Common Head Ache struggles each of us occasionally without any specific reason. We used to take pain killers to get relief, which in turn damages our liver and other internal organs. Here I am discussing an easy way to get rid of “Common Head Ache” and this remedy is based on SUJOK Acupressure Therapy (A Fast Spreading Korean Treatment). Take a rubber band and tie it tightly on our right thumb (just above the bottom line of the nail). Keep it for 2 minutes. After two minutes remove the rubber band. Your Head Ache must have gone or reduced. If it has not been completely gone, repeat this procedure on the left thumb also….. Are you ready for a tryout next time?

CERVIX CANCER ---PRESENT SCENRIO DR Nitin Khunteta

There has been tremendous change in the demographic profile of India over time, as both vital rates-birth and death rates-have gradually declined. The life expectancy at birth has increased to 65 years. Noncommunicable diseases like cancer have become a major cause of morbidity and mortality in the midst of already existing communicable diseases. According to National Cancer Registry Program of India, cancers of the uterine cervix and of the breast are the leading malignancies seen in Indian women. In view of the well-defined natural history and long detectable preclinical phase, the cancer of uterine cervix gets priority in terms of control program through mass screening. An important reason for higher cervical cancer incidence in our country is lack of effective screening programs aimed at detecting precancerous conditions before they progress to invasive cancer.

Cervical cancer is the most common cancer in Indian women. According to WHO estimates, every year 132,082 women are diagnosed with cancer and 74,118 women die from this disease. Currently there are about 365.71 million aged over 15 years and each one of them is at the risk of developing this cancer. Globally it affects 500,000 women and a fifth of them reside in India. Statistics indicate Cervical Cancer kills eight women every waking hour in India.
Worldwide, it was the second-most common cancer after breast cancer.
"It is the commonest cancer in India and all sexually active women are at a risk of contracting this disease. But it's mostly seen in woman aged between 50 to 55 years. If detected at a pre-cancerous stage, this cancer is 100 per cent curable." says Dr Nitin Khunteta, a consultant in Bhagwan Mahaveer Cancer Hospital, Jaipur.
Main cause
HPV (Human papillomavirus infection) is the virus for this cancer. It is a sexually transmitted virus . Most people never even know they have HPV, or that they are passing it to their partner.

Risk factors:
Having sex at an early age , Having many sexual partners , Having many pregnancies , Using birth control pills for 5 or more years
Consuming any form of tobacco .

Symptoms
Pelvic pain or pain during intercourse, bleeding between periods, post-menstrual bleeding and discharge from the vagina .

Prevention Strategies--
1-Cervical cancer vaccine: Is the first vaccine ever designed to prevent cancer. It is recommended to girls aged 11 to 12 years as it allows a girl's immune system to be activated before she's likely to encounter HPV.
2-Delay sex
3-Limit number of sexual partners and to avoid having sex with someone who has had many other sexual partners.
4-Use condoms: Condoms when used correctly can lower the HPV infection rate by about 70%. They can't protect one completely because they don't cover every possible HPV-infected area of the body, such as the skin of the genital or the anal area.

Important Tests
Pap test: Cells are collected from the surface of the cervix and checked on a slide.
HPV test: Doctors take DNA cells by swabbing the cervix. "The HPV test is ideal for the detection of cervical cancer. It is slightly more accurate than the Pap test.
Colposcopy test: It enlarges the image of the cervix and the cells can be then seen clearly. This test is available at Bhagwan Mahaveer Cancer Hospital, Jaipur.

Treatment
The three main treatments available today are surgery, radiotherapy and chemotherapy.

Seeing the present scenario we all need to be aware about this disease, which is preventable to a large extent, can be cured if diagnosed in early stage.

Low-Level Laser Acupuncture

Traditional Chinese Medicine (TCM) theory states that Qi, or the vital energy, is the living force behind life, all the cosmic forces in nature, and is the root of all things. Most practitioners of Oriental medicine believe that the human being is created when the Qi of Heaven and the Qi of Earth come together. Many also believe that the Qi of Heaven continues to enter the formed human body through the pineal organ in the form of light. We are perhaps starting to recognize, understand, and investigate the profound role light plays in regulating and maintaining health in the human body. Its application to acupuncture is natural.

