Radiant Pulse features important information from both the group hospitals encapsulating breakthrough achievements, innovations, insight into rare and complex cases and expert advise from renowned doctors!
It is that time of the year again when mosquito borne diseases such as Chikungunya, Dengue and Malaria take the centre stage. Many cases have been reported from various parts of the country, especially Delhi & NCR region. This month's cover story highlights the symptoms and management of Chikungunya which took a higher toll on patients this season, as compared to last year. Taking adequate precautions is the best way to fight the problem. Basic precautions should be taken by people travelling to risk areas and these include use of repellents, wearing full sleeves clothes and ensuring rooms are fitted with screens to prevent mosquitoes from entering.
The issue also encapsulates other stories like the Low Rectal Cancer Surgery, an unusual case of a 50 year old patient with 4 critical blockages and computer-navigated Total Knee Replacement surgery.
Last month our team of surgeons visited Gambia to strengthen bilateral cooperation, a step which was highly appreciated. You can read more of it in our international section. In September, the hospital also won the Asian Hospital Management 'Excellence Awards' in Marketing, PR or Online Presence as well as in the Human Resource categories at a glittering ceremony held in Ho Chi Minh City, Vietnam.
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Here’s wishing everyone great health!
The aim of treating Rectal Cancer is to have a good regional control with
improvement in overall disease-free survival. Distal third Rectal
Cancers were traditionally treated with Abdominoperineal Resection.
The sphincter-saving procedures have been increasing owing to
advances in better surgical techniques and instruments, introduction of
multidisciplinary approach (pre-op Chemoradiation - CT / RT),
specialised high volume centres and improved understanding of
sphincter mechanism and the tumour biology.
A 68-year-old gentleman had a history of bleeding rectum and was also experiencing change in bowel habits for the past one year. Close examination revealed a fungating mass 3-4 cm from anal verge with good sphincter tone, Colonoscopy of the patient revealed eccentric passable fungating mass 3 cm from anal canal and MRI revealed a T3 tumour with mesorectal stranding and nodes.
He received pre-op RTCT (50.4Gy+ oral capecitabine tablet). Response assessment 6 weeks later revealed reduction in size, bulk of tumour and complete resolution of mesorectal nodes with residual eccentric mural thickening in lower rectum. The patient was counselled for APR with permanent stoma / low anterior resection with temporary Ileostomy. He successfully underwent Laparoscopic assisted low anterior resection with covering Ileostomy. Histopathology revealed moderately differentiated adenocarcinoma with 1 cm distal margins and negative nodes.
A 50-year-old woman was admitted with pain and discomfort in both her legs. She has been experiencing pain while walking for last 2-3 months. The pain was accompanied by chest discomfort and hypertension. Her CT Angiography showed 4 critical blockages in different vascular regions, all of which were at the ostium or origin of the vessels.
The patient's multiple problems were completely managed endovascularly, and treated in 2 sessions with 4 stents. Bilateral access via both femoral arteries was obtained and 7F sheaths were placed. Herculink Elite 7X15mm stent was deployed in the left renal artery at the ostium first. Then, continuing the same procedure, 2 extra stiff wires were passed across the blockages in the iliac vessels and after dilating the lesions with 5X40mm balloons, 2 stents, Luminexx (Bard) 10 X 40mm, in right, and Luminexx (Bard) 14 X 40mm in left, were simultaneously deployed across the blocks in the iliac arteries, extending into the aorta to reconstruct the aortic bifurcation and keep both vessels open and flowing normally.
Chikungunya is an infection caused by the Chikungunya virus. The risk
of death is a little less than 1 in 1,000. The elderly or those with
underlying chronic medical problems are most likely to have severe
The virus is passed to humans by two species of mosquito that belong to genus Aedes: A. albopictus and A. aegypti. The virus circulates within a number of animals including monkeys, birds, cattle and rodents, compared to Dengue, which affects primates only.
SIGNS AND SYMPTOMS
The incubation period of the Chikungunya virus ranges from one to twelve days. Characteristic symptoms include sudden onset of high fever, joint pain and rashes. Other symptoms may include headache, fatigue, digestive complaints and conjunctivitis.
