hair transplant

Like good health and youth, most of us take our locks for granted -- that is, until they're gone. For many people, a hair transplant can help bring back what looks like a full -- or at least a fuller -- head of hair.

If thinning up top or going bald really bothers you, the procedure can be one way to feel more confident about your looks. But first talk with your doctor about what you can expect during and after the surgery.

Hair transplantation is one of the most rapidly evolving procedures in aesthetic surgery, accompanied by regular improvement in techniques. The recent advances in technology and the concept of using follicular unit grafts have made this procedure reach a new height. The ability to provide very natural-looking results has encouraged larger number of balding men and women to opt for this surgical solution.

Hair transplantation is based on the ‘theory of donor dominance in androgenic alopecia.’ If a graft is taken from an area destined to be permanently hair-bearing and transplanted to an area suffering from male patterns baldness, it will, after an initial period of effluvium, grow hair in its new site as long as it would have at its original site. This is the scientific basis of hair transplantation surgery.

Single hair grafts are used to create a natural hairline. The planning of the hairline is one of the most important steps in hair transplantation. The hairline is the most visible landmark and the quality of work of a surgeon is often judged by the quality of the hairline.

Types of Hair Transplantation

Three most popular hair transplant techniques are Direct Hair Implantation (DHI), Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT). One of the key differences among these techniques is how the hair follicles are extracted from the donor area and then how they are implanted in the receptor area.

Follicular Unit Transplant (FUT)

FUT is the oldest hair transplant technique in which a thin strip of skin is removed from the back of the head surgically. The hair follicles are then divided into individuals units by the doctor’s assistants. The donor area is then stitched together.

FUT technique leaves a noticeable scar on the donor area. Hair follicles are implanted by creating reception incisions or holes in the treatment area and placing hair follicles with forceps. This gives little or no control over depth, angle, and direction. Thus, results are not natural.

 

Follicular Unit Extraction (FUE)

FUE is one of the most prevalent hair transplant techniques in which a hair follicle or group of hair follicles is removed by making a circular cut in the skin around it using a punch. This technique leaves small open holes in the scalp that turn into tiny white scars.

FUE scars are less visible than FUT scars.

Hair follicles are implanted the same way as in the FUT technique. Reception holes are made in the treatment area and hair follicles are placed with forceps. This gives little or no control over depth, angle, and direction. And, thus, results are not natural.

Direct Hair Implantation (DHI)

Direct Hair Implantation (DHI) is the most advanced hair transplantation technique. In DHI, hair follicles are removed from the donor area one after one using a very fine extractor with a diameter of 1mm or less. DHI procedure is always performed by certified surgeons, unlike FUE and FUT procedures that are mostly done by technicians.

The hair are then placed using a single-use implanter directly on the treatment area. DHI’s implanter give a surgeon full control over depth, angle, and direction ensuring natural results.

The transplanted hair grow naturally just like facial hair with the same texture and characteristics. Besides, you can shave newly implanted facial hair and even style them like you want.

DHITM uses direct hair implantation (DHI) technique to give you natural results and density. We use single-use patented instruments for the procedures that allow us to achieve perfect angle, depth, and direction.

The facial hair transplant procedures are performed under local anaesthesia. They are painless and last for an hour or two. There is no recovery time as such. Patients can resume their daily routine from the next day.

 

Benefits of Direct Hair Implantation (DHI):

  • 100% natural results.
  • No reception incisions.
  • No stitches.
  • No scarring.
  • Pain-free.
  • Maximum survival rate of hair follicles (more than 90%).
  • Short recovery time
  • Less donor hair requirement


Expectations and Recovery

After the surgery, your scalp may be very tender. You may need to take pain medications for several days. Your surgeon will have you wear bandages over your scalp for at least a day or two. He may also prescribe an antibiotic or an anti-inflammatory drug for you to take for several days. Most people are able to return to work 2 to 5 days after the operation.

Within 2 to 3 weeks after surgery, the transplanted hair will fall out, but you should start to notice new growth within a few months. Most people will see 60% of new hair growth after 6 to 9 months. Some surgeons prescribe the hair-growing drug minoxidil (Rogaine) to improve hair growth after transplantation, but it’s not clear how well it works.

gastric sleeve

Are you considering gastric sleeve surgery because you've tried diets and exercise for years and still have a lot of weight to lose? You'll want to know the risks and benefits, what makes someone a good candidate for the operation, and what long-term commitments you need to make to keep the results.

In this operation, surgeons remove part of your stomach and join the remaining portions together to make a new banana-sized stomach or "sleeve." With just a small sack (about 1/10th the size of your original stomach), you'll feel full a lot quicker than you did before. You won't be able to eat as much as you used to, which helps you lose weight. Plus, the surgery removes the part of your stomach that makes a hormone that boosts your appetite.

It's Different From Gastric Bypass

In gastric bypass, the surgeon makes a small pouch that skips most of your stomach, going straight to the intestine.

Gastric sleeve surgery is best for people who have a BMI (body mass index) of at least 40. That means you’re 100 pounds or more over your ideal weight. Some people are too heavy for gastric bypass surgery, so it may be a good alternative.

What Happens

The surgery takes about an hour. Your surgeon will make a few small cuts in your belly and insert a laparoscope -- an instrument with a tiny camera that sends pictures to a monitor. The surgeon will then insert other medical instruments through the additional cuts and remove 3/4 of your stomach. Finally, he’ll reattach the rest of your stomach to form the "sleeve" or tube.

You might be in hospital about 2 or 3 days. The procedure is permanent.

New Eating Habits

The first day after surgery, you'll drink clear liquids. By the time you leave the hospital, you can eat pureed foods and protein shakes and will continue to do so for about 4 weeks.

Keep in mind that you have to change the way you eat forever. After that first month, you'll switch to eating soft solid foods very slowly. Other pointers to keep in mind:

  • Everything must be chewed thoroughly before being swallowed.
  • Don't drink while you eat, as this might cause your new stomach to overfill.
  • Drink liquids a half-hour after finishing a meal.
  • Avoid high-calorie sodas and snacking.
  • Take vitamin and mineral supplements every day.

After 2 or 3 months, you can move on to regular meals. But remember, you will not be able to eat as much as you used to.

Weight Loss

People generally lose 60% of their extra weight over 12 to 18 months. So if you are 100 pounds overweight, you'll lose about 60 pounds, though some lose more and others less. Of course, exercising and eating right add to your weight loss.

 

Benefits of Sleeve Gastrectomy

Sleeve gastrectomy induces rapid and effective weight loss comparable to gastric bypass surgery. Patients can expect to lose 50% or more of their excess weight in three years. The procedure does not require implantation of a band, nor does it re-route the digestive process. Hormonal changes after the procedure help patients to feel sated, eat less, as well as improve or resolve diabetes.

 

liposuction

Liposuction is a cosmetic procedure that removes fat that you can’t seem to get rid of through diet and exercise.

A plastic or dermatologic surgeon usually does the procedure on your hips, belly, thighs, buttocks, back, arms, or face to improve their shape. But liposuction can also be done with other plastic surgeries, including facelifts, breast reductions, and tummy tucks.

Am I a Good Candidate?

You’ll want to have realistic expectations. Liposuction won’t get rid of cellulite, so if you hoped you’d come out of surgery without any, you’re out of luck.

Liposuction is a surgical procedure, and with it comes risks. So you need to be in good health before you get it. That means you must at least:

  • Be within 30% of your ideal weight
  • Have firm, elastic skin
  • Not smoke

Doctors don’t recommend the procedure if you have health problems with blood flow or have heart diseasediabetes, or a weak immune system.

How you prepare

Food and medications

Before the procedure, discuss with your surgeon what to expect from the surgery. Your surgeon will review your medical history, and ask about any medical conditions you may have and any medications, supplements or herbs you may be taking.

Your surgeon will recommend that you stop taking certain medications, such as blood thinners or NSAIDs, at least three weeks prior to surgery. You may also need to get certain lab tests before your procedure.

Other precautions

If your procedure requires the removal of only a small amount of fat, the surgery may be done in an office setting. If a large amount of fat will be removed — or if you plan to have other procedures done at the same time — the surgery may take place in a hospital followed by an overnight stay. In either case, arrange for someone to drive you home and stay with you for at least the first night after the procedure.

What you can expect

Before the procedure

·        Tumescent liposuction procedure

Tumescent liposuction procedure

Before your liposuction procedure, the surgeon may mark circles and lines on the areas of your body to be treated. Photos also may be taken so that before and after images can be compared.

How your liposuction procedure is done depends on the specific technique that's used. Your surgeon will select the appropriate technique based on your treatment goals, the area of your body to be treated, and whether you have had other liposuction procedures in the past.

·        Tumescent liposuction. This is the most common type of liposuction. The surgeon injects a sterile solution — a mixture of salt water, which aids fat removal, an anesthetic (lidocaine) to relieve pain and a drug (epinephrine) that causes the blood vessels to constrict — into the area that's being treated. The fluid mixture causes the affected area to swell and stiffen.

The surgeon then makes small cuts into your skin and inserts a thin tube called a cannula under your skin. The cannula is connected to a vacuum that suctions fat and fluids from your body. Your body fluid may be replenished through an intravenous (IV) line.

·        Ultrasound-assisted liposuction (UAL). This type of liposuction is sometimes used in conjunction with traditional liposuction. During UAL, the surgeon inserts a metal rod that emits ultrasonic energy under your skin. This ruptures the fat-cell walls and breaks down the fat for easier removal. A new generation of UAL called VASER-assisted liposuction uses a device that may improve skin contouring and reduce the chance of skin injuries.

·        Laser-assisted liposuction (LAL). This technique uses high-intensity laser light to break down fat for removal. During LAL, the surgeon inserts a laser fiber through a small incision in the skin and emulsifies fat deposits. The fat is then removed via a cannula.

·        Power-assisted liposuction (PAL). This type of liposuction uses a cannula that moves in a rapid back-and-forth motion. This vibration allows the surgeon to pull out tough fat more easily and faster. PAL may sometimes cause less pain and swelling and can allow the surgeon to remove fat with more precision. Your surgeon may select this technique if large volumes of fat need to be removed or if you've had a previous liposuction procedure.

During the procedure

Some liposuction procedures may require only local or regional anesthesia — anesthesia limited to a specific area of your body. Other procedures may require general anesthesia, which induces a temporary state of unconsciousness. You may be given a sedative, typically through an IV injection, to help you remain calm and relaxed.

The surgical team will monitor your heart rate, blood pressure and blood oxygen level throughout the procedure. If you are given local anesthesia and feel pain during the procedure, tell your surgeon. The medication or motions may need adjustment.

The procedure may last up to several hours, depending on the extent of fat removal.

If you've had general anesthesia, you'll wake in a recovery room. You'll typically spend at least a few hours in the hospital or clinic so that medical personnel can monitor your recovery. If you're in a hospital, you may stay overnight to make sure that you're not dehydrated or in shock from fluid loss.

After the procedure

Expect some pain, swelling and bruising after the procedure. Your surgeon may prescribe medication to help control the pain and antibiotics to reduce the risk of infection.

After the procedure, the surgeon may leave your incisions open and place temporary drains to promote fluid drainage. You usually need to wear tight compression garments, which help reduce swelling, for a few weeks.

You may need to wait a few days before returning to work and a few weeks before resuming your normal activities — including exercise.

During this time, expect some contour irregularities as the remaining fat settles into position.

Results

After liposuction, swelling typically subsides within a few weeks. By this time, the treated area should look less bulky. Within several months, expect the treated area to have a leaner appearance.

It's natural for skin to lose some firmness with aging, but liposuction results are generally long lasting as long as you maintain your weight. If you gain weight after liposuction, your fat distribution may change. For example, you may accumulate fat around your abdomen regardless of what areas were originally treated.

rhinoplasty

RHINOPLASTY

Rhinoplasty, or nose reshaping is one of the most common of all plastic surgery procedures.  


A lot of people are unhappy with the size and/or shape of their nose. The nose is central to facial balance and many people opt for surgical nose reshaping, or rhinoplasty, in an effort to find a more harmonious alignment of their features. Sometimes the problem can be more to do with the position of the chin or jaw, but patients tend to focus their dissatisfaction on the nose.


While surgical techniques are advanced, there are limitations as to how much the nose can be altered.


Outcomes depend on the size of the nose, the condition of the skin and the age of the patient. The most important thing is that there is clear communication between a patient and a surgeon about what is wanted and what is achievable. Patients should also bear in mind that surgery alone will not solve any emotional or social problems they may attribute to their nose or to their appearance generally

What are the most common reasons for people wanting nose operations?


Cosmetic reasons

Most people who dislike their nose have concerns about the bridge or the tip. At the bridge, or dorsum, people often complain about having a hump. Meanwhile, people who want to change the tip often see this part of the nose as being too wide, round, blobby, beaked or lacking in definition. Some people also dislike the length of their nose.


Medical reasons

Other patients may opt for a rhinoplasty because of an injury to the nose, whereby the nose may be broken or bent following an accident of some kind. Others may have functional breathing problems relating to the nasal airways. In these cases, surgical interventions would be considered reconstructive, whereas for the majority of nose operations the surgery is classed as cosmetic.


