Ileal Bladder

The urinary system is composed of two kidneys, two ureters, the urinary bladder, and the urethra. The kidneys remove waste products from the blood and form urine. Urine then travels through the tube-like ureters and is stored in the bladder before it is eliminated from the body via the urethra.

The bladder is susceptible to developing cancer. The most common treatment for invasive bladder cancer is complete removal of the bladder, called total cystectomy.

Ileal conduit urinary diversion is a surgical procedure performed for urine elimination after cystectomy. This is done through an ileal bladder.

During this surgery, a portion of the bowel called the ileum is removed in order to form a conduit, or tube which will be the ileal bladder. The ileal bladder is then implanted into the urinary system, allowing for urine to be removed from the body into an ostomy bag.

There are several potential complications associated with this procedure that should be discussed with a doctor prior to surgery.

Hyperthermia Treatment

Typically, when treating cancerous tumors, a patient may receive radiation therapy or chemotherapy.  While these treatments can be beneficial in some cases, an innovative technology called Hyperthermia, may be used in conjunction with these therapies to increase their effectiveness.

Hyperthermia is used to damage and kill cancer cells.  It may also make cancer cells more sensitive to the effects of radiation and certain anticancer drugs, potentially reducing the number of radiation treatments needed. There are also minimal side-effects.

Prior to this procedure, a CT scan is performed to precisely locate the tumor area. During Hyperthermia treatment, the affected area is heated superficially by the use of an applicator.  The applicator is placed over the patient and may sometimes be filled with water to conform to the patient’s surface anatomy. Microwaves are used to heat the area. The body tissue is exposed to high temperatures (up to approximately 109ºF or 43ºC).

As the heat travels into the body, it dilates blood vessels around the tumor, causing oxygen-carrying red blood cells to spread into the tumor. When the patient is later exposed to radiation treatment, the radiation reacts with the high levels of oxygen in the tumor, killing the tumor cells. This procedure can take up to 1 hour and is performed twice a week for the duration of radiation treatment.

It is recommended to consult your doctor so they can determine the cancer therapy most appropriate for you.

Balance and Equilibrium

The human ear is divided into three compartments:  the external ear, middle ear, and inner ear. The inner ear contains the spiral shaped cochlea, where sound waves are transduced into neural signals, and the vestibular complex, which contains the receptors for our sense of equilibrium.

The central, egg-shaped cavity is the vestibule, which contains a pair of membranous sacs, the saccule and the utricle.  Inside the utricle and saccule are hair cells similar to those in the organ of Corti. The hair cells are clustered in the macula, where their processes are embedded in a gelatinous mass and lie under a thin layer of crystals, called otoconia.  When the head tilts, gravity moves the crystal mass and distorts the stereocilia of the hair cells. This is how the saccule and utricle provide information about position, with respect to gravity.

Behind the vestibule is the third portion of the bony labyrinth known as the semicircular canals. The canals project from the posterior region of the vestibule and are responsible for the detection of head motion in three spatial planes. The anterior duct sense forward and backward motion. The posterior duct detects moving up and down. The lateral duct senses moving left to right.

Each canal contains a membranous semicircular duct where angular momentum is sensed.  At the base of each duct is an expansion called the ampulla. Within the ampulla, long stereocilia of hair cells are embedded in the cupula, which sticks out into the endolymph.  When your head moves, the endolymph moves the cupula and stimulates the stereocilia.

Vertigo

The human ear is divided into three compartments:  the external ear, middle ear, and inner ear. The inner ear contains the spiral shaped cochlea, where sound waves are transduced into neural signals, and the vestibular complex, which contains the receptors for our sense of equilibrium.

The semicircular canals project from the posterior region of the vestibule and are responsible for the detection of head motion in three spatial planes. The anterior duct sense forward and backward motion. The posterior duct detects moving up and down. The lateral duct senses moving left to right.

Each canal contains a membranous semicircular duct where angular momentum is sensed.  At the base of each duct is an expansion called the ampulla.  Within the ampulla, long stereocilia of hair cells are embedded in the cupula, which sticks out into the endolymph. When your head moves, the endolymph moves the cupula and stimulates the stereocilia.

Vertigo is a feeling of dizziness or the sudden sensation of spinning when there is no real movement.

