Apollo News (1108)
Clinical Excellence
Endovascular Aneurysm repair at Apollo Hospitals Chennai
Aneurysms of thoracic aorta and abdominal aorta are rare and their treatment traditionally involved complex surgical repair with attendant morbidity and mortality. Nowadays, interventional non-surgical management with Endovascular grafting using covered stent grafts (EVAR : Endovascular Aneurysm Repair) has become the treatment of choice in the majority of cases.
This is the tale of a 67 year old hypertensive gentleman with Coronary artery Disease presenting with very large saccular Aneurysm in the Descending thoracic Aorta with another large saccular aneurysm in infra-renal abdominal aorta, again with impending rupture and layered clot in the aneurysm sac. He was refused treatment citing high risk as the reason in several placed and came to us as a last resort.
A double TEVAR and EVAR procedure was performed by Dr Y Vijayachandra Reddy, Consultant Cardiologist, Apollo Hospitals Chennai. The final result was excellent with no complications and no endo-leaks. Patient withstood the procedure well and was shifted to ICU. He has been extubated and doing well now.
The points of interest in this case are
1. Rarity of the procedure – stenting of both thoracic and abdominal aortic aneurysms in the same sitting
2. Aneurysm starting just after the left subclavian artery was considered inoperable because of high surgical risk involved and non interventionable due to lack of good landing zone for stenting. A carotid subclavian bypass was done enabling the case to be made suitable for TEVAR : the perfect example of a hybrid procedure.
3. The anatomy of abdominal aorta Aneurysm was interesting with gross disparity in size and tapering distal end precluding the use of the usual aneurysm stents . A balloon expanding Covered stent was deployed across the abdominal aorta aneurysm with post-dilation to mould the stent to the tapered aorta
Clinical Excellence
Immune Adsorption columns used at Apollo Hospitals Chennai to enable ABO incompatible Kidney transplant !
The first ABO-incompatible kidney transplant at the Apollo hospitals Chennai was done by using the Immune adsorption columns to reduce the specific blood group antibody titer before the ABO-incompatible transplant. This is the first case in the country using column adsorption of blood group antibodies .
What is Column Adsorption Technology?
Traditionally ABO compatible donor organs are essential to achieve a successful organ transplant. Transplantation of solid organs like kidney between donors and recipients of incompatible blood group is usually contraindicated because of the risk of “”hyper acute”” rejection. This rejection occurs due to the presence of pre existing Anti-A or Anti B antibodies in the recipient that can destroy the incompatible donor organ.
Limitations in donor availability for organ transplantation makes “”living donor”” solid organ transplantation across the blood group barrier to become an alternative to ABO compatible transplantation for those with end stage renal disease facing long waiting times. This problem has been overcome by using a highly selective procedure to remove the potentially damaging blood group antibodies and slow their production during the critical post operative period. This is achieved by removing the anti-A or Anti B from the recipient using antigen-specific immune adsorption by performing several sessions of plasmapheresis. No other beneficial substances present in the plasma are removed and no plasma substitution is made either. This procedure is supported by a protocol of pharmacological drug based immune suppression and the ABO incompatible kidney transplant is performed.
The Glycosorb ABO immunoadsorption column contains ABO blood group antigens covalently bound to sepharose particles. The column is used to deplete anti-A or Anti-B from plasma. Plasma is separated from whole blood in the Apheresis system, processed through the column before it is reinfused. The reinfused plasma is depleted only of the anti-A/B but not the other proteins like the coagulation factors or other antibodies in blood. More than 2000 ABO incompatible kidney transplants have been performed worldwide without any serious side effects using the Column Adsorption technology.
Our first case
A 52-year old male, a case of Diabetic Nephropathy and advanced chronic Kidney Disease was on regular dialysis. Live related renal transplant was performed but had graft loss due to Renal Artery thrombosis and underwent graft nephrectomy. ABO-incompatible re-transplant (donor-Brother) was planned due to non availability of ABO compatible kidney. Recipient was O Positive and donor A Positive.
Patient underwent column adsorption plasmapheresis pre-operatively to reduce the Anti-A titer from 1:256 to 1:4 .This is the first time immunoadsorption therapy was instituted in our country using plasmapheresis. He received the kidney from his brother and had a fairly smooth post operative period in the hospital and was discharged on the 11th post operative day. He had normal kidney function and good urine output. One month after the surgery his kidney functions normally and urine output is good. Patient is back at work 3 months after his surgery.
New Initiatives
Apollo Hospitals Chennai launches the Apollo Foot Care Service !
The Apollo Foot Care [Electronic Baropaedometer & Insole Maker] Service launched at Apollo Hospitals Chennai has been commenced to help in diagnosis of foot and ankle pains & production of thermoformed plantar insoles to treat them by introducing biomechanical corrections. It would deal with patients not only with foot problems [that may include lower kinetic chain problem, neuropathy, orthopaedic problems] but also fitness, sports, athletes and everyday walker. In short it would cater to both the ends of clientele illness as well as wellness.