INTRODUCTION
Just as Traditional Chinese Medicine and acupuncture are very old systems of medicine being rediscovered, so is light therapy. Heliotherapy (light therapy) was practiced by physicians in ancient cultures in Egypt, Greece, China, and India to address many conditions.1 In the 1660s, Isaac Newton separated light with a prism and discovered the visible spectrum. In the 1890s, a Danish physician, Dr Niels Finsen, pioneered light therapy. He observed that tubercular skin lesions were much more common during the long dark winter months, but rare in the summer months. In 1893, he began treating this condition, lupus vulgaris, with light. Later, he would use red light to prevent scar formation from smallpox and eventually established a light institute for the treatment of tuberculosis. So successful was his work in treating skin tuberculosis with ultraviolet light that he was awarded the Nobel prize in 1903. This was the first recognized therapeutic application of an artificial light source.2

In the United States, Dr Dinsha Ghadiali, an American who emigrated from India in the 1800s, also did extensive work with photo therapy, but his alternative approaches to healing were met with resistance and most of his work was destroyed.3 Low-level lasers are still considered investigational in the United States. The US Food and Drug Administration (FDA) has approved some low-level lasers for limited applications. It has been shown that low-level lasers can be effective, but their optimal treatment parameters are not known.

BASIC SCIENCE
Works of the above-mentioned innovators and others provide us with sufficient empirical evidence of the value of light in medicine. The scientific evidence for this rests in quantum physics and the color theory, the photoelectric effect first discovered by Hertz, and the theory of light elucidated by Albert Einstein. According to the photoelectric effect, when light strikes any material substance, electrons are discharged, creating a current. Simply, light interacts with matter as the energy of the light is transferred to the electrons. In 1905, Einstein offered an explanation for this phenomenon with his Corpuscular Theory of Light, for which he was awarded a Nobel Prize.

Einstein proposed that light is composed of corpuscular units called photons. He further claimed that a photon is the smallest unit of light and has a dual nature, being both a particle and a wave at the same time. A photon travels at the speed of light and its energy is related to the frequency of radiation. The energy of the photon is transferred to the electrons when it collides with any material substance. The shorter the waves of light, the greater the energy is transferred to the electron (Figure 1). The intensity of the light determines how many photons strike given surface and how many electrons are, thus, affected. The higher the intensity, the greater the number of photons and therefore, the greater the amount of energy transferred to the electrons. Hence the physics of lasers were first imagined by Einstein.2,4

Color is frequency within the visible spectrum of light. It is composed of a small band of the total electromagnetic spectrum, from violet at 400 nm (higher-energy photon) through red at 700 nm (lower-energy photon) (Figure 2). Beyond violet, in increasingly shorter wavelengths, are ultraviolet light, x-rays, and gamma radiation which contain tremendous amounts of energy. Infrared and radio waves are longer wavelengths outside the red end and less energetics. Each color of the spectrum is composed of a band of frequencies. Therapeutic application of light to the body is accomplished by applying a single monochromatic wavelength within that band.2,4-7

In the 1960s, Theodore Maiman, a physicist, constructed the first laser at Hughes Aircraft Research Laboratories in Malibu, California. The early 1960s saw the development of numerous lasers and numerous new applications in industry and medicine. Many of these new medical applications were in surgery and involved powerful instruments with outputs in the tens-to-hundreds of watts. Surgeons noticed faster healing times and less scarring when doing procedures with lasers than when using the standard scalpel. This was later found to be the result of biostimulation.4

Russian researchers at the Institute for Clinical and Experimental Medicine have shown that light applied to the human skin penetrates the body between 2 and 30 mm, depending on the color frequency. The researchers also found that only certain areas of the body were able to transfer light beneath the surface, and these areas corresponded to acupuncture points. Furthermore, the light was conducted within the body along the acupuncture meridians. It appears that the meridians are a light transferral system within the body somewhat like optical fiber.8

Tina Karu, PhD, of the Laser Technology Center in Russia and affiliated with the University of California at Berkley, has researched the effects of light on the cell since the 1980s. She found there are photo receptors at the molecular level that, when triggered, activate a number of biological reactions such as DNA/RNA synthesis, increased cAMP levels, protein and collagen synthesis, and cellular proliferation. The result is rapid regeneration, normalization, and healing of damaged cellular tissue. Thus, light is a trigger for the rearrangement of cellular metabolism.1,2,4,5,9

