Book an Appointment
Emergency: 022-61305005
I want to find
My Health Records

Ovarian Tissue Cryopreservation (OTC)

Management Team

Ovarian Tissue Cryopreservation (OTC)

Overview

Ovarian tissue cryopreservation (OTC) refers to the freezing of the ovarian cortex, i.e., the outer layer of the ovary; this layer is the egg-producing layer of the ovary and often determines the fertility of women. OTC is a useful technique that is most commonly used to preserve fertility and extend childbearing years in women. However, potential applications for OTC beyond fertility preservation include cHRT and cell-/tissue-based hormone replacement therapy for treating cancers in young women and the treatment of other gynaecological conditions, such as premature ovarian insufficiency and polycystic ovary syndrome (PCOS).

  • OTC and transplantation have garnered an increasing amount of attention as successful methods for preserving fertility in young women with primary malignancies; these methods offer them an opportunity to become biological mothers once they have recovered from cancer. Apart from the preservation of the reproductive potential, OTC also enables the endocrine functions of the ovaries to be restored, ultimately protecting the female reproductive cycle by promoting the secretion of natural levels of essential hormones.
  • Given the increasing incidence of the loss of ovarian function resulting from ageing and induced primary ovarian insufficiency (POI), presently, new treatment modalities whereby the surplus of follicles that most women possess since birth can be utilised are urgently needed; this can help women conquer major health issues resulting from the deficiency of ovarian hormones.

Currently, more than 20,000 girls and women worldwide have been estimated to have undergone OTC. This procedure involves the following steps:

  • First, the ovarian tissues are laparoscopically or surgically removed, followed by freezing of the cortical tissues to yield tissue sections (thickness, approximately 1 mm). Then, the tissues are fragmented mechanically and examined histopathologically to ascertain the presence of malignant cells (and eliminate them) and assess the tissue quality (using the primordial follicle density as an indicator). Finally, the sections are frozen in small fragments.
  • Upon the completion of anti-cancer treatment and recovery, the woman may develop ovarian insufficiency. She is then eligible for ovarian tissue transplantation, which, after tissue thawing, can be performed either orthotopically or heterotopically. This process ensures that the endocrine function is resumed and puberty is initiated.
  • As the cortical tissues primarily contain ovarian follicles at the early stages of follicular development, these tissues require about 3–6 months to regain their full activity and functions, including the sustenance of preovulatory follicle development and the release of fertilisable oocytes.

Overall, OTC is a useful technique associated with the following advantages:

  • Prior ovarian stimulation is not required. Thus, anti-cancer treatment can be administered immediately.
  • It ensures that the primordial follicles of the ovarian cortex are more resistant to cryoinjury than mature oocytes.
  • A large number of primordial follicles can be cryopreserved; this increases the possibility of maintaining fertility for the entirety of the graft's lifetime and decreases the possibility of multiple IVF attempts being required for achieving pregnancy.
  • Fertility can be preserved for a longer duration than that achieved using embryo and oocyte freezing.
  • OTC offers protection against earlier onset of menopause.
Filter Alphabet

Oesophageal pH

Management Team

Oesophageal pH

Overview

Oesophageal pH Test is a diagnostic test performed to identify a condition called Gastroesophageal reflux (GERD) or acid reflux. It is also called Bravo test. The oesophagus is a muscular tube in the human digestive system. It carries food and liquids from the throat to the stomach. Typically, the lower oesophageal sphincter (LES) which is like a valve prevents the stomach acid from flowing back into the oesophagus. However, when the LES malfunctions, acid reflux can occur, leading to discomfort such as heartburn and potentially causing long-term damage to the oesophagus. In such cases, the oesophageal pH test is used to determine how often and for how long stomach acid enters the oesophagus.

An oesophageal pH test may be recommended by your doctor if you have the following conditions:

  • Heartburn: Persistent or frequent heartburn that may suggest acid reflux as the underlying cause.
  • Difficulty swallowing: A sensation of food or liquid getting stuck, which can result from acid-induced scarring in the oesophagus.
  • Chest pain: Unexplained chest pain that may be linked to acid reflux
  • To assess treatment effectiveness: The test can help evaluate how well treatments for acid reflux are working.
  • Diagnostic clarification: It can be used alongside other tests, such as an upper GI series or endoscopy, to provide a clearer picture of the condition of the ossiphageous.

As a preparation for the oesophageal pH test, patients are asked not to consume anything for at least 8 hours before the test. Some medications can influence the test results. Patients should discuss their medications with their doctor, who may advise discontinuing certain drugs at least 48 hours before the test.

