| Dr.
Miguel B. Royo Salvador
Wamwrika-vijfana ki salyacikiwsa aur reedh ki haddee |
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<< Syringomyelia | |
<< Arnold Chiari I vikruti | |||||||||||||
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"Scoliosis, syringomyelia aur Arnold Chiari I vikruti ko roka jaa sakta hai." |
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ARNOLD CHIARI I MALFORMATION
Arnold chiari I malformation kya hota hai?
Arnold Chiari ya Chiari Vikruti (malformation) takreeban sao saal pehle bayaan kiya gaya tha. is paristhiti
mein dimaag ka nichla bhaag neeche ki aur hat ta hai- cerebellar tonsils aur cerebellum ka nichla bhaag foramen
occipitals mein se merudandneey nalli mein bahar nikalti hai. Vikrtuti do aur teen mein merudand nicheyy hat ta
hai kyun ki woh dusre merudand vikruti jaise myelomeningocele se nirdhaarit hota hai. Jab yeh shreni vibhajan kiya
gaya chiari I ka spashtkaran ke liye aur koi vikruti nahi dekhi gayi thi. Doosre karanon ka sanket kiya gaya tha jaise
ki cerebrospinal paani ke sanchaar mein samasya ya chhota posterior fossa (jahaan cerebeelum hota hai). Tees saal se
adhik se hamari saushodhan spasht karta hai ki Chiari ek vikruti mein merudand niche hat ta hai is ki wajah ek vikruti
hai jo pakdai nahi hai. Tthos Filum terminale wohi aasaar paida karta hai jo Chiari do aur teen vikruti ki hote hai- woh
merudand ko reedh ki haddi mein merudandi nalli mein khenchta hai. Manav bhroon (embryo) mein merudand (vertebral column)
aur uske andar merurajju ki lambai panch mahiney tak samaan hoti hai . Vyakti ki samanya vikaas ke saath saath reedh ki haddi
merurajju se bees centimeter zyaada lambi ho jaati hai. Merurajju aur reedh ki haddi ke beech mein ek asthibandh hota hai jo
unhe jodta hai aur use filum terminale kehte hain. Pachaas saal se maloom hai ki yeh asthibandh kuch logon mein merurejju mein
khinchaav paida karta hai usi terah jaise chiari II aur chiari III vikruti mein myelomeningocele karta hai.
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Filum terminale ka karya kya hai?
Chiari I ko samajhane se mareezon ko kya fayda hai? |
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Aakruti 2.- Khopdi aur dimaag ki Saral sagittal kataayi, baanyi taraf saadharan, daini taraf; cerebellum foramen occipitalismein se niche nikalta hua, jaisa ki Arnold chiari Vikruti mein nikalta hai.
Kya filum terminale ki katai vikrut reedh ki haddi ko phir se seedha kar sakti hai?
Agar manushya ki reedh ki haddi mein spring ki sughatyata aur lacheelapan hota ya rabad ka bana hota toh woh phir se apni prarambhik
seedhe mudra par pahunch jaati. Par reedh ki haddi teevra dabaav mein viksit hui hai aur haddiyon, jod, aur asthibadh ko saalon tak
moda hua hai.jab yah dabaav se chutkaara mil jaata hai, uska swaasth laabh uske sughatyata ki maatra par aadhaarit hai, jo mareez ke
umar, patraik (genes), dabaav ki prabalta aur samay par aadhaarit hai.
Asthibadh kaatne ka kya faydaa hai?
Filum terminale kaatne ka pehla parinaam yah hota hai ki who khench ruk jaati hai jis se bimari badhti hai. Is prakaar jab mool kaaran
ko daba diya jaata hai toh bimaari ki pragati ruk jaati hai. Chiari I ke aasaar ka kaaran hai dimaagi utak par dabaav jab woh nichey
hat te hue foramen occipitalis mein se bahar nikalta hai. Jab filum terminale ko kaata jaata hai haalaan ki MRI mein dimaag ke bahar
nikalte hue sthiti mein koi parak nahi dikhta hai phir bhi merurajju par dabaav khatam ho chukka hota hai aur foramen occipitalis ke
andar utpeedan kam hoti hai. Sankulta aur khoon ki kami mein sudhaar aa jaata hai aur is liye inke aasaar bhi sudhar jaate hain.
