Endoscope Health Dictionary

Inspection of the interior of a joint (usually the knee) to diagnose any disorder there. The instrument used is a type of ENDOSCOPE called an ARTHROSCOPE. The knee is often affected by conditions that are not easy to diagnose and are not revealed by X-ray examination. Surgery can be performed using arthroscopy and this reduces the time a patient has to be in hospital.... arthroscopy

A method of viewing the interior of the abdomen in patients in whom a tumour or some other condition requiring operation may be present but cannot with certainty be diagnosed. The examination is carried out by making a minute opening under local anaesthesia, and inserting an ENDOSCOPE – a long ?exible instrument bearing an electric lamp and telescopic lenses like that for examining the bladder (CYSTOSCOPE) – into the abdominal cavity. Certain of the abdominal organs can then be directly inspected in turn.... coelioscopy

Examination of a body cavity – for example, PLEURAL CAVITY, GASTROINTESTINAL TRACT, BILE DUCT and URINARY BLADDER – using an ENDOSCOPE in order to diagnose or treat a disorder in the cavity. The development of endoscopy has reduced the need for major surgery, as many diagnostic procedures can be performed with an endoscope (as can MINIMALLY INVASIVE SURGERY (MIS)). The development of ?bre optics (the transmission of light along bundles of glass or plastic ?bres) has greatly advanced the practice of endoscopy and hospitals now routinely run endoscopy clinics on an out-patient basis, often without the necessity for a general anaesthetic.... endoscopy

An endoscopic instrument (see ENDOSCOPE) for viewing the interior of the STOMACH. Introduced into the stomach via the mouth and OESOPHAGUS, the long ?exible instrument (also called an oesophagogastroduodenoscope) transmits an image through a ?breoptic bundle or by a small video camera. The operator can see and photograph all areas of the stomach and also take biopsy specimens when required. (See also FIBREOPTIC ENDOSCOPY.)... gastroscope

An instrument consisting, essentially, of a rigid or ?exible cylinder, an eyepiece and a light source, which is inserted through a small incision into the abdominal cavity (which has already been distended with carbon dioxode gas). The laparoscope allows the contents of the abdominal cavity to be examined without performing a LAPAROTOMY. Some operations may be performed using the laparoscope to guide the manipulation of instruments inserted through another small incision – for example, STERILISATION; CHOLECYSTECTOMY. (See also ENDOSCOPE; MINIMALLY INVASIVE SURGERY (MIS).)... laparoscope

Also called peritoneoscopy, this is a technique using an instrument called an ENDOSCOPE for viewing the contents of the ABDOMEN. The instrument is inserted via an incision just below the UMBILICUS and air is then pumped into the peritoneal (abdominal) cavity. Visual inspection may help in the diagnosis of cancer, APPENDICITIS, SALPINGITIS, and abnormalities of the LIVER, GALL-BLADDER, OVARIES or GASTROINTESTINAL TRACT. A BIOPSY can be taken of tissue suspected of being abnormal, and operations such as removal of the gall-bladder or appendix may be carried out. (See also MINIMALLY INVASIVE SURGERY (MIS).)... laparoscopy

Examination of the RECTUM and sigmoid COLON (see also INTESTINE) with an endoscopic viewing device called a sigmoidoscope (see also ENDOSCOPE). The procedure is done to investigate rectal bleeding or persistent diarrhoea, with the aim of detecting or excluding cancer of the rectum and COLITIS. Sigmoidoscopy, which nowadays is performed with a ?exible instrument, can usually be performed on an outpatient basis.... sigmoidoscopy

A procedure for directly observing a fetus inside the uterus by means of a fetoscope, a type of endoscope. Fetoscopy is used to diagnose various congenital abnormalities before the baby is born. Because the technique carries some risks, it is performed only when other tests such as ultrasound scanning have detected an abnormality. By attaching additional instruments, it is also possible to use the fetoscope to take samples of fetal blood or tissue for analysis and to correct surgically some fetal disorders. (See also amniocentesis; chorionic villus sampling.)... fetoscopy

A technique that uses a hysteroscope (see endoscope) to diagnose disorders, such as uterine polyps, inside the uterus and fallopian tubes. Hysteroscopy can be performed under local anaesthesia. Minor surgery, such as the removal of fibroids, may also be carried out through the hysteroscope.... hysteroscopy

Investigation of the mediastinum by means of an endoscope inserted through an incision in the neck. Mediastinoscopy is used mainly to perform a biopsy of a lymph node. The sample is removed by tiny blades on the endoscope.... mediastinoscopy

Surgery using a rigid endoscope passed into the body through a small incision. Further small openings are made for surgical instruments so that the operation can be performed without a long surgical incision. Minimally invasive surgery may be used for many operations in the abdomen (see laparoscopy), including appendicectomy, cholecystectomy, hernia repair, and many gynaecological procedures. Knee operations (see arthroscopy) are also often performed by minimally invasive surgery.... minimally invasive surgery

A method of obtaining an image of the structure and movement of the heart with ultrasound. Echocardiography is a major diagnostic technique used to detect structural, and some functional, abnormalities of the heart wall, heart chambers, heart valves, and large coronary arteries. It is also used to diagnose congenital heart disease (see heart disease, congenital), cardiomyopathy, aneurysms, pericarditis, and blood clots in the heart.

A transducer (an instrument that sends out and receives sound signals) is placed on the chest, or an ultrasound probe is passed into the oesophagus using a flexible endoscope. Ultrasound waves are reflected differently by each part of the heart, resulting in a complex series of echoes, which are viewed on a screen and can be recorded or the results printed out. Developments such as multiple moving transducers and computer analysis give clear anatomical pictures of the heart.

Doppler echocardiography measures the velocity of blood flow through the heart, allowing assessment of structural abnormalities, such as septal defects.... echocardiography

An endoscopic instrument (see ENDOSCOPE) that enables the operator to see inside a joint cavity and, if necessary, take a biopsy or carry out an operation.... arthroscope

An instrument constructed on the principle of the telescope, which on introduction into the mouth is passed down through the LARYNX and TRACHEA and enables the observer to see the interior of the larger bronchial tubes. The bronchoscope has largely been superseded by ?breoptic bronchoscopy. (See ENDOSCOPE.)... bronchoscope

An ENDOSCOPE for viewing the interior of the COLON. It is made of ?breglass which ensures ?exibility, and incorporates a system of lenses for magni?cation and a lighting system.... colonoscope

Commonly referred to as D and C, a gynaecological operation to scrape away the lining of the UTERUS (ENDOMETRIUM). The procedure may be used to diagnose and treat heavy bleeding from the womb (ENDOMETRIOSIS) as well as other uterine disorders. It can be used to terminate a pregnancy or to clean out the uterus after a partial miscarriage. D and C is increasingly being replaced with a LASER technique using a hysteroscope – a type of ENDOSCOPE.... dilatation and curettage

This is a procedure in which a catheter (see CATHETERS) is passed via an ENDOSCOPE into the AMPULLA OF VATER of the common BILE DUCT. The duct is then injected with a radio-opaque material to show up the ducts radiologically. The technique is used to diagnose pancreatic disease as well as obstructive jaundice.... endoscopic retrograde cholangiopancreatography (ercp)

A visualising technique enabling the operator to examine the internal organs with the minimum of disturbance or damage to the tissues. The procedure has transformed the management of, for example, gastrointestinal disease. In chest disease, ?breoptic bronchoscopy has now replaced the rigid wide-bore metal tube which was previously used for examination of the tracheo-bronchial tree.

The principle of ?breoptics in medicine is that a light from a cold light source passes down a bundle of quartz ?bres in the endoscope to illuminate the lumen of the gastrointestinal tract or the bronchi. The re?ected light is returned to the observer’s eye via the image bundle which may contain up to 20,000 ?bres. The tip of the instrument can be angulated in both directions, and ?ngertip controls are provided for suction, air insu?ation and for water injection to clear the lens or the mucosa. The oesophagus, stomach and duodenum can be visualised; furthermore, visualisation of the pancreatic duct and direct endoscopic cannulation is now possible, as is visualisation of the bile duct. Fibreoptic colonoscopy can visualise the entire length of the colon and it is now possible to biopsy polyps or suspected carcinomas and to perform polypectomy.

The ?exible smaller ?breoptic bronchoscope has many advantages over the rigid tube, extending the range of view to all segmental bronchi and enabling biopsy of pulmonary parenchyma. Biopsy forceps can be directed well beyond the tip of the bronchoscope itself, and the more ?exible ?breoptic instrument causes less discomfort to the patient.