In 1966, Endre Mester, a physician in Hungary, performed a series of experiments that showed the biostimulatory effect of visible red and infrared laser light at low intensity. He published his findings in an obscure Hungarian medical journal, which may explain why the benefits of low-level lasers were appreciated in the Eastern bloc long before they were recognized in the West. In the United States, Margaret Naesser, PhD, research professor and acupuncturist at Boston University School of Medicine, conducted research using low-level laser acupuncture with positive results for the treatment of paralysis in patients following stroke and in carpal tunnel syndrome.4

WHAT IS A LASER?
A laser (light amplification by stimulated emission of radiation) is an amplifier of light. It is a specialized environment that will support and sustain stimulated emission. There are 2 properties of laser light that separates it from incandescent light (such as that from a light
bulb).2,4,10

Monochromatic. A laser emits light at a specific wavelength, pure light, rather than over the wide spectral distribution of most light sources. It has a very narrow band width.

Coherent. Laser light is extremely well organized and synchronous (Figure 3). The photons emitted from a laser have been compared to a troop of soldiers marching in precise order.

Two of the most common misconceptions about lasers is that 1) all lasers are high powered, and 2) their beams are always parallel. Conversely, low-level lasers are most often designed with divergent beams as a safety precaution, and they operate at very low levels of power (0.05 to 0.5 W).2,4

Figure 1. Relationship of wavelength to energy


Figure 2. The electromagnetic spectrum




Principles of Use
Low-level laser acupuncture involves the application of photic energy to acupuncture points/tissues with the objective of augmentation of the normal healing process and/or pain relief. The usual wavelengths of lasers that are most commonly used in acupuncture are those that penetrate most deeply due to low absorption in the principal constituent in soft tissues, water.1 Except for the helium-neon laser, currently all therapeutic/low-level lasers use a diode.

Helium-Neon Laser (632.8 nm)
Helium-neon gas mixture. Visible red light. Relatively shallow depth of penetration. Very useful for laser acupuncture, superficial applications, and wound healing. Absorbed by mitochondrial cytochromes. Large, fragile, and expensive instrument (Figure 4).

Indium-Gallium-Aluminum-Phosphorus Laser (633-635 nm)
Now replacing helium-neon lasers. Visible red light, smaller and portable, inexpensive; higher power than the helium-neon, more durable. Same applications as helium-neon (Figure 4).

Gallium-Aluminum-Arsenide Laser (780-890 nm)
Deeper penetration. Near infrared, invisible light. Many applications, inexpensive, very useful for the treatment of pain, but also effective in healing. Most popular therapeutic laser. Valuable to reach very deep acupuncture points or deep Ah Shi points (Figure 4).

Gallium-Arsenide Laser (904 nm)
Greatest depth of penetration, deeper than gallium-aluminum-arsenide. This is due to a much longer wavelength and because they are pulsed, forcing the laser light deep into the tissues. Useful for reaching deep acupuncture points and for the treatment of pain. Continuous wave lasers are now also available (Figure 4).

Mechanism of Action
Energization of depleted enzymes. This may be denatured or depleted in areas of inflammation by hypoxia and acidosis. Examples are:

Sodium Potassium ATPase. Essential for nerve polarization in transmission of an action potential. Low-laser energies (<4 J/cm2 at a given site) tend to increase its concentration and are therefore recommended in cases where nerve regeneration or stimulation is desirable (e.g., Bell's palsy or facial paralysis).1 (The biostimulatory effects of low-level laser are governed by the Arndt-Schulz Law in which low energies stimulate and high energies suppress.1,2,4)

High-laser energies (>4 J/cm2), in contrast, tend to decrease its concentration, therefore being indicated for pain where the object is stabilization of sensitized pain fibers.1

Superoxide Dysmutase. This enzyme breaks down free radicals, which are a cause of pain in trigger areas in myofascial pain.

Transforming Growth Factor (b Fraction). Energization will help accelerate the repair and healing process.1

Vascular Effects. Evidence exists that laser energy is capable of initiating new vessel formation, which is an important factor in the healing process.1,5

Cellular Energization
Cells, after exposure to low-level laser, demonstrate accumulation of energy molecules in the form of ATP.1,5

Overall Effect
Low-level laser photic energy shortens the inflammatory phase, accelerating the repair process, and remodeling after tissue injury. In addition, increased plasma concentrations of certain types of prostaglandins, enkephalins, and endorphins have all been identified and most likely play a major role in the mechanisms associated with pain attenuation.1,5,11

Safety
Low-level lasers are very safe; however, there is a potential for damage to the eye. The laser beam, if directed through the lens of the eye, could damage the retina. Yet in more than 30 years of research and clinical practice, an event of this type has never been reported. Protective goggles that filter out the specific wavelength of the laser light should be worn by the patient and acupuncturist/physician during a therapy session.