Nose operations are most commonly carried out to:

• Alter the hump at the bridge of the nose

• Reshape the tip of the nose

• Alter the length of the nose

• Alter the width of the nose

• Alter the width of the nostrils

• Restructure and reposition the nose after an injury 

• Open up the nasal airways to help breathing. 

What surgery is available, and what techniques are involved?

Rhynoplasty-preop nose

A nose reshaping operation is either performed from inside the nostrils- this is referred to as a closed rhinoplasty; or else by making a small cut on the nose and elevating the skin – known as an open rhinoplasty (shown in this image).


The precise nature of the operation will vary depending on the area of the nose that is being treated.  


Bridge (or dorsum)

If the bridge of the nose is being operated on, the surgeon removes the bone and cartilage that is causing ‘the hump’. The nose may then be broken to allow the remaining pieces of bone to be moved closer together, resulting in the narrowing of the nose.


Tip

When the tip of the nose is operated on, the cartilage that makes up the tip-support needs to be partly removed or reshaped. This is done through the nostril, or by making a small cut in the bit between the nostrils (known as the columella) in an open rhinoplasty.


Length

A surgeon can adjust and reduce the central structure of the nose, known as the septum, to help shrink the tip and reduce the overall length of the nose. Adjustment to the tip cartilages also helps adjust nasal length.


Width

By breaking and repositioning the side nasal bone, a surgeon can also reduce the width of the nose and achieve a narrower appearance.


Additional rhinoplasty

Surgeons can also add to the nose using cartilage grafts from the septum or, occasionally, silicone implants, in what is called an additional rhinoplasty. This type of operation is used to build up a ‘flat’ bridge or tip.


The above techniques can also be used to straighten and refine a nose that has been broken through injury, and to relieve breathing difficulties. 

Is this surgery available on the NHS?


Surgery to reshape the nose after an injury is sometimes available on the NHS, as is reconstructive surgery aimed at helping a patient to breathe. However, nose surgery that is purely cosmetic, i.e. requested and carried out on the basis of appearance only, is not usually available on the NHS and must be sought privately.

Who will I see as a patient?


Rhinoplasty operations are conducted by one surgeon with the help of an assistant. Prior to an operation, however, careful examinations will be carried out to determine whether surgery is the right course of action and confirm what can be achieved. Occasionally you may also meet with a clinical psychologist to discuss the psycho-social implications of your appearance and the relevance of nose reshaping to that. 

What should I expect in terms of treatment, procedures and outcomes?


Operations take between 90-180 minutes, depending on the technique being used. Following an operation, patients usually need to spend one or occasionally two nights in hospital. You will need to have a splint held over your nose by tape for seven days, and a pad under your nose for 12 hours


Allow two weeks off work following a nose operation. In terms of exercise, you should be able to walk a distance after three-to-five days, and to swim after three weeks, although strenuous exercise should be avoided for four-to-six weeks.


Most closed rhinoplasty operations (those carried out through the nostril) usually take about two weeks to settle. There will be no external scarring, but if a nose is broken as part of the surgery there will be noticeable bruising around the eyes for about seven-to-ten days, with yellowing around the eyes for 10-20 days.


If you have the tip of your nose operated on, 60% of the changes will be apparent after three weeks, while the remaining 40% of the changes will evolve over several months or even a year. 


If you undergo an open rhinoplasty whereby the columella is cut and the nose-skin opened up, so exposing the cartilages directly during the operation, the surgeon has a better view and this can be more accurate for changes to the tip. However, the swelling will be greater and the recovery time longer.


As with all operations, there are risks involved. After a rhinoplasty, some patients experience an altered sense of smell, while others find that their nasal breathing is affected. Minor bleeding is common while heavy bleeding is very rare but can be severe. Some patients experience pain for a number of weeks. Slight irregularity in the bone or cartilage may be felt or occasionally seen. Some patients will be dissatisfied with the outcome of a nose reshaping operation. Usually it is best to accept what improvement has been achieved and not opt for a further operation. However, it is sometimes reasonable to consider a further slight adjustment. 


You should establish from your surgeon in advance what the conditions for a re-operation would be, and what any arrangements for payment would be.


For people who return for additional surgery, there is also a risk that the structural scaffolding of the nose could collapse. The nose is a delicate structure, and too much surgery can weaken and damage it.

Ophthalmology

LASIK, or "laser-assisted in situ keratomileusis," is the most commonly performed laser eye surgery to treat myopia (nearsightedness), hyperopia (farsightedness) and astigmatism.


Like other types of refractive surgery


, the LASIK procedure reshapes the cornea to enable light entering the eye to be properly focused onto the retina for clearer vision.


In most cases, laser eye surgery is pain-free and completed within 15 minutes for both eyes. The results — improved vision without eyeglasses or contact lenses — can usually be seen in as little as 24 hours.


If you're not a good LASIK candidate, a number of other vision correction surgeries are available, such as PRK and LASEK laser eye surgery and phakic IOL surgery. Your eye doctor will determine if one of these procedures is suitable for your condition and, if so, which technique is best.


LASIK, or "laser-assisted in situ keratomileusis," is the most commonly performed laser eye surgery to treat myopia (nearsightedness), hyperopia (farsightedness) and astigmatism.


Like other types of refractive surgery


, the LASIK procedure reshapes the cornea to enable light entering the eye to be properly focused onto the retina for clearer vision.


In most cases, laser eye surgery is pain-free and completed within 15 minutes for both eyes. The results — improved vision without eyeglasses or contact lenses — can usually be seen in as little as 24 hours.


If you're not a good LASIK candidate, a number of other vision correction surgeries are available, such as PRK and LASEK laser eye surgery and phakic IOL surgery. Your eye doctor will determine if one of these procedures is suitable for your condition and, if so, which technique is best.


The surgeon then folds back the hinged flap to access the underlying cornea (called the stroma

) and removes some corneal tissue using an excimer laser


.


This highly specialized laser uses a cool ultraviolet light beam to remove ("ablate") microscopic amounts of tissue from the cornea to reshape it so it more accurately focuses light on the retina for improved vision.


For nearsighted people, the goal is to flatten the cornea; with farsighted people, a steeper cornea is desired.


Excimer lasers also can correct astigmatism by smoothing an irregular cornea into a more normal shape. It is a misconception that LASIK cannot treat astigmatism.


After the laser reshapes the cornea, the flap is then laid back in place, covering the area where the corneal tissue was removed. Then the cornea is allowed to heal naturally.


Laser eye surgery requires only topical anesthetic drops, and no bandages or stitches are required.



Before LASIK Surgery

Your eye doctor will perform a thorough eye exam to ensure your eyes are healthy enough for the procedure. He or she will evaluate: the shape and thickness of your cornea; pupil size; refractive errors (myopia, hyperopia and astigmatism); as well as any other eye conditions.


The moistness of your eyes will also be evaluated, and a precautionary treatment may be recommended to reduce your risk of developing dry eyes after LASIK.


Usually, an automated instrument called a corneal topographer is used to measure the curvature of the front surface of your eye and create a "map" of your cornea.


With wavefront technology associated with custom LASIK, you also are likely to undergo a wavefront analysis that sends light waves through the eye to provide an even more precise map of aberrations affecting your vision.


Your eye doctor will also note your general health history and any medications you are taking to determine if you are a suitable candidate for LASIK.


You should stop wearing contact lenses for a period of time advised by your doctor (typically around two weeks) before your eye exam and before the LASIK procedure, as contacts can alter the natural shape of your cornea.



What To Expect During LASIK

Before your surgery begins, numbing eye drops are applied to your eye to prevent any discomfort during the procedure. Your doctor may also give you some medication to help you relax.


Your eye will be positioned under the laser, and an instrument called a lid speculum is used to keep your eyelids open.


The surgeon uses an ink marker to mark the cornea before creating the flap. A suction ring is applied to the front of your eye to prevent eye movements or loss of contact that could affect flap quality.


After the corneal flap is created, the surgeon then uses a computer to adjust the excimer laser for your particular prescription.


You will be asked to look at a target light for a short time while he or she watches your eye through a microscope as the laser sends pulses of light to your cornea.


The laser light pulses painlessly reshape the cornea, although you may feel some pressure on your eye. You'll also hear a steady clicking sound while the laser is operating.


LASIK is performed on each eye separately, with each procedure taking only about five minutes.


Immediately After LASIK Surgery

Upon completion of your LASIK surgery, your surgeon will have you rest for a bit. You may feel a temporary burning or itching sensation immediately following the procedure. After a brief post-operative exam, someone can drive you home. (You cannot drive after LASIK until your eye doctor sees you the following day and confirms your uncorrected vision meets the legal standard for driving.)


You should expect some blurry vision and haziness immediately after surgery; however, clarity should improve by the very next morning.


Your eyesight should stabilize and continue to improve within a few days, although in rare cases it may take several weeks or longer. For most people, vision improves immediately.


You may be able to go to work the next day, but many doctors advise a couple of days of rest instead.


Also, it is usually recommended that you refrain from any strenuous exercise for at least a week, since this can traumatize the eye and affect healing.


Generally, you will return to see your eye doctor or your LASIK surgeon the day after surgery.


At this initial check-up, he or she will test your vision to make sure you are legal to drive without glasses or contact lenses. In most states, this requires uncorrected visual acuity of 20/40 or better.


As with any other surgery, always follow your doctor's instructions and take any medication prescribed. Also, avoid rubbing your eyes, as there's a small chance this could dislodge the flap until it heals and adheres more securely to the underlying cornea.


Long-Term Results

Laser eye surgery offers numerous benefits and can dramatically improve your quality of life. Most people achieve 20/20 vision or better after the surgery, but LASIK results do vary. Some people may achieve only 20/40 vision or less.


You may still need to wear glasses or contact lenses following laser vision correction, though your prescription level typically will be much lower than before.


If you have mild residual refractive error after LASIK and you want sharper vision for certain activities like driving at night, prescription lenses with anti-reflective coating often can be helpful. Also, if you are sensitive to sunlight after LASIK, ask your eye care professional about eyeglasses with photochromic lenses.


While the procedure has an excellent safety profile, LASIK complications can occur and may include infection or night glare (starbursts or halos that are most noticeable when you're viewing lights at night, such as while you're driving).


A small percentage of people will need a LASIK enhancement, or "touch up" procedure, a few months after the primary LASIK surgery to achieve acceptable visual acuity.


You also may still need reading glasses once you reach your 40s, due to a normal age-related loss of near vision called presbyopia.


While LASIK surgery has a high success rate, it is important that you discuss all facets of the procedure with your surgeon prior to consenting to the surgery.


treatment of adduction


Opioid addiction to prescription and illicit drugs is a serious and growing problem. In the US alone, >2.4 million people suffer from opioid use disorder. Government and pharmaceutical agencies have begun to address this crisis with recently released and revised task forces and medication-assisted therapies (MAT). For decades, oral or intravenous (IV) MATs have helped patients in their recovery by administration of opioid agonists (methadone, buprenorphine, oxycodone), antagonists (naltrexone, naloxone), and combinations of the two (buprenorphine/naloxone). While shown to be successful, particularly when combined with psychological counseling, oral and IV forms of treatment come with constraints and challenges. Patients can become addicted to the agonists themselves, and there is increased risk for diversion, abuse, or missed dosages. Consequently, long-acting implants have begun to be developed as a potentially preferable method of agonist delivery. To date, the newest implant approved by the US Food and Drug Administration (May 2016) is Probuphine®, which delivers steady-state levels of buprenorphine over the course of 6 months. Numerous studies have demonstrated its efficacy and safety. Yet, implants come with their own risks such as surgical site irritation, possible movement, and protrusion of implant out of skin. This review introduces the opioid abuse epidemic, examines existing medications used for therapy, and highlights Probuphine as a new treatment option. Costs associated with MATs are also discussed.


The National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, is pleased to announce that the U.S. Food and Drug Administration (FDA) has approved the first long-acting, subdermal buprenorphine implant for the treatment of opioid dependence. The medicated rods, implanted in a single procedure, are designed to provide an ongoing release of a low dosage of buprenorphine over the span of six months. The implant technology is approved for a specific subset of patients who are already clinically stable for at least six months on other approved buprenorphine delivery systems, including moderate doses of buprenorphine tablets or films.


Buprenorphine is a medicine currently approved to treat opioid use disorder and is available as a buccal tablet or a film placed under the tongue or against the inside of the cheek, both requiring self-administration by patients on a daily basis. The newly approved implantable form of buprenorphine, called Probuphine, is placed under the skin in the upper arm in an out-patient setting, and removed in a similar manner at the end of the treatment period. Other medications for opioid use disorder include methadone and naltrexone.


Medication-assisted treatment (MAT) is cost-effective and has been proven to help patients recover from opioid use disorder, reduce fatal overdoses, improve social functioning, reduce criminal activity, and lessen the risk of transmitting infectious diseases like HIV and Hepatitis C.


Yet, of the 2.2 million Americans 12 years of age or older who abused or were dependent on opioids in 2014, fewer than 1 million received MAT. Also, less than half of private-sector treatment programs have adopted MAT, and even in programs that offer MAT, only 34.4 percent of patients are prescribed them.



US scientists have invented an injectable microchip which is able to monitor the levels of alcohol and drugs in your body.


