nanavati · 2020-01-18 · blk super speciality hospital pusa road, new delhi-110005 (india)...

BLK Super Speciality HospitalPusa Road, New Delhi-110005 (India)

24-Hour Helpline: 011- 3040 3040 Email- [email protected]

www.blkhospital.com

Nanavati Super Speciality HospitalSwami Vivekanand Road, Vile Parle West,Mumbai, Maharashtra- 400 05624-Hour Helpline: +91-22-26267500www.nanavatihospital.org

Nanavati

Radiant

PULSEAUGUST 2017 | ISSUE 17

TOO HOT TO HANDLEA burger eating competition gone wrong

FREEDOM OF MOBILITY RESTOREDTaking care of a doctor’s dilemma by removing paralabral cyst of shoulder

Radiant Life Care | Newsletter

03Radiant Life CareBLK, New Delhi | Nanavati, Mumbai

Naresh KapoorExecutive DirectorRadiant Life Care

FROM THE ED’S DESK

Dear Readers,

Challenging cases, engagement programmes, newer collaborations, the month of July was replete with many activities for both the hospitals in Delhi and Mumbai.

The cover story, this month is about a case where doctors at BLK displayed quick decision making to save the life of a young man, who had burnt the inner lining of his stomach while eating chilly burgers in a contest. There is also this story about an elderly lady who underwent Hypertrophic Obstructive Cardiomyopathy which is a high risk surgery demanding acute precision.

Apart from these intriguing cases from BLK, we also have some remarkable stories from the team of doctors at Nanavati, our group hospital in Mumbai. The case of a young doctor dealing with pain and weakness because of a paralabral cyst on his shoulder with nerve compression or the challenging case of a 32 year old pregnant lady diagnosed with Peripartum Cardiomyopathy, all add to our growing repertoire of ‘medical marvels.’

As a group, it is an ongoing progression for us to increase our footprint both in India as well as overseas. In continuation with our vision, we have entered into yet another strategic agreement with three different agencies of Republic of Sudan. The agreement aims to promote cooperation, mutual understanding between our two countries with an aim to develop educational, scientifi c and medical cooperation for excellence through knowledge, skills transfer and capacity building.

We have always been at the forefront of adopting new technology and techniques in all our programs and very recently, we have been lauded for our Cost Management Programme, fetching us the much -coveted ‘National Award for Excellence in Cost Management,’ by Institute of Cost Accountants of India. Such recognition of our efforts, surely makes our achievements more meaningful.

We would again like to thank all of you who have supported us through your valuable articles and feedbacks. If we haven’t featured your submitted articles, please bear with us and wait for us to bring them out in our subsequent issues.

You can connect with us at [email protected] for anything with respect to your newsletter Pulse.

Stay Healthy, Stay Happy!

EDITOR-IN-CHIEF PARUL CHHABRA

CREATIVE CONCEPT

PARUL CHHABRASHIKHA GIRGLA

SUNIL KUMAR

DESIGN & VISUALISATION

SUNIL KUMAR

CONTENT SHIKHA GIRGLA MAMTA SINGH

Nanavati Super Speciality HospitalMumbai, Editorial Team

AVANTI PAWAR

PRAJAKTI SHIRSEKAR

SHYAM SHIRSEKAR

C O N T E N T S

SMALL INCISION, BIG CUREby Dr. Prashant Jain

4

TOO HOT TO HANDLEby Dr. Deep Goel& Dr. Yogesh Batra

6-7

FREEDOM OF MOBILITY RESTOREDby Dr. Prasad Bhagunde

9

RECLAIMING THE LIMBSby Dr. Haresh Manglani

11

BLK & NANAVATI IN NEWS

14-15

COMING OUT OF DANGERby Dr. Abdul Samad Ansari& Dr. Rajendra M. Saraogi

5

RISKY BUT NOT IMPOSSIBLEby Dr. Sushant Srivastava

8

A SINGLE AND SIMPLE SOLUTIONby Dr. Poonam Khera

& Dr. Kanika Garg

10

EVENTS AND ACTIVITIES

12-13

August 2017



Dr. Abdul Samad AnsariDirectorCritical Care ServicesNanavati Super SpecialityHospital, Mumbai

Dr. Rajendra M. SaraogiConsultant- Obstetrician & GynaecologistGynaecology & ObstetricsNanavati Super SpecialityHospital, Mumbai

Coming Out of DangerSmall Incision, Big CureReaping Dividends of Advancement in Paediatric Thoracoscopy

Dealing with a tricky case of Peripartum Cardiomyopathy

THE CASE A two-year old boy was admitted in BLK Super Speciality Hospital with complaints of intermittent cough for about a month which had intensifi ed in the past 3 days. The boy was not responding well to medical treatment. He also developed abnormal sounds (stridor) while breathing, suggestive of some severe form of obstruction in the large airway.

