damaged. Your dentist or a surgeon who specializes in surgeries of the mouth (oral and maxillofacial surgeon) can remove a tooth.

Before removing your tooth, your dentist will give you a local anaesthetic to numb the area where the tooth will be removed. A stronger, general anaesthetic may be used, especially if several or all of your teeth need to be removed. A general anaesthetic prevents pain in the whole body and will make you sleep through the procedure.

After the tooth is removed, you may need stitches. You can gently bite down on a cotton gauze pad placed over the wound to help stop the bleeding. The removed tooth can be replaced with an implant, a denture, or a bridge. A bridge camera.gif is a replacement for one or more (but not all) of the teeth and may be permanent or removable.

Dental Caps

Dental Caps

A dental crown is a tooth-shaped “cap” that is placed over a tooth — to cover the tooth to restore its shape and size, strength, and improve its appearance.

The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at and above the gum line.

Tooth Impactions

Tooth Impactions

An impacted tooth is one that fails to erupt into the dental arch within the expected developmental window. Because impacted teeth do not erupt, they are retained throughout the individual’s lifetime unless extracted or exposed surgically. Teeth may become impacted because of adjacent teeth, dense overlying bone, excessive soft tissue or a genetic abnormality. Most often, the cause of impaction is inadequate arch length and space in which to erupt.

That is the total length of the alveolar arch is smaller than the tooth arch (the combined mesiodistal width of each tooth). The wisdom teeth (third molars) are frequently impacted because they are the last teeth to erupt in the oral cavity. Mandibular third molars are more commonly impacted than their maxillary counterparts. As a general rule, all impacted teeth must be removed, except canine teeth; canines do not need surgery and may just remain buried and give no further problems.

Dental Bridges

Dental Bridges

Dental bridges literally bridge the gap created by one or more missing teeth.

A bridge is made up of two or more crowns for the teeth on either side of the gap — these two or more anchoring teeth are called abutment teeth and a false tooth/teeth in between. These false teeth are called pontics and can be made from gold, alloys, porcelain, or a combination of these materials. Dental bridges are supported by natural teeth or implants.

Benefits of Dental Bridges
  1. Restore your smile
  2. Restore the ability to properly chew and speak
  3. Maintain the shape of your face
  4. Distribute the forces in your bite properly by replacing missing teeth
  5. Prevent remaining teeth from drifting out of position

 

 

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Cosmetic Dentistry – Part 2

Full Mouth Radiograph

Dental X-rays are pictures of the teeth, bones, and soft tissues around them to help find problems with the teeth, mouth, and jaw. X-ray pictures can show cavities, hidden dental structures (such as wisdom teeth), and bone loss that cannot be seen during a visual examination. Dental X-rays may also be done as follow-up after dental treatments.

Mouth Radiograph

The following types of dental X-rays are commonly used. The X-rays use small amounts of radiation.

  1. Bitewing X-rays show the upper and lower back teeth in a single view. These X-rays are used to check for decay between the teeth and to show how well the upper and lower teeth line up. They also show bone loss when severe gum disease or a dental infection is present.
  2. Periapical X-rays show the entire tooth, from the exposed crown to the end of the root and the bones that support the tooth. These X-rays are used to find dental problems below the gum line or in the jaw, such as impacted teeth, abscesses, cysts, tumors, and bone changes linked to some diseases.
  3. Occlusal X-rays show the roof or floor of the mouth and are used to find extra teeth, teeth that have not yet broken through the gums, jaw fractures, a cleft in the roof of the mouth (cleft palate), cysts, abscesses, or growths. Occlusal X-rays may also be used to find a foreign object.
  4. Panoramic X-rays show a broad view of the jaws, teeth, sinuses, nasal area, and temporomandibular (jaw) joints. These X-rays show problems such as impacted teeth, bone abnormalities, cysts, solid growths (tumors), infections, and fractures.
  5. Digital X-rays can be sent to a computer to be recorded and saved.

Dental Implants

Dental Implants

Dental implants are replacement tooth roots. Implants provide a strong foundation for fixed (permanent) or removable replacement teeth that are made to match your natural teeth.

  1. Improved appearance. Dental implants look and feel like your own teeth. And because they are designed to fuse with bone, they become permanent.
  2. Improved speech. With poor-fitting dentures, the teeth can slip within the mouth causing you to mumble or slur your words. Dental implants allow you to speak without the worry that teeth might slip.
  3. Improved comfort. Because they become part of you, implants eliminate the discomfort of removable dentures.
  4. Easier eating. Sliding dentures can make chewing difficult. Dental implants function like your own teeth, allowing you to eat your favorite foods with confidence and without pain.
  5. Improved self-esteem. Dental implants can give you back your smile and help you feel better about yourself.
  6. Improved oral health. Dental implants don’t require reducing other teeth, as a tooth-supported bridge does. Because nearby teeth are not altered to support the implant, more of your own teeth are left intact, improving long-term oral health. Individual implants also allow easier access between teeth, improving oral hygiene.
  7. Durability. Implants are very durable and will last many years. With good care, many implants last a lifetime.
  8. Convenience. Removable dentures are just that; removable. Dental implants eliminate the embarrassing inconvenience of removing dentures, as well as the need for messy adhesives to keep them in place.

Tooth Contouring and Reshaping

Tooth reshaping, or contouring, is one of few instant treatments now available in cosmetic dentistry. Dental reshaping and contouring is a procedure to correct crooked teeth, chipped teeth, cracked teeth or even overlapping teeth in just one session.

Tooth ReshapingThe dental contouring procedure can even be a substitute for braces under certain circumstances. It is also a procedure of subtle changes. A few millimetres of reduction and a few millimetres of tooth-coloured laminate can create a beautiful smile when performed by a cosmetic dentist, with no discomfort to you. Tooth reshaping, or dental contouring, is commonly used to alter the length, shape or position of your teeth.

Dental Crowns

A dental crown is a tooth-shaped “cap” that is placed over a tooth — to cover the tooth to restore its shape and size, strength, and improve its appearance.

Dental Crowns

The crowns, when cemented into place, fully encase the entire visible portion of a tooth that lies at and above the gum line.

A dental crown may be needed in the following situations:

  1. To protect a weak tooth (for instance, from decay) from breaking or to hold together parts of a cracked tooth.
  2. To restore an already broken tooth or a tooth that has been severely worn down.
  3. To cover and support a tooth with a large filling when there isn’t a lot of tooth left.
  4. To hold a dental bridge in place.
  5. To cover misshapened or severely discolored teeth.
  6. To cover a dental implant.
  7. To make a cosmetic modification.

Veneers, Bonding, Inlays and Overlays

Inlays and onlays are dental restorations used by a select number of dentists. In certain cases, inlays and onlays are a conservative alternative to full coverage dental crowns. Also known as indirect fillings, inlays and onlays offer a well-fitting, stronger, longer lasting reparative solution to tooth decay or similar damage. These restorations are beneficial from both an esthetic and functional point of view.

Veneers, Bonding, Inlays and Overlays

Inlays and onlays can often be used in place of traditional dental fillings to treat tooth decay or similar structural damage. Whereas dental fillings are molded into place within the mouth during a dental visit, inlays and onlays are fabricated indirectly in a dental lab before being fitted and bonded to the damaged tooth by your dentist.

The restoration is dubbed an “inlay” when the material is bonded within the center of a tooth. Conversely, the restoration is dubbed an “onlay” when the extent of the damage requires inclusion of one or more cusps (points) of the tooth or full coverage of the biting surface.

Cosmetic Dentistry continues in Part -3 – Click here

In case You missed the Cosmetic Dentistry Part -1  Click here

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