Developed by engineers from Jacobs School of Engineering at the University of San Diego, it is hoped that the tiny chip will one day be used to help patients with addictions.


Currently, breathalysers and blood tests are the most common ways to monitor blood alcohol levels but both require patient cooperation and the expertise of a trained professional.


As such, this invention could prove invaluable to those in recovery by allowing them to easily measure and reduce the level of substances like alcohol in their body. 


“This is a proof-of-concept and an enabling tool that would slot into a larger ecosystem for treatment," Drew Hall, project lead and an electrical engineering professor at Jacobs School of Engineering at the University of San Diego told Forbes. 


“We’ve shown that this chip can work for alcohol, but we envision creating others that can detect different substances of abuse and inject a customised cocktail of them into a patient to provide long-term, personalised medical monitoring.”




esearchers in Turkey say they may have created the cure to drug addiction through the implementation of a device called a "sub surface chip implant." Addiction medicine expert Akın Bostanoğlu said that a maintenance treatment that combines medication with the subsurface chip gives patients the best chance of sustainable recovery.


While there is widespread interest within the treatment community for the use of the medicines promoted by the Alcohol and Substance Addiction Research Treatment and Training Center (AMATEM), there is also growing concern about the addictive properties of the drugs.


A woman who struggled with drug addiction four three years, identified as E.Ü., said, "I applied to AMATEM and they installed a chip under my skin. Now I am more than happy. I have normal life and I don't want to remember those [dark] days anymore." E.Ü. has now been using the chip treatment for one and a half years.


Across the country, physicians and legislators are ramping up efforts to stem the escalating heroin and other drug addiction crises. Treatment methods, however, vary in efficiency, which complicates the efforts of people with drug addiction in finding a sustainable recovery.


bone marrow transplantation

What is a bone marrow transplant?

A bone marrow transplant is a process to replace unhealthy bone marrow with healthy bone marrow.


What is bone marrow?

Bone marrow is the soft, spongy tissue inside your bones that makes blood-forming cells (blood stem cells). These cells turn into blood cells including:

  • White blood cells to fight infections.
  • Red blood cells to carry oxygen throughout the body.
  • Platelets to control bleeding.

Blood-forming cells are also found in the blood stream and the umbilical cord blood.

 BloodVessel

How does transplant work?

Before transplant, you get chemotherapy (chemo) with or without radiation to destroy the diseased blood-forming cells and marrow. Then, healthy cells are given to you (it’s not surgery). The new cells go into your bloodstream through an intravenous (IV) line, or tube. It’s just like getting blood or medicine through an IV. The cells find their way into your marrow, where they grow and start to make healthy red blood cells, white blood cells and platelets.


What diseases can BMT treat?

Bone marrow transplants can treat:

  • Blood cancers like leukemia or lymphoma
  • Bone marrow diseases like aplastic anemia
  • Other immune system or genetic diseases like sickle cell disease


the 3 common types of BMT


Autologous transplant – uses your own blood-forming cells

For an autologous transplant, your own blood-forming cells are collected, frozen and stored. Then, they’re given back to you after chemotherapy (chemo) and possibly radiation. Your doctor will decide the best time to collect your cells. After they are collected, the cells can be frozen for months or years until you need them for your transplant.

How are my cells collected?

There are 2 options. Your doctor will decide which is best for you.

1. Peripheral blood stem cell (PBSC) collection: The cells are collected from your bloodstream. This process is called apheresis. Before apheresis, you get shots for a few days to increase the number of blood-forming cells in your bloodstream. During apheresis, blood is removed from your vein through an intravenous (IV) line, passed through a machine, and put back into your vein. The machine takes out the blood-forming cells that will be used for your transplant. Most patients who have an autologous transplant collect their cells this way. 


2.  Bone marrow collection: The cells are collected from the pelvic (hip) bone during surgery. You get anesthesia so you don’t feel pain. A doctor uses a special needle to take out the blood-forming cells

from your bone marrow.


Allogeneic transplant – uses blood-forming cells donated by someone else

[15:11, 3/28/2019] Anadolu Health: 

[15:12, 3/28/2019] Anadolu Health: forming cells donated by someone else. The donor can be a family member or someone unrelated to you. Sometimes, people get donated blood-forming cells from umbilical cord blood. This is the blood collected from the umbilical cord and placenta after a baby is born and made available through Be The Match Registry.


First, your doctor tests your blood to find out your human leukocyte antigen (HLA) type. HLA is a protein — or marker — found on most cells in your body. Your doctors will look for a donor or umbilical cord blood that closely matches your HLA. 


The best transplant outcomes (results) happen when a patient’s HLA closely matches the donor’s HLA. A close HLA match also helps lower the risk for problems after transplant. Matching HLA markers is much more complex than matching blood types. 


Usually, your doctor will first look for a matching donor in your family usually a brother or sister. That’s because you inherit HLA markers from your parents. Each brother and sister has a 25% (1 out of 4) chance of completely matching you, if you have the same mom and dad. Your parents and your children always match exactly half of your HLA markers. For some people a transplant from a half-matched donor, or a haploidentical transplant, is a treatment option.


About 70% of patients (7 out of 10) who need a transplant don’t have a close match in their family. If you don’t have a match in your family, your doctor will search the Be The Match Registry® for an unrelated donor or umbilical cord blood. Finding a donor can take time, so your doctor should start a donor search as soon as possible. Your doctor can look for a donor even if you don’t need a transplant right away.


Haploidentical transplant – a type of allogeneic transplant

A haploidentical transplant is a type of allogeneic transplant. It uses healthy, blood-forming cells from a half- matched donor to replace the unhealthy ones. The donor is typically a family member. 


For allogeneic transplants, your doctor tests your blood to find out your human leukocyte antigen (HLA) type. HLA is a protein — or marker — found on most cells in your body. Doctors look for a donor or umbilical cord blood that closely matches your HLA. 


But sometimes they can’t find a close HLA match. Then, a haploidentical transplant may be an option. This is a type of allogeneic transplant where the donor matches exactly half of your HLA. 


A haploidentical, or half-matched, donor is usually your mom, your dad or your child. Parents are always a half-match for their children. Siblings (brothers or sisters) have a 50% (1 out of 2) chance of being a half-match for each other. It’s very unlikely that other family members (like cousins, aunts or uncles) would be a half-match. 


A haploidentical transplant is a newer type of transplant. This means: 


You may have the option to join a clinical trial (research study).

Not all transplant centers will do this type of transplant.

neurosurgery

Neurosurgery is the surgical specialty that deals with the nervous system, including the brain, spinal cord and nerves of the body.


Types of Neurosurgeons

A neurosurgeon, who may also be referred to as a brain surgeon, is a specialist who has received extensive training in general surgery. The neurosurgeon typically trains as a general surgeon resident for five years, followed by many additional years receiving additional specialized training in neurosurgery for adults or children. These physicians are trained to diagnose, treat, rehabilitate and perform surgery to correct issues that may occur in the nervous system. 


If you need to have surgery on your brain or spinal cord, It is important to select a neurosurgeon who is very experienced in type of surgery that you need. It is also important to remember that there is some overlap with other surgical specialties, particularly orthopedics, as both specialties perform back surgeries and spinal surgeries.


Some neurosurgeons specialize in a specific area of the nervous system while others practice on the brain, neck, and spine. At smaller facilities, they often perform many types of neurosurgery, very specialized surgeons are more typically found at very large facilities. These surgeons may specialize in brain surgery, or they may be "super" specialized, for example, only performing surgeries to remove cancerous tumors from the brain. Others may specialize in surgery on the lower back, neck, or other areas. 


Pediatric Neurosurgery

Pediatric neurosurgery is the practice of neurosurgery on patients under the age of eighteen. Some adults may also be treated by a pediatric neurosurgeon, particularly if they have been treated by the neurosurgeon as a child or if the problem that requires surgical intervention was present at birth. These surgeons are very experienced at performing surgery that is necessary due to a birth defect or another problem that occurs early in life as they routinely correct these types of issues, regardless of the age of the patient. In some cases, the patient may be referred to neurosurgery at an early age but not need or be able to have corrective surgery until later in life. This is why it isn't totally unheard of to see an adult in the pediatric ICU or another pediatric surgical unit.

Reasons for Neurosurgery

In children, neurosurgery is typically needed to correct a problem that was present at birth, such as fluid collecting in the brain (hydrocephalus). Trauma is a very common reason for neurosurgery. After severe trauma to the head, the brain often begins to swell and surgery may be performed to release this pressure and to provide the brain with room to swell without causing further damage. 


Imagine spraining an ankle, afterward the ankle becomes bruised and swollen. The brain does the same thing when injured, but is surrounded by the bones of the skull. As the brain swells, pressure inside the skull increases and can cause additional damage. In some cases the swelling is so severe that a piece of the skull needs to be removed in order to allow the swelling to happen without damaging other areas of the brain. When the swelling goes down, the piece of skull can be replaced.


Cancer can also be the reason that neurosurgery is needed as cancer can occur in the brain and along the spinal cord. A tumor may need to be removed, or reduced in size during a procedure called debulking. 


The Future of Neurosurgery

Neurosurgery advances on a daily basis, with surgical techniques being discovered and perfected. Minimally invasive techniques are being developed to help minimize stress on the brain and body during surgery, and to enable the patient to recover more quickly and easily. You can expect to see more percutaneous procedures, which are procedures that don't require opening of the brain, and you can also expect to see less invasive versions of procedures that are currently being done.


Decompression surgery

Overview

Decompression surgery (laminectomy) opens the bony canals through which the spinal cord and nerves pass, creating more space for them to move freely. Narrowing / stenosis of the spinal and nerve root canals can cause chronic pain, numbness, and muscle weakness in your arms or legs. Surgery may be recommended if your symptoms have not improved with physical therapy or medications.


What is spinal decompression?

Spinal stenosis is often caused by age-related changes: arthritis, enlarged joints, bulging discs, bone spurs, and thickened ligaments. Spinal decompression can be performed anywhere along the spine from the neck (cervical) to the lower back (lumbar). The surgery is performed through an incision in the back (posterior) muscles. The lamina bone forms the backside of the spinal canal and makes a roof over the spinal cord. Removing the lamina and thickened ligament gives more room for the nerves and allows for removal of bone spurs (osteophytes). Depending on the extent of stenosis, one vertebra (single-level) or more (multi-level) may be involved.

There are several types of decompression surgery:


Laminectomy is the removal of the entire bony lamina, a portion of the enlarged facet joints, and the thickened ligaments overlying the spinal cord and nerves.

Laminotomy is the removal of a small portion of the lamina and ligaments, usually on one side. Using this method the natural support of the lamina is left in place, decreasing the chance of spinal instability. Sometimes an endoscope may be used, allowing for a smaller, less invasive incision.

Foraminotomy is the removal of bone around the neural foramen - the canal where the nerve root exits the spine. This method is used when disc degeneration has caused the height of the foramen to collapse and pinch a nerve.

Laminaplasty is the expansion of the spinal canal by cutting the laminae on one side and swinging them open like a door. It is used only in the neck (cervical) area.

Discectomy is the removal of a portion of a bulging or degenerative disc to relieve pressure on the nerves.

In some cases, spinal fusion may be done at the same time to help stabilize sections of the spine treated with laminectomy. Fusion uses a combination of bone graft, screws, and rods to connect two separate vertebrae together into one new piece of bone. Fusing the joint prevents the spinal stenosis from recurring and can help eliminate pain from an unstable spine.


Who is a candidate?

You may be a candidate for decompression if you have:


significant pain, weakness, or numbness in your leg or foot

leg pain worse than back pain

not improved with physical therapy or medication

difficulty walking or standing that affects your quality of life

diagnostic tests (MRI, CT, myelogram) that show stenosis in the central canal or lateral recess.

The surgical decision

Decompression surgery for spinal stenosis is elective, except in the rare instance of cauda equina syndrome or rapidly progressing neurologic deficits. Your doctor may recommend treatment options, but only you can decide whether surgery is right for you. Be sure to look at all the risks and benefits before making a decision. Decompression does not cure spinal stenosis nor eliminate arthritis; it only relieves some of the symptoms. Unfortunately, the symptoms may recur as the degenerative aging process that produces stenosis continues.


Who performs the procedure?

A neurosurgeon or an orthopedic surgeon can perform spine surgery. Many spine surgeons have specialized training in complex spine surgery. Ask your surgeon about their training, especially if your case is complex or you’ve had more than one spinal surgery.


What happens before surgery?

You may be scheduled for presurgical tests (e.g., blood test, electrocardiogram, chest X-ray) several days before surgery. In the doctors office you will sign consent forms and fill out paperwork so that the surgeon knows your medical history (allergies, medicines/vitamins, bleeding history, anesthesia reactions, previous surgeries). You should stop taking all non-steroidal anti-inflammatory medicines (Naprosyn, Advil, Motrin, Nuprin, Aleve, etc.) and blood thinners (coumadin, aspirin, etc.) one week before surgery. Additionally, stop smoking, chewing tobacco, and drinking alcohol one week before and 2 weeks after surgery as these activities can cause bleeding problems.


Patients are admitted to the hospital the morning of the procedure. No food or drink is permitted past midnight the night before surgery. An intravenous (IV) line is placed in your arm. An anesthesiologist will explain the effects of anesthesia and its risks.

