27 year old software engineer survives a massive cardiac arrest

Wednesday, December 23, 2009


In an extra ordinary medical feat Wockhardt Hospitals,Bangalore – "A Network Hospital of Fortis, has set yet another benchmark in the history of medical science by performing a very complicated cardiac surgery on a 27 year old who suffered a massive heart attack.

Rupesh Mathur, a 27 year old engineer hailing from Bihar, complained of breathing difficulty and chest pain on 15th of November 2009 while on his way back home. As the pain increased his friends took him to a city hospital where he was diagnosed with heart attack and was initially treated with clot dissolving medicines. His family later shifted him to Wockhardt Hospitals.


“An angiogram showed severe blockage in 3 arteries. His heart was severely damaged and weakened. His life was in danger. We had to put him on an Intra-Aortic- Balloon-Pump (IABP), but he still had breathing difficulty. So he was put on a ventilator and special medication to stop clots from forming again. Surgery was the only option to save his life as his chances for survival was minimal even after surgery”, said Dr. N S Devananda, Cardiac Surgeon, Wockhardt Hospitals,Bangalore – A Network of Fortis.

“It was a big decision for his family to make him undergo surgery with less than 5% chance of survival. But his parents decided to go ahead” he added.

Rupesh underwent bypass surgery with the assistance of heart and lung machine to maintain blood circulation. Post the surgery his heart was extremely weak (Pulmonary Adema) and was not coping and he was on the verge of death, hence the doctors could not take him off the heart and lung machine.

Later the doctors decided to place him on an extra carboniam membrane operation (ECMO) and he was shifted to the ICU for 24 hours. ECMO treatment provides oxygenation until the patients lung function has sufficiently recovered to maintain appropriate O2 saturation.

It is often a last resort. Rupesh’s lungs had weakened due to poor circulation of oxygen. Keeping him on ECMO was a major challenge as his chest had to be open and his blood needed to be thin, which lead to bleeding. After 24 hours doctors tried to take him off the bypass however they were forced to put him back on circulatory support after just 45 minutes as his heart could not cope. The situation was extremely grim and doctors had left with two options 1) to keep him on life support system for further 24 hours and hope that his heart strengthens 2) A heart transplant, which was next to impossible to get a donor heart on such short notice.

On 22nd of November 2009 Rupesh was taken off circulatory system for 4 hours with his chest still open, but his heart was still too weak. Doctors put him back on circulatory support for another 12 hours after which his heart started strengthening and he was removed from the machine. 4 days later he was removed from the IABB and 9 days later he was taken off the ventilator. His heart recovered well and was discharged after 2 weeks.

Dr. Devananda said “I have never come across such a difficult case in my entire career. This is miracle, where a patient who was on mechanical life support for survival for so long recovering to live a normal life. This is truly a victory for modern technology and the never say die attitude of this 27 year old”.

These days’ young people are not immune to heart diseases and when it happens in younger people it is sudden, severe and caused more damage to the heart. Of late there is an alarming increase in the number of youngsters with heart diseases.

Young Philippino who never had a hip socket since birth undergoes revision hip replacement surgery



Orthopedic team led by Dr. Kaushal Malhan, Consultant Orthopedic Surgeon, Wockhardt Hospitals,Mulund,Mumbai performed a revision hip replacement surgery on a 29 year old girl from Philippines.

29 year old Elvira was suffering from a congenital birth defect wherein her hip bone had not developed and her hip had no cup since birth. At the age of 21 she had her first hip replacement surgery in Philippines. However the surgery was not a successful one and after a month of her operation she had to undergo a second surgery on the same hip. The second surgery was also not a success and Alvira’s left leg was shortened nearly by 6 cms due to dislocation of her hip joint. Since then she continued to be in pain and had difficulty in walking and performing all the simple day to day chores. Her physical condition restricted her life to a great extent and she lived a compromised life without being able to enjoy the pleasures that one enjoyed at her age. This left Elvira in pain, frustrated, mentally depressed and she decided to sit back home and not interact with any one, for over 3 yrs.

To distract herself and get out of her agony Elvira decided to go for her graduation in 2005 and completed Pharmacy graduation in 2009. Meanwhile destiny gave her a second chance, having suffered for so long Elvira mustered the courage to rectify her problem and decided to come down to India and get operated upon her hip once again.