The child was previously diagnosed as a case of cystic lesion in the mediastinum during antenatal scans. The child after birth was asymptomatic and was hence under regular observation and follow-up.

On examination by the doctors at BLK, the boy was symptomatic with features suggestive of tracheal obstruction. MRI chest was done which revealed a well-defi ned cystic lesion in the posterior mediastinum insinuating between the trachea-esophageal groove of size 5.5 cm x 4 cm. The cyst had increased by almost 5 times from the previously known size and was causing compression over the trachea.

THE PROCEDUREPreparation was made for Thoracoscopic Excision of the cyst. This is the procedure in which a surgeon views inside the chest cavity and dissects the lesion through a key-hole incision. The challenge was to separate the cyst from vital structures in the chest. Although, it is technically a very challenging procedure in small chests, if performed skillfully, it can prevent signifi cant morbidity of an open surgery. The high resolution cameras help the surgeon to dissect the lesion without injuring the vital structure. The procedure is not only challenging for the surgeon but also for the anaesthetist. During the procedure, the carbondioxide gas is insuffl ated inside the chest cavity, causing a rise in the gas levels in the patient’s blood which can be fatal. A close monitoring is required for the patient’s safety.

The cyst was excised completely after separating it carefully from the windpipe and the foodpipe, with the help of Thoracoscopic procedure. THE RESULTThe child was discharged after 48 hours of surgery. Histopathology confi rmed the diagnosis of bronchogenic cyst. Due to availability of high resolution cameras and advancements in very fi ne miniature instruments designed exclusively for paediatric minimal access surgery, paediatric surgeons can also perform many such complex procedures safely and skillfully.

Dr. Prashant Jain

Sr. ConsultantPaediatric SurgeryBLK Centre of Neonatal,Paediatric & AdolescentMedicineBLK Super SpecialityHospital, New Delhi

THE CASE

A 32-year old pregnant lady with 39 weeks of gestation was admitted in Nanavati Super Speciality Hospital while experiencing sudden onset of breathlessness and dry cough. The patient was a known case of Hepatitis B and Hypothyroidism. On arrival in the hospital, the patient was in acute hypoxic cardio-respiratory failure with LVEF-25%, pulmonary edema, mixed acidosis and positive cardiac markers.

THE PROCEDURE

The patient was intubated and taken up for emergency caesarean section in view of foetal distress. Post operatively, her overall condition deteriorated with increase in metabolic lactic acidosis, increased pulmonary edema and low urine output. She was then supported with diuretic drip and bicarbonate infusion. But eventually she developed profound hypotension, vaginal bleed and experienced a drop in haemoglobin from 14% to 7% gm.

Her blood pressure was very low for which she was started on medication to maintain a good perfusion to all the organs. On future investigation, it was seen that there were multiple blood clots in both the lower limbs suggestive of DVT (Deep Vein Thrombosis). As her blood pressure was on lower side and her kidney function was also deteriorating, she was started on dialysis support. Her per vaginal bleeding was controlled by medicines.

Post-surgery, the major clinical dilemma was to continue blood thinners in the face of ongoing bleeding and recent surgery. Over the next 48 hours, her blood pressure and her urine output started improving, hence, the dialysis support and blood pressure medications could be lowered. Appropriate antibiotics were continued and her CT scan suggested higher chances of pulmonary embolism (clot in the lungs).

THE RESULT

Repeat blood tests revealed controlled infection and the patient was discharged on supportive medications and regular follow-up.

MRI scan of the chest showing the cystic lesion

The removed cyst

Thoracoscopic view of cyst

August 2017


Radiant Life Care | Newsletter August 2017

“It was a challenging case for the team, but

our quick decision making in the nick of

time helped the patient to pull through.”

− Dr. Yogesh Batra

“If he hadn’t been brought to the

hospital in time, the boy would have been in a critical state.”