Fibreoptic laparoscopy is a valuable technique that allows the direct vizualisation of the abdominal contents: for example, the female pelvic organs, in order to detect the presence of suspected lesions (and, in certain cases, e?ect their subsequent removal); check on the development and position of the fetus; and test the patency of the Fallopian tubes.

(See also ENDOSCOPE; BRONCHOSCOPE; LARYNGOSCOPE; LAPAROSCOPE; COLONOSCOPE.)... fibreoptic endoscopy

This disorder is related to gastric ulcer (see STOMACH, DISEASES OF), both being a form of chronic peptic ulcer. Although becoming less frequent in western communities, peptic ulcers still affect around 10 per cent of the UK population at some time. Duodenal ulcers are 10–15 times more common than gastric ulcers, and occur in people aged from 20 years onwards. The male to female ratio for duodenal ulcer varies between 4:1 and 2:1 in di?erent communities. Social class and blood groups are also in?uential, with duodenal ulcer being more common among the upper social classes, and those of blood group O.

Causes It is likely that there is some abrasion, or break, in the lining membrane (or mucosa) of the stomach and/or duodenum, and that it is gradually eroded and deepened by the acidic gastric juice. The bacterium helicobacter pylori is present in the antrum of the stomach of people with peptic ulcers; 15 per cent of people infected with the bacterium develop an ulcer, and the ulcers heal if H. pylori is eradicated. Thus, this organism has an important role in creating ulcers. Mental stress may possibly be a provocative factor. Smoking seems to accentuate, if not cause, duodenal ulcer, and the drinking of alcohol is probably harmful. The apparent association with a given blood group, and the fact that relatives of a patient with a peptic ulcer are unduly likely to develop such an ulcer, suggest that there is some constitutional factor.

Symptoms and signs Peptic ulcers may present in di?erent ways, but chronic, episodic pain lasting several months or years is most common. Occasionally, however, there may be an acute episode of bleeding or perforation, or obstruction of the gastric outlet, with little previous history. Most commonly there is pain of varying intensity in the middle or upper right part of the abdomen. It tends to occur 2–3 hours after a meal, most commonly at night, and is relieved by some food such as a glass of milk; untreated it may last up to an hour. Vomiting is unusual, but there is often tenderness and sti?ness (‘guarding’) of the abdominal muscles. Con?rmation of the diagnosis is made by radiological examination (‘barium meal’), the ulcer appearing as a niche on the ?lm, or by looking at the ulcer directly with an endoscope (see FIBREOPTIC ENDOSCOPY). Chief complications are perforation of the ulcer, leading to the vomiting of blood, or HAEMATEMESIS; or less severe bleeding from the ulcer, the blood passing down the gut, resulting in dark, tarry stools (see MELAENA).

Treatment of a perforation involves initial management of any complications, such as shock, haemorrhage, perforation, or gastric outlet obstruction, usually involving surgery and blood replacement. Medical treatment of a chronic ulcer should include regular meals, and the avoidance of fatty foods, strong tea or co?ee and alcohol. Patients should also stop smoking and try to reduce the stress in their lives. ANTACIDS may provide symptomatic relief. However, the mainstay of treatment involves four- to six-week courses with drugs such as CIMETIDINE and RANITIDINE. These are H2 RECEPTOR ANTAGONISTS which heal peptic ulcers by reducing gastric-acid output. Of those relapsing after stopping this treatment, 60–95 per cent have infection with H. pylori. A combination of BISMUTH chelate, amoxycillin (see PENICILLIN; ANTIBIOTICS) and METRONIDAZOLE – ‘triple regime’ – should eliminate the infection: most physicians advise the triple regime as ?rst-choice treatment because it is more likely to eradicate Helicobacter and this, in turn, enhances healing of the ulcer or prevents recurrence. Surgery may be necessary if medical measures fail, but its use is much rarer than before e?ective medical treatments were developed.... duodenal ulcer

A general term applied to any operation in which the abdominal cavity is opened (see ABDOMEN). A laparotomy may be exploratory to establish a diagnosis, or carried out as a preliminary to major surgery. Viewing of the peritoneal cavity (see PERITONEUM) through an ENDOSCOPE is called a LAPAROSCOPY or peritoneoscopy.... laparotomy

Examination of the LARYNX may be performed indirectly with use of a laryngeal mirror, or directly by use of a laryngoscope – a type of endoscope. The direct examination is usually performed under general anaesthetic.... laryngoscope

A periodic change occurring in (female) human beings and the higher apes, consisting chie?y in a ?ow of blood from the cavity of the womb (UTERUS) and associated with various slight constitutional disturbances. It begins between the ages of 12 and 15, as a rule – although its onset may be delayed until as late as 20, or it may begin as early as ten or 11. Along with its ?rst appearance, the body develops the secondary sex characteristics: for example, enlargement of the BREASTS, and characteristic hair distribution. The duration of each menstrual period varies in di?erent persons from 2– 8 days. It recurs in the great majority of cases with regularity, most commonly at intervals of 28 or 30 days, less often with intervals of 21 or 27 days, and ceasing only during pregnancy and lactation, until the age of 45 or 50 arrives, when it stops altogether – as a rule ceasing early if it has begun early, and vice versa. The ?nal stoppage is known as the MENOPAUSE or the CLIMACTERIC.

Menstruation depends upon a functioning ovary (see OVARIES) and this upon a healthy PITUITARY GLAND. The regular rhythm may depend upon a centre in the HYPOTHALAMUS, which is in close connection with the pituitary. After menstruation, the denuded uterine ENDOMETRIUM is regenerated under the in?uence of the follicular hormone, oestradiol. The epithelium of the endometrium proliferates, and about a fortnight after the beginning of menstruation great development of the endometrial glands takes place under the in?uence of progesterone, the hormone secreted by the CORPUS LUTEUM. These changes are made for the reception of the fertilised OVUM. In the absence of fertilisation the uterine endometrium breaks down in the subsequent menstrual discharge.

Disorders of menstruation In most healthy women, menstruation proceeds regularly for 30 years or more, with the exceptions connected with childbirth. In many women, however, menstruation may be absent, excessive or painful. The term amenorrhoea is applied to the condition of absent menstruation; the terms menorrhagia and metrorrhagia describe excessive menstrual loss – the former if the excess occurs at the regular periods, and the latter if it is irregular. Dysmenorrhoea is the name given to painful menstruation. AMENORRHOEA If menstruation has never occurred, the amenorrhoea is termed primary; if it ceases after having once become established it is known as secondary amenorrhoea. The only value of these terms is that some patients with either chromosomal abnormalities (see CHROMOSOMES) or malformations of the genital tract fall into the primary category. Otherwise, the age of onset of symptoms is more important.

The causes of amenorrhoea are numerous and treatment requires dealing with the primary cause. The commonest cause is pregnancy; psychological stress or eating disorders can cause amenorrhoea, as can poor nutrition or loss of weight by dieting, and any serious underlying disease such as TUBERCULOSIS or MALARIA. The excess secretion of PROLACTIN, whether this is the result of a micro-adenoma of the pituitary gland or whether it is drug induced, will cause amenorrhoea and possibly GALACTORRHOEA as well. Malfunction of the pituitary gland will result in a failure to produce the gonadotrophic hormones (see GONADOTROPHINS) with consequent amenorrhoea. Excessive production of cortisol, as in CUSHING’S SYNDROME, or of androgens (see ANDROGEN) – as in the adreno-genital syndrome or the polycystic ovary syndrome – will result in amenorrhoea. Amenorrhoea occasionally follows use of the oral contraceptive pill and may be associated with both hypothyroidism (see under THYROID GLAND, DISEASES OF) and OBESITY.

