Bypass Surgery:Reasons for The Procedure and Benefits
Tuesday, March 31, 2009
Doctor Sameer Diwale, Cardiovascular and Thoracic Surgeon, Wockhardt Heart Center at LB Nagar talks about the procedure for doing a Bypass Surgery and the benefits which accompanies this surgery
Cardiovascular and Thoracic Surgeon, The term “bypass surgery” was very prominent in the headlines across the media recently. This was due to the fact that our Minister Dr. Manmohan Singh underwent this procedure a couple of months ago .
Cardiovascular and Thoracic Surgeon, The term “bypass surgery” was very prominent in the headlines across the media recently. This was due to the fact that our Minister Dr. Manmohan Singh underwent this procedure a couple of months ago .
What does bypass surgery mean? When is it recommended for patients? What are the benefits of this operation? What are the different ways in which it can be performed? These are some common queries that came immediately to mind when one hears this term.
Bypass surgery means exactly what it says. Wherever there is an obstruction to the smooth flow of blood to the heart, heart surgeons can create a “bypass” road so as to restore the blood supply to the heart. This is exactly like building a flyover over a busy junction that is blocked due to heavy traffic. Surgeons are trained to remove (spare) arteries or veins from the patient’s own body and use them to construct bypass channels.
Bypass surgery generally is recommended for patients who have more than one block in their arteries that supply blood to the heart. Bypass is also recommended if there is a single block but it is at a critical location. In this situation, balloon angioplasty/stent placement is not possible or is considered risky. Bypass Surgery is strongly recommended for diabetic patients with one or more blocks in view of its superior long term results.
The greatest benefit of the bypass operation is that it eliminates the risk of having a sudden major heart attack in patients suffering from blocked circulation to their hearts . Therefore, this is a life-saving operation. The other major benefit is that a patient’s quality of life improves dramatically after the operation as he/she no longer suffers from chest pain. The patient is free to pursue an active lifestyle without the constant worry and anxiety associated with heart disease. Moreover, the beneficial effects of this operation lasts for 15 to 20 years if due care is taken.
Bypass surgery is conventionally carried out using a heart-lung machine and the heart is stopped for the duration of the operation. This is a very safe and standard technique and millions of patients have undergone the operation in this manner. The operation is also done on a beating heart which is a more recent technique and has certain advantages over the traditional method, especially in patients suffering from lung or kidney disease and patients who are at risk of having a stroke (paralytic attack).
Wockhardt Hospitals Heart Care is a Center of Excellence and offers both the above techniques of bypass surgery. Great care is taken to assess the profile of each patient so as to select the most appropriate technique. This approach has resulted in outstanding success rate for bypass surgery, that is at par with the best hospitals in the world. Our focus is to offer all our patients an active, long and healthy life.
Dr. Sameer Diwale, Cardiovascular and Thoracic Surgeon,
Wockhardt Heart Center, L.B.Nagar,
Hyderabad.
For scheduling an online appointment with any of our heart and cardiac care doctors. Pls write into enquiries@wockhardthospitals.net
Wockhardt Heart Center, L.B.Nagar,
Hyderabad.
For scheduling an online appointment with any of our heart and cardiac care doctors. Pls write into enquiries@wockhardthospitals.net
Brain Tumor: Symptoms and Treatement
Monday, March 30, 2009
By Dr. K N Krishna, Consultant Neuro Surgeon, Wockhardt Hospitals
What is a Brain Tumor
A brain tumor is a disease in which certain cells of the brain and it’s covering called the meninges grow without any control inside the brain.
Kind of Brain Tumors
There are two main types of brain tumors:
( a) Benign tumors are those tumors which generally grow slowly and do not destroy normal brain tissue. They do not generally regrow after radical surgical removal. They usually do not need radiotherapy.
( b) Malignant tumors are typically called brain cancers. These tumors can grow again after surgical removal. They are very aggressive tumors and difficult to treat them. They are basically of two types
(1)Primary brain cancer originates inside the brain.
(2) Secondary or metastatic brain cancer spreads to the brain from another cancer site in the body like lung cancer and breast cancer. This is again a very difficult tumor to treat and the tumor can regrow after treatment.
Causes of a Brain Tumor
The cause of primary brain cancer is unknown. As mentioned above, secondary brain cancers grow from a cancer elsewhere in the body.
