Posts Tagged ‘Options’

How is hemochromatosis treated?

Hemochromatosis (HE-mo-kro-ma-TO-sis) is a disease in which too much of iron builds up in your body (iron overload).

Overview
- Iron is a mineral found in many foods.
- Too much iron is toxic to your body.
- It can poison your organs and cause organ failure.
- In hemochromatosis, iron can build up in most of your body’s organs.
- It builds especially in the liver, heart, and pancreas.
- Too much iron in the heart can cause irregular heartbeats called arrhythmias (ah-RITH-me-ahs) and heart failure.
- Too much iron in the pancreas can lead to diabetes.
- If hemochromatosis isn’t treated, it may even cause death.

Too much iron in the liver can cause:
- an enlarged liver,
- liver failure,
- liver cancer,
- cirrhosis (sir-RO-sis): scarring of the liver, which causes the organ to not work well.

Signs and Symptoms of Hemochromatosis:
- Joint pain
- Fatigue
- Lack of energy
- Abdominal pain
- Loss of sex drive
- Heart problems
- Arthritis
- Amenorrhea
- Early menopause
- Loss of sex drive
- Impotence
- Shortness of breath
- Liver disease, including an enlarged liver, cirrhosis, cancer, and liver failure.
- Damage to the pancreas, possibly causing diabetes
- Chronic (ongoing) abdominal pain

The goals of treating hemochromatosis include:
- Reducing the amount of iron in your body to normal levels.
- Preventing or delaying organ damage from iron overload.
- Treating complications of the disease.
- Maintaining a normal amount of iron in your body for the rest of your life.
- The most effective treatment for hemochromatosis is to reduce iron in the body by phlebotomy (withdrawal of blood from the arm veins).
- One unit of blood, which contains 250 mg of iron, usually is withdrawn every one to two weeks.
- Serum ferritin and transferrin saturation are checked every two to three months.
- Once ferritin levels are below 50 ng/ml and transferrin saturations are below 50%, the frequency of phlebotomies is reduced to every two to three months.
- When hemochromatosis is diagnosed early and is treated effectively, damage to the liver, heart, testicles, pancreas and joints can be prevented completely.
- In patients with established cirrhosis, effective treatment can improve the function of the heart, skin color, and diabetes.
- The cirrhosis is irreversible and the risk of developing liver cancer remains.

The benefits of therapeutic phlebotomy in hemochromatosis are as follows:
- It prevents the development of liver cirrhosis and liver cancer upon early detection.
- It improves liver function partially in patients who have already developed advanced cirrhosis.
- It improves and completely resolves symptoms of weakness, liver pain, joint pain, and fatigue.
- It improves function of the heart in patients with mild and early heart disease.

What are dietary recommendations in hemochromatosis?
- A normal balanced diet is recommended.
- Iron containing foods are not totally avoided.
- Alcohol should be avoided.
- Alcohol consumption increases the risk of developing cirrhosis and liver cancer.
- Ingestion of high doses of vitamin C in patients with iron overload may lead to fatal abnormal heart rhythms.
- It is reasonable to avoid vitamin C supplementation until patients are adequately treated.
- Raw seafood should be avoided.
- Patients with hemochromatosis are at risk of acquiring bacterial infections that flourish in iron rich environment.

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What are different treatment options available for treating cirrhosis?

Treatment of cirrhosis includes
- Preventing further damage to the liver,
- Treating the complications of cirrhosis,
- Preventing liver cancer or detecting it early,
- Liver transplantation.

Many medicines have been studied, such as
- Steroids
- Penicillamine (Cuprimine, Depen)
- An anti-inflammatory agent (colchicine)
- Researchers are studying various experimental treatments for cirrhosis.

Ascites
- Your health care provider may prescribe water pills (a diuretic).
- This removes extra fluid from your body.
- This medication will make you urinate more often.
- Your health care provider may insert a needle into your abdomen to directly remove large amounts of fluid.
- However, the fluid usually collects again.
- If the fluid becomes infected, you will have to stay in the hospital and receive IV antibiotics.

Hepatic encephalopathy
- You will be given lactulose, a drink that reduces the amounts of toxins that are absorbed into your intestinal tract.
- You may be started on a low-protein diet.
- These 2 treatments may be combined to improve symptoms in 75 percent of cases.

Clotting disorders
Adequate protein intake and vitamin supplements can help to correct clotting disorders.

Itching
Medications are available to reduce itching.

Surgery: Liver Transplantation
- In this operation, the diseased liver is removed and replaced with a healthy liver that is taken from an organ donor.
- About 80-90 percent of people undergoing liver transplantation survive.
- As in all transplantation procedures, supportive before and after the procedure is very important in determining the success of the operation.

Portal Hypertension
- Some people are treated with a drug called a beta-blocker to lower the pressure in the blood vessels.
- Various surgeries can be performed to redirect liver blood flow into the circulatory system.
- Reducing liver blood pressures.
- However, surgery may worsen hepatic encephalopathy or ascites.