Patients should be reassured that amenorrhoea can often be successfully treated and does not necessarily affect their ability to have normal sexual relations and to conceive. When weight loss is the cause of amenorrhoea, restoration of body weight alone can result in spontaneous menstruation (see also EATING DISORDERS – Anorexia nervosa). Patients with raised concentration of serum gonadotrophin hormones have primary ovarian failure, and this is not amenable to treatment. Cyclical oestrogen/progestogen therapy will usually establish withdrawal bleeding. If the amenorrhoea is due to mild pituitary failure, menstruation may return after treatment with clomiphene, a nonsteroidal agent which competes for oestrogen receptors in the hypothalamus. The patients who are most likely to respond to clomiphene are those who have some evidence of endogenous oestrogen and gonadotrophin production. IRREGULAR MENSTRUATION This is a change from the normal monthly cycle of menstruation, the duration of bleeding or the amount of blood lost (see menorrhagia, below). Such changes may be the result of an upset in the balance of oestrogen and progesterone hormones which between them control the cycle. Cycles may be irregular after the MENARCHE and before the menopause. Unsuspected pregnancy may manifest itself as an ‘irregularity’, as can an early miscarriage (see ABORTION). Disorders of the uterus, ovaries or organs in the pelvic cavity can also cause irregular menstruation. Women with the condition should seek medical advice. MENORRHAGIA Abnormal bleeding from the uterus during menstruation. A woman loses on average about 60 ml of blood during her period; in menorrhagia this can rise to 100 ml. Some women have this problem occasionally, some quite frequently and others never. One cause is an imbalance of progesterone and oestrogen hormones which between them control menstruation: the result is an abnormal increase in the lining (endometrium) of the uterus, which increases the amount of ‘bleeding’ tissue. Other causes include ?broids, polyps, pelvic infection or an intrauterine contraceptive device (IUD – see under CONTRACEPTION). Sometimes no physical reason for menorrhagia can be identi?ed.

Treatment of the disorder will depend on how severe the loss of blood is (some women will become anaemic – see ANAEMIA – and require iron-replacement therapy); the woman’s age; the cause of heavy bleeding; and whether or not she wants children. An increase in menstrual bleeding may occur in the months before the menopause, in which case time may produce a cure. Medical or surgical treatments are available. Non-steroidal anti-in?ammatory drugs may help, as may tranexamic acid, which prevents the breakdown of blood clots in the circulation (FIBRINOLYSIS): this drug can be helpful if an IUD is causing bleeding. Hormones such as dydrogesterone (by mouth) may cure the condition, as may an IUD that releases small quantities of a PROGESTOGEN into the lining of the womb.

Traditionally, surgical intervention was either dilatation and curettage of the womb lining (D & C) or removal of the whole uterus (HYSTERECTOMY). Most surgery is now done using minimally invasive techniques. These do not require the abdomen to be cut open, as an ENDOSCOPE is passed via the vagina into the uterus. Using DIATHERMY or a laser, the surgeon then removes the whole lining of the womb. DYSMENORRHOEA This varies from discomfort to serious pain, and sometimes includes vomiting and general malaise. Anaemia is sometimes a cause of painful menstruation as well as of stoppage of this function.

In?ammation of the uterus, ovaries or FALLOPIAN TUBES is a common cause of dysmenorrhoea which comes on for the ?rst time late in life, especially when the trouble follows the birth of a child. In this case the pain exists more or less at all times, but is aggravated at the periods. Treatment with analgesics and remedying the underlying cause is called for.

Many cases of dysmenorrhoea appear with the beginning of menstrual life, and accompany every period. It has been estimated that 5–10 per cent of girls in their late teens or early 20s are severely incapacitated by dysmenorrhoea for several hours each month. Various causes have been suggested for the pain, one being an excessive production of PROSTAGLANDINS. There may be a psychological factor in some sufferers and, whether this is the result of inadequate sex instruction, fear, family, school or work problems, it is important to o?er advice and support, which in itself may resolve the dysmenorrhoea. Symptomatic relief is of value.... menstruation

An endoscopic instrument for observing the lining of the OESOPHAGUS. (See ENDOSCOPE.)... oesophagoscope

An operation, usually done under local anaesthetic, in which the lining membrane of the UTERUS (womb) is excised using a type of LASER or DIATHERMY surgery that utilises a hysterescope (a variety of ENDOSCOPE) through which the operator can visualise the inside of the uterus. The operation is done to treat MENORRHAGIA (heavy blood loss during MENSTRUATION) and its introduction has reduced the need to perform HYSTERECTOMY for the condition.... transcervical resection of endometrium (tcre)

A ?exible or rigid endoscopic instrument (see ENDOSCOPE) that is inserted (via the URINARY BLADDER) into the URETER and up into the pelvis of the kidney (see KIDNEYS). The instrument is commonly used to identify a stone in the ureter and to remove it under vision with forceps or a stone basket. If the stone is large it is broken into fragments, using an ultrasound or electrohydraulic LITHOTRIPSY probe that is inserted through the instrument.... ureteroscope

The gall-bladder rests on the underside of the LIVER and joins the common hepatic duct via the cystic duct to form the common BILE DUCT. The gall-bladder acts as a reservoir and concentrator of BILE, alterations in the composition of which may result in the formation of gallstones, the most common disease of the gallbladder.

Gall-stones affect 22 per cent of women and 11 per cent of men. The incidence increases with age, but only about 30 per cent of those with gall-stones undergo treatment as the majority of cases are asymptomatic. There are three types of stone: cholesterol, pigment and mixed, depending upon their composition; stones are usually mixed and may contain calcium deposits. The cause of most cases is not clear but sometimes gall-stones will form around a ‘foreign body’ within the bile ducts or gall-bladder, such as suture material. BILIARY COLIC Muscle ?bres in the biliary system contract around a stone in the cystic duct or common bile duct in an attempt to expel it. This causes pain in the right upper quarter of the abdomen, with nausea and occasionally vomiting. JAUNDICE Gall-stones small enough to enter the common bile duct may block the ?ow of bile and cause jaundice. ACUTE CHOLECYSTITIS Blockage of the cystic duct may lead to this. The gall-bladder wall becomes in?amed, resulting in pain in the right upper quarter of the abdomen, fever, and an increase in the white-blood-cell count. There is characteristically tenderness over the tip of the right ninth rib on deep inhalation (Murphy’s sign). Infection of the gall-bladder may accompany the acute in?ammation and occasionally an EMPYEMA of the gall-bladder may result. CHRONIC CHOLECYSTITIS A more insidious form of gall-bladder in?ammation, producing non-speci?c symptoms of abdominal pain, nausea and ?atulence which may be worse after a fatty meal.

Diagnosis Stones are usually diagnosed on the basis of the patient’s reported symptoms, although asymptomatic gall-stones are often an incidental ?nding when investigating another complaint. Con?rmatory investigations include abdominal RADIOGRAPHY – although many gall-stones are not calci?ed and thus do not show up on these images; ULTRASOUND scanning; oral CHOLECYSTOGRAPHY – which entails a patient’s swallowing a substance opaque to X-rays which is concentrated in the gall-bladder; and endoscopic retrograde cholangiopancreatography (ERCP) – a technique in which an ENDOSCOPE is passed into the duodenum and a contrast medium injected into the biliary duct.

Treatment Biliary colic is treated with bed rest and injection of morphine-like analgesics. Once the pain has subsided, the patient may then be referred for further treatment as outlined below. Acute cholecystitis is treated by surgical removal of the gall-bladder. There are two techniques available for this procedure: ?rstly, conventional cholecystectomy, in which the abdomen is opened and the gall-bladder cut out; and, secondly, laparoscopic cholecystectomy, in which ?breoptic instruments called endoscopes (see FIBREOPTIC ENDOSCOPY) are introduced into the abdominal cavity via several small incisions (see MINIMALLY INVASIVE SURGERY (MIS)). Laparoscopic surgery has the advantage of reducing the patient’s recovery time. Gall-stones may be removed during ERCP; they can sometimes be dissolved using ultrasound waves (lithotripsy) or tablet therapy (dissolution chemotherapy). Pigment stones, calci?ed stones or stones larger than 15 mm in diameter are not suitable for this treatment, which is also less likely to succeed in the overweight patient. Drug treatment is prolonged but stones can disappear completely after two years. Stones may re-form on stopping therapy. The drugs used are derivatives of bile salts, particularly chenodeoxycholic acid; side-effects include diarrhoea and liver damage.... gall-bladder, diseases of

Laser stands for Light Ampli?cation by Stimulated Emission of Radiation. The light produced by a laser is of a single wavelength and all the waves are in phase with each other, allowing a very high level of energy to be projected as a parallel beam or focused on to a small spot.

Various gases, liquids and solids will emit light when they are suitably stimulated. A gassed laser is pumped by the ionising e?ect of a high-voltage current. This is the same process as that used in a ?uorescent tube. Each type of laser has a di?erent e?ect on biological tissues and this is related to the wavelength of the light produced. The wavelength determines the degree of energy absorption by di?erent tissues, and because of this, di?erent lasers are needed for di?erent tasks. The argon laser produces light in the visible green wavelength which is selectively absorbed by HAEMOGLOBIN. It heats and coagulates (see COAGULATION) tissues so can be used to seal bleeding blood vessels and to selectively destroy pigmented lesions. The carbon-dioxide laser is the standard laser for cutting tissue: the infra-red beam it produces is strongly absorbed by water and so vaporises cells. Thus, by moving a ?nely focused beam across the tissue, it is possible to make an incision.

