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juniperpublishersoa · 4 years ago

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Juniper Publishers| A Novel Approach to Laparoscopic Colonoscopic Polypectomies

Journal of Surgery

JuniperPublishers

Abstract

Introduction: Many benign colorectal polyps cannot be positioned correctly or reached by the endoscope for polypectomy. Accordingly, patients undergo surgical resection of involved bowel. Due to this fact, we have attempted to develop minimally invasive techniques in porcine models to assist with endoscopic polypectomies. The MiniLap is a novel device that deploys a grasping mechanism through a needle-tipped shaft. We used this device for dissection, exposure, retraction, as well as transcolonic insertion to assist in this endeavor.

Methods: Under IACUC approval, using a supine porcine model, two 12mm ports are placed (periumbilical and right lower quadrant) for a camera and instrumentation. Minilaps are inserted to assist with exposing, retracting, and dissecting. Once the area of polypectomy was exposed, the MiniLap was inserted (using the needle tip) transcolonically to present the polyp to the endoscope. After polypectomy, the colotomy was closed with a purse string and instruments were removed.

Results: We were able to simulate endoscopic polypectomies with transcolonic assistance from the MiniLap for polyps that would normally be inaccessible. Intracolonically, the MiniLap can be placed through a loop cautery and used to grasp the polyp. The loop then slides over the device to the base o

Conclusion: In the porcine model, the MiniLap can be used to assist endoscopic removal of difficult to reach polyps. This will hopefully translate into decreased bowel resections, morbidity and hospital stay in human subjects.

Keywords: Benign polyps; Polypectomy

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Background

William Wolff and Hiromi Shinya were among the first to develop and implement endoscopic polypectomies for treatment of colorectal polyps [1]. Several advances have been made throughout the past decade to make this outpatient procedure a safe form of treatment. Endoscopic polypectomy remains the first tier of treatment for colonic polyps [2]. The alternative tier of treatment is surgical resection. Surgical resection carries the burden of hospitalization cost which may be avoided if colonic polyps can be removed endoscopically [3]. Although considered a safe treatment for these polyps, endoscopic polypectomy does increase the potential risk for hemorrhage and perforation of the bowel [3]. Previous studies of endoscopic polypectomies have revealed complication rates ranging from 1 to 9% [3].

Colonic polyps found during colonoscopy are typically biopsied or removed using cold or hot snares. At times it is very difficult to remove these polyps because they may be large or flat, risking bowel perforation in the process. Additionally, access to the polyp may be difficult due to adhesion from previous surgeries or redundancy of the colon and makes removal of the polyp also difficult. Traditionally, these patients would have to undergo a bowel resection to remove the polyp consequentially with many associated complications. Over the last decade, many cases for colon polyps not amendable to colonoscopic removal have been referred for surgical removal. This novel approach deals with the issue head on of unnecessary bowel resection for benign polyps allowing colonoscopies to be performed in the operating room [4].

We can be more aggressive in our polypectomies due to the fact that if perforation occurs we can immediately repair it. If warranted, laparoscopic assistance is used for enhanced colonic visualization, mobilization of the bowel and, if required, take-down of adhesions. This procedure allows access to polyps that we not previously accessible with traditional colonoscopy. This approach also allows the laparoscopic repair of any colotomy made and buttresses any serosal tear preventing unnecessary bowel resections. The MiniLap device can be used to aid in mobilization of the colon without having to add formal ports for traditional graspers (as we currently do), as well as aid in handling the colon itself. The MiniLap device was inserted through the colon wall into the lumen of the colon to grasp the polyp itself.

By doing this we could retract the polyp towards the colonoscope to add in colonoscopic removal. If Colonoscopic removal is not feasible, we used the MiniLap to precisely locate and grasp the polyp for removal by simple colotomy with simple laparoscopic closure, thus also adverting an open bowel resection. A retrospective chart review of our institution revealed 106 patients with a diagnosis of benign polyps by colonoscopy underwent repeat intraoperative colonoscopies with repeat intraoperative colonoscopic polypectomies with laparoscopic assistance between March 2001 and September 2009 [5]. The median age was 65 with 56% male patients. Of these patients, 74 (70%) were successfully treated with colonoscopic polypectomy, 10 of which utilized laparoscopy for mobilization and positioning of the colon.

Of the 32 operative patients (30%), there were 17 colectomies, 7 cecectomies, 5 transanal excisions, 2 low anterior resections, and one colotomy with mass excision. These patients underwent formal resections due to size, inaccessibility or appearance suspicious for malignancy. Upon analysis, we found a significant difference in the length of hospital stay between these two groups (p<0.01). The mean stay for the non-operative group was less than one day (median 0), while the operative group had a mean stay of 5 days (median 4). Complications included 1 perforation during colonoscopy (recognized at the time of operation), 1 patient with continued rectal bleeding after colonoscopy (self-resolving), 2 carcinomas originally diagnosed as benign, 1 anastomotic leak, and 1 perioperative surgical site infection.

Repeating the colonoscopy intraoperatively with laparoscopic assistance appeared to have an overwhelming benefit. Thus, we anticipate an increase in the number of successful treatments through MiniLap. In addition, with the use of the MiniLap we may be able to treat many of the other patients with simple colotomy, polypectomy and simple laparoscopic closure, avoiding an open formal bowel resection and its associated complications and prolonged hospital stay. This project was completed with a total of five milestones. Each milestone was intended to further develop the surgeons’ skill and familiarity with the device. Summary descriptions of each milestone can be found in (Table 1). This purpose of this project was to demonstrate the role of the MiniLap device in laparoscopic assisted colonoscopic polypectomies. We hoped to demonstrate how the device may make more patients eligiblefor colonoscopic polypectomies with improved cosmesis and decreased number of formal laparoscopic ports [6,7].

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Materials and Methods

Under Institutional Animal Care & Use Committee (IACUC) approval this project was carried out in a swine (pig) model. Three days before the planned operation the pig began a bowel prep to provide as much catharsis of fecal material as possible before the proposed procedure. On the day of the procedure, the pig was placed under general anesthesia by trained animal lab staff. The pig was placed in the supine position. A colonoscope was placed per rectum. Laparoscopic ports were inserted in positions deemed appropriate at the time of operation. The MiniLap devices were inserted transabdominally and used for mobilization and dissection of the colon. We also planned to insert the MiniLap devices through the colon wall in order to grasp the lumen of the colon and mimic assistance for a colonoscopic polypectomy. This process was visualized with the colonoscope. We then explored the use of the MiniLap in grasping mucosa through the colon and excising this segment with simple colotomy and laparoscopic closure, with the mucosal segment once again representing a polyp. In this way we hoped to determine if the MiniLap device can feasible be used in humans to prevent formal bowel resections for benign polyps. After the procedure the pig were euthanized in an IACUC approved manner.

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Results

We developed the proper techniques for safely inserting the device into the pig. We discovered that a separate stab incision did not need to be made in order to safely enter the abdominal cavity. We found that separate MiniLaps inserted into the left and right upper quadrants allowed for good triangulation (along with an umbilical camera port) for dissection. We were able to insert the MiniLap through the colon and close the colotomy with a purse string closure during this session as well. During session two, we were able to complete a simulation of a transabdominal, transcolonic polypectomies. We found a novel use for the MiniLap as well. We used multiple MiniLaps inserted into the abdominal cavity as self-retaining retractors after grabbing viscera (such as bladder).

We also found that placing a U-stitch around the area where the colotomy is going to be made provides for additional retraction and allows the colotomy to be closed at the same time that the MiniLap is being removed from the colon (the suture is tightened as the device is removed), minimizing any fecal contamination. We also attempted to close the colotomy with clips/staples, but found this to be more difficult and less successful. Finally, we attempted to find pitfalls with using the MiniLap. We were able (although with some difficulty) to injure the bowel by grabbing too hard with the MiniLap and trapping bowel inside the needle.

We were able to create serosal injuries, but we were not able to make full thickness injuries. We also tried to injure blood vessels within the abdominal wall, but found that the vessels seemed to “roll” out of the way. Through completing session three, we attempted to refine and explore other techniques for a transabdominal, transcolonic polypectomies. In order to only use an umbilical port (similar to single incision surgery) and the MiniLaps, we attempted to place our U stitch and perform a colotomy closure using a straight needle placed through the abdominal wall and tie the knots intracorporeally, This proved very difficult in the narrow porcine abdomen and we caused bowel injury before successfully closing the colotomy. We then changed our plan and placed a port near our umbilical port to simulate a single incision port. We were able to close the colotomy effectively.

During session four, we were able to complete the transabdominal, transcolonic polypectomy through a single incision port. We did this using a 5mm, rigid, 30-degree camera. We found that the procedure was difficult and the colotomy closure was less precise. The colotomy closures did encompass more bowel and appeared to stricture the bowel somewhat externally, but intraluminally (as viewed through the colonoscope) there was minimal narrowing and the scope easily passed through. Although we demonstrated the procedure was feasible through a single incision with assistance from the MiniLap, more refinements were needed (a flexible tipped scope would also be of tremendous help in this procedure).

During the last session, session five, we attempted to use the techniques that we had developed to truly simulate a transabdominal, transcolonic polypectomy. We decided to use a two port technique with an umbilical port and a right lower quadrant port. We used a MiniLap in the low midline to be used as a self-retaining retractor for the bladder. We used right upper and left upper MiniLaps for retraction and exposure, and a infraumbilical MiniLap in the midline for the polypectomy. The exposure was optimal. A U stitch was placed at the area of colotomy. The MiniLap was placed through the colon wall into the lumen. A simulated polypectomy was performed lifting mucosa from behind a fold and presenting it to the colonoscope. The colotomy was closed with the U stitch that had been previously placed. Ensuring the closure was air tight, the instruments were then removed. We wanted this simulation to go as flawlessly aspossible so we performed this with optimal exposure and did not attempt a single incision technique, although we had previously proved that this was feasible.

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Discussion

Each individual milestone set forth at the beginning of the project was successfully completed. During session one, we first inserted the device by making a “puncture” with a scalpel through the skin, followed by inserting the needle-point of the MiniLap through the subcutaneous tissue and fascia into the abdominal cavity without difficulty. However, we also found that we were easily capable of inserting the device without creating the “puncture” with the scalpel. We used the needle tip of the MiniLap to pierce the skin/subcutaneous tissue/fascia. We held the shaft of the device 2-4cm proximal to the needle tip to ensure that the device did not penetrate too deep into the abdominal cavity and injure viscera.

The cosmesis through this technique was much improved. In addition, we attempted to injure superficial blood vessels within the abdominal wall (this is sometimes done inadvertently when placing laparoscopic ports). This was done easily when using the scalpel, however, when using the MiniLap, this was surprisingly difficult. The vessels seem to “roll” and actually puncturing those (causing bleeding) took effort and multiple attempts. Location of insertion was determined after examining the abdomen through a laparoscopic camera in an umbilical port, we decided to place our initial MiniLaps in the right and left upper quadrants. These sites allowed us to retract bowel effectively. An additional MiniLap was eventually placed in the lower quadrant at midline for transcolonic insertion. This location would vary depending on the location of the polyp to be removed. It appeared that these locations were appropriate, although we may try to complete the procedure without either the left or right upper quadrant sites in the future.

The device was then inserted into the bowel. Transcolonic insertion initially proved to be difficult. Simply using insufflation from the endoscope as counter resistance and inserting the MiniLap through the colon wall caused unintended injury. Multiple attempts were made unsuccessfully as the MiniLap would slide from its intended insertion site. This would cause serosal tearing. This problem was solved by grasping the colon just proximal to its intended insertion site with another MiniLap. This provided enough counter resistance for the other MiniLap to be inserted into its intended site. Although we effectively inserted the MiniLap transcolonically, further technique improvements are still needed.

