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| HEALTH TRIBUNE | Wednesday, April 16, 2003, Chandigarh, India |
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For cancer-free journey in menopausal zone Reviving failing heart INFO CAPSULE
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Piles — a common but neglected problem Piles, known as “bawasir” in local parlance and as haemorrhoids in medical terminology, is a common problem, affecting people of all ages and both sexes. Because of the lack of proper knowledge the common man does not properly understand piles. It may not be wrong to say that a majority of the patients of piles do not go to qualified medical persons for treatment. The problem is handled by quacks or the paramedical staff or with the help of home remedies. Piles are dilated vascular and connective tissue cushions that lie in the rectum and the anal canal. These blood vessels at times bleed. The patient, while passing stools, passes blood, which is fresh red and comes in drops. At times a patient may be losing a lot of blood and, as a matter of fact, it is not one of the commonest causes of anaemia (deficiency of blood). The patient does not feel pain unless the pile mass has developed some complication or is associated with fissure-in-ano. Lack of pain is another reason that the patient continues to ignore the problem and goes to the doctor at a very late stage. This negligence may bring more problems to the patient. The exact cause of piles is not known, but constipation and the passage of hard stools, prolonged straining during the act of bowel evacuation, increased abdominal pressure, lack of support to the pelvic muscles as may happen during childbirth, or diseases like portal hypertension may give rise to the disease. The hereditary factor is also associated with this problem. Piles can be internal (lying in the upper part of the anal canal), external (lying in the lower part) or a combination of both and known as external-internal. These are also graded as the first degree of bleeding, the second degree (they bleed and come out of the anus but reduce spontaneously, the third degree (bleed, come out but do not get back themselves and have to be pushed back manually) and the fourth degree (bleeding and thrombosed). This staging is necessary as the treatment depends upon the stage. Diagnosis: The diagnosis of piles should never be made without a proper examination of the patient — of his rectum with the help of a finger (digital rectal examination) and by an instrument known as the Proctoscopic examination. This will not only show the sites of the pile masses and their numbers but also inform the surgeon about the presence of any complication. Usually, there are tree main pile masses (primary piles) and there may be a couple of small-sized pile masses in between these large ones. Treatment: All patients of piles require a change in their dietary habits. They should avoid constipation by taking a lot of green vegetables and fruits along with plenty of water. This can be further supplemented by giving laxatives. Isabgol husk is one of the best for this purpose. The patient should avoid straining during the acts of passing stools. He/she should also give up the habit of sitting on the commode for long hours with magazines and newspapers. The patients should avoid the intake of chillies and condiments. The above mentioned measures should be able to take care the patients of the first degree and second degree piles, but at times they may be prescribed some ointments. The patients of second degree piles who do not respond to the above mentioned measures plus some patients of the third degree piles may be offered one of the following measures: (a) Sclerotherapy — the piles are injected with some drugs which obliterate the veins. The injection treatment may be required three or four times at an interval of 10 or 15 days for complete relief. (b) Banding — this procedure is done for internal piles only. In this the pile masses are tied by elastic bands. A special equipment is available by which the band may be applied properly. (c) Cryotherapy — in this the pile mass is obliterated by rapid freezing followed by rapid thawing with a special equipment. Usually nitrous oxide, which reduces the temperature to — 85 degree is used for cryotherapy. (d) Laser is being currently used for the treatment of piles, and it is supposed to be causing much less pain. The patients of large third degree and fourth degree piles are treated with surgery, in which case the pile mass is excised and this can give permanent solution to the problem. Recently “stapled haemorrhoidectomy” has been shown to give better results than open surgery. Our experience has been good in this respect, particularly with regard to the post-operative pain and early return to normal activity. Complicated piles require non-surgical measures followed by surgical operations for their proper management. A number of ointments and tablets are available in the market, and many of these are claimed to give relief. But, truly speaking, all these are of limited value only. One should not depend upon them too much or for too long. Here is a caution:
Management of a patient of bleeding per rectum without proper rectal examination may lead to gross errors as a patient of rectal cancer may continue to be treated as a case of bleeding piles, and the implications are obviously dangerous. —
The writer, a former Professor and Head of Surgery, PGI, Chandigarh, is the President of the Association of Surgeons of India
