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Radiant Pulse

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!

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Dear Readers,

We are at the cusp of winter and it is the time of the year that everyone looks forward to. However, this transitional period, is always the time for all of us to be extra careful towards our health. Earlier in the month, we had even treated many patients with respiratory complaints. Quite understandably, it could be attributed to the sudden spike in the pollution level in the national capital region.

Continuing our focus on Cancer, this issue carries two separate cases where a woman went through a breast saving surgery while an elderly gentleman with a family history of malignancies diagnosed with multiple cancers in his body underwent a successful surgery. These are the kind of stories that remind us to go for regular health-check ups. Another case that you cannot miss is the rarest of the rare case of a 7 kg tumour, the size of a watermelon which was surgically removed by our doctors to salvage the patient's Kidney and her life.

In continuation of our effort to build healthcare capacities for our esteemed international partners, we had invited team of specialists from Tanzania's National Referral Hospital, Research Centre and University Teaching Hospital to attend observership and training courses on Kidney Transplant at our hospital for a period of 3 months.

I must also mention here that we value your words of encouragement that we have been receiving for our editorial team. You can reach us at: editorial@blkhospital.com with your feedback, suggestions and inputs that you think would make this newsletter a more enjoyable read.

   
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THE CASE

Kajal had been facing problems with her right Kidney for a long period of time. She consulted few doctors who advised on the removal of her Kidney. Kajal was gaining weight rapidly over a period of 6 months and she looked like an expectant mother. It was then she visited Dr. Bhatyal (Advisor & Sr. Consultant, Urology, Andrology and Renal Transplant, BLK Centre for Renal Sciences and Kidney Transplant) who planned her surgery strategically, removing the gigantic mass and saving part of the uninvolved Kidney. The problem was more complicated than it seemed. Even the slightest injury to the abdomen might have led to heavy internal bleeding and possible death.
THE PROCEDURE

In addition to the large tumour, there were three more small tumours (AML) in the lower part of the right Kidney. Upon complete evaluation, the team decided to perform a surgery known as Partial Nephrectomy, which is a meticulous and painstaking surgical procedure for removal of such a huge vascular mass. The other three small tumours were also removed to prevent similar kind of growth in the salvaged part of the Kidney.

   

 

THE CASE

Kamlesh, a 22-year-old daily wage-worker had an accident at work. His employer and colleagues wasted no time in rushing him to a local clinic when his wrist got stuck under the sheet cutting machine and was ripped off completely. The severed part was preserved in the ice bag immediately at a nearby clinic and the patient was then referred to BLK Super Speciality Hospital for immediate surgery

THE PROCEDURE

After a very challenging 17-hours long surgery, the wrist was replanted by a team comprising of 7 experts and 2 surgeons led by Dr. Lokesh Kumar, Director & HOD, BLK Centre for Plastic & Cosmetic Surgery. The severed part had squashed arteries and nerves, the challenge was to precisely identify each and separate them. Arteries, nerves and tendons of the amputated part was fixed to the stump using K wires, which held the severed hand together in place before titanium plates were inserted to join the bones.

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Breast Conservation Surgery has been the standard of care for more than twenty years; with local control rates and overall survival being equivalent to Mastectomy. With recent advances in imaging techniques such as MR Mammography, Sentinel Node Biopsy and development of Breast Oncoplasty, the long term and cosmetic results of the procedure have improved.

THE CASE

A 46-year-old pre-menopausal female visited BLK Cancer Centre with a recently noticed lump in the left breast. On clinical examination, a 2x2 cm size well defined lump in upper outer quadrant of left breast was found with no significant palpable axillary lymphadenopathy. Upon further investigation with MR Mammography two other suspicious lesions were seen in close proximity to the main tumour. US guided biopsy of lump was infiltrating ductal carcinoma.

THE PROCEDURE

The patient was subjected to Breast Scintigraphy on the day of surgery after injecting radioactive Tc99 nano colloid in retroareolar region of left breast. Gamma scan was performed after 2.5 hours of injection; which showed uptake in two lymph nodes along anterior axillary fold. She was then shifted to the operation theatre. The sentinel lymph nodes were dissected by axillary incision, the radioactivity was confirmed using handheld gamma probe and all hot nodes were sent for frozen section examination, which revealed absence of axillary lymph node metastases. A wide local excision of breast lump was done with a surgical margin of 1 cm circumferentially. The tumour bed was marked with surgical clips to aid in Adjuvant Radiation Therapy planning. The defect created after removal of lump was reconstructed by Breast Oncoplasty with transposition and suturing of adjacent breast parenchyma into the defect.

   

 

Certain types of Cancer seem to run in some families owing to certain risk factors in common, such as smoking and obesity. But in some cases, an abnormal gene that is being passed along from generation to generation causes the Cancer. Although, this is often referred to as inherited Cancer, what is actually inherited is the abnormal gene that can lead to Cancer

THE CASE

A 62-year-old gentleman without any co-morbidities was brought to the Surgical Oncology OPD with complaints of generalised weakness. He had come for regular follow-up and evaluation for anaemia (6 gms %). He was first diagnosed as a case of Adeno Carcinoma Rectum treated in April 2008 with Neo Adjuvant Chemotherapy, Radiotherapy and Low Anterior Resection. He was diagnosed with second malignancy – Adeno Carcinoma Transverse Colon in 2011 for which he underwent surgery, received Adjuvant Chemotherapy but didn't complete the course.

He had a very significant family history of malignancies with his elder brother having Carcinoma Oesophagus at the age of 65, and younger brother having Carcinoma Stomach at the age of 56.

   
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THE CASE

A 50-year-old housewife had recently visited Orthopaediac OPD with complaint of Unicompartmental Osteoarthritis. She had good quality bones and her anatomy and alignment were well preserved. She had a painful walk and typical waddling gait due to medial joint disease. Her walking distance was significantly reduced and she had trouble doing her day-to day chores. She was too young for Total Joint Replacement as the disease was limited only to the medial compartment of the Knee.

THE PROCEDURE

Dr. Pradeep Sharma, Director & Head - Centre for Orthopaedics, Joint Reconstruction & Spine Surgery and team performed the surgery using bilateral unicompartmental oxford mobile bearing Knee. The joint was exposed through a medial parapatellar incision. The diseased condylar surfaces were excised and after adequate preparations a unicondylar femoral and tibial component were fixed.

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THE CASE

A 7 year old boy from Uzbekistan, weighing 21 kg was admitted with pain and discomfort in both lower limbs. The boy was experiencing fatiguability for a long time while walking. Transthoracic Echocardiography showed severe Coarctation of Aorta (COA) with pandiastolic spill with moderate sized outlet muscular Ventricular Septal Defect (VSD) shunting left to right.

Family was counselled regarding treatment options either surgically or by intervention methods. As patient weight was not suitable for stenting of Coarctation of Aorta so ballooning of Coarctation along with device closure of VSD was planned.

THE PROCEDURE

Procedure was done in conscious sedation. Right femoral Vein and Artery was taken and secured with 6F and 5F shorts sheaths respectively. Pre balloon COA pressure gradient was 40 mm Hg. Ballooning of COA segment was done with Tyshak II 8*40 mm followed by 10*40 mm balloons.

There was a significant step up in saturation from SVC to Pulmonary Artery. LV Angiogram was done which showed 4.9 mm outlet muscular VSD with good separation from aortic valve.
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