Finally, we closed the colotomy using an endostitch device. We created a purse string closure with a silk stitch. This very effectively closed the colotomy. The closure was air tight (maintained insufflation) and had very minimal narrowing as seen from the endoscope. Although effective, we would like to refine the closure in future sessions. Session one indicated the MiniLap device can be inserted safely with direct insertion into the abdominal cavity. A device inserted into the right and left upper quadrant helps assist in dissection. The MiniLap can be inserted transcolonically for assistance in endoscopic polypectomies. The colotomy made can effectively be closed with a purse string closure.

As we moved forward to session two, mobilizing, dissecting, retracting, and exposing the colon was attempted. In order to expose the colon, small and large bowel must be moved. We found this could be done either by sweeping the bowel with the grasper closed or using the grasper with gentle closure and placing the bowel in the appropriate quadrants. This session’s pig had a persistent urachus which had to be taken done with electrocautery dissection and gentle retraction. This was done easily with the MiniLaps and a single incision umbilical port (the camera and electrocautery were placed through the same port).

The MiniLap was surprisingly very effective as a selfretaining retractor. The abnormally large bladder was grasped with the MiniLap and the extracorporeal disk of the MiniLap was placed flush with the abdominal wall providing retraction. A similar tactic was used with bowel in the right upper quadrant. The area for planned polypectomy was completely exposed at this point. We then used both a preplaced purse string suture and extra MiniLap grasping proximal to provide counter resistance. The MiniLap’s needle point was easily introduced into the colon under endoscopic visualization, at this point we grasped mucosa. We used snare cautery to remove mucosal segments. We found this could be done in one of two ways. The first was to grab nearby mucosa and present the “polyp” to the endoscope.

The second method involved threading the MiniLap through the loop of the snare, then grabbing the tip of the “polyp”, sliding the snare over the MiniLap to the base of the “polyp”. At this point during the project we developed potential improvements which should be explored. We found that placing a U-stitch around the area where the colotomy is going to be made provides for additional retraction and allows the colotomy to be closed at the same time that the MiniLap is being removed from the colon (the suture is tightened as the device is removed), minimizing any fecal contamination. We attempted colotomy closure with staples with one successful attempt and one unsuccessful attempt. It was clear that the U-stitch method was both easier and more effective. There are several potential dangers that were observed during this session. We intentionally attempted to injure bowel with the MiniLap device, which was not easy, but possible.

By taking large bites of bowel/viscera and closing the device, we could cause significant serosal tearing (mainly by taken tissue into the needle-tipped shaft), although we were not able to penetrate the bowel/viscera. We also found that we could grasp part of the mesentery containing the blood supply and cause ischemia. We originally attempted to perform thesuturing through a single incision port with the camera, limiting the procedure to one traditional incision in the umbilicus. This was very difficult and resulted in the suture sawing through the bowel wall and causing a large colotomy. The procedure was then completed after a new port was inserted into the left lower quadrant for the endostitch. We would like to refine our technique and attempt the procedure as a single incision with MiniLap assistance at a future session (likely using a 5mm camera to provide greater space and ease of movement). Session two indicated, endoscopic polypectomy with transabdominal, transcolonic assistance from the MiniLap device is feasible, although techniques need to be further refined.

Session three started with through a 12mm umbilical port, a 12mm right lowers quadrant port as well as inserting the MiniLap devices in the right and left upper quadrants as well as the pelvis for a self-retained bladder retractor. We used a MiniLap in the lower midline for the transabdominal transcolonic insertion, and then inserted a straight needle through the right lower quadrant. We subsequently inserted a U stitch around the area of purposed MiniLap insertion with the straight needle. The straight needle was then advanced back out the abdominal wall just next to the original insertion site. Using the stitch on both sides of the colon, the colon was tented up to allow for precise insertion of the MiniLap through the colon wall. However, the proximal side of the U stitch was placed too superficially and tore, creating a serosal (not complete) tear.

At this point, the MiniLap was still inserted transcolonically and the polypectomy was completed. The straight needle was backed into the abdominal cavity, a deeper bite was made for the proximal stitch, the needle was advanced back out the abdominal wall, the needle was removed, and the colotomy was closed with an intracorporeal knot. We then focused our attention to the use of an endostitch. With the use of the endostitch inserted very proximal to our camera port, we attempted to simulate the colotomy closure that would be performed in a single incision surgery. We were able to close the colotomy relatively easily; using the same techniques we had used during sessions 1&2 (Making the first throw and then the second while removing the MiniLap in an attempt to limit fecal contamination). We have actually used the MiniLap device for a transabdominal transcolonic polypectomy in our first patient.

This patient had a cecal polyp that we could visualize, but could not quite reach with our colonoscope even after full mobilization of the colon laparoscopically. We inserted the MiniLap device transcolonically, grasped nearby mucosa and presented the polyp to the snare of the endoscope. Unfortunately, the polyp had high grade dysplasia at the margins and the patient then underwent an ileocecectomy, but we plan to use the MiniLap in similar situations in the future to prevent the need for formal bowel resections. We also hope to develop more minimally invasive techniques (such as single incision) to assist in this endeavor.

As opposed to previous sessions when we obtained access through a 12mm umbilical port, and 12mm right lower quadrant port, in session four we instead inserted a single incision port in the umbilicus. We still inserted the MiniLap devices in the right and left upper quadrants as well as the pelvis for a selfretained bladder retractor. We also still used a MiniLap in the lower midline for the transabdominal transcolonic insertion. We inserted a 5mm, rigid, 30-degree camera as well as an endostitch through the single incision port. Using the MiniLap for grasping, we then created a U stitch around our area of planned colonic insertion. We did find that it was more difficult to place the stitch with precision, especially with the rigid camera in the way, but after some time, it was performed effectively.

We also did find that more torque was placed of the bowel when trying to place the suture all the way through the colon wall, although no serosal or transmural tears occurred. The polypectomy was performed with the use of the transcolonic MiniLap and the colonoscope without difficulty. The colotomy was once again closed by throwing two knots using the endostitch while removing the MiniLap at the same time to prevent fecal contamination. The excess suture was cut using endoshears and the closure appeared air tight. As mentioned previously, the U stitches placed during this session did not seem as precise as previous sessions due to some compromised mobility. However, the closures were air tight and there was not significant narrowing seen intralumenally. In fact, we repeated this experiment several times in this session, with multiple colotomy closures, and even after all these attempts; we were still able to pass the colonoscope through these areas with relative ease.

We feel that we definitively demonstrated that transabdominal transcolonic polypectomies can be performed with a single incision port and some addition MiniLaps. In the future, we would like to refine this technique with the use of a 5mm flexible tipped camera. During the last session, we attempted to use the techniques that we had developed to truly simulate a transabdominal, transcolonic polypectomy. We decided to use a two port technique with an umbilical port and a right lower quadrant port. We used a MiniLap in the low midline to be used as a self-retaining retractor for the bladder.

We used right upper and left upper MiniLaps for retraction and exposure, and a infraumbilical MiniLap in the midline for the polypectomy. The exposure was optimal. A U stitch was placed at the area of colotomy and the MiniLap was placed through the colon wall into the lumen. A simulated polypectomy was performed lifting mucosa from behind a fold and presenting it to the colonoscope. The colotomy was closed with the U stitch that had been previously placed. We ensured the closure was air tight and removed the instruments. We wanted this simulation to go as flawlessly as possible so we performed this with optimal exposure and did not attempt a single incision technique, although we had previously proved that this was feasible.

We have successfully performed a transabdominal, transcolonic polypectomy with the use of the MiniLap and a colonoscope in one of our patients whose polyp was located behind a fold in the cecum. We plan to continue to use the MiniLap in similar situations to increase the number of patients eligible for colonoscopic polypectomies as well as decrease our procedural time in patients already undergoing colonoscopic polypectomies in the operating room.

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thedivinewaters-blog · 5 years ago

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WHAT DOCTORS, SCIENTISTS AND NUTRITIONISTS SAY ABOUT KANGEN WATER

Dr. Hiromi Shinya

“I have examined more than 300,000 people’s stomachs and intestines for 35 years and realize that our health depends largely on our dietary life. And from my experiences I would like to teach you healthy, dietary habits to help you enjoy your life!

“It is widely recognized in the medical profession that a healthy and clean colon is one of the most important precursors to good health and that the great majority of body ailments and diseases originate in an acidic and dirty colon. Water is essential for your health. Drinking “good water;” especially hard water which has much calcium and magnesium keeps your body at an optimal alkaline pH.

“Kangen Water® is alkaline rich water (ph 8-9), and is considered the very best drinking water because of its incomparable powers of hydration, detoxification, and anti-oxidation.”

~ Dr. Hiromi Shinya, Leading Endocrinologist (see footnote, #1)

Dr. Horst Filtzer

“When I first drank Kangen Water® I experienced something I had never had before, I liked it, I liked it very much. … As I investigated the product, as I investigated the concept of ionized water, as I investigated the concept of alkalization of the body cells, I became more and more convinced that this is a product that is of absolute value to all mankind. That it is a product that should be used in all households if at all possible, because it clearly is superior to any form of water than I ever encountered.

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~ Dr. Horst Filtzer, Vascular Surgeon (see footnote, #2)

Dr. Corinne Allen

“Brain inflammation can occur from many causes including: head injuries, premature birth, lack of oxygen and various infections. The resulting inflammation can provide dysfunction in the body’s ability to detoxify harmful substances. They can also exhibit mitochondria that have low energy output and high free-radical generation. Often those with brain challenges like Autism and Aspergers, drink almost no water each day, only accentuating the problems in brain functioning. In Autistics and others where brain inflammation is high, toxins can more easily cross the blood brain flooding the brain with free radicals. Kangen Water® has been providing my clients with a strong source of antioxidants and improved hydration. In our brain programs we observed that our therapeutic expectations have been significantly exceeded by adding Kangen Water® to the treatment plan.”

~ Dr. Corinne Allen, Nutritionist (see footnote, #3)

Dr. Dave Carpenter

“This [alkalizing] program contains a whole new way of looking at diet and nutrition. When followed, it leads to a healthy, lean, trim body and an enhanced level of wellness, energy, and mental clarity most people have not experienced previously.

“Based on years of research and observation, we have concluded that over acidification of the body is the underlying cause of all disease. Because many people consume a diet primarily comprised of acid forming foods, (i.e. sugars, meat, dairy, yeast breads, coffee, alcohol, starches, etc.) rather than whole plant foods, they are frequently sick and tired.

“In my experience, Kangen Water® supercharges your nutritional program better than anything. Water is the key and this [Enagic® Kangen® Water] is the best water I know of. Anyone who gives it an honest try will experience it in their own health, without question!”

~ Dr. Dave Carpenter, Naturopathic Physician (see footnote, #4)

Dr. Fereydoon Batmanghelidj

“I am a researcher. I have researched dehydration for the past 20 years. When I discovered that the solution to most of the disease conditions of our society is not a moneymaker, I decided to take my information to the public. My research revealed that unintentional dehydration produces stress, chronic pains and many degenerative diseases. Dry mouth is not the only sign of dehydration and waiting to get thirsty is wrong. Medicine has based its understanding that it is solid matter in the body that regulates all functions of the body. I have explained scientifically at the molecular level that it is water that regulates all functions of the body including functions of solid matter. 75% of our bodies are composed of water. The brain is 85% water. It is water that energizes and activates the solid matter. If you don’t take enough water, some functions of the body will suffer. Dehydration produces system disturbances. When I use the word water cure, I am referring to curing dehydration with water.”

