Wednesday, January 26, 2011

Common garden weed can cure cancer

London: A new study conducted by scientists in Australia has revealed a common weed can cure skin cancers.

The sap from a plant known as petty spurge or milkweed — found by roadsides and in woodland — can "kill" certain types of cancer cells when applied to the skin, reports the Daily Mail. It works on non-melanoma skin cancers, which are triggered by sun damage. And, although not usually fatal, can be disfiguring without treatment.

The plant has been used for centuries as a traditional folk medicine to treat conditions such as warts, asthma and several types of cancer. This is the first time the scientists team has carried out a clinical study of sap from Euphorbia peplus. In the study of 36 patients after an average of 15 months following treatment, two thirds of the 48 skin cancer lesions still showed a complete response.

Read more: Common garden weed can cure - The Times of India

Tuesday, January 18, 2011

Nephrectomy (Kidney removal)

Today we will talk about Surgery.
There are some words used in surgery like ECTOMY or OSTOMY.... people usually confuse this words, but it is very simple.
When the suffix ECTOMY is used it basically means removal of that part like PROSTECTOMY (removal of Prostate Gland), APPENDISECTOMY (removal of Appendix) etc....
When the suffix OSTOMY is used don't mistake it for ECTOMY, because it can give a whole new meaning to it..
OSTOMY means making a incision or just making a hole like THORACOTOMY (means making a incision in your chest (thorax)).


     It is removal of kidney along with part of ureter, perinephric pad of fat and enlarged lymph nodes near the hilum.

Partial nephrectomy
Total Nephrectomy
Radical Nephrectomy

What are the indications:
Stone with gross infected kidney (polynephrosis)
Stone with hydronephrosis with non functional kidney
Multiple stones scattered in the kidney substances and in different calyces.
Renal Tuberculosis
Carcinoma of kidney - WILMS Tumor.
Pyogenic infections
Raised Blood Pressure due to renal causes

Now the Procedure:
Before doing this, must remember that the central arteral kidney must be proved healthy before considering the operation.
Next ask the patient to sleep on the later side.
That way operated kidney is kept on superior side.
Next, arms of the operated side should be supported well.
The legs are extended and fixed.
Antibiotics are given to lower the infection
General anesthesia is given to the patient.

5 Muscles are incised.
Latissmus dorsi
Serratus Anterior
3 oblique muscles of abdomen
Posterior lumbar fascia
and extra peritoneal fat.

Oblique incision on the skin is put to form the angle of 12th rib to spine.
Ligate the renal artery and cut the artery
similarly after ligate the renal vein and cut it.
Than cut the ureter.
Slowly remove the kidney and suture and close back layer by layer with antiseptic solution.

Thus, in the process of total nephrectomy  alnog with kidney, part of ureters surrounding soft tissues, lymph nodes, veins and arteries are also removed.

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Friday, January 14, 2011

Humidifiers (Humidity Therapy)

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It is adding up of water-vapor and heat to the inspired gas.

The primary functions of the upper respiratory tract is heat and moisture exchange and filtration.
The nasal mucosal lining is kept moist by the secretion from mucous glands.
The high vascularity of the mucosa provides heat transfer.
The nasal mucosa is cooled during inhalation and heated during exhalation.
cooled air holds less water vapor and vice versa.

Isothermic Saturation Boundary:
It is the boundary above which temperature and humidity decreases during inspiration and increases during exhalation.
Normally this boundary is 5cm below the carina.
ISB will shift down in cases of:
Breathing cold air, breathing dry air, and bypassed airways etc...

Breathing indications:
To humidify dry medical gases, when upper airways are bypassed.

To manage hypothermia in intra-operative.
To treat bronchospasm created by cold air especially after exercise.
If the application of dry medical gas is prolonged there will be structural damage of upper respiratory tract.
Ciliary motility decreases
Airways become irritable
Increased mucous production
Thickening of mucosa
Airway epithelial destruction
leading to Atelectasis.

In cases of endotracheal incubation the heat and moisture exchange capability is lost and hance the danger is high.


Is the device that adds molecular water and heat to gas.

Principles of Humidifiers

Surface Area
Time of contact

Greater the temperature greater the water vapor it can hold.  So heated humidifier out performs. Normal temp. 40 degree C.

Surface Area
Greater the area of contact, greater the humidification.

Time of Contact
Greater the contact time, greater the evaporation.

Types of Humidifiers
3 primary types of humidifiers
   Pass over (wick type, membrane type)
  Heat and moisture exchange (artificial nose)
      Simple condenser humidifier
      Hygroscopic condenser humidifier
      Hydrophobic condenser humidifier
It can be classified as heated and non heated humidifier

Bubble Humidifier
Breaks an under water gas stream into small bubbles

Pass over
  Wick humidifiers
It is a cylinder of absorbant material.  The wick will absorb water from reservoir and heat itself moistened.
The dry gas passes over this and takes up the moisture.