Symptoms of Brain TumorThe Symptoms are mainly of two types
1.Due to addition of extra mass (tumor and fluid retention) inside the skull which increases the pressure. They may be headache, vomiting, blurring of vision/double vision, vertigo
2.Due to irritation or paralysis of the part of the brain or the nerves coming after the brain resulting in seizure, weakness of one limb or one half of the body, vertigo with imbalance, buzzing sound in the ear with diminished hearing (specially one sided), pain or numbness in one half of the face, difficulty in swallowing, nasal regurgitation, change in voice, repeated aspiration into the lungs.
Diagnosis of a Brain Tumor
The doctor may ask about symptoms and medical history and perform a physical exam, with particular attention to the neurologic exam such as muscle strength, co-ordination, reflexes, response to stimuli and alertness. The doctor will also look into your eyes to check for signs of brain swelling
Diagnostic Tests may include:MRI Scan a test that uses harmless (even to foetus and elderly) magnetic waves to scan the brain and nerves. CT Scan a type of x-ray that uses a computer to make pictures of structures inside the brain.
Treatment For Brain TumorThe main aim of treatment is not only to prevent further damage to the brain but also recover the functions of the brain by removal of the tumor itself and additionally by using the medication.
Medicines: The doctor prescribes medicines to reduce brain swelling (steroids), seizures (anti epileptic), etc. the latter might have to be taken for longer duration.
Craniotomy and Resection of tumor: Most of the tumor surgeries are done under general anesthesia so that the patient is relaxed and do not suffer from any pain.However in recent times certain brain tumors are removed under local anesthesia where in patient will be awake and talking but not feel the pain , this special procedure is done in such situation where the tumor is growing in close proximity to vital centers like the speech centers ,center for movement etc in the brain.
To access the brain tumor, a portion of the skull bone is delicately cut using high speed pneumatic bone dissector so that it can be replaced and fixed after the surgery. Neurosurgeons operate under high magnification and lighting by using special operating microscope and endoscopes which help in reaching various parts of the brain through narrow gaps safely without damaging the normal brain around the tumor.
In addition operative tools like operative imaging, neuronavigation, etc. help the surgeon in accurately localizing and precisely delineating the tumor from the normal structure and then remove it radically. Special equipments such as CUSA and lasers are sometimes necessary to breakdown deep routed or a difficult tumor.
Usually the patient is kept in the intensive care unit (ICU) on the night of surgery for monitoring his neurological functions closely. Next day morning he is started on oral feeds and shifted to the ward for nursing care He will be given some injections for a few days and subsequently, oral drugs started. Patient will be released from the hospital in 4-5 days and followed up in the clinic.
Stereotactic biopsy: Here, the neurosurgeon uses a MRI /CT scan images of the brain to delineate the tumor.
By using a special stereotaxy frame or Computor assisted Neuro Navigation system the tumor site is localized to an accuracy of 1mm. Thena small needle is pushed in to the tumor through the hole and a sample of tumor tissue is obtained. This tissue is sent for pathological tests to identify the tumor. This type of surgery is done for tumors located deep inside the brain or near critical areas. Depending on the pathological tests, further treatment is recommended.
How difficult is it to Treat Brain Tumor.With advances in brain tumor surgery management, most patients with benign tumors have normal lives. Brain cancer patients have a shorter period of survival and longevity, depending on the type and location of the tumor. With early diagnosis and microsurgical medical tumor removal followed by chemotherapy and radiotherapy, patients even with tumors have led almost a normal life for few years. Therefore, do not overlook a headache or any other symptom of brain tumor.
M.Ch (Neuro Surgery).
Chief Consultant Neuro Surgeon
Wockhardt Hospitals,Bangalore
To schedule an appoinment with Dr K.N.Krishna,write into enquiries@wockhardthospitals.net or log on here
Newer development in the treatment of urinary bladder cancer
Creation of Neo-urinary bladder: Newer development in the treatment of urinary bladder cancer:Bladder cancer is one of the common cancer affecting our population. Surgical removal of the urinary bladder along with the cancer is offered as a preferred treatment option to those patients who are affected by more aggressive cancers. The urinary bladder serves as a reservoir for storage of urine, which is periodically emptied via the urethra ( the natural urine passage). Therefore after surgical removal of the bladder the surgical team has to reconstruct a passage for conveying the urine from the kidneys to outside the body.
In the neo bladder reconstruction the bladder is reconstructed using the intestine of the patient. The small intestine is reconfigured to make a spherical reservoir. This serves as a storage reservoir for the patient. The ureters, which convey urine from the kidneys to the urinary bladder, are then surgically attached to drain into the neo-urinary bladder. This reservoir is then attached to the urethra. This allows the patient to hold urine without the help of any external collecting device. When the patient desires to void, he is able to pass urine via the natural urine passage.