Medications that may need to be stopped include caffeine (coffee, tea, soda, chocolate), alcohol, Reglan, Urecholine, Erythromycin, Nitroglycerin, and others like calcium channel blockers, beta blockers, and antacids such as Tagamet, Zantac, Prilosec, and others.

The procedure is typically quick and can be performed on an outpatient basis. It involves the following steps:

  • The patient is asked to be seated or lie on their side for the procedure.
  • A soft, thin tube is inserted through the nose or mouth and gently passed down into the oesophagus.
  • The tube is connected to a small portable device that records the pH levels in the oesophagus throughout the test.
  • The test usually lasts 12-24 hours, during which time the patient is asked to continue with their usual activities.
  • The test measures stomach acid in the oesophagus. Normal results show infrequent reflux, while abnormal results suggest acid reflux issues, guiding treatment options.

The oesophageal pH test is highly beneficial because it provides specific data about the amount and duration of acid reflux, allowing for precise treatment decisions. Some key benefits include:

  • The test helps tailor treatment strategies based on the severity of acid reflux.
  • If the results are normal, it can reassure both the doctor and patient that acid reflux is not the cause of symptoms.
  • It helps evaluate the effectiveness of treatments, such as proton pump inhibitors (PPIs), in controlling acid reflux.

While other diagnostic methods like an upper GI series or endoscopy are useful, they do not provide the same level of insight into acid reflux as the pH test. The pH test is often paired with oesophageal manometry (a test that measures oesophageal pressure) for a more comprehensive evaluation.

Despite the fact that the test is generally secure, there are a few potential side effects, such as:

  • Gagging: A minor sensation of gagging may be experienced during the insertion of the tube. Breathing techniques are typically effective in managing it.
  • Mild Discomfort: The tube may cause mild discomfort or congestion in certain patients following the procedure.
Filter Alphabet

Oesophageal Manometry

Management Team

Oesophageal Manometry

Overview

Oesophageal manometry is a test that measures the rhythmic muscle contractions (motility) in the oesophagus. It evaluates the function of the lower oesophageal sphincter (LES), the muscle that controls the opening between the oesophagus and the stomach, and the oesophageal body. This test helps diagnose conditions like achalasia, GERD, and swallowing disorders.

Your doctor may recommend oesophageal manometry in the following cases:

  • Dysphagia (Difficulty Swallowing): To determine if the cause is due to muscle problems in the oesophagus.
  • Chest Pain: If chest pain is suspected to be related to oesophageal motility issues rather than heart problems.
  • Gastroesophageal Reflux Disease (GERD): To assess the function of the LES and determine if it is causing acid reflux.
  • Achalasia: A disorder where the oesophagus has difficulty moving food to the stomach due to poor muscle function, often resulting in swallowing difficulties.
  • Pre-Surgical Assessment: To evaluate oesophageal function before certain surgeries, such as fundoplication for GERD.

Patients are usually instructed to avoid food and drinks for 8 hours before the procedure. Certain medications that affect oesophageal function (e.g., calcium channel blockers, sedatives, antacids) may need to be stopped 48 hours before the test. Notify your doctor of any allergies, medical conditions, or medications, as some may affect the results.

Oesophageal manometry is typically done as an outpatient procedure. The steps include:

  • Local anaesthesia or a mild sedative may be administered to reduce discomfort.
  • A thin, flexible tube (catheter) is inserted through the nose or mouth and passed down the oesophagus.
  • The catheter has sensors that measure the pressure and contractions in different parts of the oesophagus while you swallow small amounts of water.
  • The test usually takes about 20-30 minutes, and patients can resume normal activities afterward.

  • Diagnosis of the cause of swallowing difficulties and other oesophageal problems.
  • Provides valuable information for treatment planning, especially in conditions like achalasia and GERD.

  • Upper Endoscopy: Visual examination of the oesophagus using a flexible tube with a camera.
  • Barium Swallow: An X-ray test that can detect structural problems in the oesophagus.

  • Discomfort: Some discomfort, such as a sore throat or nasal irritation, may occur.
  • Gagging or Coughing: Common reactions during the test as the catheter is inserted.
  • Infection or Bleeding: Though rare, infection or bleeding may occur if the catheter causes any injury to the oesophagus.
Filter Alphabet

Oesophageal Dilatation

Management Team

Oesophageal Dilatation

Overview

Oesophageal dilatation is a medical procedure used to widen a narrowed or blocked oesophagus. This narrowing (stricture) can occur due to various conditions, such as gastroesophageal reflux disease (GERD), oesophageal cancer, or injury. The procedure is typically performed using a balloon or bougie (a thin, flexible instrument) to gently stretch the affected area, improving the ability to swallow food and liquids.