What happens during surgery?

There are seven steps of the procedure. The operation generally lasts 1 to 3 hours.


Step 1: prepare the patient

You will lie on your back on the operative table and be given anesthesia. Once asleep you will be rolled over onto your stomach with your chest and sides supported by pillows. The area where the incison will be made is cleansed and prepped. If a fusion is planned and you have decided to use your own bone, the hip area will be prepped to obtain a bone graft. If you’ve decided to use donor bone, a hip incision is not necessary.


Step 2: incision

A skin incision is made down the middle of your back over the appropriate vertebrae. The length of the incision depends on how many laminectomies are to be performed. The strong back muscles are split down the middle and moved to either side exposing the lamina of each vertebra.

Step 3: laminectomy or laminotomy

Once the bone is exposed, an X-ray is taken to verify the correct vertebra.


Laminectomy: The surgeon removes the bony spinous process. Next, the bony lamina is removed with a drill or bone-biting tools. The thickened ligamentum flavum that connects the laminae of the vertebra below with the vertebra above is removed. This is repeated for each affected vertebrae.

Laminotomy: In some cases, the surgeon may not want to remove the entire protective bony lamina. A small opening of the lamina above and below the spinal nerve may be enough to relieve compression. Laminotomy can be done on one side (unilateral) or both sides (bilateral) and on multiple vertebrae levels.

Step 4: decompress the spinal cord

Once the lamina and ligamentum flavum are removed the protective covering of the spinal cord (dura mater) is visible. The surgeon can gently retract the protective sac of the spinal cord and nerve root to remove bone spurs and thickened ligament.


Step 5: decompress the spinal nerve

The facet joints, which are directly over the nerve roots, may be undercut (trimmed) to give the nerve roots more room. Called a foraminotomy, this maneuver enlarges the neural foramen (where the spinal nerves exit the spinal canal). If a herniated disc is causing compression the surgeon will perform a discectomy.

Step 6: fusion (if necessary)

If you have spinal instability or have laminectomies to multiple vertebrae, a fusion may be performed. Fusion is the joining of two vertebrae with a bone graft held together with hardware such as plates, rods, hooks, pedicle screws, or cages. The goal of the bone graft is to join the vertebrae above and below to form one solid piece of bone. There are several ways to create a fusion. The right one for you depends on your own choice and your doctor’s recommendation.


The most common type of fusion is called the posterolateral fusion. The topmost layer of bone on the transverse processes is removed with a drill to create a bed for the bone graft to grow. Bone graft, taken from the top of your hip, is placed along the posterolateral bed. The surgeon may reinforce the fusion with metal rods and screws inserted into the vertebrae. The back muscles are laid over the bone graft to hold it in place.


Step 7: closure

The muscle and skin incisions are sewn together with sutures or staples.


What happens after surgery?

You will wake up in the postoperative recovery area, called the PACU. Your blood pressure, heart rate, and respiration will be monitored, and yourpain will be addressed. Once awake you will be moved to a regular roomwhere you’ll increase your activity level (sitting in a chair, walking).If you’ve had a fusion, a brace may need to be worn. In 1 to 2 days you’ll be released from the hospital and given discharge instructions.

Discharge instructions:

Discomfort


Take pain medication as directed by your surgeon. Narcotics can be addictive and are used for a limited period of time.

Narcotics can also cause constipation. Drink lots of water and eat high-fiber foods. Laxatives and stool softeners such as Dulcolax, Senokot, Colace, and Milk of Magnesia are available without a prescription.

Ice your incision 3-4 times per day for 15-20 minutes to reduce pain and swelling.

Restrictions


Avoid bending, lifting or twisting your back for the next 2 weeks.

Do not lift anything heavier than 5 pounds for 2 weeks after surgery. 

No strenuous activity for the next 2 weeks including yard work, housework and sex.

Do not drive for 2 weeks after surgery or until discussed with your surgeon.

Do not drink alcohol for 2 weeks after surgery or while you are taking narcotic medication.

If you have had a fusion, do not use non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., aspirin; ibuprofen, Advil, Motrin, Nuprin; naproxen sodium, Aleve) for six months after surgery. NSAIDs may cause bleeding and interfere with bone healing.

Do not smoke, vape, dip, chew or use nicotine products. It delays healing and prevents new bone growth.

Activity


You may need help with daily activities (dressing, bathing) for the first few weeks. Fatigue is common. Let pain be your guide.

Get up and walk 5-10 minutes every 3-4 hours. Gradually increase your walking time, as you are able. 

If you were given a brace, where it at all times unless you are sleeping or showering.

Bathing/Incision Care


Wash your hands thoroughly before and after cleaning your incision to prevent infection.

If you have Dermabond (skin glue) covering the incision, you may shower the day after surgery. Gently wash with soap and water. Pat dry.

If you have staples or steri-strips, you may shower 2 days after surgery. Remove the dressing and gently wash with soap and water. Pat dry. Replace dressing if there is drainage.

Do not submerge or soak the incision in water (bath, pool or tub).

Do not apply lotions or ointments to incision.

Some drainage from the incision is normal. A large amount of drainage, foul smelling drainage, or drainage that is yellow or green should be reported to your surgeon’s office.

Staples or steri-strips will be removed at your follow-up appointment.

When to Call Your Doctor


If your temperature exceeds 101.5° F, or if the incision begins to separate or show signs of infection, such as redness, swelling, pain, or drainage.

Swelling and tenderness in the calf of one leg.

New onset of tingling or numbness in the legs or numbness in the groin area.

What are the results?

Decompressive laminectomy is successful in relieving leg pain in 70% of patients allowing significant improvement in function (ability to perform normal daily activities) and markedly reduced level of pain and discomfort. However, back pain may not be relieved and 17% of older adults need another treatment. Symptoms may return after a few years.


Decompressive laminotomy is successful in relieving back pain (72%) and leg pain (86%), and in improving walking ability (88%) [3]. Endoscopic laminotomy results in less blood loss, shorter hospital stay, and less postoperative pain medication than an open laminotomy.


The results of the surgery are largely up to you. It is important to keep a positive attitude and diligently perform your physical therapy exercises. Maintaining a weight that is appropriate for your height can significantly reduce pain. Do not expect your back to be as good as new. Be mindful that you’ll always have a bad back and will need to use correct posture and lifting techniques to avoid re-injury.


What are the risks?

No surgery is without risks. General complications of any surgery include bleeding, infection, blood clots, and reactions to anesthesia. If spinal fusion is done at the same time as a laminectomy, there is greater risk of complications. The following are risks that should be considered:


Nerve damage or persistent pain. Any operation on the spine comes with the risk of damaging the nerves or spinal cord. Damage can cause numbness or even paralysis. However, the most common cause of persistent pain is nerve damage from the stenosis. Some bone spurs may permanently damage a nerve making it unresponsive to decompressive surgery. In these cases, spinal cord stimulation or other treatments may provide relief. Be sure to go into surgery with realistic expectations about your pain. Discuss your expectations with your doctor.


Vertebrae failing to fuse. Among many reasons why vertebrae fail to fuse, common ones include smoking, osteoporosis, obesity, and malnutrition. Smoking is by far the greatest factor that can prevent fusion. Nicotine is a toxin that inhibits bone-growing cells. If you continue to smoke after your spinal surgery, you could undermine the fusion process.


Deep vein thrombosis (DVT) is a potentially serious condition caused when blood clots form inside the veins of your legs. If the clots break free and travel to your lungs, lung collapse or even death is a risk. However, there are several ways to treat or prevent DVT. If your blood is moving it is less likely to clot, so an effective treatment is getting you out of bed as soon as possible. Support hose and pulsatile stockings keep the blood from pooling in the veins. Drugs such as aspirin, Heparin, Lovenox, or Coumadin are also commonly used.


Hardware fracture. The metal screws, rods and plates used to stabilize your spine are called "hardware." The hardware may move or break before your vertebrae are completely fused. If this occurs, a second surgery may be needed to fix or replace the hardware.


Bone graft migration. In rare cases (1 to 2%), the bone graft can move from the correct position between the vertebrae soon after surgery. This is more likely to occur if hardware (plates and screws) are not used to secure the bone graft. It’s also more likely to occur if multiple vertebral levels are fused. If this occurs, a second surgery may be necessary.


Transitional syndrome (adjacent-segment disease). This syndrome occurs when the vertebrae above or below a fusion take on extra stress. The added stress can eventually degenerate the adjacent vertebrae and cause pain

IVF

In vitro fertilization (IVF) is a complex series of procedures used to treat fertility or genetic problems and assist with the conception of a child.

During IVF, mature eggs are collected (retrieved) from your ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs are implanted in your uterus. One cycle of IVF takes about two weeks.

IVF is the most effective form of assisted reproductive technology. The procedure can be done using your own eggs and your partner's sperm. Or IVF may involve eggs, sperm or embryos from a known or anonymous donor. In some cases, a gestational carrier — a woman who has an embryo implanted in her uterus — might be used.

Your chances of having a healthy baby using IVF depend on many factors, such as your age and the cause of infertility. In addition, IVF can be time-consuming, expensive and invasive. If more than one embryo is implanted in your uterus, IVF can result in a pregnancy with more than one fetus (multiple pregnancy).

Your doctor can help you understand how IVF works, the potential risks and whether this method of treating infertility is right for you.

Why it's done

In vitro fertilization (IVF) is a treatment for infertility or genetic problems. If IVF is performed to treat infertility, you and your partner might be able to try less invasive treatment options before attempting IVF, including fertility drugs to increase production of eggs or intrauterine insemination — a procedure in which sperm are placed directly in your uterus near the time of ovulation.

Sometimes, IVF is offered as a primary treatment for infertility in women over age 40. IVF can also be done if you have certain health conditions. For example, IVF may be an option if you or your partner has:

·        Fallopian tube damage or blockage. Fallopian tube damage or blockage makes it difficult for an egg to be fertilized or for an embryo to travel to the uterus.

·        Ovulation disorders. If ovulation is infrequent or absent, fewer eggs are available for fertilization.

·        Premature ovarian failure. Premature ovarian failure is the loss of normal ovarian function before age 40. If your ovaries fail, they don't produce normal amounts of the hormone estrogen or have eggs to release regularly.

·        Endometriosis. Endometriosis occurs when the uterine tissue implants and grows outside of the uterus — often affecting the function of the ovaries, uterus and fallopian tubes.

·        Uterine fibroids. Fibroids are benign tumors in the wall of the uterus and are common in women in their 30s and 40s. Fibroids can interfere with implantation of the fertilized egg.

·        Previous tubal sterilization or removal. If you've had tubal ligation — a type of sterilization in which your fallopian tubes are cut or blocked to permanently prevent pregnancy — and want to conceive, IVF may be an alternative to tubal ligation reversal.

·        Impaired sperm production or function. Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If semen abnormalities are found, your partner might need to see a specialist to determine if there are correctable problems or underlying health concerns.

·        Unexplained infertility. Unexplained infertility means no cause of infertility has been found despite evaluation for common causes.

·        A genetic disorder. If you or your partner is at risk of passing on a genetic disorder to your child, you may be candidates for preimplantation genetic diagnosis — a procedure that involves IVF. After the eggs are harvested and fertilized, they're screened for certain genetic problems, although not all genetic problems can be found. Embryos that don't contain identified problems can be transferred to the uterus.

·        Fertility preservation for cancer or other health conditions. If you're about to start cancer treatment — such as radiation or chemotherapy — that could harm your fertility, IVF for fertility preservation may be an option. Women can have eggs harvested from their ovaries and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embryos for future use.

Women who don't have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using another person to carry the pregnancy (gestational carrier). In this case, the woman's eggs are fertilized with sperm, but the resulting embryos are placed in the gestational carrier's uterus.

Risks

Specific steps of an in vitro fertilization (IVF) cycle carry risks, including:

·        Multiple births. IVF increases the risk of multiple births if more than one embryo is implanted in your uterus. A pregnancy with multiple fetuses carries a higher risk of early labor and low birth weight than pregnancy with a single fetus does.

·        Premature delivery and low birth weight. Research suggests that use of IVF slightly increases the risk that a baby will be born early or with a low birth weight.

·        Ovarian hyperstimulation syndrome. Use of injectable fertility drugs, such as human chorionic gonadotropin (HCG), to induce ovulation can cause ovarian hyperstimulation syndrome, in which your ovaries become swollen and painful.

Signs and symptoms typically last a week and include mild abdominal pain, bloating, nausea, vomiting and diarrhea. If you become pregnant, however, your symptoms might last several weeks. Rarely, it's possible to develop a more-severe form of ovarian hyperstimulation syndrome that can also cause rapid weight gain and shortness of breath.

·        Miscarriage. The rate of miscarriage for women who conceive using IVF with fresh embryos is similar to that of women who conceive naturally — about 15 to 25 percent — but the rate increases with maternal age. Use of frozen embryos during IVF, however, may slightly increase the risk of miscarriage.

·        Egg-retrieval procedure complications. Use of an aspirating needle to collect eggs could possibly cause bleeding, infection or damage to the bowel, bladder or a blood vessel. Risks are also associated with general anesthesia, if used.