~ Dr Fereydoon Batmanghelidj, Medical Doctor, Researcher (see footnote, #5)

Dr. Otto Warburg

Dr. Otto Warburg in his lab at the Max Planck Institute for Cell Physiology in Berlin-Dahlem. 1960s

“All normal cells have an absolute requirement for oxygen, but cancer cells can live without oxygen – a rule without exception.

“Cancerous tissues are acidic, whereas healthy tissues are alkaline.”

~ Dr. Otto Warburg, Chemist, Nobel Prize Winner (see footnote, #6)

Dr. William Howard Hay

“All disease is caused by auto-toxification (self-poisoning) due to acid accumulation in the body.

“Now we depart from health in just the proportion to which we have allowed our alkalies to be dissipated by introduction of acid forming food in too great amount… It may seem strange to say that all disease is the same thing, no matter what its myriad modes of expression, but it is verily so.

“It was said earlier that all we can do for disease is to stop creating this background of acid end-products of digestion and metabolism, and this is true, for if disease comes always and only from this acid collection, then it must be evident to anyone that the cure lies in the discontinuance of this accumulation.

“Pneumonia, erysipelas, typhoid fever, influenza, acute arthritis, colitis, hay fever, all subside when the body is fairly detoxicated and the diet so corrected as to stop this excessive formation of the acid end-products, simply because each was expressing the end-point of tolerance of toxins, and each was the means by which the body sought to unload this unwanted mass.

“If the blood develops a more acidic condition, then these excess acidic wastes have to be deposited somewhere in the body. If this unhealthy process continues year after year, these areas steadily increase in acidity and their cells begin to die. Other cells in the affected area may survive by becoming abnormal, these are called malignant. Malignant cells cannot respond to brain commands. They undergo a cellular division that is out of control. This is the beginning of cancer.”

~ Dr. William Howard Hay, Surgeon, Developer of Hay Diet (see footnote, #7)

Dr. Keiichi Morishita

“Modern medicine… treats these malignant cells as if they were bacteria and viruses, it uses chemotherapy, radiation and surgery to treat cancer. Yet none of these treatments will help very much if the environment of the body continues to remain acidic.

“Drinking water that has a high alkaline pH, because of its de-acidifying effect, will help in preventing cancer. In Asia, alkaline water is regularly served to patients, and is considered a regular part of treatment.”

~ Dr Keiichi Morishita, Director of the Ochanomizu Clinic in Japan and the Head of the International Natural Medicine Association (see footnote, #9)

Dr. Robert C. Atkins

“Just about every condition I can think of, from arthritis to diabetes to cancer, is associated with acidity. It is no coincidence that many of our modern habits such as alcohol consumption, smoking, eating sugar, and stress, all tend to increase acidity. The only parts of our body that are supposed to be acidic are the contents of the stomach, the skin, and perspiration. Virtually everything else is supposed to be at least slightly alkaline.”

~ Dr. Robert C. Atkins, Physician, Cardiologist (see footnote, #9)

Footnotes:

1. Dr. Hiromi Shinya was born in 1935 in Fukuoka. After graduating from Juntendo Univesity, School of Medicine, he was internationally active and made a phenomenal impact as a pioneer in the field of Gastrointestinal Endoscopy. Dr. Hiromi Shinya is a clinical professor of surgery at Albert Einstein College of Medicine at Yeshiva University; head of the endoscopic center at Beth Israel Medical Center in New York, New York; and Vice-chairman of the Japanese Medical Association in the United States. He is also affiliated with both the Maeda Hospital and Hanzoo-mon Gastrointestinal Clinic in Japan. Dr. Shinya pioneered modern colonoscopic techniques, and invented the electrosurgical polypectomy snare now common on colonoscopes, allowing for removal of colon polyps without invasive surgery. He also authored of The Enzyme Factor, the English translation of his book on the relationship between enzymes and health that has sold two million copies in Japan. In his book and even on the cover Dr. Shinya extols the virtues of drinking alkaline ionized water, specifically, Kangen Water® produced only by the Enagic® devices. Dr. Shinya puts all his patients on Kangen Water® as part of his recommended diet.

2. Dr. Horst Filtzer, M.D. a Harvard Medical School graduate cum laude is a Vascular Surgeon. Horst has 35 years of active surgical practice in General and Vascular Surgery at Cambridge City Hospital in capacities as Assistant Director, Department Chairman, and Program Director He is also Director of the Wound Care Center in Western Arizona Regional Medical Center, Bullhead City, AZ.

3. Dr. Corinne Allen is an international researcher and practitioner in natural health and nutrition and has been in practice for more than 30 years. After receiving her doctorate in nutrition, Dr. Allen went on to more training in neurokinesiology and brain-stimulation techniques. She is recognized for her natural and practical approach to health regarding natural and alternative methods of stimulating permanent changes in the brain in dyslexia, ADD, autism, Asperger’s syndrome, learning disabilities, academic and behavioral issues and brain injuries. She runs the Advanced Learning & Development Institute.

4. Dr. Dave Carpenter is a member of the Idaho Association of Naturopathic Physicians. He is currently the President of the International Iridology Practitioners Association (IIPA), has served on the Board of Directors of IIPA since 1996 as Public Relations Director and Vice-President. Dr. Dave Carpenter is a Licensed Acupuncturist, Fellow of the International Academy of Medical Acupuncturists, and an IIPA Certified Comprehensive Iridologist (CCI). He is also a member of the American Naturopathic Medical Association, the Idaho Acupuncture Association, faculty member of the Intermountain Institute of Natural Health, and a graduate of Central States College of Health Sciences as a Naturopathic Medical Doctor, and the Royal Academy of Naturopathy in Australia as a Naturopathic Doctor, a graduate of the International Academy of Medical Acupuncturists. Dr. Carpenter also holds a BS degree in Nutrition.

5. Dr. Fereydoon Batmanghelidj, M.D., an internationally renowned researcher, author and advocate of the natural healing power of water, was born in Iran in 1931. He attended Fettes College in Scotland and was a graduate of St. Mary’s Hospital Medical School of London University, where he studied under Sir Alexander Fleming, who shared the Nobel Prize for the discovery of penicillin. Dr. Batmanghelidj practiced medicine in the United Kingdom before returning to Iran where he played a key role in the development of hospitals and medical centers. His groundbreaking book, Your Body’s Many Cries for Water (1992), has been translated into 15 languages and has sold over a million copies.

6. Otto Heinrich Warburg was born on October 8, 1883, in Freiburg, Baden. His father, the physicist Emil Warburg, was President of the Physikalische Reichsanstalt, Wirklicher Geheimer Oberregierungsrat. Otto studied chemistry under the great Emil Fischer, and gained the degree, Doctor of Chemistry (Berlin), in 1906. He then studied under von Krehl and obtained the degree, Doctor of Medicine (Heidelberg), in 1911. He served in the Prussian Horse Guards during World War I. In 1918 he was appointed Professor at the Kaiser Wilhelm Institute for Biology, Berlin-Dahlem. Since 1931 he is Director of the Kaiser Wilhelm Institute for Cell Physiology, there, a donation of the Rockefeller Foundation to the Kaiser Wilhelm Gesellschaft, founded the previous year. For his discovery of the nature and mode of action of the respiratory enzyme, the Nobel Prize has been awarded to him in 1931. This discovery has opened up new ways in the fields of cellular metabolism and cellular respiration. He has shown, among other things, that cancerous cells can live and develop, even in the absence of oxygen. Otto Warburg is a Foreign Member of the Royal Society, London (1934) and a member of the Academies of Berlin, Halle, Copenhagen, Rome, and India. He has gained l’Ordre pour le Mérite, the Great Cross, and the Star and Shoulder Ribbon of the Bundesrepublik. In 1965 he was made doctor honoris causa at Oxford University. Copyright © The Nobel Foundation.

7. Dr. William Howard Hay graduated from the New York University Medical College in 1891 and spent 16 years in regular medicine, specializing in surgery. He later developed Bright’s Disease, and was unable to cure it using accepted medical methods of the time. This led him to find alternative methods to rid himself of disease. He came up with the concept of food combining (also known as the Dr. Hay diet), the idea that certain foods require an acid pH environment in digestion, and other foods require an alkaline pH environment, and that both cannot take place at the same time, in the same environment. After curing himself through proper diet, he wrote several books, started a sanatorium, and lectured throughout United States and Canada.

8. Dr. Keiichi Morishita is Director of the Ochanomizu Clinic in Japan and the Head of the International Natural Medicine Association. He is also an Honorary Professor, Georgia Tbilisi State Medical University, Professor, Choson University & Graduate School, Korea, Visiting Professor, Shenyang Pharmaceutical University, China and Honorary Director, China Health Care Food Association & Senile-Resistant Association, Honorary Director, Non-Pharmacotherapy Treatment & Research Center, Heilongjiang Province China, and Honorary President, Guangxi Pama Institute of Longevity, China, among many others. He is the author of The Hidden Truth of Cancer 1950 Graduated from the Tokyo Medical University where he majored blood physiology. 1955 Received Ph.D. from Chiba University, the school of Medicine. 1960 Presented a basic theory of Natural Medicine for cancer treatment and longevity (Morishita Theory) 1966 Testified as a member of the academic panel at the hearing on cancer by the special Committee for Advancement of Scientific Technologies of the Japanese House of Representatives. 1970 Established the Natural Medicine Society, the Life Science Association and Ochanomizu Clinic 1977. The effectiveness of Natural Medicine was endorsed by the McGovern Report written by Senator George McGovern of the U.S.A. 1982. The validity of the theory, diet of meat produces cancer; diet of grain/vegetables prevents cancer, presented at the hearing was proven by the National Academy of Science (USA) Recommendation.

9. Dr. Robert C. Atkins, a physician and cardiologist was one of the pioneers of complementary medicine in the United States and one of the most famous, successful and enduring nutrition experts of the last 40 years. He was the founder of The Atkins Center for Complementary Medicine and Atkins Nutritionals, Inc. He also authored more than a dozen health and nutrition books, including Dr. Atkins’ New Diet Revolution, one of the 50 best-selling books of all time, and Atkins for Life, which quickly joined Dr. Atkins’ New Diet Revolution on The New York Times bestseller list.

