Cytology -Fine needle aspiration cytology Test

Adverse respiratory events (AREs) are leading causes of post-operative morbidity and mortality. Anesthesia is the use of medicine to prevent or reduce the feeling of pain or sensation during surgery or other painful procedures (such as getting stitches). Giving as an injection or through inhaled gases or vapours, different types of anesthesia affect the nervous system in various ways by blocking nerve impulses and, therefore, pain.

Anesthesia can help control your breathing, blood pressure, blood flow, and heart rate. It may be used to:

1. Relax you,
2. Block pain,
3. Make you sleepy or forgetful,
4. Make you unconscious for your surgery.

Adverse Respiratory Events (ARE)
Adverse outcomes of such events are fatal and lead to Death & Brain Damage. Three mechanisms of injury are reported to account for highest adverse respiratory events:
Inadequate Ventilation: Insufficient Gas Exchange can produce the adverse outcome. Esophageal Intubation: Incubation between the two sides of the esophagus inadvertently.
Difficult tracheal intubation: Tracheal Intubation is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway. It is performed facilitate ventilation of lungs in severely ill, anesthetized patients.

Other’s are as listed below:

• Airway Obstruction
• Inadequate inspired oxygen delivery
• Aspiration
• Endobronchial Intubation
• Premature Extubation

Residual neuromuscular blockade is an important postoperative complication associated to the use of neuromuscular blocking drugs and is commonly observed in the post-anesthesia care unit (PACU) after non-depolarizing neuromuscular blocking agents (NMBAs) are administered intra-operatively. Incomplete neuromuscular recovery can be minimized with acceleromyography monitoring. The risk of adverse respiratory events during early recovery from anesthesia can be reduced by intra-operative acceleromyography use.

Reintubation is a serious adverse respiratory event and the consequences include increased cardiac and respiratory complications, prolonged length of stay at the PACU, intensive care unit (ICU) and hospital, prolonged mechanical ventilator support, higher costs, and increased mortality. Overweight and obesity have also been identified as risk factors for postoperative respiratory complications. Most adverse respiratory events are considered preventable with improved monitoring such as:

• Pulse Oximetry
• Capnometry
• Combination of Both

Closed observation of the clinical factors and appropriate monitoring by well trained people are factors necessary to prevent adverse outcome. If you wish to discuss about any specific problem, you can consult a General Surgeon.

Sciatica is defined as pain or discomfort associated with the sciatic nerve which runs from the lower back, down the back of the legs to the feet. It most commonly occurs in adults aged 20 to 60 years. It is estimated that up to 40% of the new zealand population will experience sciatica at some point in their lives.

Causes

The sciatic nerve is the largest and longest nerve in the body. It originates in the lower spine, branches into the pelvis, then travels through the buttocks, down the back of the legs and branches into the lower legs and feet. Sciatic pain occurs when there is pressure on, or damage to, the sciatic nerve.
 
The most common cause of sciatica is disc prolapse (also known as disc herniation or slipped disc). This occurs when one of the soft, gel-filled discs between the vertebrae of the spine bulges or ruptures, compressing and/or irritating the sciatic nerve. 
Muscle spasms can also cause sciatica by compressing the sciatic nerve as it travels through the muscles. One such condition is piriformis syndrome, where the piriformis muscle irritates the sciatic nerve. Other less common causes of sciatica include:

• Infection
• Tumours

In older age groups, sciatica commonly occurs as the result of conditions caused by spinal degeneration, such as spinal stenosis. This is where the pathways through which the sciatic nerve travels are narrowed. Again, this causes compression and/or irritation of the sciatic nerve. 

Factors that increase the likelihood of developing sciatica include.

• Age
• Pregnancy
• Being overweight
• Smoking
• Jobs that involve twisting of the back or carrying heavy loads
• Sitting for long periods.

Essentially, any injury or process which causes compression of the sciatic nerve can cause sciatic pain. In many cases however, no specific cause for the sciatic pain can be identified.

Signs and symptoms.

• The pain caused by sciatica can range from being mild to very severe. It can occur suddenly or have a gradual onset. Sciatic pain is commonly described as a cramp-like pain that can be burning or sharp in nature. It may be associated with sensations such as pins and needles, tingling, numbness and weakness.
• Sciatic pain is typically felt in the lower back and hip and radiates down the back of one leg. The characteristic that distinguishes it from other types of back pain is that the pain travels below the knee. The pain may be aggravated by specific actions, such as sneezing, coughing, lifting or sitting.
• Pain and symptoms are usually most severe in the early stages of the condition, when compression and inflammation of the sciatic nerve are at their greatest. It is common for the pain to gradually reduce after this time until it resolves completely - usually within four to eight weeks.
• In rare cases compression of the sciatic nerve can be so severe that there is progressive weakness in the legs and/or loss of bowel and bladder function. If these symptoms are experienced, medical attention should be sought immediately as they can signal severe nerve damage.