Before the advent of this procedure urinary reconstruction after radical cystectomy would require the patient to wear an external bag to collect the urine. The neo-urinary bladder procedure allows the patient to avoid the usage of any external device thereby not altering the body image or the life style of the patient.
Long term follow-up studies have shown that this procedure does not affect the cancer cure rate and the after mild adjustment in the life style the patient can continue with normal daily activity which he was used to.
This procedure is an advanced reconstructive procedure, which requires a highly skilled and coordinated team approach. Therefore such a major reconstructive procedure can be performed only at selected uro-oncological centers. With recent acquisition of technological advances this advanced procedures are being delivered in eastern India at Wockhardt Hospital & Kidney Institute, Kolkata. Wockhardt Hospital and Kidney Institute is the only dedicated centre for Urology & Nephrology in the eastern part of India.
For an Online appointment with our Kidney Specialtist in Kolkata please log on here
This article was written by
Dr Avishek Mukherjee
Consultant – Urologist
Wockhardt Hospital & Kidney Institute
24 Hour Helpline : 98310 96761
e-mail : helpkolkata@wockhardthospitals.com
Successful Motherhood After a Kidney Transplant
Successful pregnancy in kidney transplant recipients is not uncommon and worldwide about 12000 such cases have been reported. A reasonably good graft function is a prerequisite. Immunosuppressive medications must be continued throughout the pregnancy period, however safety of some of these agents is not well documented. We report successful pregnancy in one of our patients who had undergone kidney transplantation in Wockhardt Hospital & Kidney Institute four years back. To our knowledge this is the first such instance in Eastern India.
A patient of 26 years old, presented to us in July 2002 with hypertension, swelling and pallor. Investigations revealed elevated Creatinine (2.5mg %), albuminuria, microscopic hematuria. Ultrasound showed echogenic small kidneys. ANA, ANCA were negative. She was diagnosed to have Chronic Kidney Disease presumably due to glomerulonephritis. Renal biopsy was not done for confirmation as the kidneys were small and it was considered unlikely to be of any major therapeutic benefit. She was treated with antihypertensive, phosphate binders and Erythropoeitin and the family was counseled regarding the prognosis and eventual need of renal replacement therapy.
Conservative management yielded good results initially with improvement of Hb levels and stabilization of renal function. Towards the end of 2003 she again started to feel weak and serum creatinine started rising rapidly reaching values of 6.5mg% by November. The family was again counseled regarding the need for transplantation and her mother (56years) was willing to donate. She underwent preemptive renal transplantation in February 2004.
The graft kidney functioned very well in the initial period. She was on standard triple immunosuppression with Cyclosporine, Azathioprine and steroids. Serum Creatinine stabilized around 1.6mg%. Although slightly high this was attributed to the relatively older kidney of her mother. By the end of 2005 serum creatinine started creeping reaching levels of 1.9mg% and there was mild proteinuria. Cyclosporine toxicity/ Chronic Allograft Nephropathy was considered; Cyclosporine dose was reduced and Sirolimus started with improvement of graft function. She was also put on a small dose of Losartan.
In 2006 she was married with the groom fully counseled of her condition and uncertainties regarding pregnancy. They were advised barrier contraception for the time being and it was explained that pregnancy is possible in future after a change in immunosuppression. Losartan is potentially teratogenic and Sirolimus is a relatively new drug with no safety data. In fact it is not recommended in pregnancy.
She presented to us in early August 2007 with a confirmed pregnancy of 6 -7 weeks. Though this was unplanned and attributed to failure of contraception the family was extremely keen to continue as it was felt to be their best chance. Her serum Creatinine was 1.7mg%. Losartan was stopped immediately and Amlodipine was started. Although Sirolimus is not a preferred drug in pregnancy a switchover to other agents would bring in other uncertainties regarding graft function and rejection, and since drug levels were low for some time it was decided to carry on with the same regimen. It was explained that she might have to terminate the pregnancy at the slightest hint of a problem.
Fortunately the entire course of pregnancy was smooth. The normal GFR increase during pregnancy could be seen as the Serum Creatinine dropped to 1.4mg%. Serial USG studies showed normal foetal growth. On 2nd March 2008 a baby girl weighing 2.8 Kg was delivered by Caesarean section. The post operative period was uneventful and she was discharged on the third day.