Filum Terminale ki shalyak (surgical) kataai kya hoti hai?
Filum Terminale ki shalyak kataai reedh ki haddi ke ant mein sacrum par chota cheera karne se ki jaati hai taaki reedh ki prakriya
mein koi antar nahi aaye, filum terminale ko microsurgery takneek se dekh kar kaata jaata hai. Yeh sab sirf aadhe ghante mein kiya
jaata hai aur mareez ko aspataal mein ek din se bhi kam rehna padta hai.
Iss Asthibandh (Ligament) ko kaatne ke pareenaam kya hote hai?
Filum Terminale merurajju ke nichle prushtth ya lumbosacral kshetra ke khali dhakkan ka parinaam hai. Manav bhroon
(embryo) mein merudand (vertebral column) aur uske andar merurajju ki lambai samaan hoti hai aur unke darmiyan Jhilliyan (membranes) hoti hain,
naamak dura mater, arachnoid mater and pia mater . Vyakti ki samanya vikaas ke saath saath reedh ki haddi merurajju se bees centimeter zyaada
lambi ho jaati hai. Jo parat merurajju ko reedh hi haddi ke nichle prushtth bhaag se alag karte hain unme ab merurajju nahi rehta aur woh ek
reshedaar rajju (cord) ki tarah mud jaati hai aur yeh filum terminale banta hai ; yah merurajju ka bhaag ek mozey ki bhaanti hota hai jise hamney
pehena hua ho, aur kheench kar aadhe pair par se utaar dein, woh bhaag jisme pair nahi hai use pair ko koi nuksaan pahunchaaey bina kaata jaa sakta hai.
Usi tarah filum terminale ko bhi bina kisi nuksaan ke kaata jaa sakta hai.
Kya merurajju judrane (tethering) ke kaaran peesit (suffer) hota hai?
Jaanvaron par saunshodhan aur jaanch se saabit hua hai ki reedh ki haddi ki halki tethering ke kaaran nakaafi khoon ke sanchaar
se gyan-tantu(neurons) ka karya bandh ho jaata hai. Insaanon mein teevra Tethering se reedh ke haddi ke andar khoon ka sanchaar
kam ho jaata hai kyun ki wahan reedh ki haddi ke liye mahatvapurna rudhir-vahini nalika (arteries) hoti hain aur yeh bahar se andar
jaati hain khaas kar ke Cervical bhaag mein kyun ki nichey ki taraf jaane par bandish hoti. Khoon sancharan ki kami se merurajju ke
kuch hisse mar ya sadd jaate hai aur phir woh reedh ki haddi mein se Interstitial paani khench kar merurajju ke beech guhika (cyst)
banata hai. Ise syringomyelic cavity, syrinx ya Syringomyelia kehte hai. Yeh bimari paanch sao saal pehle bayaan ki gayi thi lekin aaj
tak is ki wajah nahi malum hai.
Kya reedh ki haddi ki judrane (tethering) ka koi asar dimaag par hota hai?
Filum terminale par dabaav (strain) reedh ki haddee ko mud ne ke liye majboor karne ke alaava is dabaav se bachne ke liye,
dimaag ki nichle bhaag (jise cerebellar tonsils kehte hai) ko neechey ki aur, foramen occipitalis, jo khopdi ko reedh ki haddi
se jodta hai), ke andar kheecha jaata hai jis se Arnold Chiari vikrut rachna (malformation) hoti hai. Yeh bimaari sao saal par
bayan ki gayi thi aur iska kaaran aaj tak agyaat hai.
Arnold Chirai Vikruti (malformation) ke liye filum terminale ki shalyak kataai se neeche ki aur
jaata hua dabaav cerebellar tonsils ke liye gayab ho jaata hai. Woh unhe takleef nahin honey deta hai kyun ki ab woh apne
aap ko foramen occipitalis ke andar daman (oppress) nahi karte. Shalyak Chikitsa kaafi bimaari ke aasaaron ko sudhar ta hai
aur cerebellar tonsils ko upar ki taraf hilne nahi deta kyun ki woh vikrut hai aur unme lacheelapan kam hai.