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For cancer-free journey in menopausal zone What is the PAP smear? During a PAP smear some cells are scraped or brushed off the cervix, and prepared on a slide that is examined under a microscope. The purpose of the PAP test is to detect changes that may lead to cervical cancer long before cancer develops. The pre-cancer condition of the cervix is easily treated, and almost always prevents cancer from developing. One may see one of the following in the test. Normal, or a variation of normal, such as “irritation”. Probably normal, but there are mild changes that you should evaluate further. Pre-cancerous changes. Invasive cancer. Somewhere on the cervix the two cell types, squamous cells and columnar cells, meet and it is in this transformation zone that an abnormal growth of cells occurs. What happens if the results are abnormal? An abnormal PAP smear does not necessarily mean that cancer cells were found during the examination. There are many causes for abnormal PAP smear results. Your doctor will evaluate the results to determine if further testing is necessary. A repeat PAP smear may be necessary if you had an infection at the time of the test or if there were not enough cells collected during the test. Since decreased levels of female hormone estrogen can also influence the PAP smear results, menopausal women may need to take estrogen before they repeat the test and a colposcopy examination may also be required. Colposcopy is an examination of the cervix and the walls of the vagina through a speculum. Your doctor looks through a magnifying instrument called colposcope to detect cervical problems. Colposcopy is not always necessary immediately after an abnormal PAP smear. What symptoms should one watch for between PAP smears? Pre-cancerous conditions of the cervix seldom cause symptoms. When cancer is present in the cervix, the most common symptom is abnormal bleeding. Bleeding may start and stop between regular menstrual periods, or it may occur after sexual intercourse. Abnormal vaginal discharge is another symptom. Pain is not an early warning sign of the disease. But be sure to see your doctor if any of these symptoms last longer than two weeks. The facility of taking PAP smear is available as part of menopause consultation and early cancer detection at certain government dispensaries and other institutions. While younger women may take time to decide, those who have crossed the stage of 40 years must get their PAP test done without any delay and then every year. E-mail address for queries: menopausehelpline@gomcochandigarh.com —
The writer, a senior gynecologist, at the Sector 20 government dispensary, Chandigarh, is the author of “A Guide to Better Health After Menopause” |
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Reviving failing heart
WASHINGTON: Millions of heart failure patients have traditionally been treated with nitroglycerin or other drugs that release nitric oxide into the bloodstream. While these medicines increase the heart's ability to contract, they also blunt chemical signals allowing the heart to fully relax and pump most effectively. Now, study on animals by researchers at the Johns Hopkins has suggested that a chemical relative of nitric oxide could better restore normal function to failing hearts.
ANI
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INFO CAPSULE WASHINGTON: For the first time, scientists at the University of North Carolina at Chapel Hill have shown how Mycobacterium tuberculosis, the germ responsible for TB, uses a system for releasing proteins to help it survive the lungs' immune defenses to spread and cause the disease. The finding may some day help develop drugs against TB infection, aimed at blocking this secretion system. The study, published online in the latest issue of Molecular Microbiology, also adds crucial new knowledge to the molecular factors that underlie the virulence of M tuberculosis and may aid development of new, targeted treatments for the disease. ANI Plastic sensor to measure
glucose level
WASHINGTON: It's good news for millions of people suffering from diabetes mellitus. From now on, they may be spared the ordeal of pricking their fingers several times a day to test blood sugar levels, thanks to a non-invasive method to measure the glucose level in bodily fluids. The method, developed by researchers at the University of Pittsburgh, involves a thin plastic sensor that changes colour based on the concentrations of glucose. The sensor material would be worn like a contact lens. The researchers plan to embed the sensing material into contact lenses worn in the patients' eyes.
ANI
Eat yogurt and
lose weight
WASHINGTON: Though some people may drop dairy products while trying to cut on those extra calories, a new study has suggested that dairy products like yogurt may help turn up as the body's fat-burning ability — making it easier to lose fat while maintaining lean muscle. The new study, presented by Michael Zemel, professor of nutrition at the University of Tennessee, found that individuals, who included Yoplait Light yogurt as part of their weight loss plan, lost significantly more weight compared to others who simply reduced calories.
ANI
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Cervical cancer is the commonest cancer among the women in the menopausal zone in India. While early marriages, poor sexual hygiene and growing extra-marital and pre-marital contacts make the occurrence of this cancer common, fortunately it can be detected with the simple test even before it takes its foothold firmly in the genitals of the victim. It is called the PAP test, which is easy to perform and is painless and inexpensive. This test has to be performed regularly every year in all the females who are sexually active after the age of 18 years. However, new guidelines say it can be postponed till 21 years, and instead of the annual test, it can be done every two-three years if everything else is normal. Those women who had a hysterectomy do not need PAP smears unless the hysterectomy was performed for cancer or precancerous conditions. Continue PAP smear screenings for cervical cancer until they are 70 years old. It is important to note that more than 50 per cent of the diagnosed cases of cervical cancer occur in women who have never had a PAP smear. Another 10 per cent of diagnosed cases of cervical cancer occur in women who have not had a PAP smear during the last five years.