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| Cancer Survivors Meet - 2004
Report |
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It
was a celebration of new life. Overcoming fears, it was a
celebration of beginning new lives when they came together
and shared their experiences...
18 December, 2004 -The Amrita Cancer Institute
conducted the Cancer Survivors Meet - 2004
on the 18th of December. The meet was led by Dr. T.
K Padmanabhan, Dr. D. K. Vijaykumar,
Dr. Moni Abraham Kuriakose, and Dr.
M. Dinesh of the Cancer Institute.
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Acclaimed cine artist, Mr.
Suresh Gopi, known for his compassion in societal
challenges, inaugurated the function accompanied by
Sampooja Swami Poornamritanandapuri,
who blessed those in attendance with his holy presence
and message. There was also a group music programme,
"Madhura Smrithi" conducted by music director
Mr. A. Ramachandran and his disciples,
followed by variety entertainment by the Medical College
students.
It was a first-of-its-kind opportunity to share the
emotional bonds and supports for individuals who have
recovered from cancer, and also for those who have been
newly diagnosed. It was a heartfelt moment where those
who have lived with, through and beyond the experience
of having cancer were able to communicate the message
of hope and help others who are still struggling to
face their destiny.
Those attending listened to very honest and personal
discussions of the fears, concerns and issues faced
by each of the cancer survivors. They described the
impact that cancer has had on their lives and their
loved ones; their outlooks on the future and life in
general; as well as the support and comfort that they
have received in lessening the impact of these fears.
Sophie Jose, who was a breast cancer
patient, in thanking all the doctors of Amrita Institute
of Medical Sciences for giving her a life of new hopes
and colors, said:
"It was such
a shock when I came to know that I was having cancer.
But I didn't give up hope; I took the steps to take
care of myself. I had the extra caring and tremendous
support from the doctors of AIMS. I wanted to live,
and that's why I am living still now. Just to keep the
faith and keep hope, and not let anybody take your hope
away."
In the words of Rajesh, who is coming
out of fears of throat cancer:
"I really felt
shattered when I realized I was having cancer. My life
was just to begin and the shadow of this disease made
it utterly colorless. But slowly I began to examine
myself from the inside out. The support of family and
friends, prayer and the realization that my disease
was deeper on the inside than the outside, all combined
to strengthen my spirit and belief. I decided to go
to Amrita Institute, which I have heard is the best
among the cancer research institutes that offers hope
and support for patients and their families. While undergoing
the treatment, I began to feel better about myself.
Now I remain free of cancer, and my disease taught me
life's most important lesson that diseases are what
makes someone wise; and what makes you realize how precious
and valuable life really is."
One could sense the hard times he went through, and
feel his strong will to face this challenge.
Then there was Mr. Sugathan, who had
casinoma larnyx. He had been suffering major voice problems
due to a growth in his vocal chord. He had undergone
a radiation treatment, which was not the complete cure.
The doctors at AIMS decided to do another surgery as
he had voice related problems even after the radiation.
The doctors removed his voice box, then did a speech
valve surgery that gave him a new life. Now he is out
of the danger of cancer and he is able to speak, too.
"I have got
a new life, new breath, and a new voice. I am obliged
to the AIMS Cancer Institute and doctors, who appeared
before my destiny as a helping hand from God".
The Cancer Institute of Amrita Institute of Medical
Sciences is dedicated to provide the highest quality
of cancer care with compassion, in a modern, serene
and respectful environment, with a wide range of experts
in all disciplines related to cancer. |
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| Head & Neck Institute Gives
Yan Zhen a New Face |
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| Yan Zhen before her surgeries
at AIMS |
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A team from the Head and
Neck Institute led by Dr. Moni Abraham Kuriakose and Dr.
Subramanya Iyer performed four surgeries. They filled
the hollow of her face, outlined her eyebrow and attached
a fibre to the corner of her mouth to make her smile symmetrical.
The highlight of the procedure was the reconstruction
of the eye, complete with new upper and lower eyelids
and eyelashes. The man behind Yan's new pair of eyes was
Dr. Jijo Paul. "We had to redo the creation of eye-socket
procedure a couple of times to get back to a normal shape,"
said Dr. Mony Abraham Kuriakose. |
| Dr. Sherry Peter, Dr. Mohit
Sharma and Dr. Sasidharan were also part of the medical
team from the Head and Neck Institute. During her six
months stay in Cochin, AIMS provided Ellen and her mother
with lodging facilities. Ellen is now free of tumour as
well as the stigma associated with facial disfigurement.
