 |
|
|
|
Coronary
Bypass Surgery Conducted on a
Two Year Old Boy
|
|
 |
2005 - The Paediatric
and Congenital Heart Surgery Department has conducted Coronary
Bypass surgery on a two year-old boy with Kawasaki Disease.
The boy presented to the AIMS with advanced weakness of the
heart muscle. The cause of this weakness was investigated
and it was apparent that this was the result of blocks in
the child's coronary arteries, the blood vessels supplying
heart muscle. All the three major vessels of the heart were
affected. It is very unusual for a two year old child to develop
blocks in coronary arteries. On further investigations this
was found to be the late result of a disease that specifically
targets the coronary arteries of children. |
| This disease is known as Kawasaki disease.
It was first described in Japan and thought to be rare
elsewhere until it was recognized with increasing frequency
in other countries. It is still thought to be rare in
India, but this may be because of lack of awareness rather
than being truly rare. The disease has specific characteristics
and manifests initially with fever with a skin rash, redness
of the eyes (conjunctivitis), mouth and, enlargement of
lymph glands.. After careful review of medical data and
publications on this difficult condition, coronary artery
bypass surgery was advised. The team of doctors at AIMS
led by Dr. Shivaprakash, Consultant Paediatric Cardiac
Surgeon, and Dr. Satyaprasad, the noted Coronary Artery
Surgeon, offered surgical treatment.Dr. Satyaprasad and
Dr. Shivaprakash jointly led the eight-hour operation.
The other team members were Dr. Baiju S. Dharan and Dr.
Anil S. Prabhu. The anaesthesia team was lead by Dr. Jiju
John. The other team members were Mr. Pradeep, the perfusionist
and nurses Ms. Zeena and Ms. Suma |
|
 |
Orthopaedics Department Conducts
Minimally Invasive Hip Surgery
|
| March, 2005 - Less
cutting sounds like a good thing when it comes to hip
replacement. For the first time in Kerala, Minimal Incision
Hip Replacement was performed on a 30-year-old woman at
AIMS. A 9 cm incision was used rather than the standard
15 to 20 cm incision. Early mobilization and minimal postoperative
pain was achieved by using minimal invasive techniques
and specialized local anaesthetic cocktails.
Dr. Jacob Varghese, orthopaedic consultant
with the Department of Orthopaedics
who guided the Hip replacement surgery, says the patient
could walk the same day as surgery.
Worldwide, the trends are changing towards minimally
invasive surgery with the use of computer-aided techniques
in replacement surgery. The size of incision and morbidity
associated with hip replacement could be further minimized
with minimally invasive surgery using CAOS (computer
assisted orthopedic surgery). |
|
|
Baby Under 5 Kgs Supported
for Two Days with
Extra Corporeal Membrane Oxygenation
(ECMO)
|
 |
June 29, 2005
- In what could possibly be a first for both India and
Kerala, a child weighing less than five kilograms had
her circulation and respiration supported for over 2 days
after complex congenital heart surgery followed by a full
recovery.
The 4.9 kg female child underwent complex open heart
surgery on 1/6/05. After an uneventful surgery, the
child was transferred to the ICU in a stable condition.
Twelve hours postoperatively, she developed severe left
ventricular dysfunction, (heart failure) and a near
cardiac arrest on two occasions, the cause of which
was not clear. The only hope for this child after all
resuscitative measures failed, was mechanical circulatory
support by a technique called Extra Corporeal
Membrane Oxygenation (ECMO).
|
| Although ECMO is fairly commonplace
in the western countries, the prohibitive cost of the
materials, maintenance of support, paucity of trained
personnel and ready availability of the hardware suitable
for a small baby such as this one, has prevented its widespread
use in India. A few centers in Delhi, Chennai and Bangalore
have earlier attempted to salvage patients after cardiac
surgery with this technique, though unsuccessfully.
What makes the case unique is that it is the first
time that a baby below 5 kgs has had its heart and lungs
artificially supported successfully for more than 2
days, followed by full recovery. This form of support
is most gratifying in reversible ventricular dysfunctions
as it can save lives. It involves close coordination
amongst Cardiology, Cardiac Surgical, Anesthesia and
Perfusion teams. The Paediatric
and Congenital Heart Surgical
team was led by Dr. Suresh G. Rao,
Cardiac Anesthesia by Dr. Jiju John
and the perfusion was handled by Mr. Isaac Ramesh
Kumar and Mr. Pradeep Pillai,
Chief Perfusionist and Senior Perfusionist respectively
at AIMS.
|
|
|
Diabetic Mother Using Insulin
Pump Therapy
Gives Birth to Healthy Baby
|
 |
January, 2005
- It was a moment of pride for the AIMS medical team when
a healthy baby girl was born to a 34-year-old, Type I
diabetic patient who has been using an insulin-pump during
her pregnancy to keep her blood glucose levels stable.
This birth is most likely the first of its kind in India.
The baby is absolutely fine and so is the mother.
The Trivandrum woman was admitted to AIMS when she
lost her first baby due to uncontrolled levels of blood
glucose because of her diabetes. Using Medtronic's Continuous
Glucose Monitoring System (CGMS), the treating
doctors obtained a complete blood glucose profile of
the patient. Based on that information the diabetes
team decided that a safe delivery was possible only
if her blood glucose level were brought under control.
|
| Dr. Vasantha Nair of
the Endocrinology Department commented,
"We then decided to use insulin pump therapy
because normal insulin injections failed to control the
level of blood glucose." Consequently, the
patient was wearing the insulin pump during the duration
of her pregnancy thus helping a normal delivery without
further complications. Dr. Harish Kumar,
Head of Department of Endocrinology,
mentioned, "We designed the successful procedure
with the help of a complete team of doctors like
Dr. Vasantha Nair and Dr.
A G. Unnikrishnan from
the Department of Endocrinology,
Dr. Usha from Gynecology,
and Dr. Rajeev
from Neonatology. New technology
and teamwork across the departments of the hospital
made it possible for this young lady to have her healthy
baby." |
| Insulin
Pump Therapy - An external insulin pump
is a pager-sized, battery-operated device that can be
worn on a patient's belt or hidden beneath a layer of
clothing. It delivers fast-acting insulin from a reservoir
inside the pump to the body through a tiny plastic tube,
called an infusion set. Patients typically change their
reservoirs and infusion sets every two-to-three days.
An insulin pump automatically delivers a constant rate
of insulin around the clock, much like a healthy pancreas.
Users can easily start and stop insulin delivery upon
demand, unlike injection therapy. |
 |
| Diabetes and its
Implications |
Diabetes is reaching epidemic proportions.
The International Diabetes Federation (IDF) estimates
that more than 194 million people have diabetes worldwide.
Moreover, the World Health Organization (WHO) expects
the number of diabetes cases to reach 366 million worldwide
and nearly 80 million in India by 2030. Diabetes occurs
when the pancreas does not produce insulin (Type I diabetes),
or when the pancreas produces insulin, but it is resisted
by the body (Type II diabetes). Insulin is a hormone
that is needed to move glucose from the bloodstream
into the body's cells where it is converted into energy.
Type I develops most frequently in children and adolescents
and may account for 5 - 10 % of all diagnosed cases
of diabetes. The average life expectancy of people with
diabetes averages 10 to 15 years less than that of the
general population. For many insulin-dependent patients,
managing diabetes is difficult without the use of an
insulin pump and frequent blood glucose monitoring. |
|
|
| |
|
