Dental and Medical Myths

Introduction:
Radiotherapy is the art of using ionizing radiation to destroy malignant tumors while minimizing damage to normal tissues ( J.coate).

CIN and Cancer Difference

Radiotherapy is the important modalities of therapy for human cancers apart from surgery. It is very useful in the treatment of many cancer specially female reproductive tract.

fibroscopic visualization technique for urinary bladder visualization

Mechanism action of radiotherapy

1)Radiation causes ionization of water of the cancer cells into hydrogen and hydroxyl ions which are toxic and causes damage to DNA of the cell and thereby cell death. [The target for radiation is injury to DNA, which is responsible for cell mitosis. So injury to DNA causes mitotic cell death.]
2)It stimulates fibrous tissue reaction in the surrounding stroma and resulting filorosis causes entanglement of the tumour cells and prevents local spread.
3)Reducing vascularity by radiation end arteritis.

Technique/Methods of radiotherapy

For gynecological cancers therapeutic
radiation is delivered as –

• a) External radiation (Teletherapy)
• b) Internal radiation (Brachytherapy)

a) Teletherapy- The goal of teletherapy is to ensure that radiation is delivered to the target tissue without affecting uninvolved tissues from distance (usually 100cm). Cobalt 60 is the common teletherapy source for external radiation; other one is cesium 137. External radiation is used to treat large volumes of tumours, lymph nodes, parametrium.
b) Brachy therapy (internal radiation)

Here source of therapeutic ionizing radiation is placed close to the treatment area, chief advantages of it is that a relatively high dose of radiation can be applied to a limited anatomic region.
Commonly used sources are caesium-137
Cobalt - 60
The application may be

1. Intracavitary
2. Interstitial Intracavitary – The devices for brachytherapy consists of hollow stem; intrauterine tandem, which is placed within the uterine cavity. Special devices used for vaginal placements are called vaginal ovoids or colpostats.
   Interstitial – Using needles, wires or seeds used as radio active sources within tissues.
   

   Indication of radiotherapy

   a) Cervical cancer- It is used in all stages. In squmous cell type, response is best for radiotherapy.
   b) Endometrial cancer- Adenocarcinoma response to radiohterapy.
   c) Vaginal cancer – Here radiotherapy is best than surgery.
   d) Vulval cancer – Generally radiothery is not used, as vulval skin is moist, Causing irritation & distort the shape of vulva.
   e) Orarian cancer – Actualy no role of radiotherapy but in dysgerminoma, responsed of radiotherapy is good.
   f) Choreocarcinoma – When metastasis to liver & brain.
   

   Uses of radiotherapy in specific cancer

   Cervical cancer: Treatment of cervical cancer is a prime example of successful application of radiotherapy.
   Radio therapy can be used in all stages of carcinoma of cervix but in stage 0 or pre-invasive carcinoma we do not use radiotherapy due to damage of ovarian tissue.
   In cancer cervix
   
    
   In early stage – option of stage 1 + upto stage II A
   Mode of treatment –
   a) Only surgery
   b) surgery + Radiotherapy
   c) Only Radiotherap
   
   
   But stage IIB & on wards option of mode of treatment
   •Only radiothery
   •Here surgery is not possible.
   Goal of external radiation – in cervical cancer is to Sterilize metastatic disease to pelvic lymphnode and parametrium and to decrease the size for cervix to allow placement of intracavitary radio active sources.
   It is also used as palliative radiation for
   advanced cervical cancer for-
   •Control of bleeding
   •Pain relief.
   Radiotherapy combined with chemotherapy specially platinum based cisplatin or carboplatin provides better survival.
   Dose of radiotherapy
   Bnachytherapy – in the form of intracavitary.
   The goal is to deliver a dose of 70-80 Gy at point A, which is situated 2 cm above the mucosa of lateral vaginal fornices & 2 cm lateral to the central uterine canal.

People who have scored B.M.I (Body Mass Index) 30 or more than 30 are counted as obese person in medical science. This obesity or fattiness can decrease your level of vitamin D in your body.

Recently scientists have found that by researching  genetic data of human body and examine about 42 thousand people. They said that about 10% increasing of B.M.I (Body Mass Index) can cause decreasing of 4% vitamin D of total level.

It is considered that maximum amount of vitamin D is stored in fatty tissue of body. But in case of obese or fatty people have got more fatty tissue than normal. So, it caused obstacles in passing vitamin D trough fatty tissue to blood circulation in proper manner.  In relation with that condition Professor David Has-lam, Member of National Obesity Forum said, “ Food habit and genetic factors both are responsible for obesity of human body.”

In blood the normal level of Vitamin D is 50 nano mol per liter. If it decease less than 30 it will cause weakness of bone, Rickets of children and another bone diseases.

                                                                                                                [Source: Health Journal PLOS]

Now scientists have revolutionary thinking about using a new type of pacemaker. It is already used in animal to gain assurance about its further uses. It's called pacemaker of its own heart.

 

Pacemaker or artificial pacemaker, its not heart's natural pacemaker. It is a medical device that uses electrical impulses, delivered by electrodes contacting the heart muscles, to keep the normal beating of the heart. The primary function of a pacemaker is to maintain an adequate heart rate, if there natural pacemaker of hearts is not fast enough, or there is a heart block. A group of Scientists of Seder- Sinai Heart Institute have got a success. Human heart is made of millions of cell. But among them only 10 thousand cell contribute to pacemaker and make heart beats. For aging or other heart diseases when heart rate become high or low then electronic pacemaker is used to keep it normal.. But using this electronic device there remain some complications to risk. For consideration to low the risk scientists have used genetic recombination by replacing T BX-18 gene via a virus to cells of the heart, which can make normal heart rate in its own heart.....

 Oral Cancer

Oral cancer in medical term most commonly recognized as oral carcinoma. In Asian countries like India, Sri Lanka and Bangladesh cancer of the mouth accounts for approximately 40% or more. And it also accounts for only about 25 of all malignant tumours in such countries as the UK and the USA. Over 70% of oral cancers arised from on the lateral borders of the tongue and asjacent alveolar region and floor of the mouth. 95% cases are well or moderately well-differentiated squamous cell carcinoma.

Oral cancer is a age-related disease and more frequenty seen in those aged 30-50.

Probable Causes are Tobacco chewing, alcohol consumption, betel quid habit.

Infections like Shyphilis, Candidosis and other viral infections are sometimes responsible.

Other mucosal dieseases like Oral epithelial dysplasia, Lichen planus, Oral submucous fibrosis can cause oral cancer.

 Clinical features

In earky stage it appears as white or red paches or ulcers, sometimes may be painless or sligthly sore. later it become large and painful. It may spreads by diresct invasion by surrounding tissue and by lymphatic metastasis. The submandibular and jugolodigastric lymphnode are most commonly involved.

Investigation

• Investigation is done by Biopsy  

• Imaging for oral cavity cancers and FNAC

Treatment

In practice most cases are trested by surgery combined wuth radiotherapy. surgery alone is preffered for small carcinomas of the tongue thet may be easily excised. And if it involed bones then it depend upon surrounding region. Sometimes partial mandibulectomy( removal of a part of mandible) or hemi-mandibulectomy(removal of half portion of lower jaw in figure) is done. Partial parts of removed jaw is retained by re-construction plate(Radiographic figure).

How to Overcome Sciatica

Nerve Comes From Scarum

Disc Prolapse

Sciatic Nerve Pain Region