Bleeding varices
If you have bleeding from varices in the esophagus or stomach, you are at high risk of bleeding to death.
- You will have to stay in the hospital until the bleeding is under control.
- You have a 1 in 2 chance of dying during that hospital stay if you suffer from bleeding varicose veins in your esophagus.
- If you have significant blood loss, treatment will focus on restoring lost fluids.
- You will be monitored carefully until bleeding is controlled and your blood circulation is stabilized.
- Two large IV lines will be placed to replace lost fluids.
- You will need supplemental oxygen until you begin to replace some of the lost blood.
- You may need blood transfusions.
- Balloon inflation to compress the vein.
- Medications that decrease blood flow into the liver.
- Tying off the bleeding vein.

Hepatorenal Syndrome
- Liver transplant is the only treatment that works in this advanced disease.

Liver cancer
- People with liver cancer may die within 3-6 months after diagnosis if the cancer remains untreated.
- Even with treatment, people rarely survive beyond 5 years.
- Surgery is the only chance for a cure, but usually the cancer has progressed too far by the time surgery is performed.
- Liver transplantation may also be considered.

How to prevent further damage to the liver
- Consume a balanced diet and one multivitamin daily.
- Patients with PBC with impaired absorption of fat soluble vitamins may need additional vitamins D and K.
- Avoid drugs (including alcohol) that cause liver damage.
- All patients with cirrhosis should avoid alcohol.
- Most patients with alcohol induced cirrhosis experience an improvement in liver function with abstinence from alcohol.
- Even patients with chronic hepatitis B and C can substantially reduce liver damage.
- It will slow the progression towards cirrhosis with abstinence from alcohol.
- Avoid nonsteroidal antiinflammatory drugs (NSAIDs, e.g., ibuprofen).
- Patients with cirrhosis can experience worsening of liver and kidney function with NSAIDs.
- Eradicate hepatitis B and hepatitis C virus by using anti-viral medications.
- Immunize patients with cirrhosis against infection with hepatitis A and B to prevent a serious deterioration in liver function.

Treating the complications of cirrhosis
- Propranolol (Inderal), a beta blocker, is effective in lowering pressure in the portal vein and is used to prevent initial bleeding and rebleeding from varices in patients with cirrhosis.
- Octreotide (Sandostatin) also decreases portal vein pressure and has been used to treat variceal bleeding.
- During upper endoscopy (EGD), either sclerotherapy or band ligation can be performed to obliterate varices and stop active bleeding and prevent rebleeding.
- Transjugular intrahepatic portosystemic shunt (TIPS) is a non-surgical procedure to decrease the pressure in the portal vein.
- A surgical operation to create a shunt (passage) from the high-pressure portal vein to veins with lower pressure can lower blood flow and pressure in the portal vein and prevent varices from bleeding.

How to treat Bone cancer by Cryosurgery?

Bone Cancer is the cancer that begins in the bone. Primary bone cancer is relatively uncommon with secondary or metastatic cancer. This is cancer that occurs initially in another organ and then spreads to bone tissue.

The most common types of bone cancer includes:
- Osteosarcoma,
- Ewing’s sarcoma,
- Chondrosarcoma,
- Malignant fibrous histiocytoma,
- Fibrosarcoma,
- Chordoma

Diagnosis of bone cancer:
- Check for a complete medical history.
- A description of your symptoms can help.
- A complete physical examination can help find the cause of your symptoms.
- Testing your muscle strength.
- Sensation to touch
- Reflexes
- Certain blood tests
- Plain X-rays
Benign tumors are more likely to have a smooth border while malignant tumors have a ragged border on X-ray images.

- A CT scan
- An MRI (magnetic resonance imaging).
- Positron emission tomography (PET) scan.
- An angiogram, which is an x-ray of blood vessels.
- A bone scan.
- Obtain a biopsy sample of the tumor.
- Get examined in the laboratory by a pathologist.
- Determine what kind of tumor it is.

What is the treatment for bone cancer?
The best treatment is based on:
- the type of bone cancer,
- the location of the cancer,
- how aggressive the cancer is,
- whether or not the cancer has invaded surrounding or distant tissues (metastasized).

The main types of treatment for bone cancer:
- Surgery,
- Chemotherapy,
- Radiation therapy
- Cryosurgery
These can be used either individually or combined with each other.

Process of Cryosurgery
- This method is the use of liquid nitrogen to freeze and kill cancer cells.
- This technique can sometimes be used instead of conventional surgery to destroy the tumor.
- The application of liquid nitrogen as a local adjuvant to curettage in the treatment of bone tumors was first introduced three decades ago.
- Cryosurgery was shown to achieve excellent local control.
- It is used for a variety of benign-aggressive and malignant bone tumors.
- Cryosurgery can cause significant morbidity if performed inappropriately.

An effective and safe procedure must follow these consecutive steps:
- Adequate exposure of the tumor cavity.
- Meticulous curettage and burr drilling.
- Soft-tissue mobilization and protection.
- Introduction of LN to the tumor cavity.
- Internal fixation of the cavity after cryotherapy.
- Protection of the operated bone throughout the healing period.

Side effects
- The exposure of normal bone and soft tissues (skin, muscles, nerves, and blood vessels) to the freezing effect of LN can result in significant morbidity.
- Early studies of the use of cryosurgery in the treatment of bone high complication rates, mostly pathological fractures and infections.