“Elvira’s problem was a complicated one as she had already undergone hip replacement before and both those operations were failures. The surgeries had damaged Elvira’s bone and now we had to be very careful while performing the revision replacement surgery so as to not damage her bones any further”, said Dr. Kaushal Malhan.

“Her surgery involved removing the previous cemented Hip Replacement, and implanting new specialized components after having reconstructed the bone socket, which was had never developed since child hood. We needed to make up for the loss of bone that occurred due to lack of development and damage in the previous 2 failed operations” he added.

The length of her shortened leg was also corrected and made equal. The implants used have been put in a manner that allows her to sit on the floor without the risk of dislocation, as is seen in conventional Total Hip Replacement (THR) surgery. Elvira is very comfortable post surgery and has already started sitting properly in a manner which she has not been able to do for years. Her pain is completely reduced and now she is hoping to study further to become a doctor.

“My parents consulted a Pediatric doctor at Philippines to sort my problem but we could never get the right direction and the Doctors were not able to offer any solution as mine was a birth defect. Since then I had a compromised gait and could not do all those regular activities which a child of my age used to. When both my surgeries failed I almost lost all hopes and the thought of living a challenged life devastated by morale. But like the saying goes every cloud has a silver lining! I too saw some hope after 8 years. My fiancĂ© read about total hip replacement surgery in a magazine and we got curious and searched on the internet to know more about it. That’s when we read about the credentials of joint replacement surgeries at Wockhardt Hospitals and expertise of various joint replacement surgeons including Dr. Kaushal Malhan who has done some interesting and compelling replacement surgeries. Hence we contacted Wockhardt Hospitals and once everything was finalized we decided to fly down to India for my surgery” said Elvira.

“I no longer have to limp, I am no more in pain and most importantly I can now do everything I had dreamt of doing all these years. This has given a new meaning to my life and I would like to make the most of it now without losing a single opportunity!! All I want to say is there is a solution to every problem, only thing is we need to hunt out for the opportunity and everything else falls in place”, says Elvira with a comforting smile on her face.

Public Forum on Causes ,Prevention and Treatement of Knee and Hip pain

Sunday, December 13, 2009

Rare and complicated spinal deformity correction surgery gives 14 year old Shah Rukh Khan a new Life

Wednesday, December 9, 2009



Doctors at Wockhardt Hospitals led by Dr. K N Krishna, Senior Consultant in the Brain and Spine service successfully performed a rare and complicated spinal deformity correction surgery to save a 14 year old from leading a complete disabled life. Shah Rukh Khan a 9th standard student was suffering from Neurofibromatosis (an autosomal dominant disorder that affects the bone, the nervous system, soft tissue, and the skin) with a severe spinal deformity. There have been only a few cases reported the world over on surgical treatment for a rotational dislocation of the spine in neurofibromatosis.

Shah Rukh Khan who hails from Malur was suffering from Neurofibromatosis since birth however his condition had progression over the years and it was only in the last four months that it manifested in severe deformity leaving him in extreme pain and on the brink of paralysis. His spine was grossly dislocated and twisted putting pressure on the spinal cord. It was at an advanced stage that the child was brought to Wockhardt Hospitals, Bannerghatta for treatment where he was diagnosed with Neurofibromatosis and a dislocated spine necessitating immediate surgery to prevent him from further deterioration of his condition.

“In India, unlike western countries, spinal deformity in Neurofibromatosis tends to go undiagnosed due to lack of awareness and also very few hospitals have the infrastructure and expertise to treat this condition. In most cases patients advance to a stage where the spinal deformity can become severe, spinal cord damage can become irreparable and correction very dangerous” said Dr Dilip Gopalakrishnan, Consultant Spine Surgeon, Wockhardt Hospitals.
The complex surgery involved spinal decompression, stabilization of the deformity and fusion of the spine thus restoring the function of the spinal cord and protecting it from further damage. Shahruk Khan is now able to stand on his feet unassisted with relatively no pain and will soon be discharged.

“Shahruk Khan’s case required considerable study and preparation as there is so little documentation on the surgery at this stage of Neurofibromatosis. A high level of expertise is needed to perform this surgery” said Dr. K N Krishna, Consultant Neuro Surgeon, Wockhardt Hospitals.

