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APPENDICITIES: WHAT?

Laparoscopic surgery, or keyhole surgery has already gained popularity among patients. It has been accepted worldwide as the ‘standard of care’ in treating many common as well as uncommon conditions that require surgery. Advances in the telescope used for a laparoscopic procedure allows surgeons to visualise and examine carefully the internal  organs and pin-point the exact source of pain.

Relatively the youngest technique, laparoscopy has advanced a great deal in the last few years. Dr. Deepraj Bhandarkar, laparoscopic and gastrointestinal surgeon at PD Hinduja, Sir Hurkisondas and Motiben Dalvi Hospitals, says that hernias and appendicitis are easily taken care of by tiny cut as opposed to a large scar in the groin, abdomen or hip. “Lightweight meshes that get partially absorbed in the body leaving behind less foreign material are now being used,” says Dr. Bahndarkar. But where or not the long tern results obtained are as good as the older meshes which have been  in use for several years remains to be seen, he adds.

Another new technique in the appendicitis surgery is the use of glue to fix the mesh in place. “The mesh has been traditionally fixed with tacks. Only recently has ‘glue’ been introduced. This is sprayed over the mesh to make it stick to body tissues. Use of  the glue is said to further reduce the pain after surgery,” says Dr. Bhandarkar.

Our liver transplant programme would soon be ready, Public and private sectors will work together for the cause of organ donation.

Organ transplant drive to get a new lease of life

Mumbai: There were tears and some pride as the families trudged to the stage to get a citation from government officials. Each of the six families present in KEM Hospital’s seminar hall on Saturday had given the gift of life to several patients even as their loved one lay in an ICU in a state of brain death.

`The state government felicitated 18 families who had donated organs last year on Maharashtra Organ Donation day, held on March 27 every year to commemorate the first transplant from a deceased donor (cadaver) to a kidney failure patient that took place in Sion Hospital.

“My brother loved to help patients coming to KEM Hospital. When he died, following his wishes, we donated his organs ,” said Umesh Gopal Shetty’s brother. Piyush Thacker said he was elated to learn that his wife Vandana’s kidney was donated to a 12-year-old Muslim boy on the occasion of Ramzan Id.

On Saturday, it appeared that the Much-neglected cause of organ donation was getting wide support. It was announced that the zonal Transplant Coordination Centre (ZTCC)—that coordinate cadaveric organ transplants—would at long last get a spacious office. Said ZTCC secretary general Dr. Sujata Patwardhan, “Sion Hospital has agreed to give us a 800-square-feet office in its to-be-inaugurated new OPD building.

Secondly, medical students would be trained on the nuances of brain stem death, said Dr. Patwardhan at a ceremony held to observe the day at KEM Hospital, Parel . Poor awarneses about brain stem death has been identified as the roadblock in popularity of cadaver or deceased donor programme.

Thirdly, KEM Hospital dean dr. Sanjay oak said that his hospital’s liver transplant programme would soon be ready. “Public and private sectors will work together for the cause of organ donation,” he said.

Dr. Pravin Shingare, joint director of the department of medical education and research said. “The number of cadaver transplants performed in India is low. Barely 3,500 receive a donor kidney and only a small percentages of these are cadaver organs.” It is estimated said Shingare, that 10,000 patients in Maharashtra ,with the all-India figure standing at 1.5 lakh. “In 2009, only 36 kidneys and six livers were donated in Mumbai and 10 in Pune, “ shingare added.

Pacemaker in colon gives man relief from constipation

Clearing the Bowels

Fecal incontinence loss of the regular control of bowels occurs due to a congenital defect called Spina Bifida Occulta, which is triggered by the deficiency of folic acid in pregnant women

Symptoms

*4-5 hours to clear bowel

*Acute abdominal pain

*Patient feels bloated all the time.

*Constant complaints of incomplete evacuation

Cost Rs. 3 lakh

First of its kind surgery performed by AIIMS doctors in India. So far close to 10 such surgeries have been done worldwide.

Treatment sacral Nerve Stimulation (SNS). It's a minimally invasive surgical technique that allows for direct electrical stimulation of the sacral nerves S3, which are known to be connected with a majority of colonic functions.

Step 1 Two electrodes are inserted just above the hip into sacral nerve S3

Step 2 Electrodes are externally stimulated one by one using a machine, Depending on the response, the best responding electrode is left in the patient's body and connected to an external stimulator

Step 3 Bowel movements and the effect of stimulation is studied for a week

Step 4 If it shows good response, the electrode is permanently connected to a small stimulator, implanted in the hip

Step 5 Patient is given a wireless regulator through which he controls colon movement.

New Device to scan liver in 2 mins


Mumbai: During a trip to Mumbai, US-based Smita Thomas, who was undergoing treatment in America for fatty liver, consulted an endocrinologist in Mumbai. As suggested by the doctor, she went for a fibroscan that showed that Smita has been suffering from fourth-stage liver cirrhosis for a while.