To safely operate a laser, the practitioner must thoroughly understand the nature of the equipment.2,4,6,10 Certain technical parameters exist that one must first comprehend. These parameters are the power (for low-level lasers, this is expressed in milliwatts), wavelength, the characteristics of the laser beam (its optics; such as divergence, convergence, or parallel nature of the beam). All these influence the level of risk. Obviously, a high-power laser is riskier than a lower-power one. An infrared laser is riskier to use than a visible, red light laser with the same power and beam characteristics because the light is invisible and does not promote a blink response.2,4,6,10

INDICATIONS
The following is a partial list of conditions that have shown promising results with laser acupuncture. Laser acupuncture is painless and may be offered to patients with needlephobia and to children.1,2,4,10-18

Acute/chronic pain


TMJ dysfunction

Paresthesias


Cervical/lumbar spine syndromes

Neuralgias


Dermatoses

Allergic rhinitis/sinusitis


Asthma

Frozen shoulder


Phantom pain

Arthritis/arthrosis


Fibromyalgia

Bursitis, tendonitis


Nerve regeneration

Carpal tunnel syndrome


Wound healing

In addition, most lasers may be used in all instances for which moxibustion is indicated. There is no reducing or tonifying technique when performing laser acupuncture. Low-level lasers when used in pulsed mode have significant effects that may correspond with central bioresonances. The following frequencies are suggested from prior research studies.1,2,4,10,17,18

2 Hz


Nerve regeneration, neurite outgrowth

7 Hz


Bone growth

3-20 Hz


Pain

700-2500 Hz


Stimulatory effect

>2500 Hz


Inflammation, edema

>5000 Hz




Laser acupuncture may be combined with regular needle acupuncture at the same time with other forms of energy medicine (e.g., homeopathy, Chinese herbs, etc), and with medications such as anticonvulsants and antidepressants in chronic pain management, thereby reducing their dosage.

DISCUSSION
No doubt, the FDA will continue to approve the use of lasers for a variety of conditions (recently, a laser company in the United States received approval for the treatment of carpal tunnel syndrome). There are FDA guidelines that govern the use of low-level lasers as an investigational device, as well as state regulations. The FDA classifies low-level lasers as class IIIB non-significant risk devices.

CONCLUSION
Low-level lasers are used extensively in Europe and Asia for many applications, including acupuncture. Low-level lasers may be an effective modality in battling many situations. More research is needed to establish ideal treatment parameters for specific conditions.

