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| HEALTH & FITNESS |
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Liver injury: speed is of essence
Respiratory problem as a bolt from the blue
Shoulder injury: ensure early management
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Liver injury: speed is of essence
Liver is a vital organ, very important for the maintenance of life. It is involved in a large number of functions like the production of essential serum proteins, digestion, metabolism, blood-clotting mechanism, detoxification and excretion of many drugs and waste products. One cannot dispense with the liver as is possible in the case of one lung or one kidney, the stomach or a segment of the intestine, uterus or testis, etc. But, then, liver also has a great regeneration power. If even a four-fifth of the liver is removed the remaining part quickly grows in size and compensates for the loss, and maintains the life without much problem. It has now been conclusively proved that all liver injuries, including bullet injuries, do not require surgical intervention. The natural physiological process of the human body can stop bleeding and, therefore, a select group of patients can be successfully managed with non-operative supportive management. But, then, this should be attempted only in good hospitals and that also by experienced surgeons. The majority of liver injury cases require emergency surgical management, and the patients who seem to be bleeding profusely (they remain in a state of shock in spite of blood transfusions) should be directly wheeled to the operation theatre without any prior investigation or elaborate preparation, as speed is of the essence. An experienced surgeon with expertise in the management of abdominal trauma, good operation theatre facilities, plenty of blood (preferably fresh blood and not the stored blood) along with plasma and other blood components, a good anaesthetic team with ICU facilities are the prerequisites for a good outcome. The availability of a cardio-vascular surgeon inside the operation theatre is helpful not only for the control of the superior part of the IVC in the chest but also for the repair of the traumatised veins. In case there is uncontrollable bleeding from the liver or the veins (as seen in grade III to V injuries) more advanced techniques have to be used. Vascular isolation of the liver may be required. The bottom line in handling liver injury cases is the extent of injury sustained by the patient, the time gap between the incident leading to the injury and the operation and the expertise available in the hospital. In complex liver injury cases, the results have been very poor all over the world. |
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Respiratory problem as a bolt from the blue
The respiratory problem Mahajan faced is generally the result of an acute and severe insult to the body which may include diverse conditions such as severe infection, pancreatitis, accidents, burns, bone fractures, multiple and rapid blood transfusions, poisoning, toxic gas inhalation and even a difficult delivery. Quite often, it is difficult for the common man to understand why a person with a healthy respiratory system should develop serious respiratory failure in these conditions without a primary disease of the lungs. It is for this reason that the medical care-givers, especially doctors, become the innocent victims of medical negligence and are blamed for this inevitable calamity. Unfortunately, ARDS is unavoidable and remains a frequent occurrence after a large number of unrelated types of insults and trauma. The term was first coined in 1967 during the Vietnams war when several American soldiers died of respiratory failure following war injuries without any direct damage to the chest. Fluid accumulation in the lungs most commonly results from the failure of the heart, a condition called pulmonary oedema. Another classical example of pulmonary oedema is known to occur on rapid ascent to high altitudes beyond 10,000 or 12000 feet on the mountains. ARDS is a peculiar condition when the fluid leaks into from the blood vessels within the lungs without any failure of the heart. The fluid in the lungs soon fills the alveoli replacing the air and thereby results in profound oxygen deficiency — hypoxia. Oxygen deficiency causes extensive damage to the total body system since oxygen is required to sustain the life of each living cell in the body. ARDS is a serious condition with high fatality rates. It is not generally possible to prevent except to treat the underlying causes, which may possibly be responsible for the development of ARDS. Similarly, there is no definite treatment for ARDS but continuing with life supporting treatments and allowing the natural process of healing to take place. But this is easier said than done. Artificial or assisted life support is more than snatching life from the jaws of death. It is one of the most critical, costly and debatable components of modern medicine. Besides the lungs, almost all organs, including the kidneys, heart, liver, brain and blood, are affected in ARDS. Serious complications are bound to develop even when the patient is under the care of the best of
hands. However, chances of survival from ARDS have improved over the years with a mortality rate of about 30 per cent as of now. Many lives can be saved if appropriate care and resources are made available in time. It will, however, do good to everyone to recognise that the complication occurs naturally as “a bolt from the blue” phenomenon and requires a comprehensive, multidisciplinary approach to management. |
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Shoulder injury: ensure early management Shoulder dysfunction affects the quality of life considerably. The shoulder joint is a ball and socket joint and is inherently unstable. Ligaments, rotator cuff muscles provide stability. Rotator cuff muscles control the position of the humeral head in the glenoid fossa. Shoulder pain can be due to the rotator cuff injury, instability or referred pain in the neck. In cases of shoulder instability, there is unwanted translation, causing symptoms like pain and slipping away. Motion, strength and stability are the three components of shoulder function that can be disrupted by an acute or chronic injury. All these can be treated effectively with therapeutic rehabilitation. The most important factor that determines the success or failure of a particular shoulder rehabilitation protocol is establishing the correct diagnosis. Strict immobilisation has been shown to be responsible for the development of “functional” instability in the shoulder, muscle weakness and frozen shoulder. Shoulder rehabilitation after an injury or surgery should begin with early active motion to help restore normal shoulder mechanics. The symptoms
Treatment
Exercises
Surgery: If there is no progress in recovery with physical therapy for six weeks then surgical treatment is advocated. Prevention: Shoulder injuries/dysfunction should be diagnosed early and correctly so that chronic instability and dysfunction do not set in. Initiation of physical therapy should be undertaken early and there should be effective rehabilitation in order to obtain the optimum results. |
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Health Notes
LONDON: Forget the idea that snorers are men the wrong side of 50. Binge drinking is turning young women into chronic snorers, with increasing numbers seeking help in tackling a problem that can lead to long-term health problems and wreck relationships. New research shows that the numbers of men and women snoring, and suffering from obstructive sleep apnoea, are increasing, and it’s not just young women who are pushing up the figures. Research shows that increasing levels of obesity, a rise in allergies and a drop in the numbers of tonsils being removed in children may all be having an impact. Snoring results from the soft tissue or muscles in the air passages vibrating. During sleep, the muscles relax, narrowing the airways, and the narrower the airway, the greater the vibration.
