Spinal Cord Injury Treatment in India

 

Spinal Cord Injury – Stem Cell Treatment

 

In 1995, actor Christopher Reeve fell off a horse and severely damaged his spinal cord, leaving him paralyzed from the neck down. From then until his death in 2004, the silver screen Superman became the most famous face of spinal cord injury.

Most spinal cord injury causes permanent disability or loss of movement (paralysis) and sensation below the site of the injury. Paralysis that involves the majority of the body, including the arms and legs, is called quadriplegia or tetraplegia. When a spinal cord injury affects only the lower body, the condition is called paraplegia...

 

Symptoms

Spinal cord injury symptoms depend on two factors:

 

• The location of the injury : - In general, injuries that are higher in your spinal cord produce more paralysis. For example, a spinal cord injury at the neck level may cause paralysis in both arms and legs and make it impossible to breathe without a respirator, while a lower injury may affect only your legs and lower parts of your body...
  
  
• The severity of the injury : - Spinal cord injuries are classified as partial or complete, depending on how much of the cord width is damaged...

 

Spinal cord injuries of any kind may result in one or more of the following signs and symptoms : -

 

• Pain or an intense stinging sensation caused by damage to the nerve fibers in your spinal cord
• Loss of lower back injuries symptoms movement
• Loss of sensation, including the ability to feel heat, cold and touch
• Loss of bowel or bladder control
• Exaggerated reflex activities or spasms
• Changes in sexual function, sexual sensitivity and fertility
• Difficulty breathing, coughing or clearing secretions from your lungs...

 

 

Spinal cord injuries

Paralysis of the lower half of the body is called paraplegia. Paralysis of both arms and legs is called quadriplegia...

 

Causes

1. Your brain and central nervous system

Together, your spinal cord and your brain make up your central nervous system, which controls most of the functions of your body. Your spinal cord runs approximately 15 to 17 inches from the base of your brain to your waist and is composed of long nerve fibers that carry messages to and from your brain...

 

2. Injury may be traumatic or nontraumatic

A traumatic spinal cord injury may stem from a sudden, traumatic blow to your spine that fractures, dislocates, crushes or compresses one or more of your vertebrae. It may also result from a gunshot or knife wound that penetrates and cuts your spinal cord. Additional damage usually occurs over days or weeks because of bleeding, swelling, inflammation and fluid accumulation in and around your spinal cord...

 

Common causes of spinal cord injury

The most common causes of spinal cord injury in the United States are : -

• Motor vehicle accidents : - Auto and motorcycle accidents are the leading cause of spinal cord injuries, accounting for almost 50 percent of new spinal cord injuries each year.
  
  
• Acts of violence : - About 15 percent of spinal cord injuries result from violent encounters, often involving gunshot and knife wounds.
  
  
• Falls : - Spinal cord injury after age 65 is most often caused by a fall. Overall, falls make up approximately 22 percent of spinal cord injuries.
  
  
• Sports and recreation injuries : - Athletic activities such as impact sports and diving in shallow water cause about 8 percent of spinal cord injuries.
  
  
• Diseases : - Cancer, infections, arthritis and inflammation of the spinal cord also cause spinal cord injuries each year...

 

 

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Backache is medically known as lumbago. It is the disease which afflicts any region of the vertebral column or the associated muscles. Each of the 32 vertebrae can develop sudden pains which could become a chronic condition. Though we use the term backache in general, actually it is a collection of various types of pains of the vertebral column.

People find these kinds of pains to be more common as they grow older. Though there are no gender specifics, lumbago may be a bit more in men than in women.

In Ayurveda, backache is called as Nithamba Shoola. Ayurveda treats this pain as a vata disorder, which causes both the types of weaknesses, i.e. the bone weakness and the muscle weakness. Hence when deciding on a proper treatment pattern for backache, one needs to consider the vitiation of the vata dosha.

Let us see some of the common treatment patterns used in Ayurveda for the treatment of lumbago.

(1) Useful Herbs in the Treatment of Backache

® Betel (Areca catechu)

Betel is one of the traditionally used herbs in the treatment of backache. The juice of the betel leaves is mixed with refined coconut oil. When this juice is applied on the loins, it provides relief from the sudden pains.

® Garlic (Allium sativum)

Among the many benefits that garlic has, an important one is relieving pains of lumbago. An extract of garlic provided to the patients provides relief from the pains without having any undesirable side effects.

