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Anal fistula: treatment options Over-exposure to carbon monoxide
dangerous for kids’ears Vitamin B reduces chances of
cancer Big hips can protect women from
heart attacks EYESIGHT Ayurveda
& you
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Anal fistula:
treatment options The disease of anal fistula is as old as mankind. Thousands of years ago, Hippocrates made reference to surgical therapy for fistulous disease. English surgeon John Arderne (1307-1390) wrote "Treatises of Fistula in Ano; Haemmorhoids, and Clysters" in 1376, which described fistulotomy and seton use.
Causes and types Features Diagnosis Fistulography Treatment Surgery Therefore, Seton placement, which is a non-operative treatment, is a better option. The earliest reference of Seton (Ksarshutra) can be found in the ancient Indian literature, Sushruta Samhita. A seton (thread tie) can be placed alone, combined with fistulotomy, or in a staged fashion. This technique is useful in all kinds of anal fistula. The advantage of this technique is that there is no wound after the treatment and the patient can resume work the next day. For high fistula, recurrent fistula and complicated Multiple fistulas, the seton placement can be difficult. In our experience, the use of endoscopy has simplified the placement of seton in such cases. However, there is a second school of thought according to which medicated seton leads to better healing. But this is controversial as the latest studies have shown that medicated threads are more painful and do not improve healing. (As per the study published in "Techniques in Coloproctology," Vol 5, No.3, Page-137-141, Dec. 2001) Besides this, the most important aspect is that any seton placement by quacks/unqualified persons can be dangerous and can lead to more complications. Therefore, it should be got placed by qualified surgical specialists only. Seton placement is by and large the efficient and the most convenient technique to manage anal fistula. Future The writer is Senior Consultant in
Surgery, Fortis Hospital, Mohali.
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Over-exposure to
carbon monoxide Washington: Over-exposure to carbon monoxide (C0) of low-level can cause damage to kids’ ears leading to permanent hearing-loss. In a research conducted over rats, UCLA scientists have discovered how chronic exposure to low levels of carbon monoxide (CO) damages the inner ear of young rats, resulting in permanent hearing-loss. This study appeared in this month’s issue of the Journal of Neuroscience Research. At the Ca/OSHA’s exposure limit of 0.0025 per cent — or 25 parts per million CO in the air — the gas creates oxidative stress, a condition that damages the cochlear cells, leading to impairment of the auditory nerves, says the study. The study stated, tobacco smoke, gas heaters, stoves and ovens all emit CO, which can rise to high concentrations in poorly ventilated homes. Infants and children are particularly vulnerable to CO exposure because they spend a great deal of time in the home. Many commercial home monitors sound an alarm only 20 minutes after CO concentrations reaches 70 parts per million — nearly three times the 25 parts per million limit set by Cal/OSHA. This is the first time that inhaled CO has been linked to oxidative stress, a known risk factor in many disorders, including Alzheimer’s, Parkinson’s, multiple sclerosis, Lou Gherig’s disease and cardiovascular disease. Tobacco smoke, which contains CO, aggravates many of these diseases. The study is authored by John Edmond, professor of biological chemistry, Ivan Lopez, assistant professor of head and neck surgery, and Douglas Webber, post-doctoral fellow at the David Geffen School of Medicine at UCLA. — ANI
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Vitamin B reduces chances of cancer Washington: Women with high intake of vitamin B6 are at a low risk of getting exposed to colorectal cancer (CRC) whereas women who consume moderate-to-large amounts of alcohol along with B6 have more than a 70 per cent reduced risk of developing it, says a study that appeared in the American Gastro-enterological Association (AGA) journal Gastroenterology. According to Susanna Larsson, the study author with the Karolinska Institute in Stockholm, Sweden, "Consuming a diet high in vitamin B6 may reduce the risk of colorectal cancer in women, more specifically those who consume alcohol." "Inadequate vitamin B6 status may lead to the development of cancerous polyps in the colon, so it is important for women to maintain a normal-to-high intake of vitamin B6", added Larsson. The study was conducted on almost 67,000 women, aged 40 to 75 years, and they responded to a questionnaire that solicited data on diet, family history of CRC and use of dietary supplements. It was found that alcohol consumption in women with low vitamin B6 intake resulted in higher risk of developing colorectal cancer and that increasing intake reduces this risk significantly. The recommended daily dietary intake of vitamin B6 for non-pregnant women in the United States is 1.3 to 1.5 mg. "These findings may have important implications for the prevention of colorectal cancer in women who consume alcohol because their vitamin B6 status can be easily improved through dietary modifications, vitamin supplementation and fortification," said Larsson. — ANI
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Big hips can protect women from heart attacks Washington: The women with curves are healthier than the others who have a skinny shape, says a study in the Sun. Researchers have found those with hips measuring less than 40 inches were more exposed to heart attacks and other illnesses. Berit Heitmann, a professor from the Institute for Preventive Medicine in Copenhagen, Denmark, said that fat and muscle on the hips has a protective effect. It contains adiponectin, which has anti-inflammatory properties, Heitmann added. Heitmann carried out a study of 50,000 men and women, then followed up years later to see what illnesses they suffered. "Fat on the hips is different than fat on the abdomen. If you do not have enough of this fat you may risk heartattacks," informed Heitmann. This study dismisses traditional belief that overweight people have more health problems and shows it is where the fat lies that is important. — ANI