“Most of the time, until a person’s liver has been 70% damaged, the person does not even come to know that there is something wrong. Earlier, the only option to diagnose a liver problem was through biopsy-done by extracting a tiny portion of the organ- which was a painful, complex and time-consuming method. The fibroscan of the liver, which we have recently started can scan the liver non-invasively within a span of 1.5 minutes,” said N H Banka, chief gastroenterologist at Bombay Hospital, adding that each scan cost around Rs.12,000.

The machine has a probe device, which when switched on near the belly of the patient, electrical propulsive waves touch the vibrations of the liver, reflecting the elasticity of the organ and other details on a connected screen. With the help of set parameters, the doctors can then diagnose if the person is suffering from cirrhosis and the stage of the ailment.

“There are several conditions, in which a person may be at higher risk of getting a liver disease. In any of the cases- if the person has Hepatitis B or C, has alcohol history or has a fatty liver. For each disorder, set parameters are there to test the safe elasticity of the liver,” said Banka.

However, Dr Aabha Nagral, consultant hepatologist at Jaslok and Fortis hospitals, said biopsies would always remain the golden standard. “Jaslok Hospital, too, has a similar but not quite the same machine with which we can scan the severity of the fibrosis of liver in a non-invasive way. Though this scan is good for patients where a biopsy is not possible, it can not replace biopsy,’ she said. But Nagral added that the scan helped when it came to checking on the improvements of a patient who was on antiviral drugs and those about to go for a kidney transplant who might be affected by Hepatitis B or C.

“Like a biopsy, these scans cannot find the root cause of the liver disease. However, any imaging is good as it does not need to go in the body. Earlier, the bones used to come in the way of ultrasound scans. But now, all scans have become quite advanced. However, how useful a fibroscan of the liver turns out to be, only time can tell,” said Dr Avinash Supe, professor of surgical gastroenterology at KEM Hospital.

E(eeks), It’s hepatitis at Large

You’ve heard of the ABCD of hepatitis , now learn about the E that’s causing havoc in the city. Priya Sugathan reports…

Cities and countries across the globe are gearing up to create an awareness of hepatitis on May 19, with many who are devoting the entire month to create an awareness of the dreaded disease. But while the world is focusing on creating more awareness of hepatitis B and C to prevent new liver infections, Mumbai is facing a challenge from hepatitis E, and not much is known about this form. Almost epidemical, doctors state that they treat at least one or two cases everyday.

What is Hepatitis E? *Hepatits E, recognized in 1980’s is a form of single-stranded RNA virus that leads to liver inflammation. It’s usually transported through fecal-oral route, which in layman’s term implies contaminated water-borne infection. And cases of hepatitis E have been on the rise in the past two months in Mumbai, especially South Mumbai.

“An outbreak of hepatitis E is largely seen in developing nations. And everyone is aware of the quality of water hygiene in Mumbai. The only way to prevent an infection like this is to drink or use boiled water, just filtering water is not enough,” says Dr. Pratit Samdani.

“Hepatitis E, is self-limiting viral infection. There’s no medicine or vaccine for it. It requires a wait-and watch kind of situation. Only in rare cases does it reach the fulminate stage causing liver collapse and at times, death,” adds Samdani.

Gastroneterologist Dr. Parizat Gupte cautions,”The infection largely hits the adults, but the severity of the case can be felt when it strikes a pregnant woman. It’s fatal for them.”However, luckily, this infection is that it is not contagious.

Signs and prevention

*Some of the signs of being struck by Hepatitis E are fever, nausea, vomiting, and yellowish discolouration of the (sclera) eyes. It is called the yellow fever. “One of the key symptoms of this infection is drowsiness. The victim sleeps through the day, and struggles for the same at night. One of the common mistakes that most do is the give sleeping tablets to counter the sleep struggles. Don’t do that as it could lead hepatomagaly (enlarged liver) and brain fever, which could further lead to comatose,” informs Samdani, who also warns against using ayurveda or homeopathy to treat hepatitis E warning it could lead to prolonged jaundice state.

Dr.Gupte seconds,”There’s no vaccine or medicine for hepatitis E. All one can do is prevent by boiling water, not eating street food, and being alert about leaking pipes.” Gupte states that he’s been treating those from residential areas of Girgaum and Haji Ali areas for the infection. Samdani cites the case of a government college, where more than a dozen host elites had to be treated for hepatitis E last month. The problem was identified to be contaminated water tank, and had to be kept closed for more than week. So, till a vaccine is discovered just do the basics of boiling your water to keep liver infections and cancer at bay.

GET HEPATITIS WISE

Here’s how the five types of hepatitis spread

Hepatitis A: It is caused either by eating contaminated food and drinking water or by anal oral contact during sex.

Hepatitis B: It is a sexually-transmitted disease and can be spread by contact with an infected person’s blood, semen, or other body fluid. It could involve unprotected sex, sharing drug needles, body piercing with unsterile needles, sharing toothbrush or razor with an infected person or a bite.

Hepatitis C: It is spread the same way as hepatitis B, through contact with an infected person’s blood, semen, or body fluid.

Hepatitis D: If a person is already infected by hepatitis B, then it can give rise to hepatitis D. It is spread through contact with infected blood, dirty needles, and unprotected sex with an infected person.

Hepatitis E: It is caused drinking contaminated water infected with the virus. It is usually rampant in developing countries.

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