Coronary artery disease risk factors and symptoms

The risk factors are like Having a high cholesterol level, especially a high LDL, smoking, diabetic patients, a family history of heart diseases, obesity, too much alcohol
high blood pressure, and physically inactive patients.
Symptoms are often: chest pain or discomfort which is a very important symptom that should never be ignored, shortness of breath, discomfort or numbness in the left shoulder and arm, nausea and fatigue.

Diagnosis

The most important diagnostic test is ECG Can detect heart attack, ischemia and heart rhythm issues, Echocardiogram, blood rests, and Exercise stress tests: This is a treadmill test to determine how well your heart functions when it’s working the hardest. Can detect angina and coronary blockages or others depending on the case.

Management:

Different treatment choices are depending on the severity of the disease. Which are:

Life modification

choosing foods that are low in trans fats, saturated fats, simple sugars, and sodium.

stop smoking. If you smoke or use tobacco products, quit

Exercise regularly. And achieve a healthy weight

Learn effective ways to manage your stress.

Limit alcohol use. Limit daily drinks to no more than one drink per day for women and two drinks per day for men.

When the condition of the patient is more advanced the previous procedures aren’t enough and the doctor will prescribe medications to lower your cholesterol levels, lower blood pressure, stop angina and reduce the risk of blood clots.

But sometimes the condition of the patient might be more severe and needs surgical intervention. In this case, we have two options

non-invasive cardiac surgery

the Common procedures are balloon angioplasty and stenting.
They are non-invasive because they are done with a long, thin tube called a catheter which is inserted into an artery in the wrist or the top of the leg through a small incision and guided to the blocked or narrowed area of the artery. Then the doctor inflates the balloon, which stretches the artery open so more blood can flow in the balloon angioplasty. And if it is stenting then a stent is inserted to keep the blood vessel open.
You’ll be in and out of the hospital in a few days or less.

bypass surgery:

Bypass surgery or CABG (coronary artery bypass graft) is a type of surgery in which doctors use blood vessels from other parts of your body to make a detour around blockages in your coronary arteries. Because this requires open-heart surgery, it’s most often reserved for people who have multiple narrowed coronary arteries. And it has more risks and complications as well as a longer recovery period.

Before the procedure

You must not have anything to eat or drink six to eight hours before your procedure, you may be advised to stop taking some medication temporarily for a few days before your procedure e.g. blood thinners. If you have diabetes, you may need to discuss your insulin dose with your anaesthetist and cardiologist. Hair may be shaved off at the location on your body where the procedure will take place

During the procedure

the catheter is passed into your heart and positioned within the opening of the aortic valve. Then, the balloon is gently inflated to make room for the new tissue valve, which is placed in position. The new valve which is made of cow or pig tissue is inserted and the balloon is deflated before the balloon and catheter are removed.
The surgeon reaches the heart by one of two approaches either by entering through the femoral artery (large artery in the groin), called the transfemoral approach, which does not require a surgical incision in the chest, or, by using a minimally invasive surgical approach with a small incision in the chest and entering through a large artery in the chest or through the tip of the left ventricle (the apex), which is known as the transapical approach.
Unlike surgical aortic valve replacement, which requires a long incision down the chest (open-heart surgery), TAVR is done using smaller incisions and a thin, flexible tube (catheter) to reach the heart.
you’ll be given a general or local anaesthetic and it usually takes 1-2 hours.
During the TAVI procedure, the treatment team will carefully monitor your vital signs, including blood pressure, heart rate and rhythm, and breathing.

After the procedure

You may spend the night in the intensive care unit (ICU) for monitoring after your procedure. Many returns home within about a week. It generally takes between 2-3 months to fully recover, but this varies as everyone can react differently based on their condition.
Several medications may be prescribed after TAVR, including Blood thinners (anticoagulants) to prevent blood clots formation and antibiotics as Artificial heart valves can become infected with bacteria.
Regular doctor’s checkups and imaging tests are needed after TAVR to make sure the new valve is working properly.

Candidates for Transcatheter aortic valve implantation

Patients with severe aortic stenosis that causes signs and symptoms.
Patients with a biological tissue aortic valve that isn’t working as well as it should.
When the patient suffers from another health condition, such as lung or kidney disease, that makes open-heart valve replacement surgeries too risky.
TAVI can be an effective option to improve the quality of life in patients who otherwise have limited choices for the repair of their aortic valve.

