Wockhardt Hospitals Blog

Dr.Francesco Rubino from Cornell Medical Centre, the first person to perform research to establish diabetic cure by surgery was there to share his cutting edge research with other physician & surgeons. Similarly, Many other surgeons like Michel Gagner from Mt. Sinai Medical Centre, USA, Phil Schauer from Cleveland Clinic, USA,Martin Fried from the Czech Republic, Kazunori Kasama from Japan also participated in this mega event.

The Wockhardt hospitals Bariatric Surgeon & Chairman, Organizing Committee, Dr.Ramen Goel Stated that for the first time in the entire Asian region a program of this nature was held. Almost all bariatric surgeons from india too, participated in this program.Many patients benefited from this surgery as they were treated by experts in this field.

This conference was supported by the Indian Council of Medical Research, was attended by hundreds of experts from the field of obesity & bariatric surgery. Eminent surgeons at the Wockhardt Hospitals, Mulund conducted live surgeries on obese patients. The bariatric surgery department of Wockhardt Hospital is a well equipped centre of excellence and attracts a large number of international patients for this kind of surgery, Last year, India`s heaviest patient, had undergone surgery at Wockhardt hospitals, Mulund.

The primary treatment for obesity is dieting and physical exercise. If this fails, anti-obesity drugs may be taken to reduce appetite or inhibit fat absorption. In severe cases, surgery is performed or an intragastric balloon is placed to reduce stomach volume and or bowel length, leading to earlier satiation and reduced ability to absorb nutrients from food.

Complications from bariatric surgery are frequent. A study of insurance claims of 2522 who had undergone bariatric surgery showed 21.9% complications during the initial hospital stay and a total of 40% risk of complications in the subsequent six months.

Mumbai, April 11, 2009: The liver unit team at Wockhardt Hospitals performed a life saving liver resection on an eighteen month old baby giving her a fresh lease of life. The team led by Dr. S K Mathur, Senior Consultant Surgeon, HPB Surgery & Liver Transplantation; Wockhardt Hospitals successfully completed the four hour surgery on this little baby without any complications.

The one-and-a-half year old baby a native of Orissa was diagnosed with hepatoblastoma, a rare cancerous tumour that originates in the liver. To worsen matters, it was detected at a rather locally advanced stage complicating matters for the ailing child. After undergoing chemotherapy at another Mumbai hospital she was to Wockhardt Hospitals for further intervention.

“The chemotherapy that Sumana had taken served to downsize the tumour in her liver to make it more resectable.” says Dr S K Mathur, Senior Consultant Surgeon, HPB Surgery & Liver Transplantation, Wockhardt Hospitals. “But it was the late detection that had worsened Sumana’s case. Cases of liver tumors in such young children are very rare almost one in a million. Managing such a small baby for a major liver resection was quite a difficult task and such surgeries are not commonly done on them.”

If eighteen-month old Sumana could just spell it out, she would have agreed heartedly and thanked Dr S K Mathur and Dr. Mahesh Goel and Wockhardt Hospitals for giving her a new life.

Dr. Mahesh Goel, Consultant Onco Surgeon at Wockhardt Hospitals said “This is a rare tumor potentially curable if treated at the right time and requires highly technical skill set to perform such a surgery. The challenge lies in removing the diseased part of the live safely in such a small child without any complication, no loss of blood and with adequate margin of liver to achieve cure.”

Dr. Mathur also added, “Sumana stayed in the ICU for one day, oral feeds started on the first day and she was discharged on the fifth day. The cause of her cancerous liver tumour could probably have been genetic. But it is a potentially curable cancer in a child, if it is treated in the early stages. During surgery we had to take care to prevent excessive blood loss and hypothermia (abnormally low body temperature. If Sumana’s case had gone untreated, she would probably not have survived for more than six months.”

Dr. Sangeeta Shetty, Consultant Anesthetist, Wockhardt Hospitals said, “The hospital provides technical backup during surgery of such a young patient. Intra operative care is taken during anesthetic management of such a small baby which includes maintaining temperature, physiological status, intravenous fluid and ensuring this is continued in the post operative period.”