The two main uses of laser in surgery are the endoscopic (see ENDOSCOPE) photocoagulation of bleeding vessels, and the incision of tissue. Lasers have important applications in OPHTHALMOLOGY in the treatment of such disorders as detachment of the retina and the diabetic complications of proliferative retinopathy and of the cornea (see EYE, DISORDERS OF). The destruction of abnormal cells – a sign of pre-malignancy – in the CERVIX UTERI is done using lasers. The beams may also be used to remove scar tissue from the FALLOPIAN TUBES resulting from infection, thus unblocking the tubes and improving the chances of CONCEPTION. Lasers also have several important applications in DERMATOLOGY. They are used in the treatment of pigmented lesions such as LENTIGO, in the obliteration of port-wine stains, in the removal of small, benign tumours such as verrucas, and ?nally in the removal of tattoos.

Low-intensity laser beams promote tissue healing and reduce in?ammation, pain and swelling. Their e?ect is achieved by stimulating blood and lymph ?ow and by cutting the production of PROSTAGLANDINS, which provoke in?ammation and pain. The beams are used to treat ligament sprains, muscle tears and in?amed joints and tendons.

The three great advantages of lasers are their potency, their speed of action, and the ability to focus on an extremely small area. For these reasons they are widely used, and have allowed great advances to be made in microsurgery, and particularly in FIBREOPTIC ENDOSCOPY.... laser

Absence or defects of the uterus

Rarely, the UTERUS may be completely absent as a result of abnormal development. In such patients secondary sexual development is normal but MENSTRUATION is absent (primary amennorhoea). The chromosomal make-up of the patient must be checked (see CHROMOSOMES; GENES): in a few cases the genotype is male (testicular feminisation syndrome). No treatment is available, although the woman should be counselled.

The uterus develops as two halves which fuse together. If the fusion is incomplete, a uterine SEPTUM results. Such patients with a double uterus (uterus didelphys) may have fertility problems which can be corrected by surgical removal of the uterine septum. Very rarely there may be two uteri with a double vagina.

The uterus of most women points forwards (anteversion) and bends forwards (ante?exion). However, about 25 per cent of women have a uterus which is pointed backwards (retroversion) and bent backwards (retro?exion). This is a normal variant and very rarely gives rise to any problems. If it does, the attitude of the uterus can be corrected by an operation called a ventrosuspension.

Endometritis The lining of the uterine cavity is called the ENDOMETRIUM. It is this layer that is partially shed cyclically in women of reproductive age giving rise to menstruation. Infection of the endometrium is called endometritis and usually occurs after a pregnancy or in association with the use of an intrauterine contraceptive device (IUCD – see CONTRACEPTION). The symptoms are usually of pain, bleeding and a fever. Treatment is with antibiotics. Unless the FALLOPIAN TUBES are involved and damaged, subsequent fertility is unaffected. Very rarely, the infection is caused by TUBERCULOSIS. Tuberculous endometritis may destroy the endometrium causing permanent amenorrhoea and sterility.

Menstrual disorders are common. Heavy periods (menorrhagia) are often caused by ?broids (see below) or adenomyosis (see below) or by anovulatory cycles. Anovulatory cycles result in the endometrium being subjected to unopposed oestrogen stimulation and occasionally undergoing hyperplasia. Treatment is with cyclical progestogens (see PROGESTOGEN) initially. If this form of treatment fails, endoscopic surgery to remove the endometrium may be successful. The endometrium may be removed using LASER (endometrial laser ablation) or electrocautery (transcervical resection of endometrium). Hysterectomy (see below) will cure the problem if endoscopic surgery fails. Adenomyosis is a condition in which endometrial tissue is found in the muscle layer (myometrium) of the uterus. It usually presents as heavy and painful periods, and occasionally pain during intercourse. Hysterectomy is usually required.

Oligomenorhoea (scanty or infrequent periods) may be caused by a variety of conditions including thyroid disease (see THYROID GLAND, DISEASES OF). It is most commonly associated with usage of the combined oral contraceptive pill. Once serious causes have been eliminated, the patient should be reassured. No treatment is necessary unless conception is desired, in which case the patient may require induction of ovulation.

Primary amenorrhoea means that the patient has never had a period. She should be investigated, although usually it is only due to an inexplicable delay in the onset of periods (delayed menarche) and not to any serious condition. Secondary amenorrhoea is the cessation of periods after menstruation has started. The most common cause is pregnancy. It may be also caused by endocrinological or hormonal problems, tuberculous endometritis, emotional problems and severe weight loss. The treatment of amenorrhoea depends on the cause.

Dysmenorrhoea, or painful periods, is the most common disorder; in most cases the cause is unknown, although the disorder may be due to excessive production of PROSTAGLANDINS.

Irregular menstruation (variations from the woman’s normal menstrual pattern or changes in the duration of bleeding or the amount) can be the result of a disturbance in the balance of OESTROGENS and PROGESTERONE hormone which between them regulate the cycle. For some time after the MENARCHE or before the MENOPAUSE, menstruation may be irregular. If irregularity occurs in a woman whose periods are normally regular, it may be due to unsuspected pregnancy, early miscarriage or to disorders in the uterus, OVARIES or pelvic cavity. The woman should seek medical advice.

Fibroids (leiomyomata) are benign tumours arising from the smooth muscle layer (myometrium) of the uterus. They are found in 80 per cent of women but only a small percentage give rise to any problems and may then require treatment. They may cause heavy periods and occasionally pain. Sometimes they present as a mass arising from the pelvis with pressure symptoms from the bladder or rectum. Although they can be shrunk medically using gonadorelin analogues, which raise the plasma concentrations of LUTEINISING HORMONE and FOLLICLE-STIMULATING HORMONE, this is not a long-term solution. In any case, ?broids only require treatment if they are large or enlarging, or if they cause symptoms. Treatment is either myomectomy (surgical removal) if fertility is to be retained, or a hysterectomy.

Uterine cancers tend to present after the age of 40 with abnormal bleeding (intermenstrual or postmenopausal bleeding). They are usually endometrial carcinomas. Eighty per cent present with early (Stage I) disease. Patients with operable cancers should be treated with total abdominal hysterectomy and bilateral excision of the ovaries and Fallopian tubes. Post-operative RADIOTHERAPY is usually given to those patients with adverse prognostic factors. Pre-operative radiotherapy is still given by some centres, although this practice is now regarded as outdated. PROGESTOGEN treatment may be extremely e?ective in cases of recurrence, but its value remains unproven when used as adjuvant treatment. In 2003 in England and Wales, more than 2,353 women died of uterine cancer.

Disorders of the cervix The cervix (neck of the womb) may produce an excessive discharge due to the presence of a cervical ectopy or ectropion. In both instances columnar epithelium – the layer of secreting cells – which usually lines the cervical canal is exposed on its surface. Asymptomatic patients do not require treatment. If treatment is required, cryocautery – local freezing of tissue – is usually e?ective.

Cervical smears are taken and examined in the laboratory to detect abnormal cells shed from the cervix. Its main purpose is to detect cervical intraepithelial neoplasia (CIN) – the presence of malignant cells in the surface tissue lining the cervix – since up to 40 per cent of women with this condition will develop cervical cancer if the CIN is left untreated. Women with abnormal smears should undergo colposcopy, a painless investigation using a low-powered microscope to inspect the cervix. If CIN is found, treatment consists of simply removing the area of abnormal skin, either using a diathermy loop or laser instrument.

Unfortunately, cervical cancer remains the most common of gynaecological cancers. The most common type is squamous cell carcinoma and around 4,000 new cases (all types) are diagnosed in England and Wales every year. As many as 50 per cent of the women affected may die from the disease within ?ve years. Cervical cancer is staged clinically in four bands according to how far it has extended, and treatment is determined by this staging. Stage I involves only the mucosal lining of the cervix and cone BIOPSY may be the best treatment in young women wanting children. In Stage IV the disease has spread beyond the cervix, uterus and pelvis to the URINARY BLADDER or RECTUM. For most women, radiotherapy or radical Wertheim’s hysterectomy – the latter being preferable for younger women – is the treatment of choice if the cancer is diagnosed early, both resulting in survival rates of ?ve years in 80 per cent of patients. Wertheim’s hysterectomy is a major operation in which the uterus, cervix, upper third of vagina and the tissue surrounding the cervix are removed together with the LYMPH NODES draining the area. The ovaries may be retained if desired. Patients with cervical cancer are treated by radiotherapy, either because they present too late for surgery or because the surgical skill to perform a radical hysterectomy is not available. These operations are best performed by gynaecological oncologists who are gynaecological surgeons specialising in the treatment of gynaecological tumours. The role of CHEMOTHERAPY in cervical and uterine cancer is still being evaluated.