Risks of Transcatheter aortic valve implantation

All surgeries and medical procedures come with some type of risk. Potential risks of transcatheter aortic valve replacement (TAVR) may include: worn-out valve, kidney disease, blood clots, Infection, irregular heart rhythm, The risk of having a stroke after TAVI is higher and Problems with the replacement valve, such as the valve slipping out of place or leaking (regurgitation)

Types of bone marrow transplant

There are different types of bone marrow transplant

Autologous transplant

A procedure in which a patient’s healthy stem cells (blood-forming cells) are collected from the blood or bone marrow before treatment, stored, and then given back to the same patient after the treatment chemotherapy or radiation. After the stem cells are collected, they can be frozen for months or years until the patient needs them for the transplant. This type of transplant features advantages like the patient doesn’t need to worry about incompatibility between the donor’s cells and the patient’s cells if it is autologous stem cell transplant.

Why is autologous transplant done?

This type is used mainly when the patient will be facing high doses of chemotherapy or radiation which means the bone marrow will be damaged and will fail in doing its job and producing blood components. Like in Hodgkin’s lymphoma, Myeloma, Non-Hodgkin’s lymphoma, or Plasma cell disorders

Allogenic transplant

A procedure in which a patient receives healthy stem cells from a related donor that is not an identical twin to replace their own stem cells that have been destroyed by treatment with radiation or high doses of chemotherapy. Before undergoing an allogeneic stem cell transplant, you’ll receive high doses of chemotherapy or radiation to destroy your diseased cells and prepare your body for the donor cells.

Why is allogenic transplant done?

It is used in a lot of cases to treat both cancerous and non-cancerous diseases like Acute leukemia, Primary amyloidosis, Adrenoleukodystrophy, Bone marrow failure syndromes, Chronic leukemia, Myelodysplastic syndromes, Aplastic anemia, Hemoglobinopathies, Hodgkin’s lymphoma, Inborn errors of metabolism, Multiple myeloma, Neuroblastoma, Non-Hodgkin’s lymphoma, Immune deficiencies, Plasma cell disorders, or POEMS syndrome

Umbilical cord blood transplant

Stem cells are taken from an umbilical cord immediately after delivery of an infant. These stem cells reproduce into mature, functioning blood cells quicker and more effectively than do stem cells taken from the bone marrow of another child or adult. The stem cells are tested, typed, counted, and frozen until they are needed for a transplant. Both related and unrelated cord blood transplants have been performed with high rates of success for a variety of hematologic disorders and metabolic storage diseases in the pediatric setting.

Why is umbilical cord blood transplant is done?

Because Cord blood units are stored and ready to use, so it’s quickly available when a patient needs a transplant right away. Cord blood doesn’t have to be as closely matched to the patient as a marrow donor, so it may be an option for patients with uncommon tissue types. Studies have found that a transplant complication called graft-versus-host disease (GVHD) is less common and less severe after cord blood transplant than after a transplant using peripheral blood stem cells (PBSC).

Before bone marrow transplant

Before the transplant, an extensive evaluation is completed by the bone marrow transplant team. All other treatment choices are discussed and evaluated for risk versus benefit. And you’ll undergo a series of tests and procedures to assess your general health and the status of your condition, and to ensure that you’re physically prepared for the operation. A patient will often come into the transplant center up to 10 days before transplant for hydration, evaluation, placement of the central venous line, and other preparations.

After bone marrow transplant

The transplant infusion is painless. You’ll be awake during the procedure. In the days and weeks after your bone marrow transplant, you’ll have blood tests and other tests to monitor your condition. Continuous follow-up care is essential for the patient following a bone marrow transplant. You may need medicine to manage complications, such as nausea and diarrhea.

Risk factors for brain tumors

• Exposure to radiation like therapeutic radiation therapy or survivors of atomic bomb
• Occupational exposures which mean some professionals tend to have a higher risk of brain tumor
• Head trauma
• Allergies: there is a relationship between allergies like asthma, eczema or other and brain tumor specifically glioma
• Smoking
• Alcohol
• Infections
• Genetic factors: 1 to 5 percent of brain tumors are due to genetic syndromes

Cerebral, spinal and vertebral treatment

• Chemotherapy: this therapy is effective for some tumors like medulloblastoma and lymphoma while other types do not respond to chemotherapy
• Radiotherapy is used After surgery to try to kill any remaining tumor cells
• Surgery: which is the most important step in the treatment plan.