Your doctor may recommend oesophageal dilatation in the following cases:

  • Oesophageal Stricture: Caused by chronic acid reflux, radiation therapy, or injury, leading to difficulty swallowing.
  • Dysphagia: Difficulty swallowing, often due to narrowing of the oesophagus, which can be addressed through dilation.
  • Food Impaction: When food gets stuck in the oesophagus, especially if there is a narrowing or obstruction.
  • Post-Surgical Treatment: To address complications like strictures after surgery, such as those following fundoplication for GERD.

  • Fasting: Patients are typically asked to avoid eating or drinking for at least 6 hours before the procedure to reduce the risk of aspiration during the procedure.
  • Medication Adjustments: Some medications, especially anticoagulants or those affecting oesophageal motility, may need to be paused or adjusted.
  • Consultation: Discuss any recent health changes, allergies, or past complications with your healthcare provider.

Oesophageal dilatation is generally performed on an outpatient basis and involves the following steps:

  • Sedation: Patients may be given a sedative to relax and reduce discomfort.
  • Insertion of Balloon/Bougie: A flexible tube (endoscope) is passed through the mouth and into the oesophagus, where the narrowing is identified. A balloon or bougie is then gently inflated or inserted to widen the stricture.
  • Post-Procedure Monitoring: The procedure typically lasts between 15-30 minutes, and patients are monitored for any immediate complications, such as bleeding or perforation.

  • Improves the ability to swallow food and liquids.
  • Can help prevent food impaction and other complications caused by strictures.

  • Oesophageal Stent Placement: A tube inserted to keep the oesophagus open.
  • Surgical Treatment: In severe cases, surgery may be required to correct the narrowing.

  • Minor Bleeding: Occasional minor bleeding may occur, especially if a biopsy is taken during the procedure.
  • Perforation: Although rare, there is a small risk of perforation (a tear in the oesophagus).
  • Infection: As with any medical procedure, infection is a possibility.
Filter Alphabet
O

Osteopetrosis

Management Team

Osteopetrosis

Overview

Osteopetrosis, also known as marble bone disease, refers to a rare hereditary condition characterised by diffuse and symmetric skeletal sclerosis, which means there is an increase in bone density. This condition is caused by dysfunction of osteoclasts (bone cells). Bones exhibit a ‘stone-like’ quality; however, they are abnormally brittle and can fracture like chalk.

Weak and brittle bones, dental abnormalities, anaemia, facial palsy, hypocalcaemia

Family history, examination, laboratory tests to examine mineral/hormone levels, and imaging tests to evaluate bone structure

Drug therapy including, corticosteroids, physical therapy, and bone marrow transplant for severe cases

Filter Alphabet
O

Osteomalacia

Management Team

Osteomalacia

Overview

Osteomalacia is a condition characterised by the softening or weakening of bones, making them susceptible to bending and breaking as compared to normal bone.

The most common cause of osteomalacia is insufficient vitamin D levels. A related condition known as rickets affects children and is also linked to vitamin D deficiency. The best source of vitamin D is adequate sunlight exposure on the skin. Individuals who do not receive enough sunlight are at an increased risk of developing osteomalacia.

Most individuals with osteomalacia recover with appropriate treatment. the healing process for bones and the strengthening of muscles can take several months. Delayed diagnosis can complicate recovery, particularly if fractures have occurred.

Filter Alphabet
O

Osteopenia

Management Team

Osteopenia

Overview

Osteopenia refers to a decrease in bone density, indicating that bones have less mineral content. This can weaken the bones and elevate the risk of bone fractures. If you are diagnosed with osteopenia, your bone density is lower than average, and there is potential for progression to osteoporosis. Most individuals are advised to have their bone density checked every few years after the age of 50 or upon reaching post-menopause, but those with osteopenia may require more frequent monitoring. If you have osteopenia, please consult your healthcare provider for regular check-ups, who will guide you on when to get your bone density tested.

The most significant risk factor for osteopenia is ageing. As bone mass peaks and begins to decline, old bone is resorbed faster than creation of new bone, leading to a loss of density. Women are particularly affected post-menopause due to decreased oestrogen levels, which accelerates bone loss. If too much bone is lost, bone mass may fall to levels classified as osteopenia.