Prolapse of the uterus is a disorder in which the organ drops from its normal situation down into the vagina. First-degree prolapse is a slight displacement of the uterus, second-degree a partial displacement and third-degree when the uterus can be seen outside the VULVA. It may be accompanied by a CYSTOCOELE (the bladder bulges into the front wall of the vagina), urethrocoele (the urethra bulges into the vagina) and rectocoele (the rectal wall bulges into the rear wall of the vagina). Prolapse most commonly occurs in middle-aged women who have had children, but the condition is much less common now than in the past when prenatal and obstetric care was poor, women had more pregnancies and their general health was poor. Treatment is with pelvic exercises, surgical repair of the vagina or hysterectomy. If the woman does not want or is not ?t for surgery, an internal support called a pessary can be ?tted – and changed periodically.

Vertical section of female reproductive tract (viewed from front) showing sites of common gynaecological disorders.

Hysterectomy Many serious conditions of the uterus have traditionally been treated by hysterectomy, or removal of the uterus. It remains a common surgical operation in the UK, but is being superseded in the treatment of some conditions, such as persistent MENORRHAGIA, with endometrial ablation – removal of the lining of the uterus using minimally invasive techniques, usually using an ENDOSCOPE and laser. Hysterectomy is done to treat ?broids, cancer of the uterus and cervix, menorrhagia, ENDOMETRIOSIS and sometimes for severely prolapsed uterus. Total hysterectomy is the usual type of operation: it involves the removal of the uterus and cervix and sometimes the ovaries. After hysterectomy a woman no longer menstruates and cannot become pregnant. If the ovaries have been removed as well and the woman had not reached the menopause, hormone replacement therapy (HRT – see MENOPAUSE) should be considered. Counselling helps the woman to recover from the operation which can be an emotionally challenging event for many.... uterus, diseases of

The abbreviation for endoscopic retrograde cholangiopancreatography, an X-ray procedure used for examining the biliary system and the pancreatic duct.

An endoscope is passed down the oesophagus, through the stomach, and into the duodenum.

A catheter is passed through the endoscope into the common bile duct and pancreatic duct.

A contrast medium is introduced through the catheter to make the pancreatic duct and ducts of the biliary system visible on X-rays.

In some cases, it may be possible to relieve a blockage due to a gallstone during the procedure.... ercp

This is diagnosed when a couple has not achieved a pregnancy after one year of regular unprotected sexual intercourse. Around 15–20 per cent of couples have diffculties in conceiving; in half of these cases the male partner is infertile, while the woman is infertile also in half; but in one-third of infertile couples both partners are affected. Couples should be investigated together as e?ciently and quickly as possible to decrease the distress which is invariably associated with the diagnosis of infertility. In about 10–15 per cent of women suffering from infertility, ovulation is disturbed. Mostly they will have either irregular periods or no periods at all (see MENSTRUATION).

Checking a hormone pro?le in the woman’s blood will help in the diagnosis of ovulatory disorders like polycystic ovaries, an early menopause, anorexia or other endocrine illnesses. Ovulation itself is best assessed by ultrasound scan at mid-cycle or by a blood hormone progesterone level in the second half of the cycle.

The FALLOPIAN TUBES may be damaged or blocked in 20–30 per cent of infertile women. This is usually caused by previous pelvic infection or ENDOMETRIOSIS, where menstrual blood is thought to ?ow backwards through the fallopian tubes into the pelvis and seed with cells from the lining of the uterus in the pelvis. This process often leads to scarring of the pelvic tissues; 5–10 per cent of infertility is associated with endometriosis.

To assess the Fallopian tubes adequately a procedure called LAPAROSCOPY is performed. An ENDOSCOPE is inserted through the umbilicus and at the same time a dye is pushed through the tubes to assess their patency. The procedure is performed under a general anaesthetic.

In a few cases the mucus around the cervix may be hostile to the partner’s sperm and therefore prevent fertilisation.

Defective production is responsible for up to a quarter of infertility. It may result from the failure of the testes (see TESTICLE) to descend in early life, from infections of the testes or previous surgery for testicular torsion. The semen is analysed to assess the numbers of sperm and their motility and to check for abnormal forms.

In a few cases the genetic make-up of one partner does not allow the couple ever to achieve a pregnancy naturally.

In about 25 per cent of couples no obvious cause can be found for their infertility.

Treatment Ovulation may be induced with drugs.

In some cases damaged Fallopian tubes may be repaired by tubal surgery. If the tubes are destroyed beyond repair a pregnancy may be achieved with in vitro fertilisation (IVF) – see under ASSISTED CONCEPTION.

Endometriosis may be treated either with drugs or laser therapy, and pregnancy rates after both forms of treatment are between 40–50 per cent, depending on the severity of the disease.

Few options exist for treating male-factor infertility. These are arti?cial insemination by husband or donor and more recently in vitro fertilisation. Drug treatment and surgical repair of VARICOCELE have disappointing results.

Following investigations, between 30 and 40 per cent of infertile couples will achieve a pregnancy usually within two years.

Some infertile men cannot repair any errors in the DNA in their sperm, and it has been found that the same DNA repair problem occurs in malignant cells of some patients with cancer. It is possible that these men’s infertility might be nature’s way of stopping the propagation of genetic defects. With the assisted reproduction technique called intracytoplasmic sperm injection, some men with defective sperm can fertilise an ovum. If a man with such DNA defects fathers a child via this technique, that child could be sterile and might be at increased risk of developing cancer. (See ARTIFICIAL INSEMINATION; ASSISTED CONCEPTION.)... infertility

More popularly called ‘keyhole surgery’, MIS is surgical intervention, whether diagnostic or curative, that causes patients the least possible physical trauma. It has revolutionised surgery, growing from a technique used by gynaecologists, urologists and innovative general surgeons to one regularly used in general surgery, GYNAECOLOGY, UROLOGY, thoracic surgery, orthopaedic surgery (see ORTHOPAEDICS) and OTORHINOLARYNGOLOGY.

MIS is commonly carried out by means of an operating laparoscope (a type of ENDOSCOPE) that is slipped through a small incision in the skin. MIS now accounts for around 50 per cent

of all operations carried out in the UK. A small attachment on the end of the laparoscope provides an image that can be magni?ed on a screen, leaving the surgeon’s hands free to operate while his assistant operates the laparoscope. Halogen bulbs, ?breoptic cables and rod lenses have all contributed to the technical advancement of laparoscopes. Operations done in this manner include extracorporeal shock-wave LITHOTRIPSY for stones in the gall-bladder, biliary ducts and urinary system; removal of the gall-bladder; appendicectomy; removal of the spleen and adrenal glands; and thoracic sympathectomy. MIS is also used to remove cartilage or loose pieces of bone in the knee-joint.

This method of surgery usually means that patients can be treated on a day or overnight basis, allowing them to resume normal activities more quickly than with conventional surgery. It is safer and lessens the trauma and shock for patients needing surgery. MIS is also more cost e?ective, allowing hospitals to treat more patients in a year. Surgeons undertake special training in the use of MIS, a highly skilled technique, before they are permitted to use the procedures on patients. The use of MIS for hernia repair, colon surgery and repairs of duodenal perforations is under evaluation and its advantages will be enhanced by the development of robotic surgical techniques.... minimally invasive surgery (mis)

The transmission of images through bundles of thin, flexible glass or plastic threads which propagate light by total internal reflection. This means that all the light from a powerful external source travels the length of the fibre without losing its intensity. Fibre-optics have led to the development of endoscopes, which enable structures deep within the body to be viewed directly.... fibre-optics

or polyp (plural: polypi). A general name applied to tumours which are attached by a stalk to the surface from which they spring. The term refers only to the shape of the growth and has nothing to do with its structure or nature. Most polypi are of a simple nature, although malignant polypi are also found. The usual structure of a polypus is that of a ?ne ?brous core covered with epithelium resembling that of the surrounding surface. The sites in which polypi are most usually found are the interior of the nose, the outer meatus of the ear, and the interior of the womb, bladder, or bowels (see POLYPOSIS).