“According to international studies, type 1 neurofibromatosis occurs in approximately 1 of 2,500-3,300 live births, regardless of race, sex, or ethnic background. The carrier incidence at birth is 0.0004, and the gene frequency is 0.0002. The incidence of type 2 neurofibromatosis is 1 case per 50,000-120,000 population” Dr. Krishna added.

Spending his free time in the hospital reading a story book, the much animated Shahruk shares with us about his desire to get back to school soon in the coming year and when asked on which profession he would like to pursue Shahruk promptly replies that he would become a businessman!

Shahruk lost his father when he was 9, due to financial constraints he stays with his aunt in Andhra and his mother lives with grandfather in Malur. Being the only child Shahruk has an aspiration to do something great in life and give his mother all the happiness she deserves. This incident has not dampened the child’s spirit to live life again. At 14 he has victoriously come out of the battle of life and death and with a smile says I would start going to school again from this January.

While the cost of the surgery amounts to Rs 2.5 lakh, the hospital did not charge them much, except for consumable medicines. Shahrukh's family managed to borrow Rs 70,000 for his surgery and further treatment.

About Neurofibromatosis:
Neurofibromatosis (NF) is an autosomal (Pertaining to a chromosome that is not a sex chromosome) dominant disorder that affects the bone, the nervous system, soft tissue, and the skin. It is a neurocutaneous (genetic disorders that lead to abnormal growth of tumors in various parts of the body) condition that can involve almost any organ hence the signs and symptoms can vary widely. There are two major subtypes type 1 neurofibromatosis, which is the most common subtype and is referred to as peripheral neurofibromatosis, and type 2 neurofibromatosis, which is referred to as central neurofibromatosis.

The severity of both types of neurofibromatosis varies greatly. In families where more than one person has NF, the symptoms and complications for each affected person can be different. At diagnosis, it isn't possible to know right away whether a case will be mild or lead to severe complications. Both types of neurofibromatosis are a dominant genetic disorder, which means an affected person has 50% chance of passing it on with each pregnancy. Neurofibromatosis also can be the result of a spontaneous change (mutation) in the genetic material of the sperm or egg at conception in families with no previous history of NF. About half of cases are inherited, and the other half are due to spontaneous genetic mutation

While the cost of the surgery amounts to Rs 2.5 lakh, the hospital did not charge them much, except for consumable medicines. Shahrukh's family managed to borrow Rs 70,000 for his surgery and further treatment.

68 year old Gets a New Lease of Life at Wockhardt Hospitals

Saturday, November 21, 2009

Doctors at Wockhardt Hospitals,Bangalore led by Dr. Ganeshakrishnan Iyer, Consultant Cardiovascular Surgeon, gave a news lease of life to 68 year old man who was suffering from Chronic Type B Dissection of the Aorta with rupture in the Plura (space around the lung) a condition with high fatality rate. He was returned to normal life after a marathon ten hour surgery to repair the breached aorta.

Sampangi, a retired employee of BHEL, first complained of pain in the chest, back and knee as early as 2003. After, initial treatment at a hospital in the city, he was sent home as the doctors felt that his condition was too risky for surgery. He was normal for a while and then the symptoms resurfaced within a couple of years. Once again he started complaining of pain in the knee, back and chest which his family ignored it initially. As time went by the pain became unbearable and he found it difficult to walk a few steps. He was confined to bed for more than 3 months. Later, he stopped taking solid food because of pain while swallowing.

At this stage he was brought to Wockhardt Hospitals to consult Dr. Ranganath Nayak, Consultant Cardiologist, who diagnosed him with Chronic Type B Dissection of the Aorta with rupture in the Plura. He was loosing blood in the chest (plural cavity) and his lung was compressed necessitating surgery. He was then referred to Dr. Ganeshakrishnan Iyer, Consultant, Cardiovascular Surgeon, Wockhardt Hospitals who performed the surgery.On 7th November 2009 Sampangi underwent the surgery which surgery lasted for more than 10 hours.