   Membrane Humidifier
In this a hydrophobic membrane separates water from gas stream through which water molecule can pass but not liquid water.
Heat and moisture exchange (artificial nose)
It is mainly used with endo tracheal and tracheostomy tubes.
Simple condensor humidifiers
It contains an element with high thermal conductivity like in metalic gauze, parallel metal tubes etc...
Hygroscopic condenser humidifier
Uses an element of low thermal conductivity like paper, wool, foam etc..
This element is impregnated with hygroscopic salts like Ca++ or lithium chlorides.
This salt helps to capture the extra moisture
Efficiency 70%.

Hydrophobic Condenser Humidifiers:
It uses water repellent element with large surface area and low thermal conductivity.
Some provide bacterial filtration efficiency 70%.
Thick copious and bloody secretions.
Patients with high spontaneous minute volume.
Body temp <32 C.

Thursday, January 13, 2011

Incentive Spirometry

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Incentive Spirometry
It is one of the ways to deliver lung expansion.
It helps to increase the trans-pulmonary pressure.
It mimics the natural sighing.
It is performed using devices that provides visual feedback.
The basic maneuverer of incentive spirometry is Sustained Maximal Inspiration (SMI.
SMI is a slow deep inspiration from Functional Residual Capacity (FRC) upto
Total Lung Capacity (TLC)followed by a 5-10 second breath hold.
So as the trans pulmonary pressure increases, lung expansion increases.


Presence of atelectasis
Presence of condition predisposing to atelectasis like upper abdominal surgeries, Thoracic surgeries etc..
In case of restrictive lung disease associated with quadriplegia, diaphragmatic dysfunction etc...
In post-operative period to monitor lung function.

Unconscious or uncooperative patient.
Patient unable to take deep breaths.

Acute respiratory alkalosis due to two rapid respiration
Signs of dizziness and numbness around the mouth
Pulmonary baro-trauma
Exacerbation of bronchospasm

Equipments used
They are simple, portable, and inexpensive.
they are categorized into 2.

Flow oriented
  It measures and visually indicates the inspiratory flow.  The vloume can be indirectly measured as
Volume = Flow X Time

Volume oriented
Measures and visually indicates the volume achieved. It uses bellows that rises according to inspired volume.

Administering the Incentive Spirometry
The application involves 3 phases

Follow up

It involves the assessment therapeutic outcomes selected at this phase.

The patient teaching has to be effective. the patient is positioned in a comfortable manner.  The patient is instructed to inspire slowly and deeply.  Initially the good set should be moderate.
The shoulders and upper chest should be relaxed and diaphragmatic breathing should be encouraged.
At the end of maximal inspiration, ask the patient to sustain it for 5-10 seconds.
A normal exhalation follows.
Give rest as long as needed.
Repetition 5-10 SMI/hour

Follow Up:
It includes re-assessment
Supervised till the patient masters the correct technique
Establish new and increasing inspiration volume each day.

Outcomes of Incentive Spirometry:
Absence or improvement of signs of atelectasis
Decrease in Respiratory rate (if it is increased)
normal pulse rate
Resolution of abnormal breath sounds
Improved chest radiography
Increased PaO2 and decrease PaCO2.
Increase SpO2
increased vital capacity and PEFR (Peak Expiratory flow rate)
Improved cough
Increased FVC

Examination of Peripheral Vascular Disease (PVD)

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Obtain a complete and detailed history of the patient.
Concentrate on past medical history with emphasis on diabetes mallitus, hypertension or any other cardiac diseases.
Obtain the medications and perior treatment for the current problem.
History of relevant surgical or medical.
treatment involving vascular system should be collected.
Social history should concentrate on lifestyle pattern such as use of tobacco, dietary habits, and use of alcohol, etc...
Collect details of onset of symptoms mechanism of injury, work environment, job skills.

Subjective examinations
This includes the current symptoms.
factors increasing or decreasing the symptoms
about intermittent claudication, rest pain, how positioning of
lower limb affects pain etc..

Objective Examination
On observation
check for evidence of cellulites, edema, discoloration of skin, cyanosis or pallor, loss of hair, wound, etc...

Motor Examination
Should be done to access Range Of Motion and Muscle strength.

Sensory Examination
This is done mainly for light touch and pressure, includes Semmes Weinstein monofilaments to check sensation.

Using palpation, thermistor, test tubes etc... and compare to the other side.
Usually the temperature decreases in arterial disorders.

Girth Measurement
done for edema
measurements should be taken in reference to bony prominences, volumetric is a quantitative system to measure edema.

Vascular Examination
Palpate for the pulses especially distal pulses.
Auscultation: Auscultate for identifying turbulent blood flow called bruit.