Their removal is generally easy, as they are simply twisted o?, or cut o?, by some form of snare or ligature. (The tissue removed should be checked for malignant cells.) Those which are situated in the interior of the bladder or bowels, and whose presence is usually recognised because blood appears in the urine or stools, require a more serious operation – usually an endoscopic examination (see ENDOSCOPE).... polypus

Diseases of the URINARY BLADDER are diagnosed by the patient’s symptoms and signs, examination of the URINE, and using investigations such as X-RAYS and ULTRASOUND scans. The interior of the bladder can be examined using a cystoscope, which is a ?breoptic endoscope (see FIBREOPTIC ENDOSCOPY) that is passed into the bladder via the URETHRA.

Cystitis Most cases of cystitis are caused by bacteria which have spread from the bowel, especially Escherichia coli, and entered the bladder via the urethra. Females are more prone to cystitis than are males, owing to their shorter urethra which allows easier entry for bacteria. Chronic or recurrent cystitis may result in infection spreading up the ureter to the kidney (see KIDNEY, DISEASES OF).

Symptoms Typically there is frequency and urgency of MICTURITION, with stinging and burning on passing urine (dysuria), which is often smelly or bloodstained. In severe infection patients develop fever and rigors, or loin pain. Before starting treatment a urine sample should be obtained for laboratory testing, including identi?cation of the invading bacteria.

Treatment This includes an increased ?uid intake, ANALGESICS, doses of potassium citrate to make the urine alkaline to discourage bacterial growth, and an appropriate course of ANTIBIOTICS once a urine sample has been ana-lysed in the laboratory to con?rm the diagnosis and determine what antibiotics the causative organism is likely to respond to.

Stone or calculus The usual reason for the formation of a bladder stone is an obstruction to the bladder out?ow, which results in stagnant residual urine – ideal conditions for the crystallisation of the chemicals that form stones – or from long-term indwelling CATHETERS which weaken the natural mechanical protection against bacterial entry and, by bruising the lining tissues, encourage infection.

Symptoms The classic symptom is a stoppage in the ?ow of urine during urination, associated with severe pain and the passage of blood.

Treatment This involves surgical removal of the stone either endoscopically (litholapaxy); by passing a cystoscope into the bladder via the urethra and breaking the stone; or by LITHOTRIPSY in which the stone (or stones) is destroyed by applying ultrasonic shock waves. If the stone cannot be destroyed by these methods, the bladder is opened and the stone removed (cystolithotomy).

Cancer Cancer of the bladder accounts for 7 per cent of all cancers in men and 2·5 per cent in women. The incidence increases with age, with smoking and with exposure to the industrial chemicals, beta-napththylamine and benzidine. In 2003, 2,884 men and 1,507 women died of bladder cancer in England and Wales.

Symptoms The classical presenting symptom of a bladder cancer is the painless passing of blood in the urine – haematuria. All patients with haematuria must be investigated with an X-ray of their kidneys, an INTRAVENOUS PYELOGRAM (UROGRAM) and a cystoscopy.

Treatment Super?cial bladder tumours on the lining of the bladder can be treated by local removal via the cystoscope using DIATHERMY (cystodiathermy). Invasive cancers into the bladder muscle are usually treated with RADIOTHERAPY, systemic CHEMOTHERAPY or surgical removal of the bladder (cystectomy). Local chemotherapy may be useful in some patients with multiple small tumours.... urinary bladder, diseases of

 The main symptom is hoarseness or loss of voice from malfunction of the vocal cords by disease, stroke, stress, or nerve disorder. Pain on speaking. “Raw throat.”

Constitutional disturbance: fever, malaise.

Many causes, including: drugs, drinking spirits. Gross mis-use of voice (singing or talking) may produce nodules (warts) on the cords. The smoker has inflammatory changes. Nerve paralysis in the elderly. Carcinoma of the larynx. Voice changes during menstruation are associated with hormonal changes (Agnus Castus). Professional singers, members of choirs benefit from Irish Moss, Iceland Moss, Slippery Elm or Poke root.

Alternatives. Cayenne, Caraway seed, Balm of Gilead, Lungwort, Queen’s Delight, Thyme, Wild Indigo, Marsh Cudweed, Mullein, Marshmallow.

For most infections: Equal parts, Tinctures Goldenseal and Myrrh: 3-5 drops in water 3-4 times daily; use also as a spray or gargle.

Tea. Formula. Equal parts: Mullein, Marshmallow root, Liquorice. 2 teaspoons to each cup water brought to boil; vessel removed on boiling. Drink freely.

Practitioner. Combine equal parts: Senega, Ipecacuanha and Squills (all BP). 5-10 drops thrice daily in water. Also gargle.

Poke root. Reliable standby. Decoction, tablets/capsules. Tincture: dose, 5-10 drops thrice daily in water or honey.

Topical. Aromatherapy. Steam inhalations. Oils: Bergamot, Eucalyptus, Niaouli, Geranium, Lavender, Sandalwood. Any one.

Diet. Slippery Elm gruel. Salt-free. Avoid fried foods.

Supplements. Daily. Vitamin A (7500iu). Vitamin C (1 gram thrice daily).

To prevent voice damage. The voice should not be strained by talking too much, shouting or singing – especially with a cold. Try not to cough or keep clearing the throat but instead, swallow firmly. Do not whisper – it will strain the voice.

A common cause of laryngitis is growth of a nodule, cyst or polyp on the vocal cords. They are visible on use of an endoscope. There are two vocal cords which, in speech, come together and vibrate like a reed in a musical instrument. In formation of a nodule they cannot meet, air escapes and the voice becomes hoarse. Relaxation technique.

Where the condition lasts for more than 4 weeks an ENT specialist should be consulted. ... laryngitis, chronic

A diagnostic test in which a small piece of tissue is removed from the lining of the jejunum for microscopic examination.

It is especially useful in the diagnosis of Crohn’s disease, coeliac disease, lymphoma, and other causes of malabsorption.

The biopsy is taken using an endoscope passed down the throat into the small intestine, via the stomach.... jejunal biopsy

Fibroma, myoma, lipoma, polyp, etc. When any of these breakdown bleeding can cause anaemia and melaena. Rarely painful. May obstruct intestinal canal causing vomiting. Periodic vomiting of over one year suspect.

Symptoms (non-specific). Loss of appetite, anaemia, weight loss; pain in abdomen, especially stomach area. Vomit appears as coffee grounds. Occult blood (tarry stools).

Causes. Alcohol, smoking cigarettes, low intake of fruits and vegetables. Foods rich in salt and nitrites including bacon, pickles, ham and dried fish. (Cancer Researchers in Digestive Diseases and Sciences) Long term therapy with drugs that inhibit gastric acid secretion increase risk of stomach cancer.

Of possible value. Alternatives:– Tea. Mixture. Equal parts: Red Clover, Gotu Kola, Yarrow. Strong infusion (2 or more teaspoons to each cup boiling water; infuse 15 minutes. As many cups daily as tolerated.

Formula. Condurango 2; Bayberry 1; Liquorice 1; Goldenseal quarter. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 1-2 teaspoons. Thrice daily in water or honey.

Traditional. Rosebay Willowherb. Star of Bethlehem.

Chinese green tea. Anti-cancer effects have been found in the use of Chinese green tea extracts. Clinical trials on the therapeutic effects against early stomach cancer were promising. (Chinese Journal Preventative Medicines 1990. 24 (2) 80-2)

Chinese Herbalism. Combination. Oldenlandia diffusa 2 liang; Roots of Lu (Phragmites communis) 1 liang; Blackened Ginger 1 ch’ien; Pan-chih-lien (Scutellaria barbarta 5 ch’ein; Chih-tzu (gardenia jasminoides) 3 ch’ien. One concoction/dose daily. Follow with roots of Bulrush tea.

William H. Cook, MD. “Mullein greatly relieves pain, and may be used with Wild Yam and a little Water- Pepper (Polygonum Hydropiper).” The addition of Water-Pepper (or Cayenne) ensures diffusive stimulation and increased arterial force. Burns Lingard, MNIMH. Inoperable cancer of the stomach. Prescribed: Liquid Extract Violet leaves and Red Clover, each 4 drachms; Liquid Extract Cactus grand., 2 drops. Dose every 4 hours. Woman lived 30 years after treatment attaining age of 70.

Arthur Barker, FNIMH. Mullein sometimes helpful for pain.

Wm Boericke MD. American Cranesbill.

George Burford MD. Goldenseal.