·        Ectopic pregnancy. About 2 to 5 percent of women who use IVF will have an ectopic pregnancy — when the fertilized egg implants outside the uterus, usually in a fallopian tube. The fertilized egg can't survive outside the uterus, and there's no way to continue the pregnancy.

·        Birth defects. The age of the mother is the primary risk factor in the development of birth defects, no matter how the child is conceived. More research is needed to determine whether babies conceived using IVF might be at increased risk of certain birth defects. Some experts believe that the use of IVF does not increase the risk of having a baby with birth defects.

·        Ovarian cancer. Although some early studies suggested there may be a link between certain medications used to stimulate egg growth and the development of a specific type of ovarian tumor, more recent studies do not support these findings.

·        Stress. Use of IVF can be financially, physically and emotionally draining. Support from counselors, family and friends can help you and your partner through the ups and downs of infertility treatment.

How you prepare

The Centers for Disease Control and Prevention and the Society for Assisted Reproductive Technology provide information online about U.S. clinics' individual pregnancy and live birth rates.

When choosing an in vitro fertilization (IVF) clinic, keep in mind that a clinic's success rate depends on many factors, such as patients' ages and medical issues, as well as the clinic's treatment population and treatment approaches. Ask for detailed information about the costs associated with each step of the procedure.

Before beginning a cycle of IVF using your own eggs and sperm, you and your partner will likely need various screenings, including:

·        Ovarian reserve testing. To determine the quantity and quality of your eggs, your doctor might test the concentration of follicle-stimulating hormone (FSH), estradiol (estrogen) and antimullerian hormone in your blood during the first few days of your menstrual cycle. Test results, often used together with an ultrasound of your ovaries, can help predict how your ovaries will respond to fertility medication.

·        Semen analysis. If not done as part of your initial fertility evaluation, your doctor will conduct a semen analysis shortly before the start of an IVF treatment cycle.

·        Infectious disease screening. You and your partner will both be screened for infectious diseases, including HIV.

·        Practice (mock) embryo transfer. Your doctor might conduct a mock embryo transfer to determine the depth of your uterine cavity and the technique most likely to successfully place the embryos into your uterus.

·        Uterine cavity exam. Your doctor will examine your uterine cavity before you start IVF. This might involve a sonohysterography — in which fluid is injected through the cervix into your uterus — and an ultrasound to create images of your uterine cavity. Or it might include a hysteroscopy — in which a thin, flexible, lighted telescope (hysteroscope) is inserted through your vagina and cervix into your uterus.

Before beginning a cycle of IVF, consider important questions, including:

·        How many embryos will be transferred? The number of embryos transferred is typically based on the age and number of eggs retrieved. Since the rate of implantation is lower for older women, more embryos are usually transferred — except for women using donor eggs.

Most doctors follow specific guidelines to prevent a higher order multiple pregnancy — triplets or more — and in some countries, legislation limits the number of embryos that can be transferred at once. Make sure you and your doctor agree on the number of embryos that will be transferred before the transfer procedure.

·        What will you do with any extra embryos? Extra embryos can be frozen and stored for future use for several years. Not all embryos will survive the freezing and thawing process, although most will.

Cryopreservation can make future cycles of IVF less expensive and less invasive. However, the live birth rate from frozen embryos is slightly lower than the live birth rate from fresh embryos. Or, you might be able to donate unused frozen embryos to another couple or a research facility. You might also choose to discard unused embryos.

·        How will you handle a multiple pregnancy? If more than one embryo is transferred to your uterus, IVF can result in a multiple pregnancy — which poses health risks for you and your babies. In some cases, fetal reduction can be used to help a woman deliver fewer babies with lower health risks. Pursuing fetal reduction, however, is a major decision with ethical, emotional and psychological consequences.

·        Have you considered the potential complications associated with using donor eggs,

In vitro fertilization (IVF) involves several steps — ovulation induction, egg retrieval, sperm retrieval, fertilization and embryo transfer. One cycle of IVF can take about two weeks, and more than one cycle may be required.

Ovulation induction

If you're using your own eggs during IVF, at the start of a cycle you'll begin treatment with synthetic hormones to stimulate your ovaries to produce multiple eggs — rather than the single egg that normally develops each month. Multiple eggs are needed because some eggs won't fertilize or develop normally after fertilization.

You may need several different medications, such as:

·        Medications for ovarian stimulation. To stimulate your ovaries, you might receive an injectable medication containing a follicle-stimulating hormone (FSH), a luteinizing hormone (LH) or a combination of both. These medications stimulate more than one egg to develop at a time.

·        Medications for oocyte maturation. When the follicles are ready for egg retrieval — generally after eight to 14 days — you will take human chorionic gonadotropin (HCG) or other medications to help the eggs mature.

·        Medications to prevent premature ovulation.These medications prevent your body from releasing the developing eggs too soon.

·        Medications to prepare the lining of your uterus. On the day of egg retrieval or at the time of embryo transfer, your doctor might recommend that you begin taking progesterone supplements to make the lining of your uterus more receptive to implantation.

Your doctor will work with you to determine which medications to use and when to use them.

Typically, you'll need one to two weeks of ovarian stimulation before your eggs are ready for retrieval. To determine when the eggs are ready for collection, your doctor will likely perform:

·        Vaginal ultrasound, an imaging exam of your ovaries to monitor the development of follicles — fluid-filled ovarian sacs where eggs mature

·        Blood tests, to measure your response to ovarian stimulation medications — estrogen levels typically increase as follicles develop and progesterone levels remain low until after ovulation

Sometimes IVF cycles need to be canceled before egg retrieval for one of these reasons:

·        Inadequate number of follicles developing

·        Premature ovulation

·        Too many follicles developing, creating a risk of ovarian hyperstimulation syndrome

·        Other medical issues

If your cycle is canceled, your doctor might recommend changing medications or their doses to promote a better response during future IVF cycles. Or you may be advised that you need an egg donor.

Egg retrieval

Egg retrieval can be done in your doctor's office or a clinic 34 to 36 hours after the final injection and before ovulation.

·        During egg retrieval, you'll be sedated and given pain medication.

·        Transvaginal ultrasound aspiration is the usual retrieval method. An ultrasound probe is inserted into your vagina to identify follicles. Then a thin needle is inserted into an ultrasound guide to go through the vagina and into the follicles to retrieve the eggs.

·        If your ovaries aren't accessible through transvaginal ultrasound, an abdominal surgery or laparoscopy — a procedure in which a tiny incision is made near your navel and a slender viewing instrument (laparoscope) is inserted — may be used to guide the needle.

·        The eggs are removed from the follicles through a needle connected to a suction device. Multiple eggs can be removed in about 20 minutes.

·        After egg retrieval, you may experience cramping and feelings of fullness or pressure.

·        Mature eggs are placed in a nutritive liquid (culture medium) and incubated. Eggs that appear healthy and mature will be mixed with sperm to attempt to create embryos. However, not all eggs may be successfully fertilized.

Sperm retrieval

If you're using your partner's sperm, he'll provide a semen sample at your doctor's office or a clinic through masturbation the morning of egg retrieval. Other methods, such as testicular aspiration — the use of a needle or surgical procedure to extract sperm directly from the testicle — are sometimes required. Donor sperm also can be used. Sperm are separated from the semen fluid in the lab.

Fertilization

Fertilization can be attempted using two common methods:

·        Insemination. During insemination, healthy sperm and mature eggs are mixed and incubated overnight.

·        Intracytoplasmic sperm injection (ICSI). In ICSI, a single healthy sperm is injected directly into each mature egg. ICSI is often used when semen quality or number is a problem or if fertilization attempts during prior IVF cycles failed.

In certain situations, your doctor may recommend other procedures before embryo transfer.

·        Assisted hatching. About five to six days after fertilization, an embryo "hatches" from its surrounding membrane (zona pellucida), allowing it to implant into the lining of the uterus. If you're an older woman, or if you have had multiple failed IVF attempts, your doctor might recommend assisted hatching — a technique in which a hole is made in the zona pellucida just before transfer to help the embryo hatch and implant.

·        Preimplantation genetic testing. Embryos are allowed to develop in the incubator until they reach a stage where a small sample can be removed and tested for specific genetic diseases or the correct number of chromosomes, typically after five to six days of development. Embryos that don't contain affected genes or chromosomes can be transferred to your uterus. While preimplantation genetic testing can reduce the likelihood that a parent will pass on a genetic problem, it can't eliminate the risk. Prenatal testing may still be recommended.

Embryo transfer

Embryo transfer is done at your doctor's office or a clinic and usually takes place two to six days after egg retrieval.

·        You might be given a mild sedative. The procedure is usually painless, although you might experience mild cramping.

·        The doctor or nurse will insert a long, thin, flexible tube called a catheter into your vagina, through your cervix and into your uterus.

·        A syringe containing one or more embryos suspended in a small amount of fluid is attached to the end of the catheter.

·        Using the syringe, the doctor or nurse places the embryo or embryos into your uterus.

If successful, an embryo will implant in the lining of your uterus about six to 10 days after egg retrieval.

After the procedure

After the embryo transfer, you can resume your normal daily activities. However, your ovaries may still be enlarged. Consider avoiding vigorous activity, which could cause discomfort.

Typical side effects include:

·        Passing a small amount of clear or bloody fluid shortly after the procedure — due to the swabbing of the cervix before the embryo transfer

·        Breast tenderness due to high estrogen levels

·        Mild bloating

·        Mild cramping

·        Constipation

If you develop moderate or severe pain after the embryo transfer, contact your doctor. He or she will evaluate you for complications such as infection, twisting of an ovary (ovarian torsion) and severe ovarian hyperstimulation syndrome.

Results

About 12 days to two weeks after egg retrieval, your doctor will test a sample of your blood to detect whether you're pregnant.

·        If you're pregnant, your doctor will refer you to an obstetrician or other pregnancy specialist for prenatal care.

·        If you're not pregnant, you'll stop taking progesterone and likely get your period within a week. If you don't get your period or you have unusual bleeding, contact your doctor. If you're interested in attempting another cycle of in vitro fertilization (IVF), your doctor might suggest steps you can take to improve your chances of getting pregnant through IVF.

The chances of giving birth to a healthy baby after using IVF depend on various factors, including:

·        Maternal age. The younger you are, the more likely you are to get pregnant and give birth to a healthy baby using your own eggs during IVF. Women age 41 and older are often counseled to consider using donor eggs during IVF to increase the chances of success.

·        Embryo status. Transfer of embryos that are more developed is associated with higher pregnancy rates compared with less developed embryos (day two or three). However, not all embryos survive the development process. Talk with your doctor or other care provider about your specific situation.

·        Reproductive history. Women who've previously given birth are more likely to be able to get pregnant using IVF than are women who've never given birth. Success rates are lower for women who've previously used IVF multiple times but didn't get pregnant.

·        Cause of infertility. Having a normal supply of eggs increases your chances of being able to get pregnant using IVF. Women who have severe endometriosis are less likely to be able to get pregnant using IVF than are women who have unexplained infertility.

·        Lifestyle factors. Women who smoke typically have fewer eggs retrieved during IVF and may miscarry more often. Smoking can lower a woman's chance of success using IVF by 50 percent. Obesity can decrease your chances of getting pregnant and having a baby. Use of alcohol, recreational drugs, excessive caffeine and certain medications also can be harmful.

Talk with your doctor about any factors that apply to you and how they may affect your chances of a successful pregnancy.

Face-Lift

You don't have to leave your youthful good looks behind as you age. In the hands of a skilled, board certified cosmetic surgeon, you can counteract the effects of time and gravity and restore the naturally vibrant appearance you remember from years ago, or even address the early signs of aging before they take hold. Learn more about facelift surgery below.

What is Facelift Surgery?

Facelift surgery lifts and firms sagging facial tissues to restore a more naturally youthful facial appearance. It is often said that having a facelift works to “turn back the clock,” helping a patient look like a younger version of him or herself. By removing excess, sagging skin, smoothing deep folds, and lifting and tightening the deep facial tissues, a facelift surgery can help a patient look not just younger, but simply “better.”

Why Have a Facelift?

As we age, skin begins to lose elasticity, and facial tissues lose volume. Eventually, this results in “jowls” on the lower face, deep wrinkles, and loose skin on the neck. While this is a natural part of growing older, patients who are bothered by these signs of aging may find a facelift to be a good solution. If any of the following describe you, a facelift is an option to consider:

·     You feel self-conscious about the way your face & neck look due to sagging skin

·     You wear turtlenecks and scarves not because you want to, but because you want to hide your aging neck

·     When you see your reflection, you feel that your face makes you look much older than you feel

·     You feel that an aging appearance is negatively affecting your career or personal relationships


Following a facelift, patients frequently experience an upsurge in self-confidence, as their appearance better portrays their healthy, energetic vibe.

 

How you prepare

Initially, you'll talk to a plastic surgeon about a face-lift. The visit will likely include:

·        Medical history and exam. Prepare to answer questions about past and current medical conditions, previous surgeries, previous plastic surgeries, complications from previous surgeries, history of smoking, and drug or alcohol use. Your surgeon will do a physical exam, may request recent records from your doctor or order a consultation with a specialist if there are any concerns about your ability to undergo surgery.

