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Esophageal varices injection treatment

Esophageal varices are swollen blood vessels that occur in the lower part of the esophagus and the upper part of the stomach and develop as an outgrowth of severe liver diseases. When scar tissue migrates and forms a clot to obstruct or completely stop blood flow within the liver, pressure in the portal vein rises, thus forcing blood to find alternate routes.

The small, thin blood vessels around the esophagus and lower part of the stomach are invaded with blood returning from the portal vein, and dilate to form esophageal varices. They are mainly dangerous as they can rupture and cause severe bleeding and even death.

Esophageal varices injection, also known as sclerotherapy, is a method used to stop active bleeding or prevent future bleeding. This procedure is performed under endoscopy and means essentially means injecting medicine into the swollen esophageal varices. The medicine used is a coagulant substance that forms blood clots, thus preventing or stopping bleeding.

There are a few measures to be taken before having this treatment applied. Therefore, the patient must not eat for 8 to 12 hours prior to the procedure, anti-inflammatory and blood thinning medicine should not be taken for up to one week before the esophageal varices injections. For diabetes patients, a discussion with the doctor concerning the treatment taken is mandatory. Another highly important aspect to be taken care of is the transportation arrangement after the procedure, as the patient should not be driving for hours after the esophageal varices injections.

Although the cases are rare, complications may appear, as esophageal varices injections are not completely without risk. The most common complications are painful swallowing, esophageal narrowing, infection, esophageal damage or even bleeding. The risk for these complications to occur is increased if the patient suffers from heart or lung diseases, bleeding disorders or active bleeding, if he is advanced in age or if he drinks alcohol.

During the procedure, the patient may feel discomfort in the throat, both from the injections as well as from the endoscope. After the treatment is finished, the patient may feel soar in the throat and may find it painful to swallow for a few days. In addition, esophageal varices injections may give the patient a bloating feeling and the need to belch.

There are a few instructions for the patient to follow after receiving esophageal varices injections. This may include a 24 hours driving interdiction, repose the rest of the day. The patient should resume the normal diet and medication, unless told otherwise by the doctor.

There is a risk for complications to occur after the esophageal varices injections, as well, and the patient should contact the doctor immediately at any sign of infection including fever, bleeding or bloody vomit, pain, nausea and vomiting, difficulty in swallowing, difficulty in breathing, cough or chest pain. These complications are life-threatening and should not be taken lightly, as they can worsen the patients general state very quickly and have tragic consequences.

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Bourn Hall Clinics Guide to Intracytoplasmic Sperm Injection ICSI

The first pregnancies from a technique called Intracytoplasmic Sperm Injection (ICSI) were announced in 1992 in a paper by Palermo et al, published in the Lancet. Since then, ICSI has become a mainstream treatment option for male factor infertility.

In essence, the ICSI procedure involves the injection of an immobilised sperm directly into the central part (cytoplasm) of a mature egg. ICSI is performed in addition to an in vitro fertilisation (IVF) procedure, in which several eggs are recruited and extracted from the ovaries. The eggs have the protective cumulus and corona cells removed so that their maturity can be assessed, typically 75-80% of all eggs collected will be suitable for injection.

The ICSI procedure is carried out under high magnification (x200-400) using a special inverted microscope and micromanipulators, which convert the hand movements made by the operator into precise and minute adjustments of the sterile microtools used on the approximate 120 micron diameter egg and the approximate 4 micron sperm.

A holding pipette stabilizes the egg by gentle suction, while from the opposite side a thin (7 micron diameter), hollow glass needle is used for the actual injection. A dish is prepared containing a drop of carefully prepared sperm, and further individual drops for each egg. A single sperm is immobilised by breaking its tail with the point of the needle. After moving into the egg drop the injection pipette is used to pierce the outer shell (zona pelucida) and inner membrane (oolemma) of the egg so that the tip of the pipette sits in the inner part of the oocyte (cytoplasm). The sperm is then gently released into the oocyte and the needle slowly withdrawn. After the procedure, the injected eggs are placed back into the incubator and checked the following day for signs of fertilisation.

Although ICSI is an invasive procedure, only 10-15 % of injected eggs do not survive, however 60 – 80% of injected eggs will be fertilised normally.

ICSI is now carried out in approximately 60% of all IVF procedures worldwide and has been shown to be effective for the treatment of male factor infertility, including low sperm count (oligospermia), poor sperm motility (asthenospermia), poor sperm morphology (teratozoospermia), the presence of anti-sperm antibodies and sperm retrieved directly from the testes using surgical techniques. ICSI may also be used for patients who have had a previous failed or low fertilisation using conventional IVF.

The pregnancy rates following ICSI are as good, if not better, than those achieved using conventional IVF.

TO WATCH AN ICSI PROCEDURE AT BOURN HALL CLINIC, LOG ONTO WWW.WALLACE-ICSI.COM

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