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300+ TOP LARGE INTESTINE Objective Questions and Answers

LARGE INTESTINE Multiple Choice Questions :-

1. Which answers are true? In contrast to ulcerative colitis, Crohn's disease of the colon: A. Is not associated with increased risk of colon cancer. B. Seldom presents with daily hematochezia. C. Is usually segmental rather than continuous. D. Has a lower incidence of perianal fistulas. E. Never develops toxic megacolon. Answer: BC 2. Which answers are true? Options to consider when operating for Crohn's disease of the large intestine include: A. Colectomy and ileorectostomy. B. Colectomy, closure of the rectal stump, and ileostomy. C. Colectomy and continent ileostomy (Kock pouch). D. Proctocolectomy and ileostomy. E. Proctocolectomy and ileal pouch–anal canal anastomosis. Answer: ABD 3. Crohn's disease: A. Is caused by Mycobacterium paratuberculosis. B. Is more common in Asians than in Jews. C. Tends to occur in families. D. Is less frequent in temperate climates than in tropical ones. E. Is improved by smoking. Answer: C 4. Recurrence after operation for Crohn's disease: A. Occurs after operations for ileal Crohn's but not colonic Crohn's. B. Is usually found just proximal to an enteric anastomosis. C. Rarely requires reoperation. D. Occurs in 1% of patients at risk per year during the first 10 years after the operation. E. Is prevented by maintenance therapy with corticosteroids. Answer: B 5. Excision rather than bypass is preferred for surgical treatment of small intestinal Crohn's because: A. Excision is safer. B. Bypass does not relieve symptoms. C. Excision cures the patient of Crohn's disease but bypass does not. D. Fewer early complications appear with excision. E. The risk of small intestine cancer is reduced. Answer: E 6. Which statements about anorectal Crohn's disease are true? A. It may be the only overt manifestation of Crohn's disease. B. It accompanies large intestine Crohn's more often than small-intestine Crohn's. C. It subsides when associated small intestinal Crohn's is excised. D. It should not be treated operatively. E. It may subside in response to metronidazole, 250 mg. q.i.d. Answer: ABE 7. The most common indication for operation in Crohn's disease of the colon is: A. Obstruction. B. Chronic debility. C. Bleeding. D. Perforation. E. Carcinoma. Answer: B 8. Which of the following statements about surgical anatomy of the colon and rectum is/are correct? A. The cecum has the largest inner diameter of all segments of the colon (13 to 15 cm.). B. The rectosigmoid junction is situated at approximately 15 to 18 cm. from the anus. C. The rectum is entirely an intraperitoneal organ. D. The ileocolic, right colic, and middle colic arteries are branches from the inferior mesenteric artery. E. The arterial arcade created by communicating vessels at 1 to 2 cm. from the mesenteric is called the artery of Drummond. Answer: BE 9. Which of the following statements about surgical procedures on the colon and rectum is/are correct? A. Successful healing of colonic anastomoses depends on the adequacy of the blood supply. B. In excising part of the colon containing cancer, the lymphatics should be avoided by dividing the mesentery close to the wall of the colon. C. Despite complete removal of the colon and rectum, transanal fecal flow can be preserved by means of an ileal pouch–anal anastomosis. D. When a colostomy is created it cannot be reversed. E. Colostomy can be life saving in patients with colonic perforation or obstruction. Answer: ACE 10. Which of the following statements about colon physiology is/are correct? A. Colonic recycling of urea is accomplished by the splitting of urea by bacterial ureases. B. Fermentation by colonic bacteria may rescue malabsorbed carbohydrates. C. The preferred fuel of the colonic epithelium is glucose. D. Absorption by the colonic mucosa is a passive process. E. Insoluble fibers create bulk in the stool. Answer: ABE