− Dr. Deep Goel

Too Hot To HandleA boy saved from chilli-induced internal bleeding

Dr. Deep Goel

Director & Sr. Consultant Surgical Gastroenterology, Minimal Access & Bariatric BLK Centre for Digestive & Liver DiseasesBLK Super Speciality Hospital, New Delhi

Dr. Yogesh Batra

Director & Sr. ConsultantGastroenterology BLK Centre for Digestive & Liver DiseasesBLK Super Speciality Hospital, New Delhi

THE CASEA student of a prominent university in Delhi took part in a chilli burger eating competition. The competition was organised by the young friends of the student in a restaurant in West Delhi. The task was to eat maximum chilli burgers. The winner stood to get free burgers for the following two months. The student took the challenge, beating sweat and the burning sensation in his stomach. He fi nished fi ve of the so-called double-decker chilli burgers, and won the competition. Not long after, within minutes he developed abdominal pain and started vomiting blood.

He was rushed to BLK Super Speciality Hospital where the doctors found that the chilli consumed by him had burnt the inner lining of his stomach leading to heavy bleeding inside. His friends and parents who brought him to the hospital explained what had transpired to the doctors.

The patient was experiencing pain in the abdomen and was vomiting blood. He was suffering from Hypotension and Tachycardia on admission. Endoscopy of the stomach revealed heavy bleeding. Chilli has chemicals that damage the protective inner lining of the stomach leading to bleeding inside. More than 800 millilitres of blood had collected inside the patient’s stomach.

THE PROCEDURE

A close examination of the stomach showed ulcers. There was perforation and bleeding inside the stomach. Endoscopy clipping was done to control the bleeding and seal the micro perforation. His haemoglobin count was 7.4, hence blood was transfused. THE RESULT

Post procedure, the condition of the patient was stable. He started eating from the third day and was discharged on the fourth post procedure day. Patient was doing well afterwards. DISCUSSION

Every person has a different tolerance level or sensitivity to chilli. The damage to the stomach depends on the quality and quantity of the chilli. But the key takeaway is that one should not consume more than what one can tolerate. One should stop eating chilli when it causes discomfort or intolerable burning sensation. There are reported cases of death due to excessive consumption of chilli. The cause of death is usually respiratory failure i.e. gastric fl uids getting into the respiratory tract. Vomiting several times as an after effect of chilli consumption can result in fl uids getting into the windpipe. It is possible that gastric fl uids or vomit aspirates into the windpipe of the patient, causing him or her to choke to death.



MRI scan showing the Paralabral Cyst

Dr. Sushant Srivastava

Director & Sr. ConsultantCardiothoracic & Vascular Surgery, BLK Heart CentreBLK Super SpecialityHospital, New Delhi

THE CASEA 34-year old doctor was suffering from shoulder movement disorder. He was also continuously feeling weak around his shoulder area. After multiple consultations at various hospitals, he fi nally visited Nanavati Super Speciality Hospital. A detailed study of the MRI was also done after he was brought to the hospital. The MRI showed Paralabral Cyst in posterior glenoid (3/3 cm) with compression of supra scapular nerve and eventual weakness of cuff muscle (infra spinatus). External rotation was absent and he was unable to do any overhead activities.

THE PROCEDUREThe pathology was not easily accessible by open approach. The doctors decided to employ a unique technique to reach the cyst. Following Shoulder Arthroscopy, a surgical division was made between the posterior labrum and glenoid bone and dissection was carried out further medial. The cyst was then reached with blind approach and drained. To prevent further cyst formation, the gap was sealed with labral repair using suture anchors.

THE RESULTFollowing 3 weeks of splinting, the young doctor underwent supervised physiotherapy in the hospital. Three months post operative, he has achieved complete range of motion and full strength of cuff muscles.

Dr. Prasad Bhagunde

Sr. Consultant- Orthopaedics Nanavati Super SpecialityHospital, Mumbai

Freedom of Mobility RestoredTaking care of a doctor’s dilemma by removing Paralabral Cyst of shoulder

Hypertrophic Obstructive Cardiomyopathy is a serious condition in which there is progressive left ventricular outfl ow obstruction due to assymetrical hypertrophy of the interventricular septum. Abnormal movement of the anterior mitral valve leafl et when the ventricle is ejecting can increase the gradient. These patients are prone to ventricular arrhythmias and sudden death is also reported in certain cases. Treatment is medical, catheter-based septal ablation or surgical resection.