·        Medication review. Provide the name and dosages of all medications you regularly take, including prescription drugs, over-the-counter drugs, herbal medications, vitamins and other dietary supplements.

·        Facial exam. Your plastic surgeon will take photos of your face from different angles and close-up photos of some features. The surgeon will also examine your bone structure, shape of your face, fat distribution and quality of your skin to determine your best options for face-lift surgery.

·        Expectations. Your surgeon will ask questions about your expectations for the outcomes of a face-lift. He or she will help you understand how a face-lift will likely change your appearance and what a face-lift doesn't address, such as fine wrinkles or naturally occurring asymmetry in your face.

Before a face-lift:

·        Follow medication directions. You'll receive instructions about what medications to stop taking and when to stop. For example, you'll likely be asked to discontinue any blood-thinning medication or supplement at least two weeks before surgery. Talk to your doctor about what medications are safe to take or whether the dosage should be adjusted.

·        Wash your face and hair. You'll likely be asked to wash your hair and face with a germicidal soap the morning of the surgery.

·        Avoid eating. You'll be asked to avoid eating anything after midnight the night before your face-lift. You will be able to drink water and take medications that have been approved by your surgeon.

·        Arrange for help during recovery. If your face-lift is done as an outpatient procedure, make plans for someone to drive you home after surgery and stay with you the first night after surgery.

What you can expect

A face-lift can be done in a hospital or an outpatient surgical facility.

Before the procedure

Sometimes the procedure is done with sedation and local anesthesia, which numbs only part of your body. In other cases, general anesthesia — which renders you unconscious — is recommended.



Types of Facelifts

Facelift surgery is individualized to a patient’s needs, and a cosmetic surgeon will tailor his or her techniques accordingly.

Mini-Facelift

Patients who exhibit a mild degree of jowling and sagging skin are often good candidates for a mini-facelift. This is a less invasive technique that allows a cosmetic surgeon to tighten deep facial tissues through shorter incisions, typically located along the hairline above each ear and/or in the natural creases surrounding the ear. Through these incisions, structural tissues around the cheeks are lifted and tightened to correct jowling, refine the jawline, and rejuvenate a “tired” appearance.

Depending on the case, a mini-facelift may be performed using local anesthesia with sedation or general anesthesia; your cosmetic surgeon will recommend the best option for your individual needs. A mini-facelift can help you address unwelcome signs of aging before they become too pronounced, postponing the need for more extensive surgery for many years.

Standard Facelift

A standard or “traditional” facelift will more fully address moderate to advanced aging around the mid-face and neck. While the surgery is more extensive than those for a mini-facelift, and thus more recovery time is required, the results are more dramatic. Through incisions located just behind the hairline, starting near the temples, and around the front of the ear, hidden in the natural folds, a cosmetic surgeon can reposition the deeper tissues beneath the skin and remove excess skin to smooth creases, eliminate jowling and sagging skin under the chin, and restore a naturally youthful contour to the face and neck.

How Does Facelift Surgery Work?

The exact technique a cosmetic surgeon uses during a facelift depends on a number of factors, including a patient’s anatomy and personal goals, the extent of the facelift (mini vs. standard), and whether or not another procedure is being performed at the same time. Facelifts are typically performed using general anesthesia, although local anesthesia with sedation may be used in certain less extensive procedures.

After making the initial incisions, the skin is separated from the underlying connective tissue and muscles. This allows the cosmetic surgeon to reposition the deeper facial tissues, get rid of the jowls and create a firmer foundation for the skin. Then, excess skin is removed, and the remaining skin is gently laid back over the newly rejuvenated facial tissues, giving the face a smoother, more youthful contour without over-tightening the skin.

Can a Facelift Improve My Eyelids Too?

It’s not uncommon to hear the word “facelift” used when referring to any type of facial rejuvenation surgery, and understandably, a lot of people think that a facelift involves operating on the entire face—eyes, brow, cheeks and chin. That’s understandable; after all, your eyes and forehead are part of your face too. However, a facelift on its own only addresses the lower two thirds of the face – the cheeks and jawline.

Why is this the case? It is largely due to differences in anatomy. The skin, muscles and other tissues along the brow and surrounding the eyelids are very distinct, and cosmetic surgery to each of these areas requires an entirely different set of techniques than those used during a facelift.

It is common for patients to choose to have an eyelid lift, brow lift or neck contouring at the same time as a facelift, but in these cases, a cosmetic surgeon will actually be performing two different procedures in one single operation. Likewise, patients who only want to address aging around the eyes or neck can typically achieve their goals with only an eyelid lift or neck lift, and not a facelift.

Life After a Facelift

A facelift is a complex procedure requiring exceptional surgical skill, but the recovery process is surprisingly quick for most patients. Patients typically return to normal daily activities after about 2 weeks (strenuous exercise will need to wait about 4 weeks) following a standard facelift, and these time frames are normally even shorter after a mini facelift. As every patient heals a little differently, your cosmetic surgeon will give you detailed instructions for aftercare and returning to activity.

One of the primary concerns patients have following a facelift is how soon they will look presentable after their procedures, and understandably so – unlike a breast or body procedure, for example, you cannot easily cover the area with clothing. Bruising and swelling are normal after a facelift, and will be at their peak about 2 days after surgery. After that, bruising and swelling will gradually get better, and should be difficult to notice after about 10 to 14 days. Even so, many patients feel comfortable going out in public about a week or so after their procedures. Your cosmetic surgeon can advise you about when it is safe to wear camouflage makeup.

As you ease back into your routine after a facelift, it’s especially important to keep your face protected from the sun. You will be more vulnerable to sunburn for several weeks after surgery, plus staying out of the sun will help scars heal as inconspicuously as possible. Wear a wide-brimmed hat and apply sunscreen regularly.

How Will Facelift Results Look Over the Long Term?

When performed by an experienced, board certified cosmetic surgeon, a facelift is designed to achieve results that not only look natural now, but will also age naturally with you. While nothing can stop the normal aging process, after a facelift you should always look years younger than you would have without the surgery.

However, there are certain things you can do to keep your results looking their best. Maintaining a healthy, stable weight is important as significant weight fluctuations can cause skin to stretch out again. You should also adopt a consistent, quality skin care regimen to keep your skin healthy and protected from unnecessary aging.

When performed by a qualified cosmetic surgeon, facelift surgery is a safe procedure and an excellent way to rejuvenate your appearance.


Metabolic Surgery

Nearly all individuals who have bariatric surgery show improvement in their diabetic state. Bariatric surgeries performed in more than 135,000 patients were found to affect type 2 diabetes in the following ways:


Surgery improves type 2 diabetes in nearly 90 percent of patients by:

lowering blood sugar

reducing the dosage and type of medication required

improving diabetes-related health problems

Surgery causes type 2 diabetes to go into remission in 78 percent of individuals by:

reducing blood sugar levels to normal levels

eliminating the need for diabetes medications

Health Improvements

Cause the improvement or remission of T2DM to last for years

Types of Metabolic and Bariatric Surgeries

The following are the most common bariatric surgeries performed in the United States and their known effects on T2DM. [View detailed descriptions of common bariatric surgery procedures.]()


ROUX-EN-Y GASTRIC BYPASS

Roux-en-y Gastric Bypass is a surgery that alters the GI tract to cause food to bypass most of the stomach and the upper portion of the small intestine. The operation results in significant weight-loss and causes remission of T2DM in 80 percent of patients and improvement of the disease in an additional 15 percent of patients.


Improvement or remission of diabetes with gastric bypass occurs early after surgery and before there is significant weight-loss. The weight-loss independent mechanisms of diabetes improvement after gastric bypass are partially explained by changes in hormones produced by the gut after the surgery, and this is an active area of research in the field of metabolic and bariatric surgery.


SLEEVE GASTRECTOMY

Sleeve Gastrectomy (Vertical gastrectomy) is an operation that removes a large portion of the stomach and, in doing so, causes weight-loss. The remaining stomach is narrow and provides a much smaller reservoir for food.


Sleeve gastrectomy also appears to have some weight-loss independent effects on glucose metabolism and also causes some changes in gut hormones that favor improvement in diabetes. Diabetes remission rates after sleeve gastrectomy are also very high (more than 60%) and, in some studies, similar to results seen after gastric bypass.


ADJUSTABLE GASTRIC BAND

The Adjustable Gastric Band is a weight-loss procedure that involves the placement of a band around the upper portion of the stomach.


Remission of diabetes occurs in approximately 45-60 percent of patients. The remission or improvement of diabetes, however, is secondary to the weight-loss produced by the procedure, and there does not appear to be any other mechanism for diabetes improvement in band patients. In other words, patients who have diabetes and who are unsuccessful in losing weight with the AGB will unlikely see any improvement in the diabetes.


DUODENAL SWITCH

The Duodenal Switch is a malabsorptive procedure performed far less frequently than the gastric bypass, sleeve gastrectomy or the adjustable gastric band due to the complexity of the procedure and the greater risk of complications. Studies find, however, that the operation is most effective in inducing early and sustained remission or improvement of T2DM (more than 85 percent remission rates with weight-loss independent effects)


BENEFITS VS. RISKS

Type 2 Diabetes is a leading cause of death in the U.S. and is a major contributor to morbidity and mortality from heart disease, stroke and kidney failure. Each year millions of individuals die from the effects of T2DM. With the advancements in bariatric surgery, many of these individuals could be saved and experience an improved quality of health and life.


While bariatric surgery certainly has some risk, the long-term risk of continued diabetes (which is often inadequately treated with medication) typically outweighs the risk of a surgical procedure for most patients. Each patient’s individual risks for surgery, though, should be evaluated in the context of the duration and severity of their diabetes as well as their other obesity-related health problems.


INTERNATIONAL DIABETES FOUNDATION POSITION STATEMENT ON BARIATRIC SURGERY IN THE TREATMENT OF T2DM

In 2011, diabetologists, endocrinologists, surgeons and public health experts convened at the 2nd. World Congress on Interventional Therapies for Type 2 Diabetes in New York City. Based upon the evidence presented by these world-renowned experts, The International Diabetes Foundation (IDF) released a Position Statement calling for bariatric surgery to be considered early in the treatment of T2DM.


The document recognized that:


In addition to behavioral and medical treatments, bariatric surgeries constitute a powerful option to ameliorate diabetes in patients affected by severe obesity.

Bariatric surgery is an appropriate treatment for people with T2DM and obesity not achieving recommended treatment targets with medical therapies

Surgery should be an accepted option in people who have T2DM and a BMI of 35 or more.

Surgery should be considered as an alternative treatment option in patients with a BMI between 30 and 35 when T2DM cannot be adequately controlled by optimal medical regimen, especially in the presence of other major cardiovascular disease risk factors.

Bariatric surgery for treatment of T2DM is cost-effective

The risk for complications and death with bariatric surgery is low and similar to that of well-accepted procedures such as gallbladder surgery

Metabolic and bariatric surgery for T2DM must be performed within accepted guidelines which include an ongoing multidisciplinary care, patient education, follow-up and clinical audit, as well as safe and effective surgical procedures.

hib and knee replasment

Total knee replacement facts

  • Patients with severe destruction of the knee joint associated with progressive pain and impaired function maybe candidates for total knee replacement.
  • Osteoarthritis is the most common reason for knee replacement operation in the U.S.
  • Risks of total knee replacement surgery have been identified.
  • Physical therapy is an essential part of rehabilitation after total knee replacement.
  • Patients with artificial joints are recommended to take antibiotics before, during, and after any elective invasive procedures (including dental work).

What is a total knee replacement?

A total knee replacement is a surgical procedure whereby the diseased knee joint is replaced with artificial material. The knee is a hinge joint that provides motion at the point where the thigh meets the lower leg. The thighbone (or femur) abuts the large bone of the lower leg (tibia) at the knee joint. During a total knee replacement, the end of the femur bone is removed and replaced with a metal shell. The end of the lower leg bone (tibia) is also removed and replaced with a channeled plastic piece with a metal stem. Depending on the condition of the kneecap portion of the knee joint, a plastic "button" may also be added under the kneecap surface. The artificial components of a total knee replacement are referred to as the prosthesis.

The posterior cruciate ligament is a tissue that normally stabilizes each side of the knee joint so that the lower leg cannot slide backward in relation to the thighbone. In total knee replacement surgery, this ligament is either retained, sacrificed, or substituted by a polyethylene post. Each of these various designs of total knee replacement has its own particular benefits and risks.

What patients should consider a total knee replacement?

Total knee replacement surgery is considered for patients whose knee joints have been damaged by either progressive arthritistrauma, or other rare destructive diseases of the joint. The most common reason for knee replacement in the United States is severe osteoarthritis of the knees.

Regardless of the cause of the damage to the joint, the resulting progressively increasing pain and stiffness and decreasing daily function lead the patient to consider total knee replacement. Decisions regarding whether or when to undergo knee replacement surgery are not easy. Patients should understand the risks as well as the benefits before making these decisions about knee replacement.

What is involved with the pre-operative evaluation for total knee replacement?

Before surgery, the joints adjacent to the diseased knee (hip and ankle) are carefully evaluated. This is important to ensure optimal outcome and recovery from the surgery. Replacing a knee joint that is adjacent to a severely damaged joint may not yield significant improvement in function as the nearby joint may become more painful if it is abnormal. Furthermore, all medications that the patient is taking are reviewed. Blood-thinning medications such as warfarin (Coumadin) and anti-inflammatory medications such as aspirin may have to be adjusted or discontinued prior to knee replacement surgery.