LARGE INTESTINE Objective Questions 11. Which of the following statements about colonic motility is/are true? A. Mass contractions involve only the rectum. B. “Antiperistaltic” contractions occur in the descending colon. C. The rectum can accommodate stool by receptive relaxation. D. Stool in the colon is propelled by tonic contractions. E. Defecation involves both sensory and motor pathways. Answer: ADE 12. Which of the following statements about diagnostic studies for the colon and rectum is/are true? A. Acetylcholinesterase staining of rectal biopsies is unreliable for the diagnosis of Hirschsprung's disease. B. Cinedefecography is useful for detecting “hidden” prolapse or rectal intussusception. C. A negative osmotic gap in stool is indicative of secretory diarrhea. D. A colonic transit time study involves serial abdominal x-rays after ingestion of radiopaque markers. E. Carcinoembryonic antigen (CEA) is useful for monitoring patients after resection for colon cancer. Answer: BCDE 13. Which of the following statements about anorectal functional testing is/are true? A. Anorectal manometry is often performed through open-tipped multilumen catheters perfused with fluid. B. Anorectal manometry can differentiate between segmental and global defects of the anal sphincter in patients with incontinence. C. Electromyography can demonstrate persistent contraction of the pubis rectalis muscle during defecation, which is diagnostic of paradoxical pelvic floor contraction. D. Measurement of sensory thresholds may reveal insensitivity in patients with chronic constipation. Answer: ABCD 14. Which of the following statements about the microbiology of the colon is/are true? A. The colon contains no more bacteria than the stomach. B. The predominant bacteria in the colon are aerobic. C. Nearly one third of the dry weight of feces is bacteria. D. Common bacteria in the colon are Bacteroides, Bifidobacterium, and Enterobacterium species. E. The colonic microflora is relatively stable. Answer: CDE 15. Which of the following statements about bowel preparation for colon surgery is/are true? A. Bowel preparation is accomplished by a combination of mechanical cleansing and nonabsorbable antibiotics. B. Three days of clear liquids provides sufficient mechanical cleansing. C. Commercial electrolyte-polyethylene glycol solutions provide mechanical cleansing without inducing electrolyte imbalance. D. Nonabsorbable antibiotics such as neomycin and erythromycin base are administered the day before the operation in three doses. E. Intravenous antibiotics are also administered the day before surgery. Answer: ACD 16. Which of the following patients generally does not require surgical intervention as a consequence of acute diverticulitis? A. A 35-year-old man with no history of diverticulitis. B. A 68-year-old man status 2 weeks post–renal transplantation. C. A 55-year-old woman with hypertension and diabetes mellitus. D. A 50-year-old man with pneumaturia. E. A 46-year-old man with right-sided diverticulitis. Answer: C 17. The test with the highest diagnostic yield for detecting a colovesical fistula is: A. Barium enema. B. Colonoscopy. C. Computed tomography (CT). D. Cystography. E. Cystoscopy. Answer: E 18. Which of the following is not true of diverticular disease: A. It is more common in the United States and Western Europe than in Asia and Africa. B. A low-fiber diet may predispose to development of diverticulosis. C. It involves sigmoid colon in more than 90% of patients. D. Sixty per cent develop diverticulitis sometime during their lifetime. E. It is the most common cause of massive lower gastrointestinal hemorrhage. Answer: D 19. The most common indication for surgery secondary to acute diverticulitis is: A. Abscess. B. Colonic obstruction. C. Colovesical fistula. D. Free perforation. E. Hemorrhage. Answer:A 20. Which of the following is/are true about colorectal polyps? A. Familial juvenile polyposis is associated with an increased incidence of colon cancer. B. Although the propensity for development of malignancy is related to the size of a neoplastic polyp, those with mixed tubulovillous histologic appearance are most likely to develop malignant changes. C. The loss of a single tumor suppressor gene such as p53 is sufficient to lead to the development of malignancy in colorectal neoplastic polyps. D. Endoscopic polypectomy results in a decreased incidence of carcinomas of the colon and rectum. Answer: AD 21. Which of the following statements about familial adenomatous polyposis (FAP) is/are true? A. Inherited in an autosomal-dominant manner, this genetic defect is of variable penetrance, some patients having only a few polyps whereas others develop thousands. B. The phenotypic expression of the disease depends mostly on the genotype. C. Appropriate surgical therapy includes total abdominal colectomy with ileorectal anastomosis and ileoanal pull-through with rectal mucosectomy. D. Panproctocolectomy with ileostomy is not appropriate therapy for this disease. E. Pharmacologic management of this disease may be appropriate in some instances. Answer: C 22. Which of the following statements about the etiology of chronic ulcerative colitis are true? A. Ulcerative colitis is 50% less frequent in nonwhite than in white populations. B. Psychosomatic factors play a major causative role in the development of ulcerative colitis. C. Cytokines are integrally involved in the pathogenesis of ulcerative colitis. D. Ulcerative colitis has been identified with a greater frequency in family members of patients with confirmed inflammatory bowel disease. E. Ulcerative colitis is two to four times more common in Jewish than in non-Jewish populations. Answer: ACDE 23. Surgical alternatives for the treatment of ulcerative colitis include all of the following except: A. Colectomy with ileal pouch–anal anastomosis. B. Left colectomy with colorectal anastomosis. C. Proctocolectomy with Brooke ileostomy or continent ileostomy. D. Subtotal colectomy with ileostomy and Hartmann closure of the rectum. Answer: B 24. The initial management of toxic ulcerative colitis should include: A. Broad-spectrum antibiotics. B. 6-Mercaptopurine. C. Intravenous fluid and electrolyte resuscitation. D. Opioid antidiarrheals. E. Colonoscopic decompression. Answer: AC 25. Which finding(s) suggest(s) the diagnosis of chronic ulcerative colitis as opposed to Crohn's colitis? A. Endoscopic evidence of backwash ileitis. B. Granulomas on biopsy. C. Anal fistula. D. Rectal sparing. E. Cobblestone appearance on barium enema. Answer: A 26. An 80-year-old man who has been bedridden for many years following a stroke presents with acute onset of abdominal distention, obstipation, and colicky abdominal pain. Abdominal x-rays reveal dilated loops of small bowel and a dilated sigmoid colon resembling a bent inner tube. Examination reveals distention with mild direct tenderness but no rigidity or rebound tenderness. Initial management should consist of: A. Barium enema examination. B. Laparotomy with resection of descending colon and descending colostomy. C. Multiple cleansing enemas to remove impacted feces. D. Rigid sigmoidoscopy and decompression of the sigmoid colon. Answer: D 27. Axial twisting of the right colon or cecal volvulus has been shown to be associated with each of the following except: A. A history of abdominal operation. B. A mobile cecum. C. An obstructing lesion in the transverse or left colon. D. Inflammatory bowel disease. Answer: D 28. Sigmoid volvulus has been associated with each of the following except: A. Chronic constipation and laxative abuse. B. Chronic rectal proplapse. C. Chronic traumatic paralysis. D. Medical management of Parkinson's disease. Answer: B 29. Which of the following statements is not true about inhereted susceptibility to colon cancer? A. There is no known genetic susceptibility to colon cancer. B. There are known genetic susceptibilities to colon cancer, but they are always associated with multiple adenomatous polyps. C. There are known genetic susceptibilities to colon cancer, but they are always associated with specific ethnic or racial groups. D. None of the above. Answer: D 30. Which of the following recommendations for adjuvant chemotherapy of colorectal carcinoma are true? A. Patients with Stage I or Dukes A and B1 disease should receive adjuvant treatment for 1 year with levamisole combined with 5-FU. B. Patients with Stage III or Dukes C disease should receive adjuvant treatment for 1 year with levamisole combined with 5-FU. C. There is no role for adjuvant therapy for colon cancer at any stage. D. Adjuvant chemotherapy is active in colon cancer only when combined with radiotherapy. Answer: B 31. Optimal front-line treatment of squamous cell carcinoma of the rectum includes: A. Abdominal perineal resection. B. Low anterior resection when technically feasible. C. Radiation therapy. D. Chemotherapy. E. Combined radiation and chemotherapy. Answer: E 32. Which of the following statement(s) is/are true about the maintenance of continence? A. It depends on both the internal and external sphincters as well as the puborectalis. B. Resting pressure offers a high-pressure zone that increases resistance to the passage of stools. C. Maximal squeeze pressure can last no more than 1 minute. Answer: ABC 33. Which of the following statement(s) about complete rectal prolapse, or procidentia is/are true? A. Rectal prolapse results from intussusception of the rectum and rectosigmoid. B. The disorder is more common in men than in women. C. Continence nearly always is recovered after correction of the prolapse. D. All of the above are true. Answer: A 34. Which of the following statements about hemorrhoids is/are not true? A. Hemorrhoids are specialized “cushions” present in everyone that aid continence. B. External hemorrhoids are covered by skin whereas internal hemorrhoids are covered by mucosa. C. Pain is often associated with uncomplicated hemorrhoids. D. Hemorrhoidectomy is reserved for third- and fourth-degree hemorrhoids. Answer: C 35. The widely accepted treatment of most localized epidermoid, cloacogenic, or transitional cell carcinoma of the anal canal is: A. Surgical resection. B. Chemotherapy alone. C. Radiotherapy alone. D. Combined chemoradiation. Answer: D 36. Which statement(s) is/are true about hidradenitis suppurativa? A. It is a disease of the apocrine sweat glands. B. It causes multiple perianal and perineal sinuses that drain watery pus. C. The sinuses do not communicate with the dentate line. D. The treatment is surgical. E. All of the above. Answer: E 37. Which of the following statements regarding the vasculature of the colon and rectum is/are correct? a. The middle colic artery is a branch of the superior mesenteric artery b. The inferior mesenteric artery supplies the descending and sigmoid segments of the colon c. An complete anastomotic arcade paralleling the colon wall is present in only 15 to 205 of individuals d. The middle colic artery is a branch of the inferior mesenteric artery Answer: a, b, c 38. Which of the following agents have been proposed as sensory neurotransmitters for the colon? a. Acetylcholine b. Substance P c. Calcitonin gene-related peptide d. Bradykinin e. Somatostatin Answer: b, c 39. How much of the daily insensible water loss is due to loss in stool? a. 200 ml b. 400 ml c. 600 ml d. 800 ml e. 1000 ml Answer: a 40. A 52-year-old woman is involved in an automobile accident and sustains an open fracture of the fight femur, compression fractures of the 10th and 11th thoracic vertebrae and right pulmonary contusion. On the fourth day after injury, her abdomen is noted to be distended, tympanitic and diffusely tender. Abdominal radiographs reveal gaseous distension of the ascending and transverse segments of the colon. The cecum is 13 cm in greatest diameter. Appropriate management includes which of the following as the next step? a. Right hemicolectomy b. Operative cecostomy c. Colonoscopy d. Contrast enema e. Observation Answer: c LARGE INTESTINE Interview Objective type Questions with Answers 41. Which of the following features is/are consistent with a diagnosis of colonic inertia? a. Alternating episodes of severe constipation and normal bowel activity b. Total bowel transit time of 24 hours c. Total bowel transit time of 48 hours d. Total bowel transit time of 96 hours e. Marfinoid habitus Answer: d 42. Which of the following statements regarding the myenteric plexus of the colon is/are correct? a. The myenteric plexus is located between the longitudinal and circular layers of the bowel wall b. The myenteric plexus contains only sensory neurons c. The density of neurons with the colonic plexuses decreases along the length of the bowel d. Neurons of the myenteric plexus control the motor function of the colon Answer: a, c, d 43. Which of the following ocular manifestations of ulcerative colitis respond to therapy with steroids or immunosuppressive agents? a. Iridis b. Uveitis c. Retrobulbar neuritis d. Ulcerative panophthalmitis Answer: a, b, c 44. Which of the following statements regarding the risk of cancer in the context of ulcerative colitis is/are correct? a. After 10 years of active disease, the risk of cancer approximates 20% to 30% b. After 10 years of active disease, the risk of cancer approximates 2% to 3% c. The risk of colon cancer in ulcerative colitis is identical to controls d. After 20 years of disease activity, the risk of colon cancer approximates 80% Answer: b 45. Which of the following features would be more consistent with Crohn’s disease than with ulcerative colitis? a. Transmural inflammation b. Microscopic evidence of granulomas within mucosal biopsies c. Microscopic evidence of submucosal thickening and fibrosis d. Microscopic evidence of submucosal inflammation Answer: a, b, c, d 46. A 19-year-old male is seen in consultation with complaints of bloody diarrhea (10 bowel movements per day), and weight loss (10 pounds). Physical examination reveals the presence of two circular, 4 cm erythematous lesions on the trunk. Each lesion has an area of necrosis in the center. The abdominal examination reveals mild hypogastric tenderness. The stool is guaiac positive. The most appropriate next diagnostic step includes which of the following? a. Barium enema b. Flexible sigmoidoscopy c. Liver biopsy d. Chest x-ray Answer: b 47. Which of the following statement(s) regarding ulcerative colitis is/are correct? a. The most common age of onset for ulcerative colitis is in early adulthood b. Approximately 25% of cases of ulcerative colitis occur after the age of 60 c. Males are affected approximately twice as frequently as females d. Approximately 10% to 25% of patients with ulcerative colitis have first degree relatives with the disease Answer: a, d 48. Many patients with ulcerative colitis are operated upon electively with total abdominal colectomy, rectal mucosectomy, formation of a small intestinal reservoir, and ileoanal anastomosis. The most common postoperative complication after this operation is which of the following? a. Enterocutaneous fistula b. Small bowel obstruction c. Pulmonary embolism d. Urinary retention Answer: b 49. A 25-year-old woman with known ulcerative colitis presents to the emergency room with a 24-hour history of abdominal pain, distention, and obstipation. Physical examination reveals a temperature of 38.6° C, abdominal distention, and diffuse abdominal tenderness. Abdominal x-rays show marked colonic dilatation, most pronounced in the transverse colon. Laboratory examination reveals a white blood count of 19,000/mm3. Over the first 24 hours of hospitalization, symptoms are progressive in spite of intravenous fluid resuscitation, nasogastric suctioning, and intravenous antibiotics. The most appropriate management for this patient would include which of the following? a. Decompressive colonoscopy b. Proctocolectomy with formation of end ileostomy c. Total abdominal colectomy with formation of Hartmann pouch and end ileostomy d. Cecostomy Answer: c 50. The most common postoperative complication after formation of a continent ileostomy (Kock pouch) is which of the following? a. Nipple valve failure b. Small bowel obstruction c. Pancreatitis d. Ischemic necrosis of the pouch Answer: a 51. One year following ileal pouch-anal anastomosis, the mean 24-hour stool frequency is which of the following? a. Two to three b. Five to six c. Eight to nine d. Eleven to twelve Answer: b 52. A 30-year-old male two years postoperative after total abdominal colectomy with ileoanal anastomosis reports a sudden increase in stool frequency, nocturnal leakage, and low-grade fevers. Physical examination is unremarkable. Flexible endoscopic examination of the small intestinal pouch reveals a friable erythematous mucosa. Biopsies of the mucosa are obtained. While awaiting biopsy results, which of the following is the most appropriate empiric therapy? a. Oral corticosteroids b. Oral vancomycin c. Oral metronidazole d. Corticosteroid enema Answer: c 53. A 72-year-old man returns to the hospital 2 weeks following right hip arthroplasty with complaints of 48 hours of mucoid diarrhea, fever, and crampy abdominal pain. Physical examination reveals dehydration, diffuse abdominal tenderness, and a temperature of 102°F. Outpatient medications have included digoxin, propranolol, and cephalothin. If antibiotic-associated colitis is suspected, which of the following is/are appropriate diagnostic tests? a. Fecal leukocyte smear b. Stool culture for C difficile c. Measurement of C difficile toxin in stool d. Barium enema e. Computed topography of abdomen Answer: a, b, c 54. For the patient in the preceding question, after obtaining diagnostic samples, the most appropriate management would include which of the following? a. Oral metronidazole b. Intravenous metronidazole c. Oral vancomycin d. Intravenous vancomycin e. Oral bacitracin Answer: c 55. A 72-year-old woman undergoes anterior resection for a rectal cancer located 7 cm proximal to the anal verge. Pathologic examination of the resected specimen reveals invasion of the tumor into the muscularis propria. Five of 8 lymph nodes contain microscopic tumor. There is no evidence of disseminated disease. Appropriate subsequent management includes which of the following? a. Postoperative radiation plus intravenous 5FU b. Postoperative radiation alone c. Observation d. Postoperative radiation plus intravenous adriamycin Answer: a 56. Which of the following are tumor suppressor genes that have been associated with the development of colorectal cancer? a. The DCC gene b. The APC gene c. The P53 gene d. The Rb gene Answer: a, b, c 57. Which of the following statement(s) is/are correct with regard to the use of carcinoembryonic antigen (CEA) determinations in management of colorectal cancer? a. CEA determination has 95% specificity when used for screening for colon cancer development in patients with ulcerative colitis b. CEA levels are increased in 20% of patients with local recurrence after resectional therapy c. CEA measurements are increased in 90% of patients with disseminated disease d. CEA levels are increased in 90% of patients with local recurrence after resectional therapy Answer: b, c 58. The most common oncogene abnormality observed in association with colorectal cancer is which of the following? a. Overexpression of the N-myc oncogene b. Amplification of the K-ras oncogene c. Suppression of the erbB oncogene d. Amplification of the L-myc oncogene Answer: b 59. Which of the following types of colonic polyps is associated with the highest incidence of malignant degeneration? a. Tubular adenoma b. Tubulovillous adenoma c. Villous adenoma d. Hamartomatous polyp Answer: c 60. A 52-year-old man undergoes a right hemicolectomy for a carcinoma of the ascending colon. Pathological examination of the resected specimen reveals invasion of the tumor to the level of the muscularis propria. Three of 17 lymph nodes contain microscopic tumor. What is the correct Dukes classification (Aster-Coller modification) and associated 5-year survival for this lesion? a. Dukes C2, 45% 5-year survival b. Dukes B1, 75% 5-year survival c. Dukes C1, 45% 5-year survival d. Dukes B3, 65% 5-year survival Answer: c 61. An pedunculated polyp, discovered incidentally at colonoscopy, is removed by snare polypectomy from the ascending colon. Invasive cancer to the level of the submucosa is identified histologically within the polyp. The lesion is well-differentiated. No lymphatic or vascular invasion is noted. The cauterized margin is negative for neoplasm. Appropriate subsequent management includes which of the following? a. Repeat endoscopy at 6 months b. Right hemicolectomy c. Subtotal colectomy d. Repeat endoscopy with fulguration of the polypectomy site Answer: a 62. Dietary risk factors thought to play a causative role in development of colorectal cancer include which of the following? a. High fat intake b. Low fiber intake c. High smoked food intake d. High vegetable intake Answer: a, b 63. Which of the following statements with regard to resection of rectal cancers is/are true? a. A distal margin of 5 cm should be obtained because 42% of patients have microscopic evidence of intramural spread beyond 3 cm from the palpable tumor b. A distal margin of 3 cm should be obtained because only 3% of patients have microscopic evidence of intramural spread beyond 2 cm from the palpable tumor c. Local recurrence rates correlate strongly with distal margins less than 4 cm d. There is no correlation between local recurrence and distal margins beyond 2 cm Answer: b, d 64. A 58-year-old male undergoes resection of a Dukes C2 colon cancer via right hemicolectomy. Three years postoperatively, rising CEA levels prompt evaluation including abdominal computed tomography. Two lesions, each measuring 2 cm, are noted in the right hepatic lobe. No other abnormalities are noted. A right hepatic lobectomy is performed without complication. Which of the following most closely approximates anticipated 5-year survival? a. 85–90% b. 65–70% c. 45–50% d. 25–30% Answer: d 65. An asymptomatic 52-year-old man is undergoing screening sigmoidoscopy. In the rectum, at 6 cm from the anal verge, a 2 cm yellow, submucosal nodule is noted. Deep endoscopic biopsies are consistent with carcinoid. Appropriate management includes which of the following? a. Observation b. Transanal excision c. Low anterior resection d. Abdominoperineal resection Answer: b 66. A 72-year-old woman complains of anal itching and burning. Physical examination reveals an erythematous, scaly lesion, 3 cm in circumference, within the anal canal. The intersphincteric groove can not be appreciated in the area of the lesion. The remainder of the physical examination is normal. Appropriate initial management includes which of the following? a. Acyclovir 200 mg QID for 10 days b. Hydrocortisone cream 0.1% topically for 14 days c. Incisional biopsy d. Metronidazole 250 mg PO QID for 14 days Answer: c 67. For the patient in the preceding question, biopsy revealed an invasive apocrine gland neoplasm. The deep margins included striated muscle infiltrated by neoplastic cells. Appropriate management includes which of the following? a. Primary radiation b. Abdominoperineal resection with bilateral inguinal lymph node dissection c. Abdominoperineal resection only d. Carbon dioxide laser fulguration Answer: c 68. A 43-year-old woman presents with complaints of anal pain and spotting of blood with defecation. Physical examination reveals a 2 3 cm area of ulceration within the anal canal. The remainder of the physical examination is normal. Incisional biopsy is positive for squamous cell carcinoma. Appropriate management includes which of the following? a. Abdominoperineal resection b. Wide local excision, skin grafting, proximal diverting colostomy c. Primary radiation therapy d. Local excision and primary closure Answer: c 69. Recurrent episodes of sigmoid colonic diverticulitis prompt operative therapy. Which of the following describe the appropriate margins for resection? a. Proximal margin, splenic flexure; distal margin, rectosigmoid junction b. Proximal margin, descending colon; distal margin, rectosigmoid junction c. Proximal margin, descending colon; distal margin, mid-rectum d. Proximal margin, transverse colon; distal margin, mid-rectum Answer: b 70. An elderly man presents with complaints that he is passing gas with urination. The past medical history is positive for one episode of diverticulitis, treated medically, transurethral resection of the prostate for benign prostatic hypertrophy, and diabetes. Which of the following diagnostic tests is most appropriate initially? a. Computed tomography of the abdomen and pelvis b. Cystoscopy c. Barium enema d. Intravenous pyelography Answer: a 71. For the patient in the preceding question, a colovesical fistula originating from the sigmoid colon is demonstrated. Colonoscopy reveals diverticula and excludes carcinoma. During laparotomy, a thickened sigmoid colon is found to be adherent to the dome of the bladder. A definite fistula is not observed. Appropriate operative management includes which of the following? a. Sigmoid resection, primary colonic anastomosis, catheter drainage of bladder b. En-bloc resection of sigmoid colon and adjacent bladder wall, primary colonic anastomosis, suprapubic cystostomy c. En-bloc resection of sigmoid colon and adjacent bladder wall, formation of descending colostomy and Hartmann’s pouch, suprapubic cystostomy d. Sigmoid resection, primary colonic anastomosis, bilateral percutaneous nephrostomies Answer: a 72. A 65-year-old woman develops obstipation, lower abdominal pain, and fever. Physical examination reveals a temperature of 38.5°C, left lower quadrant tenderness, and an ill-defined lower abdominal mass. White blood count is 17,500 per mm3. Intravenous hydration, broad spectrum antibiotics, and analgesics are ordered. After 48 hours, symptoms have not improved. Appropriate management includes which of the following? a. Barium enema b. Computed tomography of the abdomen c. Immediate laparotomy d. Intravenous pyelogram Answer: b 73. Which of the following statement(s) relating to anal sphincteric function is/are correct? a. When the rectum is distended, the internal anal sphincter relaxes and the external anal sphincter contracts b. When the rectum is distended, the internal anal sphincter contracts and the external anal sphincter relaxes c. The external anal sphincter is responsible for resting anal pressure d. The internal anal sphincter is responsible for resting anal pressure Answer: a, d 74. The most common complication after hemorrhoidectomy is which of the following? a. Urinary retention b. Rectal bleeding c. Incontinence d. Wound infection Answer: a 75. Appropriate treatment of chlamydial proctitis includes which of the following? a. Tetracycline 500 mg QID b. Metronidazole 250 mg QID c. Acyclovir 200 mg QID d. Erythromycin 500 mg QID Answer: a, d 76. A 65-year-old man presents with complaints of mucous discharge and perianal discomfort. Physical examination reveals a fistulous opening lateral to the anus. Anoscopic examination permits passage of a probe through the fistula tract. The fistula traverses the internal anal sphincter, the intersphincteric plane, and a portion of the external anal sphincter. The fistula is categorized as which type? a. Intersphincteric b. Transsphincteric c. Suprasphincteric d. Extrasphincteric Answer: b 77. For the patient in the preceding question, appropriate management includes which of the following? a. Division of the tissues over the probe with electrocautery, leaving the wound open to heal by secondary intention b. Division of the tissues over the probe with electrocautery, closing the wound using a pedicled skin flap c. Division of the internal anal sphincter using electrocautery, encircling the external sphincter with a seton d. Proximal diverting colostomy and antibiotics Answer: c LARGE INTESTINE Questions and Answers pdf Download Read the full article