Maria Treben. “After returning from a prison camp in 1947 I had stomach cancer. Three doctors told me it was incurable. From sheer necessity I turned to Nature’s herbs and gathered Nettle, Yarrow, Dandelion and Plantain; the juice of which I took hourly. Already after several hours I felt better. In particular I was able to keep down a little food. This was my salvation.” (Health Through God’s Pharmacy – 1981) Essiac: Old Ontario Cancer Remedy. Sheila Snow explored the controversy surrounding the famous cancer formula ‘Essiac’. This was developed by Rene Caisse, a Canadian nurse born in Bracebridge, Ontario, in 1888. Rene noticed that an elderly patient had cured herself of breast cancer with an Indian herbal tea. She asked for the recipe and later modified it. Rene’s aunt, after using the remedy for 2 years, fully recovered from an inoperable stomach cancer with liver involvement, and other terminal patients began to improve.

Rene’s request to be given the opportunity to treat cancer patients in a larger way was turned down by Ottawa’s Department of Health and Welfare. She eventually handed over the recipe to the Resperin Corporation in 1977, for the sum of one dollar, from whom cancer patients may obtain the mixture if their doctors submit a written request. However, records have not been kept up.

In 1988 Dr Gary Glum, a chiropractor in Los Angeles, published a book called ‘Calling of an Angel’: the true story of Rene Caisse. He gives the formula, which consists of 11b of powdered Rumex acetosella

(Sorrel), 1 and a half pounds cut Arctium lappa (Burdock), 4oz powdered Ulmus fulva (Slippery Elm bark), and 1oz Rheum palmatum (Turkey Rhubarb). The dosage Rene recommended was one ounce of Essiac with two ounces of hot water every other day at bedtime; on an empty stomach, 2-3 hours after supper. The treatment should be continued for 32 days, then taken every 3 days. (Canadian Journal of Herbalism, July 1991 Vol XII, No. III)

Diet. See: DIET – CANCER. Slippery Elm gruel.

Note: Anyone over 40 who has recurrent indigestion for more than three weeks should visit his family doctor. Persistent pain and indigestion after eating can be a sign of gastric cancer and no-one over 40 should ignore the symptoms. A patient should be referred to hospital for examination by endoscope which allows the physician to see into the stomach.

Study. Evidence to support the belief that the high incidence of gastric cancer in Japan is due to excessive intake of salt.

Note: A substance found in fish oil has been shown experimentally to prevent cancer of the stomach. Mackerel, herring and sardines are among the fish with the ingredient.

Treatment by or in liaison with hospital oncologist or general medical practitioner. ... cancer – stomach and intestines

A tear at the lower end of the oesophagus, causing vomiting of blood. The syndrome is commonly caused by retching and vomiting after drinking excessive amounts of alcohol. Less often, violent coughing, a severe asthma attack, or epileptic convulsions may be the cause.

An endoscope is passed down the oesophagus to confirm the diagnosis. The tear generally heals within 10 days and no special treatment is usually required. However, a blood transfusion may sometimes be necessary.... mallory–weiss syndrome

An examination of the upper digestive tract using an endoscope (see gastroscopy).... oesophagogastroduodenoscopy

Examination of the oesophagus and stomach using an endoscope (see gastroscopy).... oesophagogastroscopy

A greenish-brown alkaline liquid secreted by the liver. Bile carries away waste products formed in the liver and also helps to break down fats in the small intestine for digestion.

The waste products in bile include the pigments bilirubin and biliverdin, which give bile its greenish-brown colour; bile salts, which aid in the breakdown and absorption of fats; and cholesterol. Bile passes out of the liver through the bile ducts and is then concentrated and stored in the gallbladder. After a meal, bile is expelled and enters the duodenum (the first section of the small intestine) via the common bile duct. Most of the bile salts are later reabsorbed into the bloodstream to be recycled by the liver into bile. Bile pigments are excreted in the faeces. (See also biliary system; colestyramine.)

bile duct Any of the ducts by which bile is carried from the liver, first to the gallbladder and then to the duodenum (the first section of the small intestine). The bile duct system forms a network of tubular canals. Canaliculi (small canals) surround the liver cells and collect the bile. The canaliculi join together to form ducts of increasing size. The ducts emerge from the liver as the 2 hepatic ducts, which join within or just outside the liver to form the common hepatic duct. The cystic duct branches off to the gallbladder; from this point the common hepatic duct becomes the common bile duct and leads into the duodenum.

(See also biliary system.)

bile duct cancer See cholangiocarcinoma. bile duct obstruction A blockage or constriction of a bile duct (see biliary system). Bile duct obstruction results in accumulation of bile in the liver (cholestasis) and jaundice due to a buildup of bilirubin in the blood. Prolonged obstruction of the bile duct can lead to secondary biliary cirrhosis. The most common cause of obstruction is gallstones. Other causes include a tumour affecting the pancreas (see pancreas, cancer of), where the bile duct passes through it, or cancer that has spread from elsewhere in the body. Cholangiocarcinoma (cancer of the bile ducts) is a very rare cause of blockage. Bile duc.

obstruction is a rare side effect of certain drugs. It may also be caused by cholangitis (inflammation of the bile ducts), trauma (such as injury during surgery), and rarely by flukes or worms.

Bile duct obstruction causes “obstructive” jaundice, which is characterized by pale-coloured faeces, dark urine, and a yellow skin colour.

There may also be itching.

Other symptoms may include abdominal pain (with gallstones) or weight loss (with cancer).

Treatment depends on the cause, but surgery may be necessary.

Gallstones may be removed with an endoscope (see ERCP).... bile

A diagnostic test in which a small amount of tissue or cells are removed from the body for microscopic examination. It is an accurate method of diagnosing many illnesses, including cancer. Microscopic examination of tissue (histology) or of cells (cytology) usually gives a correct diagnosis.

There are several types of biopsy. In excisional biopsy, the whole abnormal area is removed for study. Incisional biopsy involves cutting away a small sample of skin or muscle for analysis. In a needle biopsy, a needle is inserted through the skin and into the organ or tumour to be investigated. Aspiration biopsy uses a needle and syringe to remove cells from a solid lump. Guided biopsy uses ultrasound scanning or CT scanning to locate the area of tissue to be biopsied and to follow the progress of the needle. In endoscopic biopsy, an endoscope is passed into the organ to be investigated and an attachment is used to take a sample from the lining of accessible hollow organs and structures, such as the lungs, stomach, colon, and bladder. In an open biopsy, a surgeon opens a body cavity to reveal a diseased organ or tumour and removes a sample of tissue. Prompt analysis, in some cases by frozen section, can enable the surgeon to decide whether to remove the entire diseased area immediately.... biopsy

Examination of the bronchi, which are the main airways of the lungs, by means of an endoscope known as a bronchoscope. There are 2 types of bronchoscope: rigid and flexible. The rigid type is a hollow viewing tube that is passed into the bronchi via the mouth and requires anaesthesia. The flexible fibre-optic endoscope (a narrower tube formed from light-transmitting fibres) can be inserted through either the mouth or nose. It can reach farther into the lungs and requires only a mild sedative and/or local anaesthesia.

Bronchoscopy is performed to inspect the bronchi for abnormalities, such as lung cancer and tuberculosis, to collect samples of mucus, to obtain cells, and for taking biopsy specimens from the airways or samples of lung tissue. Bronchoscopy is used in treatments such as removing inhaled foreign bodies, destroying abnormal growths, and sealing off damaged blood vessels. The last 2 are carried out by laser treatment, diathermy, or cryosurgery by means of bronchoscope attachments.... bronchoscopy

n. 1. a modified microscope used to study capillaries. 2. a narrow flexible endoscope used to examine the interior of blood vessels.... angioscope

n. inspection of the inside of the maxillary sinus (see paranasal sinuses) using an *endoscope (called an antroscope).... antroscopy

an endoscopic procedure used predominantly to control bleeding in the gastrointestinal tract. secondary to angiodysplasia and bleeding following polypectomy. Occasionally it is used in the debulking of tumours not amenable to surgery. An intermittent stream of argon gas is delivered through a catheter in the endoscope and ionized by a monopolar electrical current producing a controlled release of thermal energy. This causes coagulation in the adjacent tissues.... argon plasma coagulation

n. a flexible optical endoscope using digital video technology to visualize and sample the interior of the bile ducts.... cholangioscope

n. a procedure for relieving obstruction of the junction between the kidney pelvis and ureter. An incision is made, via an endoscope, through the obstructed junction, using electrocautery, laser, or an endoscopic scalpel. Following this, *balloon dilation is usually performed and a *stent inserted.... endopyelotomy

Examination of the stomach using a type of endoscope inserted through the mouth. Although the term specifies examination of the stomach, the oesophagus and duodenum are alsoinspected during the procedure, which is more correctly known as (see oesophagogastroduodenoscopy). Gastroscopy, in which the patient is usually sedated, is used to investigate symptoms such as bleeding from the upper gastrointestinal tract and disorders of the oesophagus, stomach, or duodenum.