® Indian Aloe (Aloe barbadensis)

The pulp of a single leaf of aloe consumed on a daily basis provides relief from backache problems.

® Lemon Grass (Cymbopogon citrates)

Lemon grass is mixed with twice its bulk of coconut oil and applied externally on the affected regions. This eases the pains.

(2) Dietary Treatment for Backache

Since backache is a condition caused due to vata vitiation, any food that can aggravate the vata further must not be taken. Sour and fried foods must be totally avoided. Even pulses must be eliminated from the diet. Rice must be reduced; rather food grains such as wheat, millet and sorghum are better.

(3) Ayurvedic Treatments for Backache

® The Ayurvedic preparation, Prasarani, is the drug that is most commonly used for the treatment of backache. Prasarani is Paederia foetida, which is a plant species. The method of use can be either external or internal. For better effects the oil of the plant is used. Massaging with this oil about two or three times a day provides immense relief from backache problems. Even if the pain subsides, the treatment must be continued for a month so that the pain does not recur.

® Other oils available for massaging the affected parts are the Narayana and the Mahanarayana oils. These oils must be used for fomentation or mixed in warm water to give a hot tub bath.

(4) Home Medications

® Mix equal proportions of limestone and honey. Apply this paste on the region where the pain is the severest.

® Grind some sesame seeds in water. Warm this solution and apply it repeatedly on the part where it pains the most.

® Put two teaspoonfuls of cumin seed powder in a glass of water and warm the solution. Soak a towel in this water and then use it to foment the affected parts. Relief should be obtained within a couple of hours.

® Roast about 100 grams of fenugreek seeds. Then grind them roughly and mix in them a quarter portion of rock salt. Put two teaspoonfuls of these in hot water every morning and evening and let the fumes come in contact with the region where the pain is persistent. This treatment provides relief in fifteen days.

® Take 1 gram of pure asafetida and mix it with egg yolk. Apply this paste on the affected spinal region. This is a quick method of getting relief from the pains, but it is a temporary method.

® Mix two or three pieces of cardamom in warm milk. Introduce about a pinch of turmeric in it. This is to be drunk every night before going to sleep. Immense relief will be obtained in the morning.

(5) Preventive Methods

® Instead of sleeping on a soft mattress at night, use a hard mattress. If you can, sleep on the ground with the back straight; that is, with the spine touching the ground as much as possible.

® Use ergonomic chairs in your workplace. See that the chair makes contact with the spine fully when you sit on it.

® Do not cramp yourself in one position. Shuffle your position often. When traveling, try to get up and move about whenever you can.

® Exercise often, but do not stretch your back. Perform gliding motions when exercising.

® Yogic asanas that can be used to prevent lumbago pains are:-

a) Bhujangasana

b) Halasana

c) Shalabhasana

d) Shavasana

e) Uttarapadasana

Many if not everyone go through a rough time in some point of their lives. More often than not, and especially if they do not have someone to talk to, some people may thing that the only way they could use to escape or to reduce the pains they are having was through cutting.

The thing with cutting is that after a while, when these scars remain there, it will always remind you of the bad times you went through. This can even Cause a more devastating effects in the long run. That is why is very important that you do just anything you can to get rid of the scars so you don't constantly get reminded treating back injuries of the bad times you have been going though.

As you may already know, there is laser treatment of scars which is very costly and very painful too. You can use a foundation or concealer stick when you are really worried about people seeing the scars. But why don't you try to get rid of them once and for all using natural safe and cheap methods?

Well, then best way I found to get rid of your scars, no matter what caused them: acne, cutting, stretch marks, pimples, burns and so on, is by using the recommendation in this great scar treatment guide: The Scar Solution.

The Scar Solution is an effective natural scar removal guide which ahs been on the net for a while and has been helping so many people round the world to get rid of their ugly scars. The recommendations in this guide for getting rid of scars are not just very fast in treating your scars, they are very safe, and voice of side effects.

Do you want to get rid of all the scars you have on your body which are reducing your self-confidence? If yes, then you need to get a copy of the scar solution guide.
Click here: The Scar Solution Review, to read more about this great scar removal product.

Have you recently suffered from a physical or emotional personal injury? Is this personal injury the result of the action of another person? If this is the case, you are entitled to make a claim and to receive compensation according to the seriousness of your case.