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vocabmeme · 5 years ago

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New Post has been published on http://dailyvocab.com/photos/snare/

Snare

(noun) a trap for catching birds or mammals, typically one having a noose of wire or cord.

(noun) a thing likely to lure or tempt someone into harm or error. “seducers laid their snares for innocent provincials”

(noun) a length of wire, gut, or hide stretched across a drumhead to produce a rattling sound.

(noun) a wire loop for severing polyps or other growths.

(verb) catch (a bird or mammal) in a snare. “the foxes were humanely snared”

(verb) catch or trap (someone). “five blackmailers were snared in a police sting”

Snare meaning in Hindi (English to Hindi meaning)

जाल, फँसाना, फंदा, फंदे में फाँसाना, स्नेयरअ, जाल में नीचे बिछी धातु की छड़, प्रलोभन का जाल, जाल में फसाना

Snare origin

late Old English sneare, from Old Norse snara . snare (sense 2 of the noun) is probably from Middle Low German, Middle Dutch snare ‘harp string’.

Snare in a sentence (word usage in recent Hindu newspaper)

India’s killer wire snares, 22 tigers and 109 leopards choked to death in India due to wire snares between 2010 and 2018. Wildlife Protection Society of India has …

Polypectomy Snare Industry 2019 Ongoing Trends and Recent …, HNY Research projects that the Polypectomy Snare market size will grow from USD XX … 1.2.2 Cold snare polypectomy … 2.2.6 India Market

Poachers’ snares kill 36 big cats across India in 2019 … In March, a wildlife photographer snapped a tiger with a snare wound on its neck.

Wire Snares: The Silent Stranglers, However, a database by Wildlife Protection Society of India (WPSI), working … “Anti-snare walks is the best preventive measure to monitor and …

Leopard caught in snare rescued near Wayanad, KOZHIKODE: A leopard, which got stuck in a wire snare inside a tea plantation at Arapetta near Meppadi in Wayanad, was rescued by forest ..

Mnemonic trick to remember the meaning of Snare

No AIR = trapped

Snare pronunciation

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meulcerativecolitisandibd · 7 years ago

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Overdue updates

Some long overdue updates regarding current flareup of ulcerative colitis. I went to hospital on 18th July, and finally got to see my proper specialist. We agreed on the following points:

I’m now at the point where I’m simply buying time with medication. I will never be able to keep this in remission indefinitely, and surgery is inevitable.

Humira registers in my blood tests as operating at its optimum level, but I’m still flaring up. That means it’s not working, so a medication switch is in order.

If I want to sack medication off completely now, and just have surgery instead, I can.

If I do make a switch, it will be to vedolizumab as previously discussed, but this biologic only has a 40% chance of working.

We decided the next step would be to have a colonoscopy to see exactly what’s going on, and then meet again in September to make the next decision.

I had the colonoscopy on 28th July. It showed:

Active ulcerative colitis in the sigmoid colon. That’s the bit coloured blue below.

Evidence of old active ulcerative colitis in the rest of the colon.

Multiple polyps also in the sigmoid colon.

Granulation. This is when you’ve had an area ulcerate, and scab over, but then your poo pulls off the scab as it’s traveling past.

The specialist took 12 biopsies, and removed a few polyps (neither he nor I can remember how many – there were lots.) I have no idea whether these were cancerous or not. I haven’t had any further info. I imagine if there was an immediate problem with either the polypectomies or the biopsies, they’d have gotten back in touch. The specialist advised not to have surgery at this point, and I think he’s right. So I think the choice for now will be to switch to vedolizumab and see what happens. It will take a while to work, and if it fails, I’ll probably be looking at having surgery after Christmas. I can’t go back to humira if vedolizumab fails, so I feel like I’m playing Russian Roulette in The Deer Hunter again.

It’s been a bit of a pain recently, because the doctors keep suggesting things that I vetoed a long time ago. I’ve gotten my point across regarding oral prednisolone, by saying, “There is no way I want that, and if you prescribe it, I simply won’t take it.” I find that my aces in the hole – osteoporosis and cervical cancer – shut anyone up who tries to argue. It’s a bit Twin Peaks though. You know if you’re watching an episode, and you get shown the same thing over and over or v e r y s l o w l y ? Well, it kind of feels like that. We’ve had this conversation before. We’ve talked about this medication before. That medication doesn’t work for me, I’ve tried it. I know who killed Laura Palmer. And so on. There’s been talk about infliximab, which I’ve never had, but wanted to try ages ago when they refused to *take me off azathioprine. I’ve kind of bypassed that, since humira is stronger and has a greater success rate. Therefore, there’s no point trying infliximab now. They seem to be coming around to understanding that. At first, I find each specialist I see here is treating me like an average case, but then, as they get further through my notes, their faces change to horror masks, and it’s all, “Oh my god what have you been through?!?” By the end, I’m usually allowed to call the shots. Thanks, cancer.

The plan of action is now a simple one:

See the specialist on 12th September.

Switch to vedolizumab.

If vedolizumab fails, have surgery in January.

*I finally got taken off azathioprine because I put together a presentation, complete with graphs and charts, and was accompanied by a work colleague to the medical appointment at which I delivered said presentation that detailed how much time I’d had to take off work, how badly the disease was affecting me, and how ineffective azathioprine was. Never underestimate the power of stats and admin, kids.

#ulcerative colitis #ibd

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shanujey82-blog · 6 years ago

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High-Risk Pregnancy | Best Prenatal Hospitals in India | ElaWoman

What Is a High-Risk Pregnancy?

But surely, a being pregnant is a high threat if there’s an above average chance of headaches, both for mother or baby, because of conditions that have an effect on fitness all through pregnancy, delivery or even after the child is born. Very few of these conditions are sincerely life-threatening. In fact, medical doctors might also label a being pregnant as high risk for fantastically minor troubles, and there’s a blurred line between what defines a low-threat pregnancy and a Risk of pregnancy. “There isn’t some point in which a patient magically transitions from every day to an excessive-threat being pregnant,” Larkin says.

It’s additionally feasible for Risk to differ in the course of being pregnant, says Ozhan Turan, MD, director of the fetal Treatment and complicated obstetrical surgical treatment at the University of Maryland Medical Center. For instance, women over 35 are robotically placed inside the high-risk class due to the fact they have a higher danger of giving a start to a child with a genetic disorder, like Down syndrome. But if fetal checking out consequences (together with from an amniocentesis) show that the baby has no abnormalities, that mother’s status would be adjusted to everyday Risk.

What does a High-Risk Pregnancy mean for You and Baby?

For many women with an High-risk pregnancy, the primary distinction is you’ll be placed below a greater microscope at the same time as looking ahead to. In addition to habitual prenatal visits and assessments, your health practitioner will possibly advise extra and more frequent checking out. If you have got hypertension, you could need to see your health practitioner frequently for blood pressure readings, as an instance. Yes, meaning a to-do listing packed with visits to the doctor’s workplace or health facility, however, the extra appointments shouldn’t be overlooked.

Baby may also be monitored intently, for the reason that high-threat pregnancies can set the fetus up for headaches which includes a low or high delivery weight, beginning defects and—in uncommon cases—the risk of demise before or after shipping. “If there's any difficulty that a circumstance may High-risk pregnancy, we really increase the amount of surveillance of toddler’s well-being,” Larkin says. One of the greater common exams is a nonstress check, which monitors the infant’s coronary heart price to ensure sufficient oxygen is being introduced to the mind.

If your ordinary obstetrician isn’t able to manage the being pregnant, you will be referred to an excessive-chance pregnancy physician, together with a maternal-fetal medicinal drug doctor. (They have an extra three years of education and concentrate on treating being pregnant headaches—you’ll be incorrect palms.) It’s also important to observe that a high-chance being pregnant may want to force you to tweak your birth plan—specially if you had been hoping to offer start at home or in a birthing middle. With extra complicated pregnancies, it’s frequently most secure to deliver in a sanatorium putting with a medical crew at the ready to step in if something does cross wrong.

