Posts Tagged ‘Pelvic’

What are causes and scope of liver cancer?

The liver is a vital organ present in vertebrates and some other animals. It has a wide range of functions.
- The liver is necessary for survival.
- This organ plays a major role in metabolism.
- It lies below the diaphragm in the abdominal-pelvic region of the abdomen.
- It produces bile, an alkaline compound which aids in digestion.
- It does so via the emulsification of lipids.
- The liver’s highly specialized tissues regulate a wide variety of high-volume biochemical reactions.
- The reactions include the synthesis and breakdown of small and complex molecules that are necessary for normal vital functions.
- Medical terms related to the liver often start in hepato- or hepatic.
- This comes from the Greek word for liver, hēpar.

Functions of Liver
More than 500 vital functions have been identified with the liver. The functions include:
- Detoxification.
- Protein synthesis.
- Production of biochemicals that are necessary for digestion.
- Glycogen storage.
- Decomposition of red blood cells.
- Plasma protein synthesis.
- Hormone production.
- Production of bile for digestion.
- Production of certain proteins for blood plasma.
- Production of cholesterol and special proteins that help to carry fats through the body.
- Conversion of excess glucose into glycogen for storage.
- Regulation of blood levels of amino acids.
- These amino acids form the building blocks of proteins.
- Processing of hemoglobin – the liver stores iron.
- Conversion of poisonous ammonia to urea.
- Clearing the blood of drugs and other poisonous substances.
- Regulating blood clotting.
- Resisting infections by producing immune factors.
- Removing bacteria from the bloodstream.
- Liver breaks down harmful substances which are excreted into the bile or blood.
- Bile by-products enter the intestine and ultimately leave the body in the feces.

Scope and Causes of the Liver Cancer
- Liver cancer is the third most common cancer in the world.
- Liver cancer will kill almost all patients who have it.
- It is known to kill almost within a year.
- About three-quarters of the cases of liver cancer are found in Southeast Asia (China, Hong Kong, Taiwan, Korea, and Japan).
- Liver cancer is also very common in sub-Saharan Africa (Mozambique and South Africa).
- Usually it is due to the prevalence of hepatitis B infection, which is the most common cause of this cancer worldwide.
- The reasons can also be due to rising obesity and diabetes rates.
- People who are prone to chronic hepatitis C which is another infection of the liver, causes liver cancer.
- l-carnitine deficiency is a risk factor for liver cancer
- Japan being member of International Cancer Genome Consortium is leading efforts to map liver cancer’s complete genome.

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What is meant by Hemicorporectomy?

In medicine (surgery), hemicorporectomy can also be called as translumbar amputation and “halfectomy”.

- It is a radical surgery in which the body below the waist is amputated that transects the lumbar spine.
- Hemi is generally used to refer to one of two sides like e.g., hemiplegia, which affects the arm and leg on one side of the body.
- The first hemicorporectomy was attempted by Charles S. Kennedy in 1960.

This includes the removal of:
- legs,
- the genitalia (internal and external),
- urinary system,
- pelvic bones,
- anus,
- rectum.

What kind of patients is recommended to undergo this procedure?
- It is a severely mutilating procedure recommended only as a last resort for patients.
- It is suggested to the patients with severe and potentially fatal illnesses like osteomyelitis, tumors, severe traumas and intractable decubiti in, or around, the pelvis.
- Cancer patients who need:
1. Extended radical mastectomy.
2. Radical gastrectomy.
3. Pancreatectomy.
4. Pelvic exenteration.
5. The ‘Commando Operation’ (tongue, jaw and neck dissection).
6. Bilateral back dissection.
7. Hemipelvectomy.
8. Hemicorporectomy or translumbar amputation.

Indications
- The operation is most often performed to treat spreading cancers related to that of the spinal cord and pelvic bones.
- Trauma affecting the pelvic girdle (“open-book fracture”).
- Uncontrollable abscess or ulcers of the pelvic region (causing sepsis).
- Other locally uncontainable conditions.

The Surgical Procedure
- It is often done in two stages.
- It is also possible to conduct the surgery in one stage.
- The first stage is the discontinuation of the waste functions in colostomy (rectum) and ileal conduit (bladder).
- The second stage is the amputation.

What are the points to be considered when undergoing this procedure?
- With the removal of almost half of the circulatory system, cardiac function needs to be closely monitored.
- A new blood pressure set-point develops.
- Removal of large parts of the colon can lead to loss of electrolytes.
- A calculated measurements of renal function (such as the Cockroft-Gault formula) are unlikely to reflect actual activity of the kidney.

Post Treatment
- Extensive physiotherapy and occupational therapy are necessary.
- The design and construction of bucket prosthesis.

Prosthetic
- Following a hemicorporectomy, patients are fitted with a socket-type prosthetic often referred to as a bucket.
- Early bucket designs often presented significant pressure problems for patients.
- New devices have incorporated with an inflatable rubber lining composed of air pockets.
- These evenly distribute pressure based on the patient’s motions.
- Two openings at the front of the bucket create space for the colostomy bag and the ileal conduit.

Postoperative management requires
- Particular attention to fluid replacement,
- Temperature control,
- Pulmonary care.

Long-term management issues involve:
- Hypertension,
- Weight gain,
- Temperature control,
- Stoma management,
- Skin care

Preventing pelvis or hip joint from brittleness…

Osteoporosis occurs when disintegration of bone cells takes place more quickly than the formation of new ones. This bone loss does not lead to any symptoms for a long time, and is only noticed when some kind of fracture happens. The pelvic girdle forms a stable base where the upper and lower body meet and the most powerful muscle groups and the strongest bones are located.

- Bone substance is built and destroyed during lifetime. Two-third of our bones are composed of mineral salts, calcium being most important. It is integrated in the bone tissue with the help of Vitamin D which is obtained through sunlight and some foods. Bone mass constantly increases until the age of 35. Later, it reduces by about 1.5 percent per year. Bone substance is disintegrated when parathyroid hormone prompts the osteoclasts to remove calcium from bones and release it in blood. Oestrogen in women and testosterone in men play an important role in the metabolism of bones.
- Hormone deficiencies, diet, hyperthyroidism, lack of exercise, and taking medication containing cortisone over a long period of time can harm the bones.
- Bone densitometry is done to diagnose osteoporosis. The radiologist determines the mineral content in the thigh bone or lumbar spine in grams per cubic centimeter. The treatment is primarily with calcium and vitamin D tablets and the administration of calcitonin and sodium fluoride. Earlier, hormone replacement therapy for oestrogen was recommended for women during menopause but recently this method was not in practice as it increases the risk of breast cancer.
- Strategies for preventing osteoporosis include plenty of sunshine and fresh air to boost body’s vitamin D and avoiding alcohol, nicotine and caffeine to prevent calcium depletion.
- A balanced diet rich in calcium and muscle training are recommended.