The Surgery

Surgery is the main treatment in brain and spine tumors because when it comes to this kind of tumors, they can be very harmful even when the tumor is benign and not malignant. The tumor takes a space in the intracranial space causing the intracranial pressure to rise which can have serious effects on the CNS system. That’s why the surgery is crucial to remove the tumor and get the intracranial pressure normal again and to remove every malignant cell in order to stop the cancer from spreading to other parts of the CNS.
Not all tumors can be removed because in some cases the tumor might be localized in a place that is hard to reach or if the patient’s overall health doesn’t qualify him to go through a surgical procedure.
The most common technique in this surgery is called Craniotomy. In this surgery the surgeon makes an opening in the skull and maybe cut into the brain to reach the tumor with the help of MRI or CT imaging.
This surgery is usually done under general anesthesia but in some cases, it is done under local anesthesia which means the patient stays awake during the operation. This is done when the brain function needs to be assessed during the operation.

Cerebral, spinal and vertebral tumors in children

An important difference between adults and children is that in children, primary CNS tumors predominate and approximately one-third to one-half are located in the posterior fossa. While in adults, metastases are the most common. And this cause different symptoms and presentation between adults and children with CNS tumors.

Prognosis in children

This depends on the tumor type and the age of the child. Pilocytic astrocytoma has the highest survival rates (the five-year survival is 97%) while atypical rhabdoid and high-grade glioma have the lowest survival rates (the five-year survival is 18%).

Drugs to help with symptoms in children with cerebral and spinal cord tumors

There are drugs that can help kids in their treatment. They do not cure the tumor but they improve the quality of the child life and relieve the symptoms whether they are due to the tumor itself or the its treatment.
These drugs like corticosteroids, anticonvulsant (anti-seizure drugs), and hormones if the pituitary gland is affected.

What is Parkinson’s disease?

It is a progressive disease which means it gradually becomes worse with time. It is a disease that affects the nervous system causing unintended or uncontrollable movements. It usually starts with tremors than the symptoms progress.

Parkinson symptoms

Rest tremor which means the tremor appears (or worsens) when the body part is not engaged in an activity
Bradykinesia which means generalized slowness of movement. This feature is present in 80% of patients at the onset of the disease and eventually seen in all patients
Rigidity is increased resistance to passive movement.it usually starts at one side and eventually progresses to the other side but stays asymmetric throughout the disease
Postural instability causes a feeling of imbalance and a tendency to fall with a significant risk of injury
Parkinson’s also causes non-motor symptoms like dementia and many other

Diagnosis

No specific test exists to diagnose Parkinson’s disease.so, This mainly depends on the medical history and the neurologic examination. The patient must have at least bradykinesia plus tremor or rigidity to consider diagnosing Parkinson’s disease.
No radiologic or blood tests can confirm the diagnosis.
MRI (magnetic resonance imaging) can be helpful in excluding other diseases but is not necessary.

Treatment

Medication: there are three main types of medication that are commonly used:

• levodopa
• dopamine agonists
• monoamine oxidase-B inhibitors

Levodopa

is the most common medication for patients with Parkinson’s disease. It passes the BBB (brain-blood barrier) and then turns into dopamine. Increasing the levels of dopamine using levodopa usually improves movement problems.

Dopamine agonists

it is similar to levodopa but milder because Dopamine agonists act as a substitute for dopamine in the brain

monoamine oxidase-B inhibitors

monoamine oxidase-B or MAO inhibitors like selegiline and rasagiline block the effects of an enzyme or brain substance that breaks down dopamine (monoamine oxidase-B), increasing dopamine levels.

Surgery

Most people with Parkinson’s disease are treated with medication, although a type of surgery is called deep brain stimulation.

Deep Brain Stimulation

Deep brain stimulation is a neurosurgical procedure that aims to implant electrodes and electrical stimulation to treat movement disorders like Parkinson’s disease and other motor diseases.
This is done by implanting one or more wires, called “leads,” inside the brain which is connected to a very small neurostimulator (electrical generator) injected under the person’s collarbone
What controls the stimulation in this technique is a pacemaker-like device placed under the skin of your upper chest. A wire that travels under your skin connects this device to the electrodes in your brain.
DBS interrupts the periodic signals that cause tremors and other movement symptoms.