Toronto lawyers represent the best option for you, since they will offer your case the proper attention and work it requires. Toronto personal injury lawyers will most likely tell you that the Court in Toronto takes into consideration a variety of factors prior to determining the amount of money that you will receive.

Some of the factors that will determine the amount of money that you will receive are: the age of the injured person; the magnitude of the injury suffered; the period of time which is necessary for the injury to heal; the nature of the treatment that is required to treat the injury; the period of time that the injured person spends in the hospital and the emotional and physical limitations that the injury will cause upon the hurt person. Toronto personal injury lawyers will properly analyze the above-mentioned how to treat a back injury factors and determine the most important factors in your case.

The types of compensation in a personal injury lawsuit are numerous and it is recommendable to figure out which type of compensation you deserve. If you have disfiguring injuries or you have suffered physical mutilation because of an accident, you are entitled to damages for disfigurement. This type of compensation will also cover the mental suffering that you have most probably endured. Toronto lawyers will explain to you that you can receive compensation for various future rehabilitation, that is, if you can prove the necessity and cost. In this case, you need the expert medical opinion of a doctor who can estimate the medical expenses that are necessary four your recovery.

A person is also entitled to compensation if one needs to hire help to provide household services because of the recovery process. Married persons deprived of the benefits of married life such as affection, comfort, and sexual life also have the right to receive compensation. If one’s ability to earn a living has suffered significant diminution or even complete loss due to a personal injury, one can receive compensation. Toronto personal injury lawyers will take into consideration the most important factors such as your age, career, health condition, skills, talents and training.

Toronto lawyers will also offer you advice on your income loss claim, which consist of what you would have earned between when you have suffered the personal injury and when you received a legal settlement of damages. The medical expenses and the medical surveillance that are necessary in order to treat your personal injury also represent a reason for a personal injury claim. If you have suffered from a personal injury, you can receive compensation, which also includes the medical expenses.

Toronto personal injury lawyers will tell you if you have a strong case and they will ask you if you can present evidence for your financial losses. If you are one of the many persons who have suffered from a personal injury, do not hesitate to contact one of the Toronto’s experienced lawyers. It is your right to receive compensation for the loss you have suffered.

In the treatment of migraines, a low level laser is an ideal choice for a chiropractor and naturopathic doctor. The cold laser, when touched on the head, has a pleasant sensation and warmth.

This cold low level laser is used by the chiropractor to quickly get rid of migraines with no harm or invasive procedures to the patient. The pain relief is usually quick and long lasting when using a scalar wave laser. When a chiropractor uses a soft laser on the patients head, the relief is shown to the chiropractor as he or she uses scalar lasers for this treatment.

Why such a treatment with a cold laser? Well the low level lasers are easy to use. The cold low level laser will also use photosynthesis to speed the healing of a cluster headache without using drugs or surgery.

This is an optimal state for using the scalar wave laser as there are no side effects present when using this type of scalar laser for treatment of migraines. In chiropractor office using this soft laser, the patient heals faster and can go back to their daily life, instead of spending days in healing without the assistance of cold lasers.

When a chiropractor uses a cold laser for healing of migraines, he or she is fully assured of the patients complete recovery. In the instances when a chiropractor decides to go only with the traditional methods, this adds healing time that could have been halved by using a cold low level laser.

By using a scalar wave laser, this assures fewer visits to the chiropractor and rapid healing of the patient. Most patients actually prefer the scalar lasers to the more traditional methods of manipulation and heat packs. Soft laser usage is also medically feasible for both doctor and patient.

Using a cold laser in healing has optimal benefits for the patient. When treatment is done with a cold low level laser, the benefits are immediate and long lasting. Scalar wave laser treatments are not new, but due to the advanced healing that they provide, these scalar lasers are more and more in demand.

The training with scalar wave lasers is easy and affordable and can be used immediately for helping patients with migraines get the relief that they are praying for. In fact, healing with a scalar laser is both easy and may be more cost effective instead of the more traditional methods of chiropractors.

When seeing a chiropractor for a migraine, it is helpful to note that the usage of a cold laser speeds up the body's ability to heal. When time is a factor in the healing, the usage of a cold low level laser greatly speeds up the process.

The look of relief on a patient after having treatment with a scalar wave laser is worth the cost. The usage of such scalar wave lasers is becoming much more prevalent in chiropractic offices around the country. The chiropractor thus ensures that their patient heals quickly.