The initial approach involves diet and exercise modifications. The risk of bone fractures in individuals with osteopenia is fairly low; hence, medication is typically not prescribed unless bone mineral density approaches the osteoporosis level.

Filter Alphabet
O

Osteoporosis

Management Team

Osteoporosis

Overview

Osteoporosis refers to a condition in which bones become fragile and brittle, increasing the likelihood of fractures.

Hormonal changes, ageing, or deficiencies in calcium and vitamin D.

Usually not noticeable until a fracture occurs.

Bone density tests (DEXA scans) to assess bone strength.

Medications to slow down bone loss or stimulate bone growth, along with calcium and vitamin D supplements. Weight-bearing exercises and lifestyle changes, such as smoking cessation and reducing alcohol intake, are important for bone health. Early detection and disease management are crucial to avoid fractures and maintain quality of life.

Filter Alphabet
O

Obesity

Management Team

Obesity

Overview

Obesity is a medical condition characterised by excess accumulation of body fat, which can negatively impact health and elevate the risk of various diseases like diabetes, heart disease, and certain cancers. It results from a mix of genetic, behavioural, and environmental factors.

Obesity symptoms include fatigue, difficulty in doing physical activity, and potential emotional distress.

Obesity management includes dietary changes to reduce calorie intake, regular physical activity, and behavioural therapy to address poor eating habits. However, some severe cases may require medications or bariatric surgery.

Efforts should aim at promoting healthy lifestyle choices and regular monitoring to prevent associated health complications.

If weight-related concerns or health issues are troubling you, please contact your endocrinologist regarding obesity management. Together with your healthcare team, you can assess your health risks and explore potential strategies for weight loss.

Filter Alphabet
O

Occupational Lung Diseases

Management Team

Occupational Lung Diseases

Overview

Occupational lung diseases are a group of lung conditions that have been caused or made worse by long-term exposure to certain irritants in the workplace.

Dust particles, chemicals, fungal spores, and certain animal droppings are examples of exposures that may increase your risk of developing occupational lung disease.

Asbestosis results from inhaling asbestos fibres.

  • Symptoms: Shortness of breath, persistent dry cough, chest tightness, and in advanced cases, finger clubbing.
  • Diagnosis: It is diagnosed based on exposure history, chest X-rays, high-resolution CT scans, and pulmonary function tests (PFTs).
  • Treatment: Supportive care, including oxygen therapy, pulmonary rehabilitation and avoiding further exposure.

Silicosis is caused by inhaling silica dust.

  • Symptoms: Shortness of breath, cough, and sometimes, chest pain.
  • Diagnosis: History taking, chest X-rays, CT scans, and PFTs.
  • Treatment: Symptom management, using corticosteroids for inflammation, and preventing further exposure.

Coal Workers' Pneumoconiosis (Black Lung Disease) results from coal dust inhalation.

  • Symptoms: Chronic cough, shortness of breath and black sputum.
  • Diagnosis: History taking, chest X-rays, CT scans, and PFTs.
  • Treatment: Supportive care, managing complications like chronic bronchitis and avoiding further exposure.

Berylliosis results from beryllium dust or fumes.

  • Symptoms: Shortness of breath, cough, fatigue, and chest pain.
  • Diagnosis: Blood tests, chest X-rays, CT scans, PFTs, and sometimes, bronchoscopy.
  • Treatment: Corticosteroids to reduce inflammation, immunosuppressive drugs in severe cases, and avoiding further exposure.

Byssinosis (Brown Lung Disease) is caused by inhalation of cotton dust.

  • Symptoms: Chest tightness, cough and wheezing, especially at the beginning of the workweek. Diagnosis: Exposure history and PFTs.
  • Treatment: Bronchodilators, corticosteroids, reducing dust exposure and using protective equipment.

Chemical Pneumonitis results from inhaling chemicals, such as chlorine or ammonia.

  • Symptoms: Cough, shortness of breath, chest pain, and sometimes, fever.
  • Diagnosis: Exposure history, chest X-rays, CT scans, and blood gas analysis.
  • Treatment: Supportive care with oxygen therapy, corticosteroids, and removing exposure to the chemical.

Providing education on preventive measures and coordinating care with other healthcare providers plays a vital role not only in treatment but also in diagnosis and long-term support as required. Tailored programmes are made considering all the above factors as per the patients’ clinical condition.

Filter Alphabet
O
Subscribe to O Bottom to top