Routine blood tests of liver and kidney function and urine tests are evaluated for signs of anemia, infection, or abnormal metabolism. Chest X-ray and EKG are performed to exclude significant heart and lung disease that may preclude surgery or anesthesia. Finally, a knee replacement surgery is less likely to have good long-term outcome if the patient's weight is greater than 200 pounds. Excess body weight simply puts the replaced knee at an increased risk of loosening and/or dislocation and makes recovery more difficult.

Another risk is encountered in younger patients who may tend to be more active, thereby adding trauma to the replaced joint.

What happens in the post-operative period? What is involved in the recovery from surgery?

A total knee replacement generally requires between one and a half to three hours of operative time. Post-surgery, patients are taken to a recovery room, where vital organs are frequently monitored. When stabilized, patients are returned to their hospital room.

Passage of urine can be difficult in the immediate postoperative period, and this condition can be aggravated by pain medications. A catheter inserted into the urethra (a Foley catheter) allows free passage of urine until the patient becomes more mobile.

Physical therapy is an extremely important part of rehabilitation and requires full participation by the patient for optimal outcome. Patients can begin physical therapy 48 hours after surgery. Some degree of pain, discomfort, and stiffness can be expected during the early days of physical therapy. Knee immobilizers are used in order to stabilize the knee while undergoing physical therapy, walking, and sleeping. They may be removed under the guidance of the physical therapist for various portions of physical therapy.

A unique device that can help speed recovery is the continuous passive motion (CPM) machine. The CPM machine is first attached to the operated leg. The machine then constantly moves the knee through various degrees of range of motion for hours while the patient relaxes. This can help to improve circulation and minimize the risk of scarring and contracture of the tissues around the knee.

Patients will start walking using a walker and crutches. Eventually, patients will learn to walk up and down stairs and grades. A number of home exercises are given to strengthen thigh and calf muscles.

How does the patient continue to improve as an outpatient after discharge from the hospital? What are recommended exercises?

For an optimal outcome after total knee replacement surgery, it is important for patients to continue in an outpatient physical-therapy program along with home exercises during the healing process. Patients will be asked to continue exercising the muscles around the replaced joint to prevent scarring (and contracture) and maintain muscle strength for the purposes of joint stability. These exercises after surgery can reduce recovery time and lead to optimal strength and stability.

The wound will be monitored by the surgeon and his/her staff for healing. Patients also should watch for warning signs of infection, including abnormal redness, increasing warmth, swelling, or unusual pain. It is important to report any injury to the joint to the doctor immediately.

Future activities are generally limited to those that do not risk injuring the replaced joint. Sports that involve running or contact are avoided, in favor of leisure sports, such as golf, and swimming. Swimming is the ideal form of exercise, since the sport improves muscle strength and endurance without exerting any pressure or stress on the replaced joint.

Patients with joint replacements should alert their doctors and dentists that they have an artificial joint. These joints are at risk for infection by bacteria introduced by any invasive procedures such as surgery, dental or gum procedures, urological and endoscopic procedures, as well as from infections elsewhere in the body.

The treating physician will typically prescribe antibiotics before, during, and immediately after any elective procedures in order to prevent infection of the replaced joint.

Though infrequent, patients with total knee replacements can require a second operation years later. The second operation can be necessary because of loosening, fracture, or other complications of the replaced joint. Reoperations are generally not as successful as original operations and carry higher risks of complications. Future replacement devices and techniques will improve patient outcomes and lead to fewer complications.

cozmetic surgery

Are sit-ups not giving you the taut tummy you want? If you've got too much flab or excess skin in your abdomen that doesn't respond to diet or exercise, you may be considering a "tummy tuck," which doctors call "abdominoplasty."

This surgery flattens the abdomen by removing extra fat and skin, and tightening muscles in your abdominal wall.

It's not the same as liposuction, although you may choose to get liposuctionalong with a tummy tuck.

This is a major surgery, so if you're considering it, you should know the facts before you decide whether to go forward.

Who Are the Best Candidates For a Tummy Tuck?

A tummy tuck is suitable for men and women who are in good health.

Women who have had several pregnancies may find the procedure useful for tightening their abdominal muscles and reducing skin.

A tummy tuck is also an option for men or women who were once obese and still have excess fat deposits or loose skin around the belly.

Who Should Not Consider a Tummy Tuck?

If you're a woman who plans to get pregnant, then you may want to postpone a tummy tuck until you're done having children. During surgery, your vertical muscles are tightened, and future pregnancies can separate those muscles.

Are you planning to lose a lot of weight? Then a tummy tuck also is not for you. A tummy tuck should be a last resort after you've tried everything else. It should not be used as an alternative to weight loss.

You should also consider the appearance of scars after a tummy tuck. You can talk about scar placement and length with the doctor before the surgery.

How to Prepare for Tummy Tuck Surgery

The first step is to choose a surgeon and see him or her for a consultation. At that meeting, you'll talk about your goals and the following options:

  • Complete abdominoplasty. The surgeon will cut your abdomen from hipbone to hipbone and then contour the skin, tissue, and muscle as needed. The surgery will involve moving your belly button, and you may need drainage tubes under your skin for a few days.
  • Partial or mini abdominoplasty. Mini-abdominoplasties are often done on people whose fat deposits are located below the navel. During this procedure, the surgeon most likely will not move your belly button, and the procedure may only take up to two hours, depending on your case.

If you smoke, your doctor will ask that you quit smoking from at least two weeks before the surgery until two weeks after the surgery. It is not enough to just cut down on smoking. You must stop completely since smoking makes complications more likely and slows healing.

Don't try a drastic diet before the surgery. Eat well-balanced, complete meals. A healthy diet may help you heal better.

Tell your doctor about everything you take, including prescription drugsherbal medicines, and other supplements. Your surgeon may instruct you to stop taking certain medications for a time before and after the surgery.

Before getting the surgery, get your home ready. You'll need:

  • Ice packs
  • Loose, comfortable clothing that can be put on and off very easily
  • Petroleum jelly
  • Hand-held shower head and bathroom chair

You'll also need someone to drive you home after the tummy tuck. If you live alone, you'll want someone to stay with you for at least the first night. Make a plan for that.

How a Tummy Tuck Is Done

This surgery can take anywhere from one to five hours. You may need to stay overnight in the hospital, depending on your case.

You will get general anesthesia, which will put you to "sleep" during the operation.

Possible Complications

You will have pain and swelling in the days following surgery. Your doctor will prescribe pain medicine and tell you how to best handle the pain. You may be sore for several weeks or months.

You may also experience numbness, bruising, and tiredness during that time.

As with any surgery, there are risks. Though they're rare, complications can include infection, bleeding under the skin flap, or blood clots. You may be more likely to have complications if you have poor circulation, diabetes, or heartlung, or liver disease.

You may experience insufficient healing, which can cause more significant scarring or loss of skin. If you do heal poorly, you may require a second surgery.

A tummy tuck leaves scars. Though they may fade slightly, they will never completely disappear. Your surgeon may recommend certain creams or ointments to use after you've completely healed to help with scars.

Taking Care of Yourself After Surgery

Whether you're having a partial or complete tummy tuck, the area that's operated on will be stitched and bandaged. It's very important to follow all your surgeon's instructions on how to care for the bandage in the days following surgery. The bandage used will be a firm, elastic band that promotes proper healing. Your surgeon will also instruct you on how to best position yourself while sitting or lying down to help ease pain.

You will have to severely limit strenuous activity for at least six weeks. You may need to take up to one month off work after the surgery to ensure proper recovery. Your doctor will advise you on what you need to do or not do.

Returning to Daily Life

Generally, most people love how they look after this procedure. That can take time, though. You may not feel like your normal self for months after the surgery.

Diet and exercise can help you maintain the results.

 

hollywood smile

Veneers (Hollywood Smile)

Dental veneer is a wafer-thin, tooth-colored layer of material placed over the frontal teeth. This is used to improve the appearance by restoring the size, shape and length of teeth. If a patient wants to improve the smile, dental veneers are a simple option. They look like natural teeth.

A dentist may offer dental veneers to correct a wide range of dental issues, such as:

  • Discolored teeth that can’t be corrected by whitening (root canal treatment, tetracycline or other drugs, excessive fluoride causes the discoloration of the tooth)
  • Worn teeth
  • Chipped or broken teeth
  • Misaligned or crooked teeth
  • Irregularly shaped teeth, which can be restored by veneers
  • Veneers used to close the gaps between the frontal teeth

The dentist will help with the choice of veneer material:

  • Porcelain veneers are strong and lasts long, more resistant than composite resin veneers. They look like natural teeth and mimic the light reflecting properties, resistant to the stains.
  • Composite resin veneers can be repaired easily and quickly, although they are less resistant than porcelain veneers. Composite resin veneers cost less and a few visits to the dentist are needed.

Compared to the crowns, less enamel is removed when veneers are placed. The veneers are a good option for patients, who want to change a little the shape of the tooth. If the crookedness is too much, crowns may be required.

During the first appointment the dentist decides whether veneers are appropriate choice for a patient. The teeth and gums must be healthy; any diseases and decays will be treated before placing veneers. If a patient clenches or grinds the teeth, veneers may chip or break easily. Special plastic guards may be suggested to wear while sleeping. The dentist takes X-Ray to detect any issues.

If the teeth are healthy, the dentist prepares teeth for veneers. A local injection is made to numb the area. After the anesthetics work, the dentist removes a thin layer of frontal surface (the amount is nearly equal to the thickness of the veneer). He or she makes impressions of the tooth or teeth and sends them to the laboratory, where the veneers will be prepared in 2-4 weeks. During that period, the patient may wear temporary veneers. With the help of the dentist the patient chooses the appropriate shade for the future veneers.

At the next appointment the dentist fixes the prepared veneers to check the size and the color. After he or she achieves the proper fit, the veneers are finally placed on the tooth. Regular dental visits are a must for keeping the teeth healthy. It is possible for veneers to come loose over time (7-15 years depend on the patient). The dentist will offer to place the new one or maybe even choose the new way of treatment.

Dental veneers require no special care, but an oral hygiene must be kept. Every day brushing, flossing, and rinsing with an antiseptic mouthwash are recommended.

physiotherapy and rehabiltation

Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice. 


They maintain health for people of all ages, helping patients to manage pain and prevent disease.


The profession helps to encourage development and facilitate recovery, enabling people to stay in work while helping them remain independent for as long as possible.


What physiotherapists do

Physiotherapy is a science-based profession and takes a ‘whole person’ approach to health and wellbeing, which includes the patient’s general lifestyle.


At the core is the patient’s involvement in their own care, through education, awareness, empowerment and participation in their treatment.


You can benefit from physiotherapy at any time in your life. Physiotherapy helps with back pain or sudden injury, managing long-term medical condition such as asthma, and in preparing for childbirth or a sporting event.


?Why physiotherapy

Physiotherapy is a degree-based healthcare profession. Physios use their knowledge and skills to improve a range of conditions associated with different systems of the body, such as:


Neurological (stroke, multiple sclerosis, Parkinson's)

Neuromusculoskeletal (back pain, whiplash associated disorder, sports injuries, arthritis)

Cardiovascular (chronic heart disease, rehabilitation after heart attack)

Respiratory (asthma, chronic obstructive pulmonary disease, cystic fibrosis).

Physiotherapists work in a variety of specialisms in health and social care. Additionally, some physiotherapists are involved in education, research and service management.

brazilian butt lift

Brazilian Butt Lift

Brazilian Butt Lift is a type of hip augmentation, and lifting surgery, which results in youthful, prominent and optimal natural looking. The procedure can help with patients who are unhappy with the appearance of their hipocks, whether due to their size or shape or the presence of sagging skin. Fat transfer to the hipocks is the latest technique applied in proper cases that gives a smoother result and has no rejection risk as its patients own tissue. We purify the fat tissue from other parts and turn into stem cell enriched fat tissue to have all benefits of stem cells like regenerative effect, a fresher look via an awarded specific process named in the literature with Doctor B, “Cihantimur Fat Transfer System”. In some patients complaining of skin sagging we can combine these procedures with his other groundbreaking technique, The Spider Web Technique. The Spider Web technique aims integration of the transferred tissue with polydioxanone sutures placed under the skin, which triggers collagen production fighting with loss of elasticity and sagging of skin.

 Advantages

  • Tightened and natural results
  • Good quality of skin and fresher look
  • Faster Healing
  • Use of regional fat
  • Reshaping of waist and hips 

 

"Wider, fresh, fit, smooth hips with a thin waist curve is the best shape. Also, fat injection is the best choice for giving this hip shape. You cannot get a desirable result from a hip augmentation surgery done without shaping the waist curve or upper leg form. Therefore, you should approach with a holistic perspective and focus on the waist and upper leg as well”

Doctor B  

 

What is Brazilian Hip Lift?