Arthritis is inflammation of one or more of your joints. Pain, swelling, and stiffness are the primary symptoms of arthritis. Any joint in the body may be affected by the disease, but it is particularly common in the knee.

Knee arthritis can make it hard to do many everyday activities, such as walking or climbing stairs. It is a major cause of lost work time and a serious disability for many people. There are 2 types of arthritis the knee joint in the human body can get afflicted with. They are:

Osteoarthritis 

The form of arthritis which, with increasing pain, slowly wears down the joint cartilages is called osteoarthritis. This form of arthritis usually affects people after the age 40. The symptoms of osteoarthritis include:

1. Severe pain in the knee joints
2. Pain after walking up the stairs and it subsiding once you are on rest
3. Severe pain after the movement of joints for a long time
4. Pain that becomes worse in rainy days
5. Joints becoming stiff after waking up in the morning but they improve in the latter part of the day
6. Pain which also occurs in the thighs and the genital regions coupled with joints swelling and joints getting stiff after rest.

Rheumatoid arthritis

Rheumatoid arthritis is a chronic form of arthritis caused because of the knee joint inflammations. This form of arthritis can occur at any age. Being an auto-immune disease, its symptoms include, but are not limited to:

1. Severe pain in the morning
2. Mild fever accompanying the pain
3. Joints suddenly becoming swollen, red and warm causing, immense pain
4. Sudden stiffness of the joints
5. Pain that increases in cold weather
6. Mild fever, extreme tiredness and weakening of the muscles

Doctors are still doubtful about what exactly causes the disease; but the deformation of the immune system might cause the damage of the joints, causing people who are already suffering from obesity, smokers, and women, in general, more prone to this disease.

1. If you are overweight or obese, losing some of those extra pounds can go a long way in reducing the pain.
2. Muscle-stretching exercises are effective in keeping the knee joints flexible.
3. Dry needling, cupping, taping can help to control the pain and keep the joint supported.
4. Prescribed dosage of anti-inflammatory drugs such as Tylenol, Motrin, and Advil or injections of hyaluronic acid might relieve your pain.

If regular treatments do not work, you might opt for knee-replacement surgery and osteotomy (the process of cutting a bone with the help of surgery) which might better the alignment of the knee by transforming the bone shapes.

Physiotherapy for knee arthritis

Physiotherapy treatment is aimed at improving the symptoms of the disease (i.e. knee pain, swelling, stiffness), and you should begin to notice a positive difference within one or a few physiotherapy sessions. The main goals of physiotherapy for your knee arthritis are:

1. Reduce your knee pain and inflammation.
2. Normalise your knee joint range of motion.
3. Strengthen your knee: esp quadriceps (esp VMO) and hamstrings.
4. Strengthen your lower limb: calves, hip and pelvis muscles.
5. Improve your patellofemoral (knee cap) alignment and function.
6. Normalise your muscle lengths.
7. Improve your proprioception, agility and balance.
8. Improve your technique and function eg walking, squatting. If you wish to discuss about any specific problem, you can consult a Physiotherapist.

It can be disheartening to find out that you're infertile, especially when you thought that everything was normal. There are many reasons why a man is not able to contribute to the conception process and, consequently, there are options that can assist with male infertility.

Here are the treatment options available for male infertility.

1. Vasectomy Reversal
In recent years many men are opting to have children after a vasectomy. Luckily, a vasectomy is not necessarily a permanent issue anymore. It can be reversed. It takes a simple surgical procedure that restores the flow of sperm. There are certain factors that affect the success rates of vasectomy reversals such as your age, the presence of antisperm antibodies, time elapsed since the vasectomy and the age of the woman. Although this procedure is an option it is generally not encourage.

2. Sperm Aspiration
This is a group of procedures which is used to get viable sperm from the man. The sperm is used with Intra Cytoplasmic Sperm Injection (ICSI). This option is suitable for men who have severe types of male infertility. For example, if there is no sperm in their ejaculate, where sperm is dead or there is no motility. With this group of procedures there are four techniques that can be used to obtain the sperm. It is important to keep in mind that each technique is not suitable for everyone. These techniques are mentioned in the next four points.

3. Testicular Sperm Extraction
In this technique the fertility doctor removes a small piece of testicular tissue through a half inch skin incision. Sperm is liberated from the seminiferous tubules (where they are produced). This procedure can be performed in the doctor's surgery or the operating room and a mild sedation is recommended for comfort. The sperm harvested with this technique can be stored for later use.

4. Microsurgical Epididymal Sperm Aspiration
If you have a reproductive tract blockage then this technique is an option. During this technique an operating microscope is used to examine the tubules that contain sperm. The fluid containing the sperm is collected and the quality is examined. Thereafter it is taken to the IVF laboratory for use.

5.Testicular Sperm Aspiration
This technique uses a needle biopsy of the testicle. The procedure is performed under local anaesthesia in a doctor's surgery. The sperm is extracted through the testicle but the amount obtained can be low because the needle cuts a thin layer of the tissue. This procedure is usually quite successful and less invasive than other methods.