WHAT CONDITIONS ARE TREATED BY A CHIROPRACTOR
AND HOW TO CHOOSE A GOOD ONE

Do you suffer from headaches, joint pain, or sciatica? If so, you may be asking yourself, "Would a Chiropractor help me?" Here is a list of the conditions and symptoms commonly treated by Chiropractors.

CONDITIONS COMMONLY TREATED BY CHIROPRACTORS

Condition Common Symptoms
Headaches Throbbing, dull or sharp pain that persists, restricted neck motion, light sensitivity.

Herniated disk Symptoms differ according to the location of the affected disk but may include lower back pain, pain in one leg, numbness in the back, chest, arm or leg; muscle spasms.

Joint Pain Pain, stiffness, sensation of warmth, swelling, tenderness.

Sciatica Sharp pain that travels from your buttocks to your leg.

Pinched nerve Sharp pain, numbness, tingling sensation, muscle weakness.

Fibromyalgia Widespread pediatric chiropractor pain lasting longer than three months, fatigue in muscles and tendons, a number of tender spots on the body,
morning stiffness, short-term memory loss, headache, insomnia

Scoliosis Spine curves to one side, difference in height of shoulders or hip,
head not centered over torso, teens and adults may have pain.

Carpal Tunnel Tingling or burning, sensation, pain or numbness in fingers, palm of hand, wrist or forearm; finger stiffness in the morning, weak grasp.

If you are suffering from one of these conditions, you may need a Chiropractor. When
selecting a Chiropractor, take the time to find a Doctor of Chiropractic (DC) who:
* Is recommended by your physician, other health care professionals or friends.
* Is licensed to practice chiropractic.
* Has experience treating your specific condition or symptoms.
* Is board certified if you need specialized care in areas such as chiropractic
neurology, chiropractic rehabilitation, chiropractic orthopedics or chiropractic
pediatrics. Board certification indicates that the DC has completed studies and
testing beyond those required to be a Doctor of Chiropractic.
* Is willing to work with your physician as part of your medical team.
* Uses diagnostic tools such as x-rays, ultrasound and paraspinal digital infrared
imaging.
* Offers holistic, preventative care and counsel.
* Will provide an initial consultation free of charge.
* Doesn't claim that chiropractic care will cure an alphabet soup of medical conditions.

Chiropractic care can help alleviate pain, improve joint function, boost mobility, and decrease stiffness. In other words, Chiropractic can do wonders in improving the comfort and quality of your life.

Resources
The American Chiropractic Association www.AcaToday.org
Chiropractic America, LLC www.YourSpine.com

Introduction
 
Bladder injury is very serious complication of lap assisted vaginal hysterectomy
Method of analysis retrospective analysis

Type of operative procedure laparoscopic assisted vaginal hysterectomy laparoscopic assisted vaginal hysterectomy performed using three port sign symptom of bladder injury During surgery balloon like distention of bladder catheter bag with gas or co2 discharge of clear fluid into the operative field haematuria management of bladder injury during surgery cause of bladder injury primary and secondary trocar perforation .hasson technique for open laparoscopy may reduce three type of injury .2nd and 3rd trocar should be inserted under  vision previous surgery increase the risk of in advertent cystostomy by placing the bladder on traction close to umbilicus or because adhesion place it in the path of secondary trocar .in addition previous surgery can result in adhesion formation which obliterator the position of the bladder adhesion can for in the area of cervico-vaginal junction as result of previous cesarean section and extend the attachment of the bladder beyond lower uterine segment .other cause of mechanical injury .sharp scissors or blunt dissection of adhesion or seen near the dame of bladder may be adhesion from previous infection surgery relating to the bowel ,appendix or peritonitis .

Thermal injury

Excessive coagulation may be responsible for thermal bladder necrosis .use of unipolar cautry in proximity to the bladder surface should be avoided. Vesico vaginal fistula can occur following operative laparoscopy .it uterus is detached from bladder using unipolar or bipolar cautry excessive thermal coagulation may be responsible for thermal bladder necrosis .thermal necrosis may be some apparent only in post operative period when a vesico-vaginal fistula occurs –fistula can also occur if bladder is taken up when vagina is sutured  from below .