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EYESIGHT Age-related macular degeneration (ARMD) is a disease that causes progressive damage to the macula. Macula is the central part of the retina that allows us to see fine details. Many people develop macular degeneration as part of the body’s natural aging process. Macular degeneration may be an inherited condition, as is the case of juvenile macular degeneration. Injury, infection, inflammation or extreme near-sightedness may also damage the delicate tissue of the macula. The two most common types of age-related macular degeneration are "dry" (atrophic) and "wet" (exudative): 1. Dry macular degeneration (also called involutional macular degeneration) is the more common form of the disease and accounts for 90 per cent of all AMD cases. It is caused by aging and thinning of the tissues of the macula. Vision loss is usually gradual and may take years. Low vision aids may help the patient to do reading and near-vision work. 2. Wet macular degeneration (also called haemorrhagic macular degeneration) is less common but more severe than the dry form. It accounts for approximately 10 per cent of all AMD cases but 90 per cent of all blindness from the disease. This form is characterised by choroidal neovasculariztion (CNV), the development of abnormal blood vessels beneath the retinal pigment epithelium (RPE) layer of the retina. These vessels can bleed and eventually cause macular scarring which can result in a profound loss of central vision (disciform scar). The symptoms 1. Colours look dim 2. Words on a page look blurred. 3. Straight lines look distorted, especially at the centre of vision 4. A dark or empty area appears in the centre of vision. The risk factors Smoking: The only environmental exposure clearly associated with macular degeneration is tobacco smoking. Beta carotene vitamin supplements were recently shown to help in slowing macular degeneration in a NIH supported study (AREDS). Family history: Macular degeneration appears to be hereditary in some families but not in others. Approximately, one-fourth of all late-stage macular degeneration cases appear to have a genetic basis. People who have first-degree relatives with late-stage macular degeneration develop macular degeneration at an increased rate at a relatively younger age. Among the other possible risk factors are hypertension, high cholesterol, obesity and high fat intake The treatment 2. Lasers: Recent studies have proved that selected patients have a much less chance of significant visual loss if they are treated by Laser photocoagulation than if they are not treated. It is estimated that 20 per cent of patients with the wet type of macular degeneration may be candidates for laser treatment. The treatment can successfully eliminate the abnormal blood vessels in approximately 50 per cent of these patients. Unfortunately, despite the best treatment, the abnormal vessels in some patients cannot be obliterated. In cases where laser photo-coagulation can not be done, photodynamic therapy (PDT) is the treatment of choice. The aim of the treatment is to stabilise the existing vision . 3. Low vision devices: In advanced stages of ARMD low visual devices like stand or hand-held magnifiers help in making the day-to-day activities easier. The writer is Chairman and Medical Director, Centre for Sight, New Delhi. E-mail: msachdev@bol.net.in.
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Ayurveda
& you Triphala, a house-hold name in India, is a unique herbal combination. People want to know more and more about it because of its usefulness. Generally, equal mixing of dried pulp of harad, baheda and amla (without the seed part) is considered the most acceptable formulation of triphala, but references are also found where the ratio of each of these is changed to gain a particular therapeutic benefit. Triphala strengthens immunity, neutralises the activity of carcinogens and supports balanced digestion, absorption and assimilation. As an anti-oxidant and tonic, it can be used in three different ways. If it is to be taken in the morning, mix it with a little honey during the day-time and take it with fresh water. At bed-time it serves well if it is taken with warm milk. One of the earliest treatises of ayurveda, the Harit Samhita, has the mention of "Triphala Kalpa" where it is used to assuage the symptoms of premature aging. In obesity resulting due to dietary and lifestyle aberrations, taking once a day two to five gm of triphala powder with honey or warm water enhances the efficacy of any other anti-obesity treatment. The triphala decoction mixed with a little honey also serves the same purpose. Besides having properties to lower the high cholesterol level, triphala is an excellent medicine to treat the raised uric acid level also. Triphala can be effectively used to strengthen the respiratory system and to treat various sinus allergies, cough, bronchitis and chest diseases. Though independently each of the ingredients of triphala has its won therapeutic value, here it is a slightly different combination — amla one part, harad two parts and baheda three parts — which if taken with honey turns out to be an excellent herbal expectorant. If the cough is dry and non-productive, the ratio of harad and amla can be interchanged. Due to its rejuvenating and revitalising properties, triphala is amply used for skin care. It can be taken mixed with 500 mg each of giloy satva and lauh bhasma to treat blemishes, pimples and anaemia. In unidentified skin allergies, inflammations, infections and stubborn conditions like psoriasis, concomitant use for triphala enhances the efficacy of the basic treatment. A wash with triphala decoction is beneficial for hair and scalp care and conjunctivits, gargles in mouth ulcers and if taken internally helps treat liver diseases. Triphala — with amla in four parts, harad two parts and baheda one part — makes an effective digestive aid. To treat acidity, gastritis and constipation, two gm of this combination can be taken after mixing it with a little of sugar preferably one hour before dinner. For more severe cases of acid dyspeptic disease, 250 gm of kamdudha Rasa (Mukta Yukta) can be added to it. Ayurvedic texts mention that in vata diseases triphala should be taken with sesame oil, in pitta diseases with ghee and in kapha problems honey serves as its adjunct. Many experienced physicians start the treatment of certain chronic ailments only after a few days of administration of triphala. In some cases, where it is used for a longer period as a laxative, the drying effect of harad can cause dependence. It should be given with care to pregnant women. It is contraindicated in conditions like diarrhoea, dysentery and IBS. For proper setting of the dosage and to be on the safer side, an expert opinion can help in gaining its maximum benefits. The writer is a Ludhiana-based senior ayurvedic physician.
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Historical references
indicate that Louis XIV was treated for an anal fistula in the 18th
century. Over the last 50 years many surgeons have presented new
techniques in an effort to minimise recurrence rates and incontinence
(loss of control over passing stools) complications. But despite 2500
years of experience, anal fistula remains a perplexing surgical
disease.