Best Prenatal Hospitals in India

Find Best Prenatal Hospitals in India. Get the first appointment FREE, check Reviews, IVF, Surrogacy Cost, IVF Success rate, Fees, Address for all Fertility treatments

Doctor Today IVF and Multispeciality Hospital

Doctor Today IVF and Multispeciality Hospital are a main IVF and Fertility Center positioned at Railway Road, Faridabad. The services supplied by means of the Best Prenatal Hospitals in India are Microsurgical Epididymal Sperm Aspiration (MESA), Testicular Sperm Aspiration (TESA), Percutaneous Sperm Aspiration (PESA), In-Vitro Fertilization (IVF), Intrauterine Insemination (IUI), Intracytoplasmic Sperm Injection (ICSI), Safe Baby Delivery (Normal & Caesarean), Myomectomy (Fibroid Treatment), Ovarian Drilling, Blastocyst Culture and Transfer, Operative Laparoscopy for PCOD, Polyps Removal (Polypectomy)Donor Sperm / Egg Programs and Semen Analysis & Sperm Function Test. The doctors comply with strict professionalism and integrity that allows you to provide the nice Treatment to all their sufferers.

Vision

To expand state of the art “Multispecialty Express Clinics” open seven days per week in each town of India wherein one review a brand new dimension in health care and get technologically advanced services at most inexpensive prices.

Mission

At Doctor Today, our number one assignment is to provide great health care with professionalism, excellence, integrity, and outcomes. These necessities middle values form the muse of our relationships with sufferers, consumers, buyers, and our commercial enterprise companions.

At Doctor Today, we ensure that the patient’s concerns are resolved and every affected person is dealt with in a well-mannered way in an greenway. Modern centers, relatively certified team of workers in a secure environment offer a comforting experience. Responsible group of workers individuals and medical doctors inform sufferers in an accurate way, even as upholding confidentiality.

Our Values

Quality:- We maintain the very best fashionable of care and reap them by way of always specializing in affected person comments and improving our healthcare structures.

Innovation:- In this technologically advanced world, purchasers have ended up more privy to valued services in a change of time and money invested. Doctor Today achieves this purpose by using providing fitness packages with the best standard of care and educational material to sufferers the usage of the trendy generation at a valued rate.

Teamwork:- We collaborate and share expertise to benefit patients and fellow caregivers for the advancement of our venture. We all proportion similar middle values that force us to deliver the first-rate of who is to work with normal which include physicians, patients and 0.33 element vendors in a professional machine.

Integrity:- We adhere to high ethical principles and expert standards with the aid of dedication to honesty, confidentiality, consider, appreciate and transparency.

Compassion:- We show our commitment to first elegance affected person care with the aid of a caring and supportive environment for our sufferer's families.

Dr. Shubhda Chopra

Dr. Shubhda Chopra is an infertility specialist and gynecologist specializing in IUI, IVF, High-chance being pregnant and Normal vaginal delivery technique. Dr. Shubhda completed MBBS, DGO after which went directly to pursue MD in Obstetrics and Gynecology. She has made it a point to offer extremely good fertility treatments and offerings to the couples with distinctive sorts of infertility problems. Every couple journeying Dr. Shubhda is satisfied and happy with the pleasant of her knowledge and fertility-associated offerings. Dr. Shubhda Chopra is currently working towards at Doctor Today IVF and Multispeciality Hospital, Railway Road, Faridabad.

Pranam Hospital

Pranam Hospital is a Multi-forte Hospital in Himmatnagar, Gujarat. The health facility is nicely-staffed with docs and nurses who are successful to look after the sufferers efficiently. A kind of services are offered through the Hospital and to name a few are Cervical Cerclage, Urogynaecology, Infertility Assessment & Treatment, Antenatal Care, Normal Vaginal Delivery (NVD), Cesarean C segment, Adiana System, and Other Gynecological Problems. Health Checkups are also supplied with the aid of the docs for all of the specialties. Dr. Ashvin J Patel, a well-reputed gynecologist, practices at Best Prenatal Hospitals in India.

This famous establishment acts as a one-prevent vacation spot servicing clients both neighborhood and from other parts of Hyderabad. In the close to destiny, this enterprise goals to increase its line of products and services and cater to a larger purchaser base. In Hyderabad, this established order occupies an outstanding place in Madinaguda. It is an easy venture in commuting to this status quo as there are numerous modes of delivery effortlessly to be had. It is at Main Road, Beside PAI Showroom, which makes it clean for first-time visitors in finding this established order. The recognition of this commercial enterprise is obvious from the 1400+ evaluations it has acquired from Justdial customers. It is known to provide pinnacle provider in the following categories: Multispeciality Hospitals, Dermatologists, Hospitals, Gynaecologist & Obstetrician Doctors, Orthopaedic Doctors, ENT Doctors, Neurologists, General Physician Doctors.

Products and Services presented:

Pranaam Multi Speciality Hospitals in Madinaguda has an extensive variety of services and products to cater to the various requirements in their customers. The team of workers at this established order are courteous and set off at supplying any assistance. They readily answer any queries or questions that you may have. Click at the map to get the instructions to reach Param Hospital. You can discover other relevant statistics of Pranam Hospital along with its address, timings, contact wide variety at elawoman.Com.

Dr. Ashvin J Patel

Dr. Ashvin J Patel is an infertility doctor and gynecologist in Himmatnagar, Gujarat. Dr. Ashvin Patel makes a specialty of Infertility assessment and Infertility Treatments like IUI and IVF treatment. Dr. Ashvin J Patel completed MBBS after which went directly to pursue M.S. In Obstetrics and Gynecology.

Services presented by way of Dr. Ashwin J Patel

Dr. Ashwin J Patel in Himatnagar treats the diverse ailments of the patients by using helping them go through exceptional treatments and approaches. Among the services supplied here, the medical institution offers treatments for Uterine Fibroids or Myomas, Ovarian Cysts, Endometriosis, Pelvic Organ Prolapse, Urinary Problems, Vaginal Discharge, Subfertility, Menopause, Gynaecological Cancers, Abnormal Pap Smears - Pre-Invasive Cervical/Vaginal Disease and Vulva Conditions. The doctor is likewise indexed under Gynaecologist & Obstetrician Doctors. Furthermore, the sufferers also visit the health facility for Contraception Advice, HPV Tests, and Biopsy Tests and many others. The hours of operation of this health facility are from 00:00 - 23:59, all days of the week

If You Have Any Query Regarding Any Kind of Infertility Issue or IVF, You Can Give Us a Call at +91-7899912611.

+(91)-7899912611

https://www.elawoman.com

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peertechz · 8 years ago

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kushkushakl · 4 years ago

Link

Routine screening in the population above 50 years: Some countries of high incidence use routine screening for detection of the precancerous stage or early-stage CRC. Faecal occult blood detection by various methods is the most used screening method.

Colonoscopy examination: This detects pre-cancerous polyps as well as frank cancers. The precancerous lesions can be removed by various endoscopic techniques like snare polypectomy or Endoscopic mucosal resection (EMR) or Endoscopic submucosal dissection (ESD). Larger and suspicious lesions can be biopsied for cancer confirmation, subtyping and grading.

Imaging: CT scans, MRI scans and PET CTs are used in varying combinations to accurately stage the disease. Staging means to find out whether the disease is confined to the colon or rectum or it has spread to the lymph nodes or adjacent or distant organs.

https://proton.apollohospitals.com/colorectal-cancer/oncologists

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erectiledysfunc · 4 years ago

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prostate gland and erectile dysfunction

Contents

Shows diagnostic centres

Erectile dysfunction. depending

Urologic cancer surgeons

Post delivery urinary

The list given below shows diagnostic centres, clinical laboratories and hospitals in Kolkata, West Bengal specializing in Cancer Treatment related treatment and diagnostic services. Peerless Hospital.

Benign prostatic hyperplasia (BPH) increases by 7 times the risk of erectile dysfunction (ED).

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RG Stone Urology & Laparoscopy Hospital Cancer Treatment, Polypectomy, Urinary Bladder Cancer, Erectile Dysfunction, Infertility Treatment. Female Urinary Incontinence, Prostate Cancer, Enlarged.

Through genome-wide association studies, the investigators have identified common variants that increase the risk of adverse outcomes (erectile dysfunction, urinary dysfunction, proctitis) for men.

The UroLift permanent implants, delivered during a transurethral outpatient procedure, relieve prostate obstruction. such as urinary incontinence, erectile dysfunction, and retrograde ejaculation.

Erectile dysfunction (ED) is a common side effect of prostate cancer treatment. Before deciding on a treatment method, understand which methods can lead to.

Since LF’s presentation was not suggestive of prostate cancer (e.g., an elevated. interest regarding the need for improvement of erectile dysfunction. If LF does not respond to the currently.

Surgery to remove the prostate gland or seminal vesicles means that you. This can cause problems with getting or keeping an erection. This is called erectile dysfunction (ED). In some cases, the.

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ED usually means that a man is not able to achieve or maintain an erection. Although ED may be caused by a variety of health problems, such as.

Erectile dysfunction (ED). This is when a man can’t have. It can also happen because of other conditions that affect the prostate gland or bladder. It can also be from certain lifestyle choices.

Erectile dysfunction is the most common side effect after prostate cancer treatment irrespective of precision dose and delivery of radiation.

The Urology Service has a long and distinguished history in the diagnosis and treatment of prostate. dysfunction, and treatment of benign prostatic hyperplasia. Our urologic cancer surgeons have.

You may hear this called erectile dysfunction or impotence. Many men get problems with their erections and this is more likely to happen as men get older.

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arvindvk · 5 years ago

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Surrogacy Cost in Raigarh

Surrogacy Cost in Raigarh | Shri Balaji Metro Hospital | Elawoman

Surrogacy Cost in Raigarh

There are two sorts of surrogacy — customary surrogacy and gestational surrogacy. In conventional surrogacy, a surrogate mother is misleadingly inseminated, either by the intended dad or an unknown benefactor, and conveys the child to term. The youngster is subsequently hereditarily identified with both the surrogate mother, who gives the egg, and the intended dad or unknown donor.In gestational surrogacy, an egg is expelled from the intended mother or a mysterious contributor and treated with the sperm of the intended dad or unknown giver. The treated egg, or fetus, is then moved to a surrogate who conveys the infant to term. The tyke is in this way hereditarily identified with the lady who gave the egg and the intended dad or sperm giver, however not the surrogate. Some lesbian couples find gestational surrogacy appealing in light of the fact that it licenses one lady to contribute her egg and the other to convey the child.Traditional surrogacy is more questionable than gestational surrogacy, in huge part in light of the fact that the natural connection between the surrogate and the tyke regularly confuses the realities of the case if parental rights or the legitimacy of the surrogacy understanding are tested. Therefore, most states restrict customary surrogacy understandings. Furthermore, numerous states that grant surrogacy understandings disallow remuneration past the installment of therapeutic and lawful costs incurred because of the surrogacy understanding.