Candidates for deep brain stimulation

• Patients under 70
• Good overall health
• Patients that have troublesome dyskinesias.
• Patients who fluctuate between “on” and “off” medication states

Side Effects That Can Happen After The Surgery

• Headache

• Seizure
• Confusion
• Hardware complications, such as an eroded lead wire
• Temporary pain and swelling at the implantation site
• Confusion and Difficulty concentrating
• Stroke
• Infection

Signs and symptoms

The patient notices that Clothes fit awkwardly or hang unevenly

• The Head is not centered directly above the pelvis
• Ribs that stick out farther on one side of your body than the other
• Waist is uneven
• A prominence on one side of the back when bending forward
• The patient might come with symptoms like low back pain, Back stiffness, Pain and numbness in your legs (from pinched nerves) and Fatigue due to muscle strain.

Diagnosis

As in any other disease, the medical history and the clinical examination are crucial, then there are multiple ways to confirm the diagnosis, most important of all is X-ray imaging.

X-ray imaging can show the structure of the vertebrae and the outline of the joints. X-rays of the spine are obtained to search for other potential causes of pain, i.e., infections, fractures, deformities, etc. which can also confirm the diagnosis of scoliosis and reveal the severity of the spinal curvature.

CT (computed tomography scan) is mainly helpful in showing the bony structures like the spinal canal and the vertebrae around it

MRI (magnetic resonance imaging) is very helpful in showing the spine itself, nerve roots and surrounding areas, as well as enlargement, degeneration and deformities.

Treatment

We have two options when it comes to managing scoliosis, Braces and surgery. The doctor will choose the appropriate procedure depending on the condition of the patient, the age, the severity of scoliosis, and even the sex of the patient as female patients have a higher risk of progression than males.
Braces: this method can be used only when the patient’s skeleton is immature (age 10 to 15).
and the angle of the scoliosis is appropriate or if the patients choose the braces over the preservation and surgery. The most common type of brace is made of plastic. This brace is almost invisible under the clothes, as it fits under the arms and around the rib cage, lower back and hips.
They should be worn between 13 and 16 hours a day. A brace’s effectiveness increases with the number of hours a day it’s worn.

Surgery

indications:

• skeletally immature patients with an angle equal to 50 or above
• (some) skeletally immature patients with an angle between 40 and 50
• Skeletally mature patients with an angle of 50 or above
• Patients with the lumbar curve with marked trunk shift

The procedure:

It is called spinal fusion where 2 or more vertebrae are joined together to stabilize, strengthen and straighten the spine. Pieces of bone or a bone-like material are placed between the vertebrae. Metal rods, hooks, screws or wires typically hold that part of the spine straight and still while the old and new bone material fuses.
The technique your surgeon uses depends on the location of the vertebrae to be fused.
It is done under general anesthesia and It may take several months for the affected bones in your spine to heal and fuse.

Risks of Spinal Fusion:

• Injury to blood vessels or nerves in and around the spine
• Poor wound healing
• Pain at the site from which the bone graft is taken
• Infection
• Blood clots
• Bleeding

Before breast cancer surgery

Some tests will be done before your operation to check for your overall health and that you are ready for the operation like blood tests, ECG, X-rays and other.
You should stop smoking as tobacco lowers the patient’s blood saturation with oxygen and prolong the recovery period
You should stop alcohol consumption because alcohol causes more complications in the procedure and after
You should tell your doctor about the medications that you take because some of them might be stopped like blood thinners because which prolongs bleeding time.

What are the breast cancer surgery types?

There are many different types of breast cancer. The type is determined by the specific kind of cells in the breast that are affected, how big the tumour is and if it has spread to other areas of the body

Simple mastectomy
It is a procedure in which the entire breast is removed but the chest muscle underneath the breast remains. the nipple is also removed and lymph nodes might be removed too.
It is usually done when cancer has not spread beyond the breast or if the surgery is a preventative mastectomy which is done to lower the risk of getting breast cancer.
Most women, if they are hospitalized, can go home the next day.

Radical mastectomy
In this procedure, the breast is completely removed as well as the overlying skin, the muscles beneath the breast, and the lymph nodes.
It’s reserved for cases where breast cancer has spread to the underlying muscles.
This surgery was once very common, but less extensive surgery (such as the modified radical mastectomy) is just as effective and with fewer side effects.

Modified radical mastectomy
Modified radical mastectomy is a less traumatic and more common procedure. It is similar to the radical mastectomy but leaves the chest muscles intact. This means it removes the entire breast and the underarm lymph nodes only.

Skin-sparing mastectomy
It is a variation of the total mastectomy and is normally performed to allow the surgeon to perform breast reconstruction.
The doctor removes breast tissue, the nipple, and the areola but saves most of the skin over the breast.
it may not be suitable for larger tumours or those that are close to the surface of the skin. And the risk of local cancer recurrence with this type of mastectomy is the same as with other types of mastectomies.