This case is indeed unique in many ways. She had a preemptive (without long period on dialysis) transplantation from a closest relation (mother) which is the best possible approach. The fact that she was married after transplantation is very encouraging and the role of the society is commendable. Overall the successful pregnancy outcome indicates great progress in the science of renal transplantation and offers new hope to similar couples.
Dr Arup Ratan Dutta
Senior General & Laparoscopic Surgeon
Consultant Nephrologists
Wockhardt Hospital & Kidney Institute
111A, Rashbehari Avenue
Kolkata – 700 029
Ph: +91 33 24633320/19/18/17
Wockhardt Hospitals Kolkata Launches Booklet on "Kidney Treatements"
Wockhardt Hospitals,Kolkata recently released a booklet to generate awareness about kidney ailments, their prevention and getting the correct treatment for Nephrological diseases.
Releasing the booklet How Well Do You Know Your Kidneys? at the Press Club, well known Bengali actress and television personality Sreelekha Mitra said: "I only know drinking a lot of water helps keep our kidneys in good know Shape,I hope this booklet gives me more details. This can be a good guide for those who believe prevention is better than cure."
Each year an additional 1.50 lakh new patients of end-stage chronic kidney disease requiring dialysis or kidney transplant are added to the list of Kidney patients. in India.Out of this only 5 -7 per cent of the patients are able to get some form of treatment, while the rest die without getting any treatement to a study conducted by All-India Institute of Medical Sciences.In India one in ten people has some form of chronic kidney disease. Diabetes and hypertension are responsible for more than 60 per cent cases of chronic kidney diseas
Each year an additional 1.50 lakh new patients of end-stage chronic kidney disease requiring dialysis or kidney transplant are added to the list of Kidney patients. in India.Out of this only 5 -7 per cent of the patients are able to get some form of treatment, while the rest die without getting any treatement to a study conducted by All-India Institute of Medical Sciences.In India one in ten people has some form of chronic kidney disease. Diabetes and hypertension are responsible for more than 60 per cent cases of chronic kidney diseas
Wockhardt Hospitals,Kolkata will initially print 4,00,000 booklets and distribute them free to patients. It will gradually print the booklet in Bengali and Hindi as well. "Those interested in acquiring a free booklet can contact our hospitals," said Shivaji Basu, Wockhardt's chief urologist.
The eight-page booklet outlines the functions of kidneys in detail, besides listing symptoms of kidney ailments and ways to treat them.
Wockhardt Hospitals Featured in CNN Health
Saturday, March 28, 2009
Wockhardt Hospitals have recently been featured in CNN Health on a story on Medical Tourism Titled Medical Tourism:Have Illness ..Will Travel.
Mark Tutton of CNN Health talks about the growing trend of Medical Tourism and identifies Wockhardt Hospitals along with Apollo and Max Healthcare which have revolutionized Healthcare Treatements in India.
India has been only ranked second after Thailand as the most favored medical tourism destination.Wockhardt Hospitals International Accreditation's like JCI and Tie up with Harvard Medical Association has made it the most sought after SpecialtyHospitals among Internations patients across the world.
Medical tourism: Have illness, will travel - CNN.com: "Medical tourism is one of the hottest topics in health care as patients around the world are increasingly traveling abroad for treatment.
Josef Woodman, author of Patients Beyond Borders, a guide to medical tourism, told CNN that two to three million people travel outside their home country for treatment each year, while consultancy firm Deloitte calculates that 750,000 Americans traveled abroad for treatment last year.
For uninsured or underinsured Americans, low prices make treatment in Asia an attractive option.Surgery in Thailand and Latin America can cost a quarter of its U.S. price, and JCI-accredited Wockhardt Hospitals offer open heart surgery in India for $8,500, compared to around $100,000 in the U.S. and $28,000 in the UK.
In countries with state-run health services, such as Britain and Canada, long waiting times for surgery are encouraging patients to look overseas for a cheaper alternative to private treatment in their own country.
In countries with state-run health services, such as Britain and Canada, long waiting times for surgery are encouraging patients to look overseas for a cheaper alternative to private treatment in their own country.
Bumrungrad International Limited (BIL), based in Thailand, owns and operates over 70 health care facilities in seven countries. According to BIL, its Bangkok flagship hospital treats over 400,000 foreign patients a year, with over 90,000 coming from the Middle East.
Continue Reading More
Indian is No 2 In Medical Tourism Hotspot
India is only second after Thailand in terms of the most favored medical tourism destination in the world.For a country that spends 1.2% of GDP on healthcare needs and has approximately 143 doctors for every 10,000 people as compared to USA's 234 doctors per 10,000 people that is by all means quite an achievement.