Attachments to the instrument enable a biopsy to be taken and treatments such as laser treatment to be carried out.

A gastroscope may also be used to ease the passage of a gastric feeding tube through the skin (see gastrostomy).... gastroscopy

Widened veins in the walls of the lower oesophagus and, sometimes, the upper part of the stomach.

Varices develop as a consequence of portal hypertension.

Blood in the portal vein, passing from the intestines to the liver, meets resistance due to liver disease.

The increased blood pressure causes blood to be diverted into small veins in the walls of the oesophagus and stomach.

These veins may become distended and rupture, causing vomiting of blood and black faeces.

There are usually other symptoms of chronic liver disease.

To control acute bleeding, a balloon catheter may be passed into the oesophagus to press on the bleeding varices.

The varices may be treated with an intravenous injection of vasopressin and/or by injection, via an endoscope, of a sclerosant that seals off the affected veins.... oesophageal varices

a radiological technique used to assess the anatomy and function of the upper gastrointestinal tract. The patient swallows radiopaque contrast (barium sulphate), which coats the mucosal surfaces of the oesophagus, stomach, and duodenum. The descent of the barium is charted by a series of radiographs. Gas-forming agents (such as sodium bicarbonate) may be given to aid gastric distension and improve the quality of the images. This can be used to diagnose disorders of oesophageal motor function, tumours, peptic ulcers, hiatus *hernias, and *gastro-oesophageal reflux disease. Many indications for this examination have been replaced by the use of an endoscope.... barium swallow and meal

a powerful nerve toxin, produced by the bacterium Clostridium botulinum, that has proved effective, in minute dosage, for the treatment of various conditions of muscle dysfunction, such as dystonic conditions (see dystonia), including *torticollis and spasm of the orbicularis muscle in patients with *blepharospasm, and spastic paralysis associated with cerebral palsy and stroke. It is also used for the treatment of severe *hyperhidrosis and the prevention of chronic migraine headaches. The toxin may also be used to treat *achalasia, being injected through an endoscope into the gastro-oesophageal sphincter, and is used in the bladder to treat urinary incontinence due to *detrusor overactivity (as in multiple sclerosis) that is resistant to other treatments. Side-effects include prolonged local muscle paralysis. Under the trade names Botox and Dysport it is widely used for the cosmetic treatment of facial wrinkles.... botulinum toxin

(ESS) surgery of the *paranasal sinuses using endoscopes. Functional endoscopic sinus surgery (FESS) clears inflamed tissue from routes of sinus drainage and aeration to allow the other sinuses to return to normal.... endoscopic sinus surgery

n. a narrow flexible fibreoptic *endoscope used to view the inner lining of the Fallopian tubes (see falloposcopy).... falloposcope

n. an *endoscope that uses *fibre optics for the transmission of images from the interior of the body. Fibrescopes have a great advantage over the older endoscopes as they are flexible and can be introduced into relatively inaccessible cavities of the body.... fibrescope

n. a device that can be passed through an endoscope to apply controlled heat in order to coagulate a bleeding peptic ulcer.... heater-probe

n. the surgical removal of a lobe of an organ or gland, such as the lung, thyroid, or brain. Lobectomy of the lung may be performed for cancer or other disease of the lung; in some cases the operation can be done through an endoscope.... lobectomy

n. an instrument (*endoscope) used for examining the interior of the kidney, usually passed into the renal pelvis through a track from the skin surface after needle *nephrostomy and dilatation of the tract over a guidewire. The nephroscope allows the passage of instruments under direct vision to remove calculi (see percutaneous nephrolithotomy), or to disintegrate them using ultrasound probes or pneumatic energy via a lithoclast, or a combination of the two.... nephroscope

the fusion of endoscopy with ultrasonography. An ultrasound probe is incorporated into the endoscope in order to deliver highly detailed images from within the body. Endoscopic ultrasound is used predominantly by gastroenterologists, to assess internal structures or organs within the upper gastrointestinal tract, or by respiratory physicians in the assessment of bronchial disease. It may be used for diagnostic purposes, to accurately stage a confirmed diagnosis of cancer or to obtain tissue samples using fine-needle aspiration. Therapeutic indications include drainage of a pancreatic *pseudocyst, the common bile duct, or the pancreatic duct, and coeliac plexus neurolysis, a technique used to deliver pain relief in cases of intractable abdominal pain, usually resulting from chronic pancreatitis.... endoscopic ultrasound

n. an illuminated optical instrument (see endoscope) used to inspect the interior of the small intestine. The image is transmitted through digital video technology. The examination can be performed using the oral and/or anal approach. The double balloon (push and pull) type, about 280 cm long with a distal balloon combined with an *overtube with a proximal balloon, is introduced under direct vision. Double balloon inflation and deflation helps in progression of the endoscope through the small intestine and is the predominant type in current use. The sonde (or push) type, about 280 cm long, has a single inflatable balloon that helps pull the instrument through the length of the intestine using peristalsis. It is now rarely used in clinical practice. The enteroscope is useful in diagnosing the cause of obscure gastrointestinal haemorrhage of the small intestine or of *stricture(s). It may also be used to treat bleeding lesions, remove small intestinal polyps, and to obtain tissue samples in suspected cases of malabsorption, inflammation, or intestinal tumours. —enteroscopy n.... enteroscope

n. a procedure in which an artificial opening is made through the anterior abdominal wall into the stomach to allow direct access for feeding or gastric decompression. A gastrostomy is performed when swallowing is considered unsafe or impossible, due either to neurological disease (such as stroke, multiple sclerosis, or motor neuron disease) or to obstruction by a tumour. It is often used temporarily after operations on the oesophagus or head and neck area until healing has occurred. Formerly a gastrostomy was always performed surgically, but it can now be done using an *endoscope (percutaneous endoscopic gastrostomy, PEG) or by direct puncture under radiological guidance (radiologically inserted gastrostomy, RIG).... gastrostomy

n. a semirigid plastic tube (25–45 cm long) designed to fit over the shaft of an *endoscope in order to minimize the risk of trauma. It can be used with a *gastroscope, *cholangioscope, *enteroscope, or colonoscope (see colonoscopy). An overtube is placed over the shaft of an endoscope prior to its insertion; once the endoscope is in the desired place, the overtube is lubricated and slid into position over the shaft. It is commonly used in combination with a gastroscope for the removal of ingested foreign bodies (especially those with sharp or serrated edges that may cause significant trauma as they are being extracted).... overtube

n. an *endoscope for the examination of the pharynx.... pharyngoscope

n. a type of surgical instrument (an *endoscope) used in resection of the prostate or in the removal of bladder tumours. The resectoscope allows continuous irrigation of the operation site during the procedure by having a fluid inlet and outlet channel. Resection is performed by an electrically activated wire loop.... resectoscope

n. examination of the interior of the nose using a speculum or endoscope.... rhinoscopy

n. examination of the inside of the ducts of the salivary glands by means of a small fibreoptic endoscope. It is used in the diagnosis and treatment of *sialoliths (salivary gland stones).... sialendoscopy

an instrument that harnesses magnetic technology to give a virtual image of an endoscope during colonoscopy. It aids steering and minimalizes looping of the endoscope. An external antenna tracks the magnetic field generated by coils built inside the endoscope, enabling real-time 3D imaging of this instrument. Trade name: ScopeGuide.... 3-d magnetic imager

n. an *endoscope, consisting of a fine tube fitted with a light and lenses, for examination of the interior of the male urethra, including the prostate region. —urethroscopy n.... urethroscope

n. the operation of cutting a short *stricture in the urethra. It is performed under direct vision with a urethrotome. This instrument, a type of *endoscope, consists of a sheath down which is passed a fine knife, which is operated by the surgeon viewing the stricture down an illuminated telescope.... urethrotomy

n. X-ray imaging of the *vas deferens. A contrast medium is injected either into the exposed vas deferens at surgery, using a fine needle, or into the ejaculatory duct (which discharges semen from the vesicle into the vas deferens) by inserting a catheter via an endoscope. The technique is used in the investigation of *azoospermia, to look for blockages in the vas.... vasography

n. observation of the ventricles of the brain through a fibre-optic instrument. See endoscope; fibre optics.... ventriculoscopy

n. a small *endoscope connected to a digital camera for examining the outer ear and eardrum.... video-otoscope