Figure 3. Comparison of laser and other light sources


Figure 4. Relative depth of various lasers commonly used in acupuncture




REFERENCES

1. Bradley PF. Laser basics: principles of low intensity laser therapy (LILT). Presented at: Third Annual Conference of the North American Association for Laser Therapy.
2. Tuner J, Hode L. Laser Therapy: Clinical Practice and Scientific Background. Gransgesberg, Sweden: Prima Books; 2002.
3. Dinsha D. Let There Be Light. Malaga, NJ: Dinsha Health Society; 1996.
4. Blahnik JA, Rindge DW. Laser Therapy: A Clinical Manual. Melbourne, FL: Healing Light Seminars Inc; 2003.
5. Karu T. The Science of Low Power Laser Therapy. Amsterdan, the Netherlands: Gordon and Beach Science Publishers; 1998.
6. Oshiro T, Calderhead RG. Low Level Laser Therapy: A Practical Introduction. Chichester, England: John Wiley & Sons Ltd; 1988.
7. Mandel P. Practical Compendium of Colorpuncture. Bruchsal, Germany: Ditton Energetik; 1986.
8. Pankratov S. Meridians Conduct Light. Germany: Raum & Zeit; 1991.
9. axter DG. Therapeutic Lasers: Theory and Practice. New York, NY: Churchill Livingstone; 1994.
10. Naesser M. Laser Acupuncture: An Introductory Textbook for Treatment of Pain, Paralysis, Spasticity and Other Disorders (Clinical and Research Uses of Laser Acupuncture From Around the World). Boston, MA; Boston Chinese Medicine; 1994.
11. Moore K. Lasers and Pain Treatment. Cinixeperience: Laser Partner. Official paper of the Czech Society for the Use of Laser in Medicine. February 26, 2004.
12. Braverman B, et al. Effects of helium-neon and infrared laser irradiation on wound healing in rabbits. Lasers Surg Med. 1989;9:50.
13. Rochkind S, et al. Systemic effects of helium-neon laser irradiation on the peripheral and central nervous system, cutaneous wound and burns. Lasers Surg Med. 1982;26:12.
14. Ariaksinen O, et al. Effects of helium-neon laser irradiation on the trigger points of patients with chronic muscle tension in the neck. Scand J Acupuncture Electrother. 1989;3:63-65.
15. Ponnuradai RN, et al. Hypoalgesic effect of laser photobiostimulation shown by rat tail flick test. Int J Acupunct Electrother Res. 1987;12:93-100.
16. Mokhtar B, et al. A double blind placebo controlled investigation of the hypoalgesic effect of low intensity laser irradiation of the cervical roots using experimental ischemic pain. Presented at: ILTA Congress; London, England; 1992. Abstracts :61.
17. Mokhtar B et al. The possible significance of pulse repetition rate in laser mediated analgesia: a double blind placebo controlled investigation using experimental ischemic pain. Presented at: ILTA Congress; London, England; 1992. Abstracts :62.
18. Kucerova H, et al. Modulatory frequency of lasers in connection to laser beam therapeutic effect. Proc SPIE. 1998;3248L:191-195. Lasers in Dentistry IV.
Author: Jose T. Vargas is a Board-certified acupuncturist, specializing in laser acupuncture. He is a Senior Physician Assistant for the Department of Medicine at Montefiore Medical Center of the Albert Einstein College of Medicine in New York City, and a faculty member at New York College of Traditional Chinese Medicine in Mineola, NY.
Jose T. Vargas, MSc, LAc, PA-C*

Here is a case review which will show the effects of obese individual who snores and wakes up in the night with history of so called sleep apnea. This is the case diagnosed and treated by us in our hospital, in fact the PFT and all could not be done due to untoward reasons, this was purely a clinical diagnosis.
CASE:
A sixty year old male came to ICCU with complains of generalized swelling and mild breathlessness since he has got generalized swelling, the duration of these complaints lasts from last 15 days, and retention of urine since one day.
Complete History:
15 days back patient was apparently alright when he noticed swelling of both the lower limbs to start with, gradual in onset and progressive in nature, of pitting type, this gradually progressed to involve the genitalia i.e. scrotal edema seen with difficulty in voiding urine since last one day, and also involved his abdomen i.e. he noticed distension of abdomen which was insidious and progressive and has progressed to the present sate in these 15 days, associated with this generalized edema all over the body patient is experiencing mild grade of breathlessness i.e. of NYHA classification Grade II, this complains of breathlessness patient had never in the past before, there are no aggravating and relieving factors for his breathlessness.
Patient gives history of cough since last one year, productive in nature, aggravating in supine position, and disturbing patient’s night sleep, producing scanty amount of sputum. Patient is a non smoker, non alcoholic, non tobacco chewer. Patient is living sedentary life style has no work, and has never worked in any industry or factories.
Patient had similar complaints of abdominal distension and pedal edema a year back for which he was consulted in some private hospital where he was diagnosed to be having cardiac problem but the details were not revealed before patient and his relatives.
Patient is not a known case of asthma, COPD, diabetes mellitus, hypertension, and no history was elicited in favor of tuberculosis in the past neither any history suggestive of any interstitial lung disease was elicited. Patient is not on any drugs like bronchodilators, antihypertensives etc.
No history was elicited in favor of any thyroid involvement in the past, and no history was elicited suggestive of IHD or CAD.
Retrospectively when history was elicited it was reviled that, patient was very obese in the past from a long time, and used to snore at night routinely, and always used to wake up at night due to shortness of breath atleast 2 or 3 times per night, and after sometime used to sleep again, this made his nights uncomfortable and sleepless, disturbing his sleep. Due to this patient used to be very lethargic, fatigued, and all the time in day used to sleep i.e. was suffering from day time somnolence. ( This history takes us away towards the syndrome called OBSTRUCTIVE SLEEP APNEA SYNDROME). From last couple of months patient has reduced his weight.
EXAMINATION:
General examination.
A sixty year old well built conscious oriented male patient.
Pallor. Present
Icterus. Absent
Cyanosis. Both central and peripheral cyanosis present.
Clubbing. Absent
Lymphnodes. Absent
Edema. Generalized edema noted with abdominal distension,edema of genitalia, and bilateral pitting type of edema.
Vitals.
Pulse: 60 beats per minute, regular, moderate volume pulse with normal character
Blood pressure: 96/70 on presentation and later after starting treatment maintained at 110-120/70- 80.
JVP: raised.
Peripheral pulses all felt with normal character and volume.
Saturation: 84% on presentation without oxygen. On starting oxygen therapy maintained on 94-96% .
Systemic Examination:
Cardiovascular examination:
Pulse: 60 beats per minute,regular,normal character, moderate volume.
JVP: Raised.
Periphral pulses all were normal in character and regular. No abnormality detected.
Blood pressure: 96/70 on presentation, improved with treatment and maintained on 110-120/70-80.
Apex beat was noted to be shifted laterally outwards in 6th intercostal space, which was confirmed by palpation.
No pulsations were noted on precordium.
Apex beat of ill sustained nature without any thrill.
A systolic thrill felt in tricuspid area.
Palpable P2 was noted.
Chest wall appeared to be thick.
No obliteration of superficial cardiac dullness, was felt in 3rd intercostals space.
Auscultation revealed,
Soft S1 in mitral area with no regurgitant or stenotic murmur.
Pansystolic mumur in tricuspid area,harsh in nature, conducting to all over the precordium, even to the carotids.
No split of heart sounds and no gallops.
Loud P2 in pulmonary area, with conducted PSM of tricuspid regurgitation, and another mumur of severe intensity was heard i.e. an Ejection Systolic Murmur (ESM).
Conducted murmur of tricuspid regurgitation noted in aortic area with conduction even to the carotids. No signs suggestive of Aortic regurgitation and aortic stenosis were noted.