“On opening the chest the lung was found to be completely compressed by a thick layer of blood clot. On removal of the blood clot the lung was still not expanding and hence it had to be removed. Subsequently the Aorta was repaired using a left heart bypass where part of the blood is drained from the heart and pumped to the lower body using a heart lung machine in order to supply blood to the lower body while the aorta is repaired.” said Dr. Ganeshakrishnan Iyer.

Post surgery, Sampangi was kept under observation for 3 days and later shifted to the room. He started having solid food the next day and started walking for 5 minutes with minimal help.

“Generally most cases of Aortic Dissection are associated with hypertension (High BP); about 80% of cases occur in patients with a history of High Blood Pressure. According to studies the occurrence of Type B Dissection of the Aorta is about 2.7% to 3.5 % per 100,000 patient-years. The condition is more common in men than women at about 5:1 ratio. Most incidents occur between 60 to 70 years. In women less than 40 years of age 50% of cases occur during pregnancy,” Dr. Iyer added.

The Aorta is the main artery that carries blood to the body. It is made up of three layers, the intima, the media, and the adventitia. During Aortic Dissection the blood penetrates the intima and enters the media layer creating a false lumen (abnormal channel of blood within the wall of the involved artery). Aortic Dissection is caused by tear in the wall of the aorta (between the intima and the media layers).

Aortic Dissection can be classified as type A and B based on the involvement of the ascending aorta or the descending aorta respectively. This condition is extremely serious and there is a high fatality rate even with immediate emergency treatment. If the tear in the aorta goes through all three layers then there is rapid blood loss resulting in 80% mortality. A high percentage of patients die before reaching the Hospital.

Type B Dissection of the Aorta accounts for 40% of all Aortic Dissection and its occurrence is more frequent in the mornings between 6 to 10 am and in the winter season.

Treatment

Aggressive blood pressure control should be initiated immediately. The treatment is targeted to reduce aortic pressure and pulsatile flow.

Type B Dissection is managed initially with aggressive drug therapy. Indications for surgical treatment of type B dissections are aortic rupture (as in the case of Sampangi); severe intractable pain; mesenteric, renal, or limb ischemia; and progression of the dissection. Some of the methods used are

• Replacement of the damaged section with a tube graft
• Insertion of a stent, combined with on-going medical management



About Wockhardt Hospitals Cardiac Care:

A center for excellence in interventional Cardiology and Cardiac Surgeries in the country, it has to its name a history of path-breaking procedures, be it the first-ever Conscious Off Pump Coronary Artery Bypass Surgery and Awake Heart Surgery in India. Collectively Wockhardt group hospitals have now have tremendous experience of performing over 40000 Cardiac Surgeries and 75000 interventional cardiology procedures since its inception. The Institute is a preferred destination for adult and pediatric cardiology and cardiac surgeries. The hospital provides treatment on the entire gamut of cardiac diseases from newborn to adolescent. Dedicated operating rooms and post-operative ICUs with state-of-the-art equipment and experienced staff round the clock are provided to continue excellent care.

For enquiries or consultations with our cardiac specialists,please email us at enquiries@wockhardthospitals.net


91 year old back on his feet after a successful bilateral knee replacement surgery

Friday, November 20, 2009





Mr Madhukar seen above with Dr Kaushal Malhan


It’s never too late for a new beginning....

For Mr Madhukar nothing is more apt than these words.

Wockhardt Hospitals,Mumbai,Mulund has successfully performed a bilateral total knee replacement surgery in a single sitting on a 91 year old man from Mulund.In the process “Wockhardt Hospitals puts 91 year old Mr. Madhukar Nimdeo back on his feet after a successful bilateral knee replacement surgery”

Dr. Kaushal Malhan, Knee & Hip Replacement Surgeon, Wockhardt Hospitals performed the surgery on 91 year old Mr. Madhukar Nimdeo who was suffering from end-stage knee arthritis with minimal blood loss with a combination of advanced muscle sparing surgical exposure, specialized mix of navigation techniques and better patient-specific implants.

Mr. Nimdeo a retired central government employee who loves traveling and has always led an active life was suffering from knee pain for the last 8 years. Due the extreme deformity in both the knees caused by arthritis Mr. Nimdeo had to restrict his physical activities. However this couldn’t curb him from exploring adventurous sport for too long. While on his visit to New Zealand five years back he participated in bungee jumping despite his knee condition and recorded as the oldest member in New Zealand to participate in bungee jumping. But once he returned to India his condition worsened. Upon consultation with Dr. Kaushal Malhan he decided to go ahead with total knee replacement of both his knees.