The female figures of archaeological excavations, female statues that symbolize fertility; all of them have something in common: large breasts and firm, protruding hips. Today, nothing has changed; according to numerous and extensive researches, we love round, protruding, smooth, firm and plump thighs. Assuming that wide hips evokes the estrogen, we can also think that there is an instinctive attraction to this point. To have that type of hips, exercise and diet is very important as well as genetic heritage. But it is very hard to achieve, so at this point we get help from aesthetic surgery. Having a thin waist, firm and fit hip is possible due to aesthetic surgery. Applied with Spider Web Aesthetic and Cihantimur Fat Transfer, Brazilian Hip Lift operations not only solves the regional lipoidosis problem but also provides you with the desired hip shape and size.

Who can get Brazilian Hip Lift?

Those who want to get more rounded, protruding, smooth, firm and plump thighs as well as a slimmer waistline and those who want to solve their regional lipoidosis problem can get Brazilian Hip Lift application. 

Examination of Brazilian Hip Lift

Brazilian Hip Lift examination begins with a pre-interview with Doctor B. Regional lipoidosis areas are examined. The proportion of waist curve and the proportion between upper leg area and hip size are estimated. The number of threads to be used in the Spider Web Aesthetic is determined. This application solves the sagging and loss of form problems. Also, Doctor B answers questions, listens to the expectations and makes the planning based on the patient’s desire regarding the size. Your photographs are taken for medical archive and you are measured.

Application of Brazilian Hip Lift

Brazilian Hip Lift operation begins after applying the preferred anesthesia type. To provide firm, tight and lifted hips, the Spider Web Aesthetic is performed in the area. A number of threads are placed on the hips for Spider Web Aestethic. The number of the threads are determined during the examination. Then, the regional fat taken from waist, upper leg or abdomen with Cihantimur Fat Transfer, is enriched with stem cells and augmentation operation is performed. These two applications provide fuller, firmer hips and a fresh and firm skin due to the stem cells. Also, in this way, thinning is ensured on the area where the fat is removed. A filler obtained from your own body, your own fat, provides an extra advantage to get the desired form.

After the Brazllian Hip Lift

Performed with methods like Cihantimur Fat Transfer and Spider Web Aestethic developed by Doctor B and patented by the Institute of European Patent, Brazilian Hip Lift is among the applications which brings positive feedbacks. Patients experience the most comfortable process during and after the operation. They spend approximately two days at the hospital and can return to their business life after one week.

beard transplantation


breast Augmentation

Breast augmentation, sometimes referred to as a "breast aug" or "boob job" by patients, involves using breast implants or fat transfer to increase the size of your breasts. This procedure can also restore breast volume lost after weight reduction or pregnancy, achieve a more rounded breast shape or improve natural breast size asymmetry.


What breast augmentation surgery can do

  • Increase fullness and projection of your breasts
  • Improve balance of breast and hip contours
  • Enhance your self-image and self-confidence

Breast implants may also be used for breast reconstruction after mastectomy or injury.

What breast augmentation surgery can't do

Breast augmentation does not correct severely drooping breasts. A breast lift may be required along with a breast augmentation for sagging breasts to look fuller and lifted.

Breast lifting can often be done at the same time as your augmentation or may require a separate operation. Your plastic surgeon will assist you in making this decision.

Who is a good candidate for breast augmentation?

Breast augmentation is a deeply personal procedure, and it's important that you're doing it for yourself and not for someone else, even if that person has offered to pay for it. Patient satisfaction is high, specifically when they want the procedure themselves.

You may be a candidate for breast augmentation if:

  • You are physically healthy and you aren't pregnant or breastfeeding
  • You have realistic expectations
  • Your breasts are fully developed
  • You are bothered by the feeling that your breasts are too small
  • You are dissatisfied with your breasts losing shape and volume after pregnancy, weight loss or with aging
  • You are unhappy with the upper part of your breast appearing "empty"
  • Your breasts are asymmetrical
  • One or both breasts failed to develop normally or have an elongated shape

If you're considering surgery, spend some time reviewing breast augmentation photos and learning about what to expect uring recovery. Preparation ahead of time helps patients have reasonable expectations and a smoother recovery.

What you can expect

Breast augmentation can be done in a surgical center or hospital outpatient facility. You'll probably go home the same day. The procedure rarely requires a hospital stay.

Sometimes, breast augmentation is done during local anesthesia — you're awake and your breast area is numbed. Often, though, breast augmentation is done during general anesthesia, in which you're asleep for the surgery.

During the procedure

To insert the breast implant, your surgeon will make a single cut (incision) in one of three places:

·        In the crease under your breast (inframammary)

·        Under your arm (axillary)

·        Around your nipple (periareolar)

After making an incision, the surgeon will separate your breast tissue from the muscles and connective tissue of your chest. This creates a pocket either behind or in front of the outermost muscle of the chest wall (pectoral muscle). The surgeon will insert the implant into this pocket and center it behind your nipple.

Saline implants are inserted empty and then filled with sterile salt water once they're in place. Silicone implants are pre-filled with silicone gel.

When the implant is in place, the surgeon will close the incision — typically with stitches (sutures) — and bandage it with skin adhesive and surgical tape.

After the procedure

Soreness and swelling are likely for a few weeks after surgery. Bruising is possible, too. Expect scars to fade over time but not disappear completely.

While you're healing, it might help to wear a compression bandage or sports bra for extra support and positioning of the breast implants. Your surgeon might prescribe pain medication as well.

Follow your surgeon's instructions about returning to regular activities. If you don't have a physically demanding job, you might be able to return to work within a few weeks. Avoid strenuous activities — anything that could raise your pulse or blood pressure — for at least two weeks. While you're healing, remember that your breasts will be sensitive to physical contact or jarring movements.

If your surgeon used sutures that don't absorb on their own or placed drainage tubes near your breasts, you'll need a follow-up appointment for removal.

If you notice warmth and redness in your breast or you run a fever, you might have an infection. Contact your surgeon as soon as possible. Also contact your surgeon if you have shortness of breath or chest pain.

Results

Breast augmentation can change the size and shape of your breasts. The surgery might improve your body image and self-esteem. But keep your expectations realistic, and don't expect perfection.

Also, your breasts will continue to age after augmentation. Weight gain or weight loss might change the way your breasts look, too. If you become dissatisfied with the appearance of your breasts, you might need more surgery to correct these issues.

STEM CELL TRANSPLANTAION

UMBILICAL CORD BLOOD

WHAT IS STEM CELL?

Stem cells are resources of all cells, tissues, and organs in an organism. They fill the blank between the fertilized egg and the end structure. As we age, stem cells renew the damaged, worn out, and spoiled tissues. Stem cells have the ability of self-regeneration and differentiation into different bodily cell types in different ratios.

Stem cell research has been going on for more than 20 years. Most of the information about the cells has been collected from blood cell cycles and research done on laboratory mice. In 2000s, after increased number of studies based on Stem cell therapy, it has become the most controversial topic ever discussed.


WHERE STEM CELLS ARE OBTAINED FROM?

Today, the most commonly used resource of stem cells is the bone marrow. Bone marrow stem cells are progenitors of hematopoietic cells and they can differentiate into cells found in blood.


Resources of stem cells might be as followings;

  • Embryonic Stem cells
  • Fetal Stem cells
  • Adult Stem cells

EMBRYONIC STEM CELLS:

Embryonic stem cells develop from the zygote which forms two-celled structure followed by fertilization. A 150-celled globe called Blastocyst forms 5 days after fertilization. Blastocyst consist of little sand like cells and contains only two types of cells; trophoblasts and cluster of cells located in the center. This cluster of cells come together and form embryonic stem cells. And these embryonic stem cells can form any type of adult cells.


FETAL STEM CELLS:

One of the potential resources of stem cells are early fetal tissue. 7-8 weeks after fertilization, embryo is called fetus. Embryonic germ line form eggs and sperms in ovary and testicles in 4-5th week of development. Concept of collection of Embryonic germ cells and production in culture first came out in 1998. It is determined that stem cells obtained from cell cluster of blastocyst are same as these germ cells after isolated and produced in culture. However, findings of studies proved that these embryonic germ cells have restricted ability to differentiate into other cell types.


ADULT STEM CELLS:

Adult stem cells are different than the ones obtained from embryo and fetus and they are found in tissues developed in humans and animals after birth. In addition, the most suitable source of these stem cells to be obtained is Bone marrow located in the center of some bones. Bone marrow is usually extracted from a part of in the back of upper hip bone called “Krista iliac”. There are different types of stem cells in bone marrow including hematopoietic stem cells, endothelial stem cells and mesenchymal stem cells. It is known that hematopoietic stem cells make blood, endothelial stem cells make vascular system (arteries and veins) and mesenchymal stem cells make bone, cartilage, muscle, fat and fibroblasts. It is assumed that stem cells can form into each other and at some day some of them will have a wide ability to differentiate into even more cell types than present. This means it is possible to regenerate damaged organs such as liver, kidney, heart and lungs only by adult bone marrow stem cells known its ability to form blood. Even though it is very interesting promising, scientists consider this subject very controversial. A careful and meticulous researches about abilities of stem cells and comparison between embryonic stem cells are highly needed.


KResources of stem cells other than bone marrow and mesenchymal stem cells are as in followings;

  • Umbilical Cord Blood: adult stem cells can also be obtained from umbilical cord of a newborn. It is easy to access than bone marrow and brain and has higher potential of reproduction.

  • Deciduous teeth: stem cells obtained from umbilical cord or deciduous dental pulp are younger than stem cells obtained from adults. They are more capable to grow in culture than many adult cells and they have an ability to create multiple tissue types. The potential of ability to differentiate into several cell types has been widely studied.

  • Adipocytes: Stem cells isolated from liposuction material for esthetic purpose in many centers abroad, are preserved for patient’s future needs.


WHAT IS UMBILICAL CORD AND WHAT IS ITS FUNCTION?

In the womb, baby is fed by maternal blood via umbilical cord through placenta. Placenta (also known as afterbirth) is an organ structure that allows nutrient uptake and oxygen exchange between mother and baby.

After birth, placenta taken out from uterus with the baby, becomes unnecessary tissue for both baby and mother and usually is thrown away. Umbilical Cord blood is the blood that remains in the placenta. The process of collection of stem cell rich blood is pain-free and has not any complication risks.


HOW TO COLLECT CORD BLOOD?

Gynecologist and laboratory where procedure will be performed, must be prepared before 1-2 weeks before the birth. Required equipment and documents must be ready.

Umbilical Cord blood is collected right after the birth by the gynecologist or a Genkord Staff. There are no differences between the process is going to be follow in normal delivery and C-section.

Right after the baby born, a clamp is put in the middle of the umbilical cord and cut it. And baby is taken to the newborn unit in order to check medical conditions. The blood drains into a collection bag. It is scientifically observed that blood collection before removing placenta is more successful. The collection process is painless and safe for you and your baby and does not affect the delivery. The entire process takes less than 5 minutes has no difficulties. The more blood we collect, the more stem cells we will have. 90 ml of blood should be collected and it is enough to fill collection bag half. Collected blood must be delivered to our laboratory in 24-36 hours and it must be preserved at room temperature during the process. There is no need to use a cooler such as ice or dry ice unless it is too hot and samples are not allowed to put in deep freezer.


FOR WHOM STEM CELL THERAPY IS GOING TO BE USED?

It can be used for the baby which are taken from itself as well as the parents and siblings unless there is histo-incompatibility. It is known that there is highest score of tissue compatibility between first degree relatives, especially between siblings.

If differentiated cells in our body has been seriously damaged or diseased, they cannot regenerate naturally. Stem cells are used to create healthy and functional cells to replace these damaged or diseased cells. Procedure of replacement diseased cells with the new ones called “Cell Therapy” is similar to organ transplantations. However, instead of using organs, this time cells are transplanted.

Stem cells can be used as regenerative and transformative resources of differentiated cells. Researchers investigate the possibility of stem cells as treatments for several diseases by differentiating adult, fetal and embryonic stem cells into cell types like nerve, muscle, blood and skin cells.

For instance, In Parkinson disease stem cells can be used to create a special kind of nerve cells that secrete dopamine. Theoretically, a treatment will be provided by transplanting these nerves cells to

where they can rearrange patient’s brain stimulations and regain its functions.


UMBILICAL CORD TISSUE

WHAT IS UMBILICAL CORD TISSUE-DERIVED MESENCHYMAL STEM CELL?

Mesenchymal stem cell is a type of multipotent adult stem cells. It can be obtained from several types of tissues such as bone marrow, umbilical cord blood, adipose tissue, placenta, dental pulp and eye. These cells are used for their ability to differentiate in various specialties in medicine. Umbilical cord exchanges nutrition and metabolites between mother and baby during pregnancy. Umbilical cord as a rich source of immature mesenchymal stem cells, is also source of cord blood that has the highest differentiation capacity and is the closest to embryonic stem cells as well.


WHAT ARE THE ADVANTAGES OF STORE UMBILICAL CORD TISSUE?

  • It is collected during the birth without any operations on both mother and baby. It is pain-free and easy to obtained.
  • They can differentiate into the cells that are going to be used in tissue engineering and regenerative medicine such as bone, cartilage, muscle and nerve cells.
  • They are used to treat diabetes, heart diseases, neurodegenerative and orthopedic diseases.
  • It is shown that they can be efficient to reduce graft rejection of tissue and organ transplantations due to immunomodulator properties.