Diagnosis

Injection of methylene blue via a bladder catheter will conform the diagnosis of vesico-vaginal fistula .I.V. P. Retrograde Cystography should also be done for through revaluation

Presentation of Bladder injury 

To minimize bladder injury in patient with previous cesarean section Tran’s vaginal lateral intervention should be used to enter the anterior cul-de-sac during laparoscopic interfacial hysterectomy lateral window of vesico vaginal space aware opened first. Management of trocar veress needle injury .may be managed with folly catheter for one week with no subsequent complication .injury to bladder during laparoscopy assisted vaginal hysterectomy is small and loaded some distance away from trigone of bladder it can be retired laparoscopically two layer closer with delayed absorbable suture material and check that the bladder is water tight by injection 300 ml of methylene blue via the bladder catheter.

Incident of Bladder Injury 4-7 out of 1000

Sign to recognize bladder injury intraopeartive including following

1.      CO2 catheter bag during insufflations

2.      Bladder appears to be pushed by the accessory trocar as it is advanced through the abdominal well

3.      Blood in Urine

4.      Urine drainage from accessory trocar incision

5.      Post operative urinary retention

6.      Post operative signs of peritonitis

7.      Leakage of Indigo carmine from the injured site

Prevention of Bladder Injury Insert is secondary Trocar under direct vision.

1.      Separate bladder from lower uterine segment by using sharp dissection never dissect the bladder bluntly

2.      Make sure the bladder is not inside the gain of laparoscopic stapling device before firing it.

3.      Avoid excessive electro surgery around the bladder

Treatment

1.      Repair is dependent upon whether injury is thermal or Mechanical

2.      Whether injury is at the base of dome of bladder

3.      Proximity of injury to trigone and ureteric opening

 

 

Treatment

If diagnosed at the time of surgery. Bladder injury at the dome can be repaired in a straight forward manner in two layer C PDS. Is layer should be continuous containing Muscular is Mucosal layers. Instillation of Indigo carmine dye assist identification of bladder boundaries laparoscopic repair of vesico vaginal fistula if presented after surgery is done after about 12 weeks. Vesico-vaginal space was developed both bladder vaginal were closed separately bladder with vicryl vagina with PDS. A peritoneal flash was used to separate vesico vaginal space and sutured with vicryl. Abdominal approach should be used for following indications.

1.      Inadequate exposure because of high or retracted fistula in a narrow vagina.

2.      Proximity of fistula to the ureter

3.      Multiple fistula

4.      Associated pelvic pathology bladder should be empted prior to surgery

New Technique

A new technique for dissecting    the bladder laparoscopically was detected by James Cook University Hospital during laparoscopic assisted vaginal hysterectomy back injury lower in department of minimal access surgery. 130 lavh were reviewed bladder was dissected laparoscopically a metal catheter was used to stretch Identification of bladder edge and a sponge forceps was inserted virginally to mark the site for anterior Colpotomy monopalar scissor were used to open virginal there was one   bladder trauma 0.7% Which was recognized immediately and repaired with laparoscopy intra corporeal knot mean operating time was 198.7 minute recorded mean hospital stay was 2.7 days with range of 2 to 5 days dissection of bladder laparoscopically adds 5 to 10 minutes to operative time but significantly facilited identifying Appropriate plane it is an easy technique to learn and teach it is associated with minimal complication With no increase in incidence of bladder injury or dysfunction injury to bladder with laparoscopy Is rare said et al reported 1.6% incidence of serious urinary complications after major operative? Laparoscopy majority being bladder perforation or fistula there are four case of bladder injury in a series of 900 laparoscopic hysterectomy three of this for woman had under gone 2 or 3 c sections woman under going vaginal  hysterectomy  are more likely to sustain bladder injury if they have had previous c section. In this study these reporting 130 consecutive lavh in which bladder were dissected and ureteric vaginal pouch then opened laparoscopically. This technique was initially designed for woman who had previous c section in whom bladder was adherent and difficult to identify and dissect vaginally technique was later adopted in all cases because it appear ed to be easier and safer then vaginal route this technique was used in 130 lavh performed at james cook hospital technique was used in all patient in the same o t high pressure entry technique 25 mm hg using 3 port in addition to 10 mm umbilical port with 5 mm port inserted under direct vision in right and left iliac fosse later to deep epigastric vessels and are one inserted supra pubically. Bipolar diathermy and scissor were used to secure pedicles down to but not including uterine vessels both round ligaments were secured with bipolar diathermy peritoneum was dissected from one round ligament to other side. A metal catheter was then inserted in the bladder catheter was rotated so the tip was pointed up ward to stretch the bladder pillars bladder was dissected with monopolar scissor with catheter in place. A sponge forceps was then pushed in to vagina in to anterior fornix to stretch the vagina and mark the site for colpotomy monopolar scissor were used to open vagina and use of cutting diathermy and firing just prior to contact with vaginal tissue helped to achieve haemostatic without significant coagulation vagina opened in layers until sponge forceps was reached which was pushed in ward and blade opened widely to stretch the colpotomy procedure was completed vaginally. A Wertheim retractor was placed through to protect bladder uterine vessels were first secured with clamps and secured with vicryl followed by cardinal and utero sacral ligament and intra peritoneal drain as well as urinary catheter until following day result out of 130 patients 12 had C sections mean operative time was 98.7 minute. There was one bladder trauma which was recognized immediately and repair with laparoscopic intra corporeal knots. Cystoscopy was performed to ensure proper bladder repair and to exclude any other injuries. Patients has bladder catheter for 7 days at follow up 6 months post operatively she was well with no residual bladder dysfunction.