Yan Zhen, who once aspired to be a model, hopes to get
her former job in a hotel. She should; the winner that
she is - against the odds. |
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| Yan Zhen after her surgeries
at AIMS |
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Complex Open Heart Surgery
on Two Day-Old Baby
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July, 2004
-In what could be one of the youngest children to undergo
complex open heart surgery in India, a one day old baby
was referred to AIMS on 8th of July, 2004 from a local
hospital for evaluation of suspected, complex congenital
heart disease.
The baby was diagnosed by an emergency echocardiogram
to have an obstructed infracardiac total anomalous venous
connection. This called for emergency open heart surgery
for the survival of the baby.
The Division of Pediatric and
Congenital Heart Surgery successfully carried
out the open heart surgery on the 2nd day of life of
this baby who weighed 3kgs at birth. The surgical team
was led by Dr. Suresh G. Rao, Chief
Paediatric and Congenital Heart Surgeon. Other members
included Dr. K. Shivaprakasha, Consultant
Paediatric & CH Surgeon, and Drs. Sajan
Koshy, Girish Warrier and
Baiju S. Dharan.
The child had an uneventful post operative recovery
and was discharged on 26th July, 2004. |
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Another Milestone for AIMS
in Newborn Heart Surgery
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July, 2004 -The
Paediatric CVTS Division of the Department
of Cardiovascular and Thoracic Surgery, has added
another feather to its cap by crossing the milestone of
performing more than 100 ‘Arterial Switch’
open heart surgeries on newborns having ‘Transposition
of Great Arteries’ (TGA), with a 90% success
rate.
Surgical correction of complex heart defects in the
newborn age group is an undertaking needing extraordinary
surgical skill and teamwork. TGA is essentially a complex
heart defect where the origin of the vessels to the
lungs and body are reversed, leaving blue blood circulating
in the body with red (pure) blood going back to the
lungs instead of the body. This circulation is incompatible
with life after birth, and the newborn baby needs a
procedure termed ‘Balloon Atrial Septostomy’
(BAS) immediately after birth. To achieve best long
term results and correct the connections between the
respective ventricles and blood vessels, an Arterial
Switch Operation needs to be performed before 3 weeks
of age, failing which the ventricle connected to the
lungs will start to thin out.
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This open heart surgery corrects the
ventricle and vessel connection and also transfers the
delicate coronary arteries to their normal vessel of origin.
In addition it also allows correction of associated defects
such as a ‘hole in the heart’ which is commonly
found.
As the heart defect is totally corrected, the baby is
expected to have a normal life thereafter, and the 30
year worldwide experience currently available appears
very satisfying.
This complex open heart surgery in a newborn needs
coordination, skill and excellence in postoperative
care of the highest degree from Neonatologists, Paediatric
Cardiologists, Cardiac Anaesthesiologists, Paediatric
Cardiac Surgeons, Perfusionists, and Physiotherapists,
with high calibre paediatric cardiac nursing care in
the post operative period.
In a short span of 6 years AIMS has emerged as one
of the four major centres in India doing this type of
surgery successfully in newborns in large numbers. The
other centres are located outside Kerala in New Delhi,
Chennai and Bangalore. Internationally referred newborn
babies to AIMS for arterial switch surgery from neighbouring
countries like Maldives, and Middle east have also benefited
from this experience.
The surgeries were carried out by Dr. Suresh
G. Rao, Chief Paediatric Cardiac Surgeon AIMS,
and Dr. K. Shivaprakasha, Consultant
Paediatric Cardiac Surgeon, assisted by cardiac surgeons,
Drs. Sajan Koshy, Girish Warrier
and Baiju Dharan. The initial stabilization
by balloon atrial septostomy was done by Dr.
R. Krishnakumar, Chief Paediatric Cardiologist
and his team. Dr. Suresh G. Nair, Chief
Cardiac Anaesthesiologist, and Drs. Suresh Chengode,
Jiju John and Abraham Cherian
were the Cardiac Anaesthesiologists involved in the
anaesthetic care of these newborn babies. |
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| Kerala's First Liver Transplant |
RAMDAS AFTER
LIVER TRANSPLANTATION |
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July, 2004
-The Digestive Diseases Department
at AIMS performed the first liver transplantation and
multi-organ harvesting in Kerala. The surgery was carried
out on the late night of 27th June and proceeded well
into the early morning of the 28th.
The donor was a 62 year old retired engineer who had
suffered head injuries and consequent brain death in
a road traffic accident. His family was magnanimous
enough to offer his liver and kidneys for organ donation,
despite it being the occasion of their greatest grief
and distress.
The patient, Mr. Ramdas, a 33 year old male was admitted
in a critical condition with end stage liver disease
due to cirrhosis resulting from viral hepatitis and
was on a steady downhill course. His relatives were
informed that without a liver transplant, his chance
of survival was low. When the donor family had agreed
to donate the liver, Ramdas and family were eager for
the liver transplant.