Benign paroxysmal positional vertigo, BPPV, is the most common cause of vertigo. BPPV develops when small calcium carbonate crystals, or otoconia, become loose and float within the posterior semicircular canal. These otoconia may slow or reverse the movement of the cupula sending the brain confusing messages about the body's position.

Vertigo can be associated with nausea, vomiting, and unsteadiness. During episodes of vertigo, it is recommended to remain still in a safe place until the sensation has passed. Vertigo can improve over time. Medications and physical therapy can help improve vertigo symptoms. It is important to always consult with your doctor before taking any therapy to treat this condition.

Hearing

Hearing occurs when sound waves are changed to neural signals inside the cochlea of the inner ear.

When the eardrum vibrates from sound waves, a chain of three tiny middle ear bones moves. The malleus, incus, and stapes (or hammer, anvil, and stirrup), together called the auditory ossicles. The arrangement of these bones forms a lever system that amplifies the energy of the sound waves before it reaches the cochlea.

The stapes fits into the membrane-covered oval window at the base of the cochlea. Within the bony cochlea is the cochlear duct. Alongside the cochlear duct are the vestibular duct and the tympanic duct. All three ducts are filled with fluid; endolymph in the cochlear duct and perilymph in both the vestibular duct and tympanic duct.

When the stapes pushes against the oval window, pressure waves in the perilymph travel up the spiral through the vestibular duct and back down in the tympanic duct.  Pressure is relieved when the wave reaches the round window.

When looking at a cross section of the cochlear duct, specialized hair cells are shown being struck by pressure waves in the perilymph. The endolymph-filled cochlear duct now appears as the central triangular section. The vestibular duct and tympanic ducts, both containing perilymph, are on either side of it.

Sitting on the basilar membrane of the cochlear duct are hair cells of the organ of Corti. Above the hair cells is the tectorial membrane. When the basilar membrane is moved by pressure waves in the perilymph, hair cells are pressed against the tectorial membrane, and their stereocilia are distorted. The distortion generates a signal that travels through the cochlear branch of the vestibulocochlear nerve to the brain, where the signal is ultimately interpreted as a sound.

HIPEC

Hyperthermic Intraperitoneal Chemotherapy, or HIPEC, is a treatment option for people who have complex and advanced abdominal cancers.

Before patients receive HIPEC treatment, doctors perform cytoreductive surgery to remove visible tumors within the abdomen. First, an incision is made into the abdominal wall. Doctors then look at the extent of disease and organs affected. This surgery is performed using various surgical techniques to remove as many tumors as possible.

After the tumors have been removed, the HIPEC procedure begins. First, temperature probes are placed in each side of the abdominal wall. Then, two inflow catheters are placed in the lower abdomen, and two outflow catheters are placed in the upper abdomen. The catheters are attached to tubes that connect to the perfusion machine, which controls the temperature and flow of the chemotherapy solution. The temperature probes allow the surgical team to monitor the temperature of the solution within the abdomen.

The abdomen is then briefly sutured closed for the procedure. Saline solution enters through the inflow catheters. The solution is warmed to the necessary temperature—41 to 42 degrees Celsius, about the temperature of a warm bath.

Next, chemotherapy is added to the solution in two doses over a 90-minute period. The pump of the machine transports the solution into the abdomen. The solution flows back to the machine, where it is warmed and re-sent into the abdomen. This cycle continues throughout the procedure. During this time, gentle shaking is applied to the abdomen to allow for better mixing of the solution, and to help ensure it reaches and bathes all surfaces of the abdominal organs and tissues.

At the end of the 90-minute treatment period, the chemotherapy solution is drained from the abdomen. The abdomen is rinsed out with more saline solution. It is then reopened, and the catheters and temperature probes are removed. Finally, the abdomen is stapled shut to complete the surgery. In total, the surgery and HIPEC procedure can take 6 to 12 hours to complete.

It is recommended to consult your doctor so they can determine the cancer treatment most appropriate for you.

Fetal Alcohol Syndrome

During pregnancy, the fetus receives all the nutrients it needs to grow and develop through the placenta. If a woman drinks alcohol (also known as ethanol) during pregnancy, the alcohol in her blood passes through the placenta to the fetus, posing a risk for Fetal Alcohol Syndrome, or FAS.

The mechanisms by which alcohol acts on and interferes with normal fetal development and whether there is an amount of alcohol consumption which does not place the fetus at risk of FAS are still largely unknown.

