Wednesday, February 17, 2010

hypertension-facts


BLOOD FACTS

  1. Length of blood vessels in the human body is over 60,000 miles. All blood vessels lined together can go round the world more than twice.
  2. Heart beats about 80 times in a minute, 115200 times in a day, 42048000 times in a year, without sick leave or holiday. When you have completed 80 years your heart has been beating 33363840000 times. When do you die? When your heart stops beating.
  3. 5 quarts a minute or 2,000 gallons a day.
  4. Hypertension is twice as common in people who are obese.
  5. African Americans are more prone to develop hypertension.
  6. People over 75 are most likely to have hypertension.
  7. The cause of hypertension cannot be diagnosed in 9 out of 10 people.

FACTORS ASSOCIATED WITH HYPERTENSION/INCREASED BLOOD PRESSURE

  • Sedentary life style
  • Lack of physical activity
  • Stress
  • Aging
  • Obesity or being overweight
  • Diabetes
  • High levels of salt intake (sodium sensitivity)
  • Insufficient calcium, potassium, and magnesium consumption
  • Vitamin D deficiency
  • High levels of alcohol consumption
  • Birth Control Pills
  • Smoking
  • Genetics (heredity) and a family history of hypertension
  • Chronic kidney disease
  • Adrenal and thyroid problems or tumors


Acknowledgment:
MEDICAL NEWS TODAY

Watch the ANSWERS TV.COM LIFE KNOW HOWVIDEO on hypertension.
To Contact the Doctor:
Go to
mydoctortells.com

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Thursday, December 24, 2009

banned-drugs-sold-in-india






Subject: FW: Banned Drugs sold in India

Subject: FW: Important: Banned Medicines that are freely available in India
For those who weren't aware, or would like to know - apologies to people who think this is spam or have received it already...!

I had sometimes used Vicks Action 500, Novalgin and Nimulid... wont now for sure!!!!!!

Take care...



INFORM ALL YOUR FRIENDS & FAMILY MEMBER
 


Make a checklist, check whether this medicine is in your home or whether it has been recommended by your doctor... please DO NOT use it...

Please Read Very Carefully - INFORM ALL YOUR FRIENDS & FAMILY MEMBERS



India has become a dumping ground for banned drugs; also the business for production of banned drugs is booming. Plz make sure that u buy drugs ! only if prescribed by a doctor(Also, ask which company manufactures it, this would help to ensure that u get what is prescribed at the Drug Store) and that also from a reputed drug store. Not many people know about these banned drugs and consume them causing a lot of damage to themselves. We forward Jokes and other junk all the time. This is far more important.

Please Make sure u forward it everyone u know.


DANGEROUS DRUGS HAVE BEEN GLOBALLY DISCARDED BUT ARE AVAILABLE IN INDIA .... The most common ones are action 500 & Nimulid.

!

PHENYLPROPANOLAMINE :

cold and cough. Reason for ban :
stroke.
Brand name :
Vicks Action-500
____________ _________ _________ _________ _________ _________ _________ ______
ANALGIN:

This is a pain-killer. . Reason for ban:
Bone marrow depression.
Brand name:
! Novalgin
____________ _________ _________ _________ _________ _________ __
CISAPRIDE:

Acidity, constipation. Reason for ban :
irregular heartbeat
Brand name :
Ciza, Syspride
____________ _________ _________ _________ _________ _________ ___
DROPERIDOL:

Anti-depressant. Reason for ban :
Irregular heartbeat.
Brand name :
Droperol
____________ _________ _________ _________ _________ _________ _____
FURAZOLIDONE:

Antidiarrhoeal. Reason for ban :
Cancer.
Brand name :
Furoxone, Lomofen
____________ _________ _________ _________ _________ _________ ____
NIMESULIDE:

Painkiller, fever.
Reason for ban : Liver failure..
Brand name :
Nise, Nimulid
____________ _________ _________ _________ _________ _________ _________ ______

NITROFURAZONE:

Antibacterial cream. Reason for ban :
Cancer.
Brand name :
Furacin
____________ _________ _________ _________ _________ _________ _________ ______

PHENOLPHTHALEIN:

Laxative.... Reason for ban :
Cancer.
Brand name :
Agarol
________! ____________ _________ _ ____________ _________ _________ _________ ___

OXYPHENBUTAZONE:

Non-steroidal anti-inflammatory drug. Reason for ban :
Bone marrow depression..
Brand name :
Sioril
____________ _________ _________ _________ _________ _________ _________ _____
PIPERAZI! NE:

Anti-worms. Reason for ban :
Nerve damage.
Brand name :
Piperazine
____________ _________ _________ _________ _________ _________ _________ ______
QUINIODOCHLOR:

Anti-diarrhoeal. Reason for ban :
Damage to sight..
Brand name:
Enteroquinol

 

PLZ SPREAD THE INFO....
YOU MAY JUST SAVE SOMEONE'S LIFE.



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Friday, December 11, 2009

slow-down-live-long





Modern society puts a premium on speed and efficiency. We figure we can accomplish more by doing two or three things at once. But we end up getting distracted.

And this distraction often comes at a price.

John Freeman, editor of Granta and author of the forthcoming book, The Tyranny of E-mail, writes, "We will die, that much is certain; and everyone we have ever loved will die, too, sometimes – heartbreakingly – before us… Busyness numbs the pain of this awareness, but it can never totally submerge it. Given that our days are limited, our hours precious, we have to decide what we want to do, what we want to say, what and who we care about, and how we want to allocate our time to these things within the limits that do not and cannot change. In short, we need to slow down."

He has a point.

~ Doctors say slower breathing is one of the simplest ways to better health. Deep breathing lowers stress and reduces systolic blood pressure. It allows oxygen to get down to the smallest airways in our lungs, the alveoli, where the oxygen exchange is most efficient. Quick, shallow breathing causes our bodies to release less nitrous oxide, so our organs and tissues are less oxygenated.

~ Eat slower and you will eat less. There is a lag time between when the stretch receptors in your stomach signal it is time to stop eating and when your brain gets the message.

If you slow your intake, you won't just savor your meals more. Researchers at the University of Rhode Island discovered that people who eat slowly consume 70 less calories per meal. Multiply that by three meals a day and you'll drop 20 pounds over the next year.

~ Slowness won't hurt your love life. Mae West once remarked that anything worth doing is worth doing slowly… very slowly. Marriage counselor Lori Buckley of Pasadena agrees, "Often, the first thing to disappear from a marital relationship is the long, lingering, teasing kiss." See if your significant other doesn't agree.

~ Slowing down prevents accidents. It's impossible to calculate the number of motorists killed or injured each year because they were in a rush. Insurance companies have found that the overwhelming majority of job-site accidents are traceable to hurrying. You actually save time, do better work and prevent more injuries by slowing down.

~ Slowness is part of successful money management. Some folks realize late in life that they haven't saved enough for retirement. To make up for lost time, they often decide to roll the dice by trading risky derivatives (futures and options), penny stocks, or hot tips from friends and colleagues. Big mistake. When it comes to meeting long-term investment goals, the tortoise generally beats the hare.

~ A more deliberate pace enhances your quality of life. There's an old Chinese saying, "Man in hurry cannot walk with dignity." A constant flurry of activity doesn't present an attractive image. It creates stress and anxiety. It causes us to miss much of what is going on around us. As the philosopher Lin Yutang noted, the wise man is not hurried and the hurried man is not wise.

Deep down, most of us realize this. But it never hurts to be reminded – and perhaps take things down a notch.

More than 150 years ago, clergyman and Transcendentalist, William Henry Channing, described the slower, more relaxed life as his "Symphony":

"To live content with small means; to seek elegance rather than luxury, and refinement rather than fashion; to be worthy, not respectable, and wealthy, not rich… to study hard, to think quietly, act frankly, talk gently, await occasions, hurry never; in a word, to let the spiritual, unbidden and unconscious, grow up through the common – this is my symphony."

We all have obligations and deadlines, of course. But hurry and extreme future-mindedness impoverish the present.

What we value most are love, friendship, solace, beauty and humor. These things are best communicated face to face in a calm, relaxed setting.