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| The AIMS transplantation
team worked in close co-ordination with SORT (Society
for Organ Retrieval and Transplantation - a network
of hospitals in Kochi to share organs from willing donors).
The organ harvesting and liver transplantation was
carried out by a large surgical team headed by Dr. Sudhindran
of the Vascular and Transplant
Surgery Unit and comprised the entire GI surgical
team. The donor surgery was completed in around three
and a half hours whilst the recipient surgery was finished
in 7 hours. |
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| Ramdas fortunately made a dramatic improvement
and is currently doing well in the postoperative recovery
ward. The initial phase of his treatment is over and his
body seems to have accepted the new liver without any
attempt at rejection.
The kidneys of the donor were harvested simultaneously
as well. One kidney was transplanted to a patient in
AIMS itself by a team headed by Dr. Sanjay Bhat of the
Urology Department. The
other kidney was transferred to PVS hospital Kochi for
transplantation to another matching recipient through
the endeavors of SORT. This inter-hospital transfer
of organs took place for the first time in Kerala and
will hopefully be a commencement to many more such accomplishments
and thereby bring hope to large number of similar unfortunate
sufferers.
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| Long-Term Outlook -
The GI and Transplantation team at AIMS had all the infrastructure
and trained manpower for liver transplantation for the
last three years or so. There were more than 10 patients
waiting for a new liver. The major hurdle in achieving
this landmark was the lack of availability of organs.
In the India the concept of brain death and organ donation
is yet to take root. Many a times we find that a consent
that is given by the younger generation is withdrawn at
the last moment by one of the older relatives. The only
way to overcome the paucity of donor organs that we face
now will be to promote and educate the populace about
brain death in general and multiple organ donation in
particular. |
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| Nuclear Medicine Utilises Gamma
Probe |
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| Tongue cancer patient receiving
radioactive injection prior to surgery |
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February, 2004 -
The Nuclear Medicine Department has recently been equipped
with a sophisticated new, hand held, cordless, miniature
gamma camera instrument called a Gamma Probe. Very few
nuclear medicine centres in India are equipped with this
instrument, which is manufactured in Germany. The Gamma
Probe is particularly useful during cancer surgeries by
onco surgeons and Head and Neck surgeons, and endocrine
surgeons for breast, head and neck, thyroid, vulval and
penile cancers, melanoma and also in parathyroid tumours.
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The advantages of using
this instrument during these surgeries are:
- accurate localisation of tumour/lymph nodes
- minimising skin incisions
- intra-operative time
- reducing blood loss
- ensuring complete removal of tumour
- minimising in-hospital stay
- increasing patient compliance and comfort.
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| Sentinel node being
marked on the skin surface using Gamma Camera |
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| Basic Principle of the
Technique |
| Lymph node being localized
using Gamma Probe during surgery |
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Just prior to surgery, lympho
scintigraphy imaging is performed where minute amounts
of radioactive colloids are injected to the patient and
the lymphatic drainage pattern is studied using a Gamma
Camera. Subsequently the first draining lymph node is
identified called the sentinel lymph node, which will
most likely be the first to be affected by metastasis.
A negative sentinel node makes it highly unlikely that
other nodes are involved in that region.
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| During surgery using the
Gamma Probe, this sentinel node is identified, excised
and sent for biopsy (frozen section). The test confirms
either the presence or absence of cancer in the sample
and is performed before completion of the surgery enabling
the surgeon to decide whether to do more extensive, mutilating
lymph node removal. This represents a significant advantage
as a minimally invasive procedure, considering that after
surgery, about 70% of patients are found to be free from
metastatic disease. The success rate of radioguidance
in localizing the sentinel lymph nodes in cancer surgery
is about 94 - 97%. |
| Radioactivity in the excised
lymph node being confirmed after surgery |
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| For localizing parathyroid tumours,
the principle for gamma probe surgeries is different.
A Technetium Sestamibi scan is conducted to confirm the
presence of the tumour, looking for ectopic parathyroid
adenomas. Pre-operatively the skin overlying this neck
tumour is marked so that surgeon incises just above the
tumour site, minimizing the size of incisions. Successful
complete excision of tumour is ensured once again with
a gamma probe .It also screens the entire neck for presence
of other unidentified tumours by way of imaging.
This Gamma probe radio guided surgeries are extensively
used in US and European hospitals with proven efficacy.
The Department of Nuclear Medicine offers this new,
exclusive and immensely beneficial facility to our patients
in association with onco surgeons, head and neck surgeons
and endocrine surgeons at AIMS. |
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