Discussion

It is difficult to detect the incidence of bladder injury with laparoscopic surgery in general LAVH specially GILMOUR et al (9) reported that major gynecological surgery the incident of bladder injury varied from 0.2 -19.5/ per one thousand with over all frequency of 2.6 per one thousand based on medlinereach for all reports between 1996 and 1998. The found a higher incidence of bladder injury when routine cystoscopic was perform with range from 0 to 29.2 and over all frequency of 10.4 per one thousand.  Author commented that only 51.6% of bladder injury were identify and managed intraoperatively. Ostrzenski et al (10) reported the overall incidence of bladder injury during laparoscopic procedure to range from 0.022% to 8.3 % of cases. These injuries most frequently occurred during LAVH.  Sharp electro surgical dissection was leading instruments cause in injury. Intra operatively diagnosis of bladder injury was made in 53.24% of all bladder injuries cases with bladder dome being most commonly injured structure. Less than half 29.87% of bladder injuries were corrected laparoscopically. In this series one bladder trauma occurred when catheter was pushed into bladder wall thus perforated through. The injury was identified immediately and successfully repaired laparoscopically with no residual permanent bladder dysfunction. Uses of metal catheter to stretch the bladder help in identify the boundary to bladder and pillars. Which significantly facilitate recognizing where to dissect and release bladder especially in patients with extensive scarring dissection should be carried out until one is satisfied that bladder has been completely freed of the vagina and use of sponge forceps to stretch the vaginal wall clearly Marks the site for colpotomy. Further largest studies are needed to obtain more accurate estimate of bladder trauma. Cystoscopy was not performed routinely unless bladder injury was suspected indigo carmine was injected intravenously a few minute prior to Cystoscopy. Some Author recommend routine use of Cystoscopy with hysterectomy because of high incidence of undetected bladder injury vakili at al (11) recently reported a 4.8% incident of urinary injury during hysterectomy  and therefore concluding that routine Cystoscopy should be considered. Harkki-Siren at al (12) reported complication rate of for per one thousand laparoscopy procedure but a rate of major complication of 10 per one thousand  with operative laparoscopy 19% percent major complication in these serious was ureteric  injury  46% was intestinal injury. They found that 75% of the major complication were associated with LAVH and commentated that many of these may be due to technique as the uterine vessel were coagulated and cut laparoscopically 86% of the time and attempt to secure uterine vessel with diathermy or staples may result in significantly more ureteric injuries (13). In these series no ureteric injury as laparoscopy dissection stopped above uterine vessel and procedure was then completed vaginally. A recent systemic review and Meta analysis of randomized controlled trial of comparing abdominal vaginal and LAVH was published by Johnson at al (14). They reported a significant increase in urinary tract injury for laparoscopic compared with abdominal hysterectomy odd ratio 2.6; 95% therefore no significant difference when comparing laparoscopic versus vaginal or laparoscopic hysterectomy versus LAVH. In this series opted for LAVH visco et al reported 2.6% of LAVH damage to urinary tract occurred among total 2998 cases. Evaluate study published by Ginny et al (17) reported 2.1% bladder injury in laparoscopic hysterectomy compared to 1% in abdominal Hysterectomy. Comparison of laparoscopic and vaginal hysterectomy bladder injury reported were 0.9% and 1.2% respectively. Incidence of bladder injury in gasser series was lower 0.7% due to ease of identify and dissecting bladder.