Slowing down enhances your sense of gratitude, improves your mental and physical health, allows you to gain control of your life, lets you appreciate beauty and enables you to reconnect with those around you.

So take a moment to enjoy what's right in front of you before it's gone. Even if it is just a meal....






SPECIALLY CONTRIBUTED BY
NAIMISHA



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Tuesday, December 8, 2009

picture-tennis-elbow



The extensor carpi radialis brevis muscle are identified in surgical pathology specimens.



To Contact the Doctor:
Go to
mydoctortells.com
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Saturday, December 5, 2009

tennis-elbow






From Wikipedia, the free encyclopedia

Tennis elbow
Classification and external resources

Left elbow-joint, showing posterior and radial collateral ligaments. (
Lateral epicondyle visible at center.)


ICD-10

M77.1
ICD-9

726.32
DiseasesDB
12950
eMedicine
orthoped/510 pmr/64sports/59
MeSH
D013716


Tennis elbow, also known as "Shooter's elbow" and "Archer's elbow", is a condition where the outer part of the elbowbecomes sore and tender. The accurate medical term is lateral epicondylalgia. It is a condition that is commonly associated with playing tennis and other racquet sports, though the injury can happen to almost anybody.[1]


The condition is also known as lateral epicondylitis ("inflammation to the outside elbow bone"),[2] a misnomer as histologic studies have shown no inflamatory process. Other descriptions for lateral epicondylalgia are lateral epicondylosis, or simply lateral elbow pain.


Runge is usually credited for the first description in 1873 of the condition.[3] The term tennis elbow was first used in 1883 by Major in his paper Lawn-tennis elbow[4][5]

[edit]Symptoms



tennis-elbow

The strongest risk factor for lateral epicondylosis is age. The peak incidence is between 30 to 60 years of age. No difference in incidence between men and women or association between tennis elbow and the dominant hand has been demonstrated.


The pathophysiology of lateral epicondylosis is degenerative. Non-inflammatory, chronic degenerative changes of the origin of the extensor carpi radialis brevis muscle are identified in surgical pathology specimens.[6] It is unclear if the pathology is affected by prior injection of corticosteroid.


Among tennis players, it is believed to be caused by the "repetitive nature of hitting thousands and thousands of tennis balls" which lead to tiny tears in the forearm tendon attachment at the elbow.[2]


The following speculative rationale is offered by proponents[who?] of an overuse theory of etiology: The extensor carpi radialis brevis has a small origin and does transmit large forces through its tendon during repetitive grasping. It has also been implicated as being vulnerable during shearing stresses during all movements of the forearm.


While it is commonly stated that lateral epicondlyosis is caused by repetitive microtrauma/overuse, this is a speculative etiological theory with limited scientific support that is likely overstated.[6] Other speculative risk factors for lateral epicondylosis include taking up tennis later in life, unaccustomed strenuous activity, decreased reaction times and speed and repetitive eccentric muscle contractions (controlled lengthening of a muscle group).



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Thursday, May 14, 2009

T3-T4-TSH-normal-levels

T3 70 to 200 ng/dl
T4 4.5 to 13 ug/dl
TSH 0.6 to 6.0 uIU/ml

Why TSH is the best test?
TSH along with free T4 is best for Thyroid screening as the first test.
Reasons
  • TSH is more sensitive and specific for Thyroid disease than any other Thyroid parameter including Free T4
  • The TSH test is a log test sch that a 2 fold change of free T4 causes 100 fold change in TSH. Thus TSH changes far in advance of changes in free T4
  • In case of thyroid swelling TSH also helps us to decide what test is required next.
    • If TSH is less than 0.3 uIU/ml then a a Thyroid scan is necessary.
    • If TSH is more than 0.3 uIU/ml then FNAC is necessary

Is a single TSH test adequate?
A single TSH value is helpful only if TSH is extremely below or above normal.
  • Example TSH less than 0.01 uIU/ml or greater than 10 uIU/ml

If TSH is minimally abnormal we should retest TSH after
4-6 weeks.
What is the best time to measure TSH?
The best time is between 08:00 and 22:00 hours.(8 am to 10 pm)

When is Thyroid anitbodies test done?
Thyroid antibodies (anti-TPO) test should be done as part of primary screening with TSH and Free T4.
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Tuesday, October 14, 2008

increaseT3-causes


Is your hyperthyroidism due to periods of long stress?