THE CASEA 62-year old lady was admitted in BLK Super Speciality Hospital with progressive Angina on exertion for six months. She underwent trans-thoracic and transesophageal ECHO which revealed Asymmetrical Septal Hypertrophy with a narrowed left ventricular outfl ow, a calcifi ed aortic valve with signifi cant aortic stenosis and regurgitation. The total gradient across the LVOT and aortic valve was 70mm Hg. Coronary Angiography was normal.

THE PROCEDUREA decision to operate upon the patient was made. She was counselled about the risk involved. The operation was conducted through a median sternotomy. The patient was placed on cardio pulmonary bypass. The aorta was opened obliquely and the diseased aortic valve was excised. The hypertrophied septum was seen bulging into the LV outfl ow tract.

A No. 15 blade was carefully inserted into the septum underneath the right coronary sinus end, advanced 2.5 cm towards the apex. A parallel incision was made 1 cm apart and the hypertrophic myocardium was resected. The LVOT opened up well, aortic valve replacement was done with a No. 18 ATS prosthetic valve. Weaning from bypass was uneventful and the post-operative gradient by TEE dropped to 24 mmHg.

THE RESULTThe operation was successful with the desired outcome. The recovery process was uneventful and the patient was discharged after proper observation.

Surgery for Hypertrophic Obstructive Cardiomyopathy is demanding and requires precision. Post operatively, a small risk of ventricular arrhythmias persists hence, the patient is advised to be on beta blockers. Symptomatic improvement is dramatic and the risk declines progressively.

Risky But Not ImpossibleSurgery for Hypertrophic Obstructive Cardiomyopathy

ECHO showing the Asymmetrical Septal

Hypertrophy

Cyst decompression Posterior labral repair with suture anchor



August 2017

Dr. Haresh Manglani

Sr. Consultant Ortho − OncologistNanavati Super Speciality Hospital, Mumbai

Uterine Fibroids are one of the most common tumours found in women of the reproductive age group. Parasitic or wandering fi broids are very rare type of Uterine Fibroids. Due to its rarity, atypical clinical presentation and unusual location, it becomes challenging to reach correct diagnosis pre-operatively. Recently, incidence of secondary parasitic leiomyomas has increased as a complication of Laparoscopic Myomectomy and Morcellation.

THE CASEA 35-year old unmarried female got admitted in BLK Super Speciality Hospital with complaints of abdomen pain and generalised weakness for 3 days. CT abdomen revealed multiple solid, non-necotic intraperitoneal masses with small bowel obstruction. The patient’sCA- 125 was 14.7. Cytology from the mass revealed reactive mesothelial cells and trucut biopsy of intraperitoneal mass in RIF region revealed leiomyoma. The patient had a history of Laparoscopic Myomectomy with Morcellation a few years back.

THE PROCEDUREThe patient was taken up for Exploratory Laparotomy. Multiple parasitic fi broids (13 in number) in relation with the bowel, mysentery and parietal wall of variable sizes from 1 cm to 8 cm were carefully removed by the Gastrointestinal Surgery team. Excision of fi brous band from parietal wall of jejunum was also done. The whole gut loops was examined to exclude any small fi broid. The uterus was enlarged to 16-18 weeks due to multiple fi broids. 11 fi broids of variable sizes (1 cm to 6 cm), both intramural and subserosal were removed from the uterus.

THE RESULTThe post-operative period was uneventful. She was discharged on normal diet and regular bowel movements.

Thus, the key to appropiate management lies in keeping parasitic fi broids in mind as there are differential diagnosis of abdominopelvic masses in females, especially with a history of Laparoscopic Myomectomy.

THE CASE

A 18-year old boy diagnosed with Osteosarcoma of right lower femur was referred from Kolkata to Nanavati Super Speciality Hospital in Mumbai for medical management and further treatment.

THE PROCEDURE

Upon admission in Nanavati Hospital, a needle biopsy was done which revealed intermediate Grade 2 Osteosarcoma. He was given 3 cycles of Chemotherapy before surgery. This comprised of medication for 3 days followed by a 21 day medicine free period. After Chemotherapy is instituted, a waiting period of 21 days was maintained for the WBC count to return to normal, which drops during Chemotherapy. After the waiting period got over, the second cycle of Chemotherapy was administered. During this time, the patient was counselled for surgery, the risk involved and the fi nancial implications.

After 3 cycles of Chemotherapy, which was around 60-65 days, the surgeon removed the tumour with safe margins all around it(en bloc resection) following the oncology principles. Once the defects were reconstructed, the soft tissue closures were shaped and the patient was sent back for physiotherapy. The tumour that is resected was assessed for the completeness of resection and also the onset of necrosis resulting from Chemotherapy.