Also present at the occasion Dr. Ravindra Karanjekar, Associate VP, Wockhardt Hospitals Mumbai said, “Wockhardt hospitals Mulund has developed expertise in Hepato billiary Surgeries including Liver transplant. With the help of Harvard International we have set up a well developed Transplant program in the country and have successfully conducted few liver transplants in the city. Such complex surgeries are not possible without highly skilled surgeons like Dr. Mathur & Dr. Goyal and require a great team work of anesthetists, nurses & other paramedical staff. Intensivists also play a vital role in such surgeries. Surgeries as such are very critical & Wockhardt Hospital is always on the forefront to bring in newer medical services to western region of the country. Our motto is save lives at any cost!”


About Hepatoblastoma

Hepatoblastoma is a very rare cancerous tumour that originates in the liver, which is one of the largest organs in the body. The primary functions of the liver include filtering and storing blood. The liver consists of left and right lobes, and it is commonly seen that most hepatoblastoma tumors generally occur in the right lobe. This disease primarily affects children from infancy to about five years of age. Most cases show up during the first 18 months of life. Hepatoblastoma cancer cells are known to metastasize or spread to other areas of the body. The most common sites of such metastasis are the lungs, into the abdomen, and in some rare cases to the central nervous system, bone and bone marrow.


About Department of Gastro-intestinal & HPB Surgery Wockhardt Hospitals:

A headache is a condition characterized by mild to severe pain in the head; symptoms that are often experienced by may people the world over. The most common types of headaches are due to tension or migraine, or a combination of both. More serious causes of headache such as stroke, brain tumor, bleed inside the skull, infections (meningitis), etc are rare and it is advisable to consult your doctor if the pain is severe or if continues for extended periods of time.

Tension Headaches

Tension Headaches often develop after a hard days work involving physical and emotional stress, anxiety and worry. Most people experience it during the course of their lives but it is often harmless and tends to go away with a little rest. Tension Headache makes the head feel like it is in a vice like grip or like a tight band is rapped around it, both sides of the head are generally affected and there may be a feeling of tension or discomfort around the upper back, shoulders and the neck.
Migraine Headaches
Migraine Headache is a type of vascular headache. According to researchers the cause is often genetic.

Symptoms

Migraine attacks are a chronic condition associated with headache often on one side of the head. It is often accompanied with nausea, sensitivity to light & blurred vision. A pounding or piercing sensation is felt with the pain and it could range from being very mild to being extremely severe preventing the person from performing normal tasks. Headaches can last from 24 hours up to a few days.

Migraine headaches are most common among women in their mid teens to late forties; men also suffer from this condition but not as often as women.

Causes
Treatment

Early and mild conditions can be controlled with anti-inflammatory drugs, however the use of steroids is not recommended. Drugs that control nausea may also be used if the patient feels nauseated and is vomiting very often. A combination of aspirin and caffeine may be very useful to relieve the symptoms. Severe cases require specialised medical care and patients are advised to visit their physician to rule out any other causes.

Prevention

Migraine is a chronic condition, however patients can keep it at bay by following a disciplined routine - Eat at regular times, don’t skip meals, keep physically fit, try to get at least 6 hours of sleep a day during the regular sleep hours, avoid unnecessary stress and stressful environment, stop smoking and reduce the intake of alcohol.

What does the Doctor say?

Generally most headaches go away with a little rest. However one should take it seriously if there is a change in pattern of a longstanding headache, associated fever or vomiting, visual problems like blurring or double vision, it is advisable to consult your doctor. Timely medical evaluation and diagnosis is mandatory.


Dr Chandran Gnanamuthu, MD, DM, FIAN, FAAN
Senior Consultant Neurologist, Wockhardt Hospitals

Wockhardt Hospitals,MulundMumbai has launched the E-One Emergency care Network Services to complement its current ne Hospitals one of India's leading super-specialty hospital groups today to complement its current network of Intensive Care Units(ICU’s) located strategically across the central suburbs of Mumbai.