A
Stress
Autoimmune thyroid disease, either hyperthyroidism or hypothyroidism, is also linked to post-traumatic stress disorder and is often first observed clinically after periods of prolonged stress.

Hyperthyroidism or hypothyroidism is linked to post-traumatic stress disorder and is often first observed clinically after periods of prolonged stress.


Thyroid disease is more prevalent in industrialized countries where pollutants or over consumption of iodine could be the cause.


B
Iodine over consumption
Some experts have suggested that autoimmune thyroid disease develops as a result of iodine over consumption.
Both the U.S. and Japan have high levels of iodine consumption and of autoimmune thyroid disease.
Japanese people consume iodine because seafood makes up a large proportion of the diet.
Americans consume salt, which is necessarily iodinated and the food industry uses iodine as a machine wash.

C
Pollutants
Other experts believe that pollutants are a more important factor. Pollutant chemicals like polychlorinated biphenyls (PCBs) and dioxins have been shown to interfere with thyroid function and are more prevalent in industrialized countries where thyroid disease levels are high.

Thyroid Hormone Disorders
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Monday, October 6, 2008

hyperthyroid-causes-fatigue

200 million people in the world have hyperthyroidism. Are you always tired?

Suspect hyperthyroidism.Check T3, T4, TSH
Total T3 normal value is 60 - 181 mg/dl

A worse problem is the lack of testing. Though an estimated 200
million people worldwide have thyroid disorders5, thyroid function
tests
are rarely given unless the doctor suspects a thyroid disorder, and most
doctors do not suspect hypothyroidism in their patients because the
symptoms are subtle. Of the estimated 13 million Americans affected by
thyroid disease, more than half are unaware of their condition4.
Thyroid
disease affects 8 times as many
women as men
, possibly because women need higher levels of TH than men do,
but it has no age, gender, or ethnic barriers.
Patients may have some or
all the obvious symptoms:
  • fatigue,
  • lack of focus,
  • depression,
  • constipation,
  • anxiety attacks,
  • dry hair,
  • dry skin,
  • edema (swelling),
  • lack of exercise tolerance,
  • weight gain (especially in the stomach),
  • muscle and joint pains,
  • problems swallowing (due to enlarged thyroid),
  • goiter,
  • facial puffiness,
  • unusual new headaches,
  • loss of eyebrows,
  • lack of sex drive,
  • lowered body temperature,
  • low or high blood pressure, and
  • slowed heart rate.

Yet patients may not be diagnosed for years.

[4]Discovery Guide
American Association of Clinical Endocrinologists
(http://www.aace.com/pub/spec/tam2001/presstam2001.html)
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Sunday, September 28, 2008

hyperthyroidism-symptoms

Is it Manic Depressive Psychosis? Check Thyroid hormone levels

Hyperthyroidism is associated with a different set of symptoms. People with this disorder
sleep with difficulty and sleep much less than normal. Unlike hypothyroid patients,
they exhibit manic-depressive behavior as the TH levels drive their energy levels beyond their physical limits.

In fact, thyroid hormone testing is routine at psychiatric admission for suspected manic-depressive patients. Lithium, a common treatment for manic-depression, is known to depress T3 in the brain back to normal levels.

Hyperthyroidism causes accelerated heart rate and fatigue, even when patients are at rest. It produces lower exercise tolerance because protein and fat catabolism are accelerated, resulting in build-up of ketones. Hyperthyroid people often show a fine tremor in their hands. They have higher resting heart rates, but not higher maximum heart rates for exercise, in comparison to normal subjects. Some experience thyroid storms--high overloads of thyroid hormones that accelerate their heart rate to as high as 300 beats a minute. This is a very life-endangering condition and can result in arrhythmia or heart attack.