— The Independent Tap water-based drinks may cause cancer
NEW YORK: Pooled data from six case-control studies suggest that higher consumption of tap water-based drinks may slightly increase the risk of bladder cancer among men. The increased risk of bladder cancer with tap water consumption was “consistently found in all six studies, making chance an unlikely explanation,” write investigators in the International Journal of Cancer. They caution, however, that for now, the study finding that tap water “is associated with a slight increased risk of bladder cancer” does not readily translate into public health recommendations. The results are based on 2,749 bladder cancer cases and 5,150 cancer-free controls. Most of the subjects resided in the US, Canada or Finland, with data from subjects in France and Italy also included. The investigators observed that the risk of bladder cancer was 50 per cent higher in men who drank more than 2.0 litres of tap water per day compared with those who drank 0.5 litres or less of tap water per day. Results among women were less consistent.
— Reuters Stroke patients: results of statin therapy
NEW YORK: Only about half of individuals who suffer a stroke and have elevated levels of harmful LDL cholesterol are prescribed a statin, and among those who are taking a statin, fewer than half meet recommended lipid goals, according to results of a recent study. Dr Bruce Ovbiagele, from the University of California Los Angeles School of Medicine, and colleagues evaluated data from 769 patients who had experienced an ischemic stroke — the type of stroke caused by a blood clot in the brain that cuts off the oxygen supply. These patients, whose average age was 69 years, were deemed to be at high risk of heart disease in the future. According to current guidelines, an LDL cholesterol level of 130 mg/dL or higher should trigger initiation of statin therapy. The goal of statin therapy is a LDL level of 100 mg/dL or lower. At baseline, 262 (34 per cent) of high-risk stroke patients had LDL cholesterol of 130 mg/dL or higher. Of these, 47 per cent were not on statin therapy. Among those who were on statin therapy, only 42 per cent met the treatment goal of LDL less than 100 mg/dL.
— Reuters When diabetics undergo surgery
WASHINGTON: A new study has found that patients suffering from diabetes who have good control of blood glucose levels before having surgery may be less likely to have infections after their procedures. The study, by a team of researchers led by Annika S. Dronge, Yale University School of Medicine, West Haven, Connecticut, examined the relationship between glycemic (blood sugar) control and postoperative infections. The study was conducted on a team of 490 diabetic patients, all of whom underwent major noncardiac surgery between January 1, 2000, and September 30, 2003. As a part of the research, the patients had their haemoglobin (Hb A1c) levels, that reflects the patient’s control of blood glucose levels over the previous two to three months, measured within 180 days prior to surgery with an Hb A1c level of less than 7 per cent defined as good glycemic control. The study found that patients who did not have good glycemic control had higher rates of infectious complications after surgery, as did those who were older, had higher scores on physical status tests, had wounds that were classified as “nonclean” or had operations that took longer.
— ANI
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The fatal attack on BJP leader Pramod Mahajan brought into sharp focus the importance of the liver in the human body. . The liver is the largest solid organ in the body occupying almost the whole of the upper abdomen and is thus very vulnerable to any injury inflicted on the abdomen or the lower part of the right chest.
The acute respiratory distress syndrome or ARDS is a term generally applied to the development of acute respiratory failure in a person with previously healthy lungs. The term has caught attention of the people following the happenings leading to the death of BJP leader Pramod Mahajan. It is one of the most fearful conditions faced by the physicians and surgeons handling emergencies.