The E-one service is a comprehensive network which connects all Wockhardt Hospitals ICU’s through a fleet of well equipped ambulances thereby ensuring not only the immediacy of the response but also timely emergency medical intervention at a well equipped ICU. E-One Network ambulance is a mobile emergency service— a state-of-the-art ambulance equipped with sophisticated life-saving equipment and trained paramedics. Rtn Ashok Nangia, President Rotary – Mulund flagged off the E-ONE service in the City.

The E-One Network will currently facilitate critical care to the patients by connecting them to the Intensive Care Units located at Wockhardt Hospitals in Mulund, Vashi and Kalyan and Pancholee Hospital in Ghatkopkar. Currently the network has 75 critical care beds and the number is expected to go up significantly in the near future. The dedicated emergency service will initially have a fleet of 5 mobile intensive care unit ambulances equipped with all advanced life saving equipments. The ambulances are equipped with a suction pump, syringe pump, ventilator, defibrillator, oxygen cylinder along with all important medicines needed in an emergency. A team of specialists trained in Emergency medicine and a team of paramedics provide 24x7 support and cover.The service ensures that in times of medical emergency the patients are treated with new generation emergency care management protocols which are uniform within the Wockhardt Network of ICU’s.

Speaking on the occasion Dr. Ravindra Karanjekar, Associate Vice President, Wockhardt Hospitals Mumbai said, “As most medical emergencies like a sudden heart attack, stroke or an accident does not give anyone the time to think and where to head to for emergency care, time and connectivity to the right centre is a critical factor. The E-One Network Care not only serves as a fully equipped ambulance but also brings the patient to the nearest Wockhardt Hospitals led intensive unit for further treatment”.

During a critical medical emergency when 67994400 is dialed at Mumbai the call is connected to Wockhardt Hospital’s E one central emergency care command centre, which promptly directs an ambulance from the nearest Wockhardt Hospitals ICU that's closest to the location of the emergency. These ambulances can be tracked through the network thereby ensuring constant monitoring of the status of the patient while the patient is in transit to the ICU.A two way communication system also ensures that the facilities at the Emergency bay and the ICU are kept ready to ensure minimum loss of time.

In critical cases expert guidance is issued via a dedicated telephone line by trained doctors from the closest branch of Wockhardt Hospitals. The trained doctor in E-ONE is in constant touch with the super specialists in the hospital. This ensures that no time is lost, and the immediate steps of treatment are already in motion even before the victim reaches the hospital.

Dr. Deepu Bannerjee, Consultant Neurosurgeon, Wockhardt Hospitals says "In most cases the first one hour after accidents is vital; it is called the Golden Hour, it is very important for the patient to get necessary treatment in this golden hour. Generally accident victims reach the hospital very late. The E-One service will benefit the patients in receiving the initial medical attention during an emergency and reaching the appropriate ICU unit on time as the biggest challenge in Mumbai today is reaching the right destination on time.”

Flagging off the E-One Network Rtn Ashok Nangia President Rotary, said, "This is an excellent initiative by Wockhardt Hospitals to save lives. The quality of Medical care rendered during an emergency decides the outcome of the quality of life. E-ONE as a comprehensive emergency care service is a solution which Mumbai needs”.

Dr. Manjeet Juneja, consultant cardiologist Wockhardt Hospitals Mumbai said, “The science of medical emergency management is evolving rapidly across all specialities.It is important that patients receive the most appropriate therapies of treatment and in this context we are backing the E one emergency care network service with a team of super specialists across different specialities who can provide the most contemporary critical care”.

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 .

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.

By Dr. K N Krishna, Consultant Neuro Surgeon, Wockhardt Hospitals

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.

(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.

The cause of primary brain cancer is unknown. As mentioned above, secondary brain cancers grow from a cancer elsewhere in the body.

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.

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.

The 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.

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.

DR (Prof). K.N.Krishna
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

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

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.