Some drugs cause a temporary TH imbalance. Caffeine and other stimulants interfere with T3 and adrenal hormone metabolism while in the body. Smoking depresses TH levels and produces an chronic underlying hypothyroidism as well as low adrenal hormone levels. The hormonal imbalances due to smoking may contribute to the severity of withdrawal symptoms in smokers trying to quit. Research shows that nicotine increases the synthesis of T3 from T4 in the brain, while alcohol and opiates block the breakdown of T3 in the brain2. Research into thyroid hormone's role in addiction might lead to better treatment and prevention of drug addiction3.


Thyroid Hormone Disorders

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Sunday, September 21, 2008

what-are-endocrine-glands

Endocrine glands
Endocrine glands
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

source
http://www.uclahealth.org

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Thursday, September 18, 2008

hyperthyroidism1


T3 and T4 are hormones that regulate internal body functions.

They are secreted by thyroid gland located on the throat, in front, just below the skin of neck

T3 is measured as part of a thyroid function evaluation. Most of the thyroid hormone made in the thyroid is in the form of T4 . The body's cells convert the T4 to T3, which is the more active hormone.
Sometimes it can be useful to measure both T4 and T3 when looking at thyroid function. For example, in some cases of hyperthyroidism , T4 may be normal but T3 will be elevated.
Most of the T4 and T3 in the body is attached to proteins in the blood. These proteins serve as carriers. The T3 test measures both the T3 that is bound to the proteins and the T3 that is "free" floating in the blood. The free fraction is the hormone that is active.

  • Unexplained tiredness,
  • leg ache,
  • fine tremors of finger,
  • increased heart beat,
  • lazy feeling (lassitude)
are indications to check for
[1]DEPRESSION,
[2]DIABETES and
[3]THYROID FUNCTIONS
There may be no symptoms.

Conditions that increase the levels of the carrier proteins -- such as pregnancy and liver disease -- will falsely raise the T3 level. In these cases, it is useful to measure either the free T3 level or to perform the RT3U test, which gives a measure of the amount of carrier protein.

T4 and T3 are important hormones in the regulation of metabolism. The exact mechanisms are not understood, but it is known that T4 increases the concentrations of numerous enzymes involved in the production of energy in the body.
Normal Values:
100 to 200 ng/dL (nanograms per deciliter)
What abnormal results mean:
Greater-than-normal levels may indicate:
* throiditis (inflammation of thyroid gland) - as innocent as cold and commonest
* hyperthyroidism (for example, Graves' disease )
* T3 thyrotoxicosis (rare)
* thyroid cancer (rare)

NOTE
[1]$ 30% - 35% of those with harmless increased T3 levels may LATER develop hypothyroidism
[2]$ Hypothyroid is as common as diabetes mellitus.
[3]$ Thyroid disorders are more common in women than men.
Lower-than-normal levels may indicate:
* chronic illness
* hypothyroidism (for example, Hashimoto's disease )
* starvation

Additional conditions under which the test may be performed:

* painless (silent) thyroiditis
* thyrotoxic periodic paralysis
* toxic nodular goiter

What the risks are:
The only risks of the test is those minor risks associated with having blood drawn.

Special considerations:

Drugs that can increase T3 measurements include clofibrate, estrogens, methadone, and oral contraceptives.

Drugs that can decrease T3 measurements include anabolic steroids, androgens, antithyroid drugs (for example, propylthiouracil), lithium, phenytoin, and propranolol.
T3
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Sunday, September 14, 2008

Thyroid-hormone


Thyroid Hormone Disorders
Hormones are named from the Greek word hormon, meaning "to urge or excite", because they were first discovered to play a role in hunger, sex, flight-or-fight response, and many other basic drives. Hormones serve within the body as invaluable messengers, governors of development, and regulators of metabolism. This Hot Topic will focus on the effects of thyroid hormone (TH) and the disorders that are associated with TH imbalance.

TH, found in all chordate animals, is the only major biochemical molecule known to incorporate iodine, a substance common in the sea but rare on land. Iodine is essential to the structure of TH, and iodine deficiency is the leading cause of hypothyroidism in undeveloped countries. TH is produced by the thyroid, a butterfly-shaped gland behind the larynx, in response to thyroid stimulating hormone (TSH), which is released by the pituitary gland.
Thyroid Gland Illustration

TH exists in two major forms. Levothyroxine (T4), with four iodine atoms per molecule, is an inactive form that can be converted into T3, and is produced exclusively by the thyroid gland. Triiodothyronine (T3), with three iodine atoms per molecule, is eight times more effective than T4. It is converted from T4 in the thyroid, brain, liver, and bloodstream, and in various tissues of the body.
In humans, thyroid hormone plays a notable role in brain development
from the middle of pregnancy to the second year of life.