“The results of the surgery are extremely encouraging and it proves that Tissue Preserving Total Knee Replacement Surgery offers good results even for very aged patients because of minimal tissue damage around the operating site. We have almost stopped the use of blood transfusions for knee replacement surgeries, even for patients who have been operated on both knees in one sitting.” said Dr. Kaushal Malhan.

Since the surgery involved minimal damage to the surrounding tissues, post operation, the nonagenarian was able to walk the same day of his surgery and also participated cheerfully in the hospital’s sporting activities held on the occasion of World Arthritis Day recently.

The Tissue Preserving Total Knee Replacement surgery goes beyond the general scope of conventional TKR surgeries that involve cutting through the quadriceps muscle during the surgery. Conventional Total Knee Replacement surgery causes trauma to the surrounding tissues that result in painful, long, recuperation periods. The patient would typically need walking aids for three to six weeks for the tissues to heal. However, in the case of Tissue Preserving TKR, the procedure involves just flipping across the muscles to reach the bone.

The specialised technique perfected by Dr Kaushal Malhan allows the advantage of satisfactory surgical exposure in all patients including the very obese with easy implantation of standard implants with standard instrumentation. Lesser tissue damage means less pain and earlier recovery.

Tissue Preserving TKR surgery aims to reduce the collateral damage which has always been part of this operation. It combines a muscle sparing exposure (which does not damage the quadriceps muscle- the front main thigh muscle) with computer assisted alignment so as to reduce the need for ligament release and appropriate implants which sacrifice less normal bone. This technique offers, among others, the ability to bend the knee almost immediately after the operation, and walk without aids much faster than conventional TKR procedures. Above all, there is no danger of any complication because there is no blood loss.

Advantages of Tissue Preserving Total Knee Replacement Surgery
  • On the whole, there is less soft tissue damage and if combined with appropriate implants, one can reduce the amount of bone sacrificed during operation.
  • Less post surgery pain
  • Less bleeding and no need for blood transfusions.
  • Faster return of knee function – muscle strength and control comes back more quickly – allows faster rehabilitation. Patients can walk on day 1 after surgery.
  • Shorter hospital stay
  • Less soft tissue damage and a better result
  • Early return of knee motion
  • After surgery recovery time is less than one third of that with conventional TKR technique.

“My painful knees were quite discouraging for me in these 8 years as I had to restrict my physical activity and mobility was also compromised to a large extent. After attending a session on tissue sparing knee replacement by Dr. Kaushal Malhan, I made up my mind to undergo surgery of both the knees and I could see the benefits from day one of my surgery. I could bend my knee on the first post operative day and with a regular physiotherapy regime I am now completely back to what I was 20 years back!” said Mr. Nimdeo.

For consultations and inquiries with Doctor Malhan,please email us at enquiries@wockhardthospitals.net


Trans Nasal Surgery Used to Remove a Woman's Tumor

Wednesday, November 18, 2009



For three years, a host of doctors were unable to diagnose Manju Talwar’s medical problem. The 24 year old school teacher complained of abnormal lactation, irregular menstrual cycles and was unable to conceive.

All symptoms suggested a possible gynaecological problem but despite heavy medication, Talwar’s condition did not improve. However, early this year, a MRI scan revealed a tumour in her pituitary gland.

The pea-sized gland situated at the base of the brain controls growth, metabolism and reproductive functions among others. In Talwar’s case, the tumour was pressing her optic nerve, which could lead to blindness. She was advised immediate surgery.

Talwar’s was not an easy surgery as while removing the tumour we had to ensure that the gland is preserved as she is in the child bearing age,” said Dr. Deepu Banerji, a neurosurgeon at Wockhardt Hospital,Mulund,Mumbai.

The Pituitary gland which is located at the center of the brain manufactures and secretes hormone that regulate growth ,sexual development and fluid balance in the body.