Respiratory System:
Bilateral air entry was equally noted in all lung fields bilaterally.
The only positive finding noted here was bilateral basal rales, with central and peripheral cyanosis.

Per Abdomen:
Abdomen is grossly distended, firm in consistency through out, with engorged veins over the abdomen, and slight tenderness in the right hypochondriac area.
Hepatomagaly present but could not be felt accurately due to tense abdomen.
Hernial orfices intact, edema noted over scrotum with difficulty in voiding urine.

Central Nervous System:
Clinically no neurodeficit noted.
INVESTIGATIONS:
Routine blood parameters were in normal range.
Serum creatinine and Blood urea in normal range.
Chest X- Ray showed Cardiomegaly s/o biventricular hypertrophy with more of right ventricular hypertrophy. No findings s/o COPD in CXR were noted.
ECG: RVH with First degree heart block.
DIAGNOSIS:
With history given by the patient it made us to think in line of involvement of heart as principal organ, it made us to go inline with right ventricular failure, considering the history and signs, but the exact cause was not revealed so that the diagnosis would be confirmed. But when the retrospective history was taken into account of obesity,snoaring,sleep apnea, it made us to think in the direction of so called the OBSTRUCTIVE SLEEP APNEA SYNDROME. With this we came to a specific diagnosis with a specific cause though rare but one of the major cause, and the case was diagnosed to be,
OBSTRUCTIVE SLEEP APNEA SYNDROME COMPLICATING TO RIGHT SIDED HEART FAILURE WITH CORPULMONALE WITH PULMONARY ARTERY HYPERTENSION, WITH TRICUSPID REGURGITATION, WITH COMPONENT OF LEFT VENTRICULAR FAILURE.
PICK WICKIAN SYNDROME....



“NEVER TAKE SNOARING AS A FUNNY PART PF LIFE,IT MAY TAKE OF THE LIFE IF IS NOT CONTROLLED …….SNOARING AND HEART THUS ARE RELATED TO EACH OTHER BUT ONLY IN ASPECTS OF DELETERIOUS EFFECTS.”

PICTURES OF THE 2DECHO AND COLOR DOPPLER OF THE SAME PATIENT SHOWING PULMONARY HYPERTENSION WITH RVH AND RA DILATATION WITH VERY MILD TR CAN BE SEEN IN MY PHOTO ALBUM AS I COULD NOT PUT THEM HERE.