Filum terminale ki tethering se cerebellum ka niche ki aur hatna aur merurajju ke kendra ki mrutyu ke alaava reedh ki haddi
par flexion paida karnewala uddeepan ko paida karta hai, jo merurajju par dabaav ko rok ne ka prayatna karta hai aur reedh ki
vikruti ( scoliosis) ka kaaran hai.
Filum terminale ki kataayi se flexion paida karne waala uddeepan ko dabaatahai aur Scoliosis ko rokta hai
Kya iska matalab hai ki syringomyelia ka bhi vahi shalyak chikitsa se ilaaj kiya jaa sakta hai,
jiska scoliosis aur Chiari I Vikruti ke ilaaj mein kiya jaata hai?
Scolosis ki tarah hi Syringomyelia mein filum terminal ki kataayi bimaari ko rok deta hai. Sadan se hui guhika(cyst) samaan hi rehti
hai lekin mumkin hai ki woh gaayab ho jaaye jab reedh ki haddi ki aazu baazu ki jagah swabhavik roop se khul jaaye ya beech ki aur khule
jahaan ependymal nalika hai jo reedh ki haddi ke Kendra ko dimagi guhika (cavity) ko jodta hai. Is bimaari ke aasaar tantu mrutyu aur guhika
(cyst) ke gaanth jaisey asar ke kaaran hotein hain. Filum ki kataayi ke do laabhprad asar hain : reedh ki haddi ki dabaav ki kaaran tantu ki
mrutyu kko rokta hai aur guhika(cyst) ke gaanth ki bhaanti asar ko kam karta hai kyun ki woh reedh ki haddi ko shithil (relax) kar deta hai.
HKya ye ilaaj mareezon par istemaal kiya gaya hai?
Ye teen beemarion (scoliosis, Arnold Chiari malformation, aur syringomyelia) key mareezon ka operation kiya gaya hai.
Kai mareez ko teeno beemaria thi aur kai mareezon mein aakasmik fayda hua
Kya aap udaharan de sakte hai?
Ek adtaalis saal ki aurat ko bohot bura scoliosis tha. Use chaudah baras ki umar se peeth mein dard hota tha. Woh jis bhi mudre (position) mein hoti
( palang mein leti hui ya utthte hue yaa aavarti (rolling) karte samay) uske peetth ka dard kabhi bhi nahi jaata. 34 saal tak uska dard ruka nahi.
Uska saat mahine pehle shaliya chikitsa (operation) kiya gaya tha aur tab se use koi dard nahi hua.(Ghatna chaudah).
Syringomeyelia ki ek ghatna: ek pachchees baras ke yuvak purush ko uske shareer ke baanyi aur taapmaan ka koi anubhav nahi tha aur usko reedh ki haddi
ke kendra mein ek badi guhika(cyst) thi (case 2 of publication 3). Shaliya chikitsa ke chhe ghante baad vishesh jaankaar ne bataya ki mareez ke sparsh
gyaan ka pura swathya laabh (recovery) hogaya, sudhaar aaj paanch saal baad tak chala. Yeh mareez ab Galicia mein ek maal godaam (warehouse) mein kaam kar
raha hai jab ki doosre vishesh jaankaron ney uske ghor ghaavon ko dekh kar purvanumaan lagaya tha ki woh syringomyelia ke nidaan (diagnose) ke do saal
baad poori tarah vikalaang (diable) ho jaaega. (ghatna 2)
Bibliography
1. Siringomielia, escoliosis y malformación de Arnold-Chiari
idiopáticas, etiología común (PDF).
2. Platibasia, impresión basilar, retroceso odontoideo y kinking
del tronco cerebral, etiología común con la siringomielia,
escoliosis y malformación de Arnold-Chiari idiopáticas (PDF).
3. Nuevo tratamiento quirúrgico para la siringomielia, la escoliosis,
la malformación de Arnold-Chiari, el kinking del tronco cerebral,
el retroceso odontoideo, la impresión basilar y la platibasia idiopáticas
(PDF).
4. "Results of the section of the filum terminale in 20 patients
with syringomyelia, scoliosis and Chiari malformation". Acta Neurochir
(Wien). 2005 Feb 24 (PDF).
5. "Aportación a la etiología de la siringomielia".
PhD thesis (PDF).