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Friday, September 12, 2008

stroke-how-to-detect-easily


STROKE: Remember The 1st Three Letters... S.T.R .
(specially contributed by Namisha)
My friend sent this to me and encouraged me to post it and spread the word. I agree. If everyone can remember something this simple, we could save some folks.

STROKE IDENTIFICATION:
During a party, a friend stumbled and took a little fall - she assured everyone that she was fine and just tripped over a brick because of her new shoes. (they offered to call ambulance)

They got her cleaned up and got her a new plate of food - while she appeared a bit shaken up, Ingrid went about enjoying herself the rest of the evening. Ingrid's husband called later telling everyone that his wife had been taken to the hospital - (at 6:00pm , Ingrid passed away.)

She had suffered a stroke at the party . Had they known how to identify the signs of a stroke, perhaps Ingrid would be with us today.

Some don't die. They end up in a helpless, hopeless condition instead. It only takes a minute to read this...

STROKE IDENTIFICATION:

A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke...totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough.

RECOGNIZING A STROKE

Remember the '3' steps, STR . Read and Learn!

Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster.
The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke.
Now doctors say a bystander can recognize a stroke by asking three simple questions :
S Ask the individual to SMILE ..

T ALK. Ask the person to SPEAK A SIMPLE SENTENCE (Coherently) (eg 'It is sunny out today').
R Ask him or her to RAISE BOTH ARMS .
If he or she has trouble with ANY ONE of these tasks, call the ambulance and describe the symptoms to the dispatcher.
NOTE :
Another 'sign' of a stroke is
1. Ask the person to 'stick' out their tongue.
2. If the tongue is 'crooked', if it goes to one side or the other that is also an indication of a stroke.
A prominent cardiologist says if you send link to this post in your email it will at least 10 people; you can bet that at least one life will be saved.
and it could be your own..
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Thursday, September 4, 2008

vertebroplasty-summary5

Vertebroplasty Provides Significant Pain Relief In Osteoporotic Fractures
Bone and Spine Health

In osteoporosis patients with spinal fractures, vertebroplasty provides significant pain relief and helps decrease disability, according to a new study.

Vertebroplasty is a procedure that involves injection of medical-grade bone cement into a fractured vertebra to shore up the fracture and provide pain relief. It’s used to treat painful vertebral compression fractures that don’t respond to conventional medical therapy with analgesics or narcotics.

The study followed 884 patients for five years who were assessed before and after vertebroplasty. Their average pre-treatment pain score on an 11-point scale decreased from 7.9 (+/- 1.5) before treatment to an average of 1.3 (+/- 1.8) after treatment.

The patients’ ability to manage everyday tasks such as washing and dressing was measured using the Oswestry Disability Questionnaire. The patients’ scores went from an average of 69.3 percent (+/-13.5) a month before treatment to 18.8 percent (+/- 6.9) a month after treatment.

“These data provide good news for physicians and osteoporosis patients. Many osteoporosis patients with compression fractures are in terrible pain and have a greatly diminished ability to perform basic daily activities, such as dressing themselves,” Dr. Giovanni C. Anselmetti, an interventional radiologist at the Institute for Cancer Research and Treatment in Turin, Italy, said in a prepared statement.

The study also found that vertebroplasty didn’t increase the risk of fracture in nearby vertebra.

“Vertebroplasty is already known to be a safe and effective treatment for osteoporotic vertebral fractures. Osteoporosis patients remain susceptible to new fractures, which often occur in the contiguous vertebra to an existing fracture. Our large-scale study shows that vertebroplasty does not increase the risk of fracture in the level contiguous to previously treated vertebra and that these new fractures occur at the same rate as they would in osteoporosis patients who did not have vertebroplasty,” Anselmetti said.

The study was to be presented Tuesday at the annual scientific meeting of the Society of International Radiology.