Pituitary adenomas(tumors) are abnormal growth on the pituitary glands which account for about 10% of intracranial neoplasms. They often remain undiagnosed, and small pituitary tumors have an estimated prevalence of 16.7% (14.4% in autopsy studies and 22.5% in radiologic studies). Tumor removal is usually done through transspheoidal approach. Endoscopic surgery is the new approach allowing a surgeon to gain maximum access within the narrow confines of the region avoiding extensive dissection.

Surgery is a common treatment for pituitary tumors. Trans-sphenoidal adenectomy surgery can often remove the tumor without affecting other parts of the brain. Endoscopic surgery has become common recently.

Dr Deepu Banerji, who operated on Talwar over three months, opted for a relatively new endoscopic trans-nasal technique for the delicate operation. This involved insertion of an endoscope through nasal cavity.

Banerji claimed that so far in Mumbai most doctors have been using microscopic transeptal technique, which involves a microscope inserted through the nasal cavity. This, he claimed has led to post-operative complications like numbness around nose and lips, nasal deformity or pain and incomplete removal of tumor.

In the new technique, an endoscope provides good view of the tumor to the doctor. Also, it makes it easier to differentiate between the tumor and the gland – leading to greater chances of complete tumour removal and preserving hormonal functions.

Talwar said she has so far not complained of any post-operative complications.For inquiries please contact us at enquiries@wockhardthospitals.net

Wockhardt Hospitals Bangalore Celebrates Children's Day

Tuesday, November 17, 2009












14th November,2009 was a special day for Wockhardt Hospitals,Bangalore.Apart from being Children s Day .. the day also celebrated as the day when Children from all over the city assembled at the hospital to say a big Cheers to Life. These Children were all at some point of their lives threatened by life threating congenital disorders,who managed to overcome their medical problems with a little help from the Hospital.

More than 50 children aged between 3 and 13 who had undergone cardiac surgery at Wockhardt Hospitals were treated to a variety of fun filled activities on the occasion of Children’s Day. Dr Devananda, Pediatric, Cardiac Surgeon Wockhardt Hospitals, who took part in the celebrations spoke on the prevalence of Congenital Heart Disease in India vis-Ă -vis the developed countries and stressed the need to create awareness among people that the Congenital Heart Disease is curable.

“Congenital Heart disease in a child is not the end of the world. This is a treatable condition with excellent success rate, the children present here today of all ages are a testament to this fact.” Dr Devananda, Pediatric, Cardiac Surgeon Wockhardt Hospitals

“Today, India has the expertise and the knowledge to treat this condition, however there are two major obstacles we need to overcome that is that lack of awareness of the disease and the non availability of finance as insurance companies in India do not cover pre-existing diseases” he added.

Magic shows, caricature, face-painting, interactive games and competitions enthralled the children who were eager to participate, adding to the happiness and joy of this special occasion.

But these were not your regular kids. All of them had suffered from life-threatening heart problems , at some point or the other and had gone through complicated surgeries at the Bannerghata Road,hospital at Bangalore.

"It was great to see these children doing so well and enjoying themselves at Children's Day. Seeing them so happy, no one would have guessed that they were suffering from fatal heart problem at one time," said Dr Devananda, pediatric cardiac surgeon.

The "reunion" party was as emotional for the families as it was for the doctors. And in between the celebrations, the parents recalled those difficult times when they were scared about their children safety.

Deepak Singh, father of Vikram Singh, who had a serious heart disease, said, "We had to take him to the hospital daily for checkups and after a lots of tests, we got to know that he had a hole in his heart. Those were the most difficult times of our life. But now that he is healthy, I have no words to explain how happy we feel."

A magic show, dance programmes and many other interactive sessions made the day special for the children. The enthusiasm of the kids soon inspired the adults too as many of them joined the little ones in the buoyant celebrations and some even shook a leg.

"Apart from the fun that we had, this event was a great platform to spread awareness about heart ailments. Also, families, which had gone through similar trauma, were brought together and the sharing of their knowledge and experiences, made the event a memorable one," said Dr Devananda.

He went on to add, "India, today, has the expertise and the knowledge to treat heart ailments, but we face two major obstacles. One is the lack of awareness and second is the non-availability of finance as insurance companies in India do not cover pre-existing diseases. We need to look into these issues now."

To contact our pediatric department pls write to us at enquiries@wockhardthospitals.net

source:DNA

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