Nipple-sparing mastectomy
In this procedure, the doctor removes all the breast tissue, including the ducts going all the way up to the nipple and areola. But they save the skin of the nipple and areola and cut out tissues under and around them. This type of mastectomy is more often an option for women who have a small, early-stage cancer, away (more than 2cm) from the nipple and areola, with no signs of cancer in the skin or the nipple.

After Breast Cancer Surgery

After having a mastectomy, a woman might want to consider having the breast mound rebuilt to restore the breast’s appearance. This is called breast reconstruction.
You’ll probably stay for 1 or 2 days, though it might be longer if you had reconstruction.
Within about four weeks, you’ll probably be comfortable doing all of your regular daily activities.
it’s common to have pain or tenderness in the surgical area.
The incision. The bandage will probably stay in until your first follow-up visit.

Whipple Surgery Types

The Whipple procedure can take several hours to perform and requires excellent surgical skill and experience. It can be done in various ways. It can be done in open surgery, by the laparoscope, or by robotic.

The open surgery:
It is done in the hospital using general anaesthesia.
The surgeon makes a large cut (incision) in your abdomen and takes a biopsy from the tissues. The surgeon then removes the tumour, tissue around the tumour, parts of the pancreas, the duodenum, the pylorus (lower part of the stomach), the gallbladder, and part of the common bile duct and nearby lymph nodes.

The laparoscopic surgery:
the surgeon makes several smaller incisions in the abdomen and inserts special instruments, including a camera that transmits video to a monitor in the operating room. Laparoscopic surgery is a type of minimally invasive surgery, and minimally invasive surgery offers some benefits, such as lower blood loss and a quicker recovery in those without complications. But it also takes longer, which can be hard on the body.

Robotic surgery:
The surgical tools are attached to a mechanical device (robot) in robotic surgery. The surgeon sits at a console nearby and uses hand controls to direct the robot. A surgical robot can use tools in tight spaces and around corners, where human hands may be too large to be effective. It is also a type of minimally invasive surgery.

Before Whipple surgery

Some types of medications should be stopped before the surgical procedure like blood thinner as they increase bleeding
it is encouraged—if possible—for a person to gain weight before the operation. Because after the procedure losing weight is expected.
wear clothing that is comfortable and loose-fitting.
Stop eating or drinking anything after midnight on the day of the procedure.
You should stop alcohol; consumption and tobacco smoking as they increase complication’s risk

After Whipple surgery

There is no doubt that the Whipple procedure is a painful operation. This is largely due to the extent of the organs being removed or rearranged and the proximity of the pancreas to nerves as they exit the spine at the back of the abdomen during the operation.
After surgery, you will stay in the hospital for 1 to 2 weeks.
After discharge from the hospital, most people can return directly home to continue recovery. Some people are asked to stay nearby for several days for monitoring and follow-up visits

Candidates:

Only about 20% of pancreatic cancer patients are eligible for the Whipple procedure and other surgeries.
Patients with tumours in the head of the pancreas that didn’t spread to other organs or major blood vessels.
Many tests and imaging are usually necessary to determine whether the patient can benefit from this surgery or not.

What are bone tumours?

There are two major groups, nonmalignant(benign) tumours and malignant tumours

Malignant tumours like osteosarcoma which is the most common, chondrosarcoma, and Ewing sarcoma which is more common in children or other

Are all cases of bone tumour eradicable?

No, the ability to do an extracting surgery on the tumour is a complicated issue that follows a specific algorithm depending on whether the tumour is benign or malignant, the stage of cancer, and the patient’s overall condition.
But whatever the cancer type is, if it has metastasized to other organs (the tumour is no longer limited to the location where it started) then surgery to remove the tumour and cure the patient is not possible. And all treatments (including surgery) are palliative.

Amputation surgery indications

• cancer has grown into the major nerves and blood vessels around your bone tumour
• you developed an infection after limb-sparing surgery and the prosthesis or bone graft had to be removed
• it is not possible to completely remove cancer with limb sparing surgery

Recovery After Bone Tumour Surgery

first you may wake up in the intensive care unit or a high dependency recovery unit. Then you will be moved back to the ward.

How fast you recover from surgery depends on the kind of surgery you had and your overall health.

-X rays and other imaging studies will be done to confirm that the tumour is gone.

You’ll be asked to attend frequent appointments in the first 2 years after treatment has finished – possibly every 3 months. These will become less frequent as the years go on.