Osteoporosis affects about 10 million Americans and causes about 1.5 million vertebral fractures each year, according to the U.S. National Institutes of Health. Multiple vertebral fractures can cause chronic pain, disability, loss of independence, stooped posture, and compression of the lungs and stomach.

Vertebroplasty Provides Significant Pain Relief In Osteoporotic Fractures | Bone and Spine Health
Source: Medline Plus
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vertebroplasty-4

Vertebroplasty provides immediate pain relief (90% cases). There is prolonged (not temporary) pain relief, which increases the patient's daily activity level, which in turn helps provide a better quality of life.

Original Study From: Percutaneous Vertebroplasty, Vertebral compression fracture, Pain Management Clinic Kolkata, India

Investigations, Procedure

Pain relieving medicines or any other medical treatment, physiotherapy would be temporary.
Vertebroplasty may be used for patients with vertebral compres¬sion fractures due to osteoporosis, metastatic tumors, or benign tumors such as vertebral heamangiomas. Patients with metastasis and myeloma usually experience severe pain and disability.

Vertebroplasty is performed to provide pain relief and to produce bone strengthening and vertebral stabilization when the lesion threatens the stability of the spine. Radiation therapy may be performed in conjunction with vertebroplasty. When the latter is performed for tumor lesions bone cement injection does not prevent tumor growths. Also radiation therapy does not interfere with the mechanical properties of bone cement and complements.
Vertebral hemangiomas are common benign lesions of the spine that are often asymptomatic and discovered incidentally during radiologic evaluation. Rarely, they may be painful, and there must be a close correlation between clinical findings and radiologic features to ensure that the patient's pain is due to the vertebral hemangioma. In such cases, vertebroplasty is performed to provide pain relief. The PMMA is injected for pain relief, bone strengthening, and direct embolization of the hemangiomatous body.
Vertebral fractures are the most common complica¬tion of osteoporosis. Age-related osteoporotic com¬pression fractures occur in more than 500,000 patients per year in the United States. About 15% of women in the United States older than 50 years of age will suffer one or more vertebra compression fractures related to osteoporosis. Patients most likely to benefit from vertebroplasty are those with a focal, intense, deep pain associated with evidence of a new or progressive compression fracture. Patients who seem to respond the best include those with a single level or a few levels for treatment, fractures that are present less than 2 months or a recent worsening of the fracture, and no significant sclerosis of the fractured vertebra. It should also be determined if the patient is able to toler¬ate lying prone for 1 to 2 hours.

Contraindications of vertebroplasty;

* Epidural involvement of the infiltrative lesion
* Coagulation disorders
* Extensive vertebral destruction
* Significant vertebral collapse with less than 1/3 of original height
* Radiculopathy into the lower extremity
* Disruption of the posterior vertebral wall
* Lesions above T 4
* Patients who cannot lie prone for prolonged period

Investigations:

Computed tomographic (CT) imaging for the diameter of the pedicles to be entered is helpful. Recent plain radiographs should be examined. Recent MRI should be available, particularly a T2-weighted sagittal image and axial views through the levels of pathology to be treated. In patients with multiple compression fractures, those vertebral bodies with enhancement demonstrate edema at that level and a greater likelihood of response.

Prothrombin time, partial thromboplastin time & platelet function studies.

Procedure:

The procedure is done under conscious sedation. Sedative analgesics like fentanyl, midazolam, or propofol are administered. Prior to the start of the procedure, a prophylactic antibiotic should be given intravenously.
The patient is taken to the fluoroscopy suite and placed in the prone position on the operating room table with all pressure points padded and standard monitoring applied. Care is taken to add extra padding to the table due to the osteoporotic spine and risk of rib fractures.
The level for the procedure is located in the posteroanterior fluoroscopic view. The fluoroscope is then rotated to an oblique posi¬tion to maximize the oval appearance of the pedicle. Proper view is identified by seeing a "Scottie dog" appearance of the pedicle. It is important to "flatten out" the end plates of the verte¬bral bodies; if necessary, cephalocaudad or caudo¬cephalad fluoroscopic angle may improve the image. This will locate the pedicle well within the vertebral body in the fluoroscopic view. It is important to oblique the fluoroscopic view enough to place the facet joint in the middle of the vertebral body and the spinous processes to the contralateral side. This facilitates a central placement of the needle. The target for entry is the superior lateral quadrant of the pedicle in the fluoroscopic view.
After the site of entry is identified, a skin is anaesthetized. A small skin incision is made with a No. 11 blade scalpel to allow insertion of a large ¬bore biopsy needle. An 11 gauge bone biopsy needle is inserted through the incision. It is advanced in "gun-barrel" fashion in the oblique fluoroscopic view to monitor direction. The oblique view will show the needle shaft end-on as a circle within the center of the pedicle. Once contact has been made with bone, insertion through the cortex of the bone may be accomplished with a twisting motion of the needle or gentle tapping of the needle with a sterile hammer. It is important to "set" the needlepoint at the exact site of entry.
In the lateral view, the needle needs to be at the upper midpoint of the pedicle so that the needle advances in the midpoint of the pedicle. The needle should follow a path that is parallel to the superior and inferior edges of the pedicle. The needle is advanced to the junction of the anterior and middle third of the vertebral body. After placement of the needle, the cement is prepared for injection. The amount to be mixed is based on the clinical observation of an average of 7 to 8 mL of cement injected in a lumbar vertebral body. The liquid monomer is titrated until it takes on toothpaste like consistency. There are several delivery systems available that may be used to simplify the mixing and delivery in addition to decreasing fumes. If these systems are not available, I-mL syringes may be filled and used one at a time to inject the cement into the ver¬tebral body. The injection of the cement is followed under fluoroscopic guidance in the lateral view. When the spread of the cement starts to invade the posterior one third of the vertebral body, injection should be stopped. The cement is 90% fixed at 1 hour.
After the procedure, the patient should be monitored for 3 hours in a recovery area prior to dismissal. The patient should be supine for 2 hours and then may sit. A CT image through the levels (2-mm slices) is recom¬mended for documentation purposes. The patient is dismissed with routine pain medications and a gradu¬ated resumption of activity. Discharge instruction for the patient should include advice to call the physician for the following symptoms: New onset of back pain, Chest pain, Lower extremity weakness, Fever > 100°F.

Complications:

Because of the size of the biopsy needle, there is risk of fracture of the lamina or pedicle. Preprocedural CT with pedicular diameter is helpful in assessing this risk. Owing to the vascularity of the vertebral body, there is the potential risk of pulmonary venous migration of the cement resulting in embolic phenomenon.
It is important to observe the spread of the cement under direct fluoroscopy to monitor for foraminal and/ or epidural extravasation. If vertebral epidural space extravasation occurs, there may be partial or com¬plete paraplegia. Emergent operative decompression must be performed if the patient is symptomatic to min¬imize any damage. This risk is more common with ver¬tebral destruction of the vertebral body from malignancy.
An intradiscal leak of the PMMA may occur associ¬ated with cortical fracture or osteolysis of the vertebral end plates. This does not seem to prevent pain relief. Secondary degenerative changes may develop because of this leak, but may not be deemed important due to the short life expectancy in these patients.
The PMMA may leak into the adjacent paraverte¬bral tissue because of the cortical osteolysis of the verte¬bral body or the hole produced by the needle after its removal. This may lead to a transitory femoral neu¬ropathy due to a leak into the psoas muscle.
Aside from extravasation, the patient may complain of transient dermatomal pain due to rib fracture or mild nerve root compression. Osteoporotic patients may fracture a rib with a vigorous cough. It is imperative to carefully pad the operating room table to minimize this complication.

Conclusion:

Vertebroplasty is a percutaneous procedure with a low complication rate that provides immediate and long-¬term pain relief to patients suffering from chronic ver¬tebral compression fracture pain. Vertebro¬plasty is a minimally invasive procedure that not only provides immediate relief but continued and prolonged relief that may increase the patient's daily activity level, which in turn helps provide a better quality of life. In several studies it has been shown that in more than 90% cases it provide immediate pain relief.
Percutaneous Vertebroplasty, Vertebral compression fracture, Pain Management Clinic Kolkata, India

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