It is thought the developing fetal brain may be highly sensitive to alcohol. During normal neurotransmission, neurons release chemicals that bind to receptors on other neurons thereby propagating a signal. Ethanol may block certain receptors in the fetal brain which can damage neural tissue.

Another theory is that ethanol may constrict blood vessels in the umbilical cord impairing blood flow to the fetus, thereby decreasing the amount of nutrients essential to fetal growth. FAS can cause life-long mental and physical defects for the fetus.

Some characteristics of FAS may include:

- Low birth weight
- Facial abnormalities
- Small head size
- Organ dysfunction
- Behavioral problems
- Mental retardation
- Slow growth and poor coordination

There is no known safe amount of alcohol to drink during pregnancy. Pregnant women should either not drink any alcohol or should seek medical advice if they have questions.

Hyperthermia Treatment (Deep Tissue)

Deep tissue hyperthermia uses heat with radiation therapy or chemotherapy to treat pelvic or abdominal region tumors.

For example, when used on some cervical cancer patients who aren’t able to receive chemotherapy, deep tissue hyperthermia combined with radiation therapy may be a promising treatment option.

Prior to this procedure, a CT scan is performed to locate the tumor. During the deep tissue hyperthermia treatment, temperature probes are placed both externally and internally to accurately monitor temperatures during the treatment.

A water-filled applicator is then placed over the patient’s abdomen and focused electromagnetic energy (radio frequency energy) is directed at the tumor, exposing the tumor to a temperature of around 104°F or 40°C. The heating effect is monitored and can be turned down if it becomes too hot. It immediately stops when the equipment is turned off.

Deep tissue hyperthermia dilates blood vessels around the tumor, causing oxygen-carrying red blood cells to spread into the tumor.

When the patient is later exposed to radiation treatment, the radiation reacts with the high levels of oxygen in the tumor, potentially destroying the tumor cells. Or if the patient receives chemotherapy after deep tissue hyperthermia, it can increase the flow of blood to the tumor area, potentially bringing more chemotherapy to the tumor.

The deep tissue hyperthermia treatment can take up to two hours and is typically performed twice a week for the duration of the radiation or chemotherapy treatment.

It is recommended to consult your doctor so they can determine the cancer therapy most appropriate for you.

Fibromyalgia

The musculoskeletal system is responsible for movement of the body. It is made up of bones, muscles, joints, and the structures that hold them together called ligaments and tendons.

When pain persists in these structures and tissues, a condition known as fibromyalgia may develop.

Fibromyalgia is a chronic pain disorder that can present in many ways. The symptoms can be a dull aching or shooting pain and can be either mild or severe. Painful areas are known as tender points and may include the neck, shoulders, back, hips and knees.

Symptoms may vary depending on factors such as stress and physical activity. Fibromyalgia may contribute to sleep disturbances, fatigue and psychological distress.  Prior to beginning any therapy, it is important to consult your doctor to determine the treatment option that is best for you.

Da Vinci Surgical System

The da Vinci Surgical System offers a minimally-invasive option for patients undergoing a complex surgery. In traditional laparoscopic surgery, the surgeon operates while standing, using rigid hand-held instruments, and looking away to a 2D video monitor to view the target anatomy.

With da Vinci, the surgeon operates from a comfortable, seated position, with eyes and hands in line with the instruments, and a magnified 3D view of the target anatomy.

During prostate removal, the surgeon first makes a few small incisions to introduce tiny instruments and a high-definition camera inside the patient. As the surgeon sits at a specially-designed console, the patient’s anatomy appears on the viewer as a magnified, high-resolution 3D image, in brilliant color and with natural depth of field.

With eyes and hands in line with the instruments, the surgeon uses controls below the viewer to move the three interactive robotic instrument arms and camera. The system then translates, in real time, the surgeon’s hand, wrist and finger movements into precise movements of the instruments inside the patient.

To remove a cancerous prostate, the surgeon frees the prostate by making cuts at the bladder neck and urethra. The surgeon can work around the anatomy and delicate nerve bundles, some of which are responsible for sexual function. Once the prostate is detached, it is then removed. A catheter is inserted and used as a guide to reattach the bladder to the urethra.

Throughout the procedure, the surgeon controls every surgical movement. The system cannot be programmed or act in any way without the surgeon’s input.

The da Vinci System can be used to treat several other cancers. It is recommended to consult your doctor so they can determine the cancer treatment most appropriate for you.