Conclusion

If one is careful one can easily avoid bladder injury by obeying the above mentioned principals. This Gasser study describe dissection of bladder laparoscopically adds 5-10 minutes to the operating time. Use of metal catheter help to identify bladder margin and by stretching of bladder pillar plane are easily recognized. Use of sponge forceps vaginally clearly m arks the vagina and thus site for colpotomy. It is easy technique to learn and adopt specially in patients with previous c section. Incident of bladder is low main advantage is facilitating bladder dissection when there are significant adhesion. Technique is associated with low incidence of bladder injury.

 

Reference

1)      Schutz K, Possover M, Merker A, Michels W, Schneider A(2002) Prospective randomized comparison of laparoscopic assisted vaginal hysterectomy (LAVH) with abdominal hysterectomy (AH) for the treatment of the uterus weighing >200g. Surg Endosc 16: 121-125.

2)      Stovall T, Elder R, Ling F (1989) Predictors of pelvic adhesions. J Report Med 34: 345-348.

3)      Zapico A, Fuentes P, Grassa A, Arnans F, Otazua J, Cortes-Prieto J (2005) Laparoscopic-assisted vaginal hysterectomy versus abdominal hysterectomy in stages I and II endometrial cancer: operating data, follow-up, and survival, Gynecol Oncol 98: 222-227.

4)      Harkki- Siren P, Kurki T (1997) A nationwide analysis of laparoscopic complications. Obstet Hynecol 89: 108-112

5)      Harkki-Siren P, Sjoberg J, Titinen A (1998) Urinary tract injuries after hysterectomy,  Obstet Gynecol 92: 113-118

6)      Ostrzenski A, Ostrzenska KM (1998) Bladder injury during laparoscopic surgery, Obstet Gynecol Surv 53: 175-180

7)      Rooney CM, Crawford AT, Vassallo BJ, Kleeman SD, Karram MM (2005) is previous cesarean section a risk for incidental cystotomy at the time of hysterectomy? A case-controlled study, Am J Obstet Gynecol 193:2041-2044

8)      Armenakas NA, Pareek G, Fracchia JA (2004) Iatrogenic bladder perforations: Long-term follow-up of 65 patients. J Am Coll Surg 198: 78-82

9)      Matheved P, Valencia P, Cousin C, Mellier G, Dargent D (2001) Operative injuries during vaginal hysterectomy, Europ J Obstet Gynecol Repord Biol 97: 71-75

10)  Berek & novak’s gynecology (2007) Lippincott Williams & Wilkins, Philadelphia, 14th ed, pp. 805-811

11)  Vessy M, Villard-Mackintosh L, McPherson K, Coulter A, Yeates D (1992). The epidemiology of hysterectomy: finding in a large cohort study. Br J Obsted Gynaecol 99: 402-407

12)  Cosson M, Lambaudie E, Boukerrou M, Querleu D, Crepin G (2001) Vaginal, Laparoscopic, or abdominal hysterectomies for benign bisorders: immediate and early postoperative complications. Eur J Obstet Gynecol Reprod Biol 98: 231-236

13)  Sheth SS, Malpani AN (1995) Vaginal hysterectomies following previous cesarean section. Int J Gynecol Obsted 50: 165-169

14)  Hsu WC, Chang WC, Huang SC, Torng Pl, Chang Dy, Sheu BC (2006) Visceral sliding technique is useful for detecting abdominal adhesion and preventing laparoscopic surgical complications. Gynecol Obstet Invest 62: 75-78

15)   Chang WC, Huang SC, Sheu BC, Chen Cl, Torng PL, Hsu WC, Chang DY (2005) Transvaginal hysterectomy or laparoscopically assisted vaginal hysterectomy for nonprolapsed uteri. Obstet  Gynecol 106: 321-326

16)  Chang WC Torng PL, Hunag SC, Sheu BC, Hsu WC, Chen RJ, Chow SN, Chang DY (2005) Laparoscopic-assisted vaginal hysterectomy with uterine artey ligation through retrograde umbilical ligament tracking. J Minim Invasive Gynecol 12: 336-342

17)  Aronson MP, Bose Tm (2002) preoperative bladder injury in pelvic surgery. Clin Obsted Gynecol 45: 428-438

18)  Neumann G, Raswmussen KL, Lauszus FF (2004) Peroperative bladder injury during hysterectomy for benign disorders. Acta Obstet Gynecol Scand 83: 1001-1002

 

 

If you're a back pain sufferer, or have a herniated disc, the best way to get lasting relief is to become an expert on it and your body and you can do that by educating yourself. Get to know about back pain and how it develops, and study the various treatment options that are available to help choose the right one for you.