Shri Balaji Metro Hospital

Shri Balaji Super Speciality Hospital ( SBSH ) is a 436 had relations with (focal india's greatest private emergency clinic) present day and best in class tertiary care focus situated in the core of Raipur, the capital city of Chhattisgarh . The emergency clinic is effectively agreeable from the nearby railroad station , transport stand and the air terminal. It was inaugurated on fifteenth Feb. 2009Shri Balaji Super Speciality Hospital ( SBSH ) is a 436 had relations with (focal india's greatest private emergency clinic) current and best in class tertiary care focus situated in the core of Raipur, the capital city of Chhattisgarh . The clinic is effectively agreeable from the neighborhood railroad station , transport stand and the air terminal. It was inaugurated on 15th Feb. 2009.Our point is to give particular and tertiary degree of medicinal services and gloat of an exceptionally qualified and committed group of expert specialists and paramedical staff. The advisor and assistant staff is resolved to give quality medicinal care as well as intend to make the patient remain a pleasing experience.Mission Shri Balaji Super Speciality Hospital (SBSH) is a multispeciality emergency clinic means to give quality and worth driven human services to the general public. We are resolved to furnish magnificent healthcare administrations with continuous upgradation of quality.In expansion Shri Balaji Super Speciality Hospital (SBSH) gives instructive projects to wellbeing experts and for people in general, and takes an interest in projects of clinical research.Vision Shri Balaji Super Speciality Hospital (SBSH) is immovably fixated on a solid convention of patient-focussed care. The emergency clinic knows about its duty to the neighborhood network as well as the populace all in all. We would like to give an altruistic touch to the generally increasingly popularized medicinal division. Along these lines the point is to give tertiary healthcare administrations at a reasonable cost.

Book Appointment Shri Balaji Metro Hospital

Our point is to give specific and tertiary degree of social insurance and gloat of a profoundly qualified and devoted group of specialist specialists and paramedical staff. The advisor and helper staff is resolved to give quality restorative care as well as mean to make the patient remain a pleasing experience.Our point is to give specific and tertiary degree of human services and gloat of a profoundly qualified and devoted group of specialist specialists and paramedical staff. The advisor and assistant staff is resolved to give quality restorative care as well as mean to make the patient remain a pleasing experience.Diagnostic Gastroscopy - to picture nourishment pipe/stomach/beginning of little intestine.Colonoscopy/illeoscopy - to envision rear-end, rectum, digestive organ, terminal part of the arrangement - UGI - Extraction of an outside body for example coin, key, metal funnels. affected sustenance particles and so on. Sclerotherapy of oesophageal varices, Endoscopic treatment of bleeding ulcers and coagulation, Polypectomy, stent position, expansion of stricture, Achalasia dilatation, Pyloric enlargement, Coagulation of bleeding points, Injection of paste into oesophageal varices, Percutaneous endoscopic gastrostomy. LGI - Polypectomy Stricture expansion of bleeding vessel. ERCP - Sphincterotomy Stent arrangement - CBD/pancreatic to alleviate biliary and pancreatic obstacle, Stone extraction, Placement of naso biliary drainage. Liver biopsy - This strategy is done to analyze infections of the liver in order to give fitting treatment.

Dr. Madhulika Beriwal

One of the leading gynecologists of the city, Dr. Madhulika Beriwal in Raigarh HO has built up the clinic and has gained a steadfast customers in the course of recent years and is likewise habitually visited by a few VIPs, aspiring models and other respectable customers and international patients too. They additionally plan on expanding their business further and providing administrations to a few additional patients owing to its prosperity in the course of recent years. The productivity, commitment, accuracy and sympathy offered at the clinic guarantee that the patient's prosperity, solace and needs are kept of top need. The clinic is outfitted with most recent sorts of gear and brags exceptionally progressed careful instruments that help in undergoing fastidious medical procedures or techniques. Locating the healthcare focus is simple as it is Pahad Mandir Road.Dr. Madhulika Beriwal in Raigarh-chhattisgarh treats the different illnesses of the patients by helping them experience fantastic medicines and strategies. Among the various administrations offered here, the clinic gives medications to Uterine Fibroids or Myomas, Ovarian Cysts, Endometriosis, Pelvic Organ Prolapse, Urinary Problems, Vaginal Discharge, Subfertility, Menopause, Gynecological Cancers, Abnormal Pap Smears - Pre-Invasive Cervical/Vaginal Disease and Vulva Conditions. The specialist is additionally recorded under Gynecologist and Obstetrician Doctors. Moreover, the patients likewise visit the clinic for Contraception Advice, HPV Tests, and Biopsy Tests and so forth.

Shri Siddhivinayak Skin Care And Maternity Clinic

Set up in the year 2016, Shri Siddhivinayak Skin Care And Maternity Clinic in Raigarh Ho, Raigarh-chhattisgarh is a top player in the classification Gynecologist and Obstetrician Doctors in the Raigarh-chhattisgarh. This outstanding foundation goes about as a one-stop destination servicing clients both neighborhood and from different pieces of Raigarh-chhattisgarh. Through the span of its adventure, this business has built up a firm decent footing in it's industry. The conviction that consumer loyalty is as significant as their items and administrations, have helped this foundation accumulate a tremendous base of clients, which continues to develop constantly. This business utilizes individuals that are committed towards their separate jobs and put in a great deal of exertion to accomplish the normal vision and bigger objectives of the organization. Soon, this business means to expand its line of items and administrations and take into account a bigger customer base. In Raigarh-chhattisgarh, this foundation involves a prominent area in Raigarh Ho. It is an easy task in commuting to this foundation as there are different methods of vehicle promptly accessible. It is at Kotra Road, Near Dashrath Paan Bhandar, which makes it simple for first-time guests in locating this foundation.

Book Appointment Shri Siddhivinayak Skin Care And Maternity Clinic

The notoriety of this business is apparent from the 50+ surveys it has gotten from Justdial clients. It is known to give top administration in the following classifications: Gynecologist and Obstetrician Doctors, Hospitals, Dermatologists, General Physician Doctors, Maternity Hospitals, Skin Care Clinics, Clinics, Sexologist Doctors.Shri Siddhivinayak Skin Care And Maternity Clinic in Raigarh Ho has a wide scope of items and administrations to take into account the fluctuated prerequisites of their clients. The staff at this foundation are considerate and brief at providing any help. They promptly answer any inquiries or questions that you may have. Pay for the item or administration easily by using any of the accessible methods of installment, for example, Cash.Book your free Appointment Shri Siddhivinayak Skin Care And Maternity Clinic!

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IUI Treatment Cost in Hyderabad | Hegde Hospital | Elawoman

Hegde Hospital

Hegde Hospital is one of the quickly growing Gynecology and Maternity hospitals in Hyderabad. Situated at House No 67/68, Vittal Rao Nagar, Madhapur, Opposite To Pizza Hut, Karachi Bakery Lane, Madhapur, Hyderabad, It was set up in 1978 with the mission to inspire expectation and add to wellbeing and prosperity by providing the best consideration to each patient through integrated clinical practice. From the foundation date up to this point, Hegde Hospital has turned into a well-confided in destination for many patients for more than 38 years. The hospital has a group of profoundly qualified specialists and best gynecologist having an incredible instructive foundation, skill, and experience. The hospital is lead by Dr. Prashanth Hegde and Dr. Vandana Hegde. Dr.Vandana Hegde is the best gynecologist in Hyderabad and has enormous notoriety in providing commendable maternity administrations and infertility medicines.

Hegde hospital is one of the leading medicinal services focuses, delivering a wide scope of Gynecological, Obstetrics, Surgical, Laparoscopic and Pediatric administrations.if you know more about IUI Treatment Cost in Hyderabad you can click here.

Hegde Maternity and Nursing Home

Hegde Maternity and Nursing is a preeminent Multispecialty Nursing Home situated in Moosarambagh, Hyderabad. It is a cutting edge clinic with offices and administrations like Intracytoplasmic Sperm Injection (ICSI), In-Vitro Fertilization (IVF), Intrauterine Insemination (IUI), General Surgery, Advanced Laparoscopic Surgery, Gastroenterology.Obstetrics and Gynecology treatment for Polycystic Ovarian Syndrome/Disease (PCOS), Endometriosis, Polyps Removal (Polypectomy), Fibroids Removal, Semen Freezing , Laser Assisted Hatching (LAH), Testicular Biopsy, Blastocyst Culture and Transfer, and Maternity Services.

It was set up in 1977. Dr. Vandana Hegde is the IVF and IUI Specialist and the consulting gynecologist at Hegde Maternity and Nursing Home.

Southern Gem Hospital

Southern Gem Hospital is at the bleeding edge of bringing delights in the lives of couples experiencing a void in their lives and hearts i.e the nearness of a kid in their family.Failure isn't a choice at Southern Gem Hospital. Each case is acknowledged as a test, regardless of whether it was a disappointment somewhere else. Accomplishment at Southern Gem i s a result of science and aptitude.

Our fertility and gynecology office is going by Dr.Sweta Agarwal MS (O&G), FRANZCOG (Australia) and Masters in Reproductive Medicine (Australia). Dr.Sweta Agarwal is a globally perceived master on ladies' wellbeing and conceptive prescription. She is helped by a group of energetic and experienced specialists.

Support up their energy and ability are inimitable offices at Southern Gem Hospital. Laparoscopic gynecology activity theater, Class 1000 IVF task theater and IVF research facility and an andrology lab, notwithstanding outpatient and inpatient offices guarantee that the absolute best is accessible at one place.Every individual from the group is driven by one mission - to get satisfaction the lives of childless couples. Numerous upbeat couples stand declaration to this commitment and application.

Kamineni Fertility Centre

Kamineni Fertility Center is one of the dominant Fertility and IVF Centers arranged in Bogulkunta, Hyderabad. Keeping the international standards in mind, the offices and administrations given by the inside are In-Vitro Fertilization (IVF), Intrauterine Insemination (IUI), Intra Cytoplasmic Sperm Injection (ICSI), Semen Freezing, Testicular Biopsy, Egg Freezing, Embryo Freezing, Intra Cytoplasmic Morphologically Selected Sperm Injection (IMSI), and infertility Evaluation and Treatment. They likewise give extra administrations, for example, symptomatic administrations, laparoscopy, ultrasound filters and in house drug store. Kamineni Fertility Center have a group of all around qualified, profoundly dedicated experts to head our forte division, bolstered by a gathering of devoted paramedical staff.

The definition of treatment and care gets redefined in each perspective. Patients can be guaranteed of solid and complete consideration through very qualified staff. With superb patient consideration, feeling and procedures, we mean to turn into the most exceptional and dynamic human services institution in this piece of the world.If you know more about Best IVF Clinic so you can click here below links.

Srujana Fertility Centre

Srujana Fertility Center is one of the eminent Fertility Centers arranged in Nagole, Hyderabad. Patients from everywhere throughout the world visit this clinic for confused infertility issues. The hospital was set up with the mission to give the best fertility administrations at moderate expense to every one of the patients. It is a multispecialty Hospital and gives administrations like In Vitro Fertilization (IVF), Intrauterine Insemination (IUI), Intra Cytoplasmic Sperm Injection (ICSI), Microsurgical Epididymal Sperm Aspiration (MESA), Testicular Sperm Aspiration (TESA), Endometriosis, Percutaneous Sperm Aspiration (PESA), Fibroids, Small Sized Uterus, Male and Female Infertility, Ectopic Pregnancy, Multiple Abortions, Azoospermia, Semen Freezing, Surrogacy, and Freezing of Embryos. The hospital was worked in 2014 with the main motivation behind providing the best kind of consideration to every one of the patients.

The committed staff and specialists are enthused about giving all the related guidance keeping the treatment straightforward. Dr. T Soujanya Reddy and Dr. N.S Rani are the visiting specialists at Srujana Fertility Center. They are capable and devoted specialists who have rich involvement in their individual fields. The hospital is spread in an enormous region and has cutting edge hardware. The mission of the hospital is to give infertility administrations to all the destitute ones with the end goal that the infertile couples satisfy their dreams of having their very own child. The hospital has distributed many research papers on its name. It has been authorize by numerous social orders and got numerous honors. It has the enrollment of numerous social orders also. They give medicines dependent on the most recent innovation. Srujana has extensive rooms ranging from general ward to sumptuous. The hospital has a well disposed condition which likewise causes patients to be relieved.

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