THE RESULT

After the surgery and physiotherapy session, the patient experienced almost full range of fl exion. He is now able to return to his full functional capacity and has the ability to squat on fl oor even after a major length resection (19 cms). The patient is comfortable, sits on the fl oor, and has resumed all his normal activities.

DISCUSSION

Carcinoma of limbs which was treated very dismally in the past is being treated very well now. Patients have moved on from the place of seclusion to a life full of function. They are socially active, have resumed their jobs and live a normal life. With regular follow-up and Chemotherapy sessions, almost 70% patients when diagnosed early with Osteosarcoma have high (10-year disease free) survival rate. With Chemotherapy advancements, outcomes have improved in the last 15-20 years.

A Single and Simple Solution Reclaiming the LimbsA rare case of multiple parasitic fi broids Successful treatment of Grade 2 Osteosarcoma in

a young boy

Dr. Poonam KheraSr. Consultant Gynaecology & ObstetricsBLK Super SpecialityHospital, New Delhi

Dr. Kanika Garg Attending Consultant Gynaecology & ObstetricsBLK Super SpecialityHospital, New Delhi

X- ray of the patient showing post-operative function – the patient has almost full range

of fl exion

MRI showing sarcoma of the lower femur

Parasitic & Uterine Fibroids

Supported by:

Dr. V. P. BhallaDirector Dr. Deep GoelSr. Consultant & Director

Surgical Gastroenterology, Minimal Access & BariatricBLK Centre for Digestive & Liver DiseasesBLK Super Speciality Hospital, New Delhi


EVENTS AND ACTIVITIES

CME on Joint Replacement, Spine Surgery & Imaging

From Left: Nurse of the Month − Ms. Lalita Rani (Ward Incharge-Nursing), Doctor of the Month − Dr. Gagan Anand (Clinical Associate-Internal Medicine), Mr. Naresh Kapoor (Executive Director), Contractual Worker of the Month − Mr. Deepak Kumar (Steward-Ujjawal Enterprises-F&B), GDA of the Month − Mr. Sanjay (Shine & Standard), Employee of the Month − Ms. Pooja Mahajan (Senior Dietician).

On 1st July, 2017 Nanavati Super Speciality Hospital celebrated World Doctor’s Day by honouring the doctors for their contribution. Dr. Rajendra Patankar – COO took the opportunity to express gratitude towards the doctors on behalf of the Management, for their compassion, medical knowledge and providing such excellent care to the patients.

National Award for Excellence in Cost Management Ms. Latesh Sen, GM − Costing and Business Anlaysis, Radiant Life Care and her team with Mr. Naresh Kapoor, Executive Director, BLK Super Speciality Hospital holding the ‘National Award for Excellence in Cost Management.”

Nanavati Super Speciality Hospital organised a CME on Orthopaedics, Spine Surgery & Imaging on 26th July, 2017 wherein lectures were conducted for doctors of ‘General Practitioners Association’ by Dr. Prof. Pradeep Bhosale – Director, Arthritis & Joint Replacement Surgery, Dr. Mihir Bapat – Director, Nanavati Institute of Spine Surgery and Dr. Deepak Patkar – Director, Medical Services & Head − Radiology.

Nanavati Celebrates World Doctor’s Day

Awards & Accolades

BLK Super Speciality Hospital has signed Memoranda of Understanding with three different agencies of Republic of Sudan with the broader aim to promote cooperation and mutual understanding between the two countries and develop educational, scientific and medical cooperation for excellence through knowledge, skills transfer and capacity building. The collaboration will also entail exchange of undergraduate and post graduate students besides doctors and scientists. It will also include collaborative work on conferences, seminars, symposiums, round tables and master classes with discussions and publication of the reports, thesis and scientific articles by professors and teaching staff of the universities.

Mr. Naresh Kapoor, Executive Director, BLK Super Speciality Hospital, New Delhi, signed the MoU with the Ministry of Health, Khartoum State; Takaful Association, Ministry of Development and Human Resources and Labor Khartoum State and Custom’s Authority, Khartoum State, Republic of Sudan.

BLK Event Calendar



BLK & NANAVATI in NEWS


nanavati · 2020-01-18 · blk super speciality hospital pusa road, new delhi-110005 (india)...

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