Typically, the disease begins with a sudden onset of high fever that lasts from a few days to a week, and sometimes up to ten days. The fever is usually above 102 °F, sometimes reaching 104 °F and may be biphasic - lasting several days, breaking and then returning. Fever occurs with the onset of viremia, and the level of virus in the blood correlates with the intensity of symptoms in the acute phase.
Joint pain is reported in 87–98% of cases, and nearly always occurs in
more than one joint including peripheral joints such as the wrists,
ankles and joints of the hands and feet as well as shoulders, elbows and
knees. Joints are more likely to be affected if they have previously been
damaged by disorders such as Arthritis. Pain may also occur in the
muscles or ligaments.
Chikungunya may also cause long-term symptoms following acute infection. This condition has been termed as chronic Chikungunya virus-induced arthralgia. Common predictors of prolonged symptoms are increased age and prior rheumatological disease.
Serological tests, such as enzyme-linked immunosorbent assays (ELISA), may confirm the presence of IgM and IgG anti-Chikungunya antibodies. IgM antibody levels are highest 3 to 5 weeks after the onset of illness and persists for about 2 months. Samples collected during the first week after the onset of symptoms should be tested by both serological and virological methods (RT-PCR). The virus may be isolated from the blood during the first few days of infection.
There is no specific antiviral drug treatment for Chikungunya. Treatment is directed primarily at relieving the symptoms, including joint pains using antipyretics such as Paracetamol / Acetaminophen and fluids. There is no commercial Chikungunya vaccine available as yet.
Ankur, a 6 year-old boy was brought to BLK Emergency in a very critical condition and under tremendous shock. He was suffering with acute abdominal pain for the past 24 hours and had multiple episodes of vomiting.
Ankur was immediately resuscitated with ion tropic and ventilator support. Paediatric surgery team was called immediately to rule out any surgical cause of his rapidly deteriorating condition. The surgical team suspected of intestinal gangrene and advised for urgent surgery to remove the gangrenous portion. Surgical exploration was done and it was found that except for about 100 cm of proximal small intestine (jejunum) and colon, rest of the small intestine was completely black (gangrenous). CT scan of the abdomen showed a very rare finding of a major blockage of one of the veins supplying to the intestine which led to the gangrene. With the help of the Haematology team, complete work-up was done to ascertain the cause of the thrombus formation.
On post-op day 8, the child again developed severe abdominal pain with blood in the vomit and stools. Repeat CT scan of the abdomen was done which showed suspected new gangrenous changes in the remaining small intestine. A second surgery was conducted by the surgical team which involved removal of 5 cm long gut. Paediatric Gastroenterologist and Nutritionist were then involved to gradually establish his enteral feeds and digested formula feeds were given. This was one of the rarest case which involved close coordination of multiple departments – Paediatric Critical Care, Paediatric Surgery, Haematology, Paediatric Gastroenterology, Dietetics & Nutrition.
Total Knee Joint Replacement surgery has been evolving over the
years. Knee Joint Replacement fails only in those patients where the
alignment or balance is inadequate. Traditional Total Knee
Replacement is done using alignment jigs and cutting blocks.
Previously, surgeons used eyeballing to make bony cuts to balance the
ligament. Computer navigation uses a software that helps the surgeon
to outline the deformity, plan accordingly and perform bone cuts and
ligament balancing with absolute precision.
Preetha, a 55 year old female from Bangalore had terrible pain in her knee for past 4 years. All this started after she had an injury 5 years ago. She started taking local treatment but her pain didn't subside, in fact it worsened. She was debilitated and could hardly perform her daily activities.
Dr. Sharma planned for a computer-navigated Total Knee Replacement surgery on the patient. Computer navigation helped in deciding the amount of bone cuts to nearest mm so that minimal bone was removed during Knee Replacement thereby facilitating bone preservation. Intramedullary canal was not violated, minimising the chances of fat embolism. The amount of soft tissue dissection needed using navigation was minimal, so blood loss was very less leading to faster rehabilitation.
Navigation helped in accurate alignment and sizing of the components on the table as well as perfect placement of the implants.