Stress and anxiety are factors that aren’t commonly thought to be triggers, but they can make the symptoms worse. Stress will affect the body’s ability to regulate itself which can weaken your health by finding and attacking the weakest condition.

A herniated disc is the spine aligning in an unnatural position resulting in pain with a bulging disc occurring. The pain is in the lower back and is felt down herniated disc exercise through the legs and feet usually felt on one side of the body. The pain typically spreads through the buttocks and goes down one of the legs. The pain can also be felt in both legs with feeling numb or weak with some tingling.

When other non-invasive treatments have been exhausted and if severe pain is still present after six weeks or more then surgery is recommended by the doctor. However not all patients should have surgery because it depends on how severe the herniated disc is, and the general health of the patient. Avoiding surgery would be my first choice if there are other non-invasive treatments available.

If the patient is in relatively good health, it would be much better to try non-invasive treatments first such as cervical traction which lifts the pressure off the nerves in the herniated disc area. Sometimes a home traction device can be rented to use in front of your television at home. This option really sounds more desirable than surgery!

Hydrotherapy which involves exercising with no gravity such as exercising in water, is a more fun and gentle way to begin your rehabilitation.

Some other treatments including ultrasound, electrical stimulation, cortisone injections, anti-inflammatory medications, hot and cold packs and/or surgery deliver some relief, but may be only temporary. In order to address the cause of the herniated disc and not just treat the symptoms, the non-invasive procedures have had great results and are really worth a try.

Find Chiropractic Medicine Education in the United States and Canada. When an individual mentions "back pain," many folks automatically think about chiropractic medicine to help alleviate physical problems such as this; and it’s no wonder - today, more and more people are seeking alternative treatment such as chiropractic medicine to help in healing for chronic pain and other health disorders.

Addressing the whole person, and not just symptoms, chiropractic medicine is indeed a holistic and integrative means to achieving whole health and wellbeing. Using special spinal adjustment techniques to free “subluxations” from the spinal column, chiropractic medicine is believed to restore balance to the body to improve physical wellbeing.

Chiropractic medicine, as well as other academic programs in holistic healthcare is quickly becoming a mainstay in the educational industry. Because consumer demand for natural therapies and holistic medicine is on the rise, so is the demand for alternative education in the healing arts.

Students seeking a comprehensive education network chiropractic in chiropractic medicine quickly discover that they must first meet certain educational requirements from an accredited university or college prior to enrollment into any one of several chiropractic medicine programs. In most cases, applicants must first meet pre-chiropractic course requirements equaling to a 4-year degree.

Another fact to consider is that while chiropractic medicine fields can be quite lucrative and personally rewarding, educational and clinical training requirements are very intensive. To successfully become a doctor of chiropractic, students enrolled in a chiropractic medicine education program will learn that this particular course of study is comprised of a minimum of 4,200 credit hours; which can run from 4-7 years, depending on part-time or full-time studies. In addition, chiropractic medicine programs may encompass specialized training in a variety of pathological focuses, such as orthopedics. Furthermore, chiropractic medicine studies don’t end once graduates have acquired licensure status; a matter of fact, it is almost always a state requirement that professional chiropractic practitioners continue their education with yearly continuing education courses to maintain licensure.

As with any potential university or college, it is always wise for prospective students to review chiropractic medicine program curriculum, tuition and prerequisites prior to applying. In a lot of cases, chiropractic medicine courses are eligible for financial aid programs such as the federal Pell grant and other common student loan programs.

If you (or someone you know) are interested in pursuing the chiropractic medicine profession, let career training within fast-growing industries like massage therapy, cosmetology, acupuncture, oriental medicine, Reiki, and others get you started! Explore career school programs near you.

Chiropractic Medicine: Education for a Lifetime
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