However the difference between India and Thailand is almost three fold. While India was home to 450,000 medical travelers across the globe ,Thailand treated 12 lakh patients globally.
This is according to a study by Deloitte Consulting,which also talks about the emerging trends of India getting more medical visitors from US and UK. Earlier most medical travelers included patients from Middle east,West Asia, and the Asian Subcontinent
Cheaper treatment is a huge attraction and, during recession, that's a big fact and often more cost effective for Westerners. But other factors, too, have contributed to the growth of medical tourism in India. "Indian clinical and paramedical talent is globally appreciated and with JCI accreditation of some hospitals, international standard is proven. Third-party intervention through health insurance has also given it a boost," said Vishal Bali, CEO, Wockhardt Group of Hospitals.
"Thailand, which revolutionized medical tourism, is more into cosmetic surgery; India focuses on cardiac, neurological or orthopaedic problems," Bali said.
Another significant factor is long patient waiting list, especially in the UK and Europe. The per-capita healthcare expenditure in Korea is $720 against India's $94. Treatment cost is lowest in India — 20% of the average cost incurred in US; in Singapore,Thailand and South Africa, it's 30% of the US cost.
source:Indiatimes
Wockhardt Heart Centre,Hyderabad : New Hub for Uzbekistan Patients
Wockhardt Heart center, LB Nagar, Hyderabad has in recent days seen a string of patients coming in from Uzbekistan
Recently Mr. Radjabov Toshmurot a 55-year-old man diagnosed with Triple vessel Disease and is also a Diabetic and Hypertensive along with a history of Renal Failure, got operated at Wockhardt Heart Centre,Hyderabad. He was diagnosed with a Triple vessel disease back in Uzbekistan, and was advised to undergo a Bypass Surgery.
Normally a patient from Uzbekistan would choose Russia as his Health Care destination and in recent times some people have even recognized India as a quality provider for Healthcare services, but mostly it’s been limited to Delhi, because of direct connectivity that Delhi has with Uzbekistan.
However in the last few Months we at Wockhardt Heart Centre have treated about 10 people from Uzbekistan with Complex Clinical History. What was common to all these people was that they were all High Risk Procedures with associated complications. Mr. Radjabov is one such case as since he has a Renal Failure Complication and it was essential that his kidney was kept away from developing more complication during the surgery.
That is why the Doctors at Wockhardt Hospitals performed a Beating Heart Coronary Artery Bypass Surgery, for him. The surgery lasted for approximately two and a half hours and during this entire duration there no Cardio Pulmonary support. Similarly the last patient that we had received from Uzbekistan had an Associated Double Valve Replacement along with the CABG, We had to operate on that patient for six hours straight.” Says Dr. Sameer Diwale, Cardiothoracic surgeon, who’s expertise have attracted these patients to Wockhardt Hospitals Hyderabad.
Dr. Sameer Dilwale has been regulary operating for Uzbekistani Patients and this has won him accolades in Uzbekistan,In fact he has had an opportunity to even Operate on one of the Dignitaries in Uzbekistan. He was recently invited by the family to celebrate the 75th Wedding Anniversary of the patient that he had operated on.
At Wockhardt Hospitals ,it gives us a great pleasure to see that we are not only establishing Quality Healthcare but we are now doing these complex surgical operations at the Global level.
Dr. Sameer has been invited to participate in Continuous Medical Education Programmes by the doctors From Uzbekistan. Dr Sameer adds, “ Its not only patient care, its also about changing the way Healthcare is administered world over. I feel that it is of immense importance that people keep abreast of what is happening in the Medical field, and its through little exchanges like these that we learn.”
Dr. Sameer has been invited to participate in Continuous Medical Education Programmes by the doctors From Uzbekistan. Dr Sameer adds, “ Its not only patient care, its also about changing the way Healthcare is administered world over. I feel that it is of immense importance that people keep abreast of what is happening in the Medical field, and its through little exchanges like these that we learn.”
This is a perfect example of a Globalized Healthcare System at its best, good for the country good for the World but most Importantly good for every individual who demands quality Health care. It’s about Empowering people at the Individual level.
Wockhardt Heart Centre
Kamineni Hospitals L B Nagar,
Hyderabad- 500 068
Andhra Pradesh - India.
Tel: 040-66064444
Fax: 040-66064242
Kamineni Wockhardt Hospitals
4-1-1227, King Koti Road,
Abids, Hyderabad- 500 001
Andhra Pradesh - India.
Tel: (040) 6692 4444
Fax: 040-6692 4242
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