The service would assess, treat, prescribe, and prepare customized insoles for every patient coming to foot care based on the individual profile and need. Everyone is unique! The focus of the rehabilitation process would be very individual, and is dependent on the nature of the problem.
Services
Apollo Foot Care would offer services that range from the proactive to the reactive. Offered services include:
Foot Assessment
Foot Scan – Posturographic Analysis (Static & Dynamic ) & 3D imaging, Foot Pressure Analysis
Observational gait Analysis
Printed & Descriptive reports
Comprehensive Physiotherapy Assessment (as appropriate)
Mould Design
Insole Design
Customised Insole Preparation
Foot Care education/advices
Foot Wear Advices
Rehabilitation/Exercises (as appropriate)
Who we can help?
Anyone with Foot, Low back and Lower Kinetic Chain issues
Diabetes [Diabetic Foot with certain limitations]
Orthopaedic/Musculoskeletal [Plantar Fasciitis, Morton’s Neuroma, Achilles Tendonitis, Heel Spur, etc]
Neurological {Tropical Neuropathy]
Sports – any sport, athletes especially runners
Every day Walker
Fitness/Wellness
For further details, contact :
Dr. Akilesh Anand Prakash, Consultant – Sports Medicine / Mr. Raj Prasanna, Cheif – Physiotherapy & Rehab
The Physiotherapy Department Apollo Main Hospital No.21, Greams Lane, Off Greams Road Chennai – 600 006. Tel. : Board : +91-44-2829 3333 / 2829 0200 Direct : +91-44-2829 6572
Clinical Excellence
3-years old Pakistani child, diagnosed with Liver cancer underwent a successful Liver Transplant at Apollo Hos...
Baby Samreen Fatima, suffering from an inherited condition – progressive familial intrahepatic cholestasis (PFIC) underwent a Liver Transplant at Apollo Hospitals, Delhi. Samreen’s father Malik Sarsa Khan, a Pakistani driver, donated 20% of his liver to his daughter.
Malik Khan had lost five children before. So when his daughter (3), who was born seven years after the death of his last child, was diagnosed with liver cancer, he decided to “”beg, borrow or steal”” to fund her liver transplant surgery in India.
Though the government of Punjab in Pakistan stepped in to help him financially, he was robbed off at gunpoint in Lahore while on his way to India. A determined Khan, somehow, managed to reach Apollo Hospital in Delhi. When finding a liver donor became difficult, he decided to donate 20% of his organ to his daughter.
A 10-hour surgery has cured Samreen. “”Liver transplant surgery for children is not conducted in Pakistan. I was told to go to either China or India. I had more faith in Indian doctors and decided to do whatever it takes to get my daughter under their care. I cannot believe that my daughter, who barely spoke a word, used to be down with high fever almost every alternate day and could not stop itching her body and vomited blood, is talking non-stop these days. She is behaving like any other normal child,”” a beaming Khan said. He added “”I had lost my last child also to liver disease. However, this time I was not going to give up. Doctors said Samreen was suffering from an inherited disease and it could be because I am married to my cousin sister – a practice being followed in my family for over three generations.””
Samreen’s case transcended “”against all odds””, said Dr Anupam Sibal, Group Medical Director, Apollo Hospitals & Pediatric Liver Consultant. “”It was heart-warming to see the commitment of the father to save her daughter. Samreen was very ill when she came to our hospital and we were worried whether she would be fit to withstand the liver transplant. Now, she is cured, and back home,”” said Dr.Sibal.
Transplant surgeon Dr Subhash Gupta said Samreen was suffering from an inherited condition – progressive familial intrahepatic cholestasis (PFIC). The liver, one of the largest organs in the body, cleans the blood and helps fight infections. It also stores vitamins, sugars, fats and nutrients that travel to the rest of the body. It also removes billirubin whose presence causes jaundice. The liver is responsible for making bile. The build-up of bile in PFIC causes the liver to be damaged. “”This eventually leads to scarring in the liver that leads to cirrhosis or cancer. If Samreen hadn’t undergone the transplant, she would have died soon,”” Dr Gupta said.
He added, “”She was malnourished, unable to walk, eat and be mentally alert. The surgery took about 10 hours. In the 70 transplants I have done on children, I can recall only three instances when a father donated for a daughter. Though she is cured, she will have to be on anti-rejection medicines for the rest of her life.””
Technology
Apollo Hospitals brings in Robot-assisted Bariatric Surgery
Apollo Hospitals launches robot-assisted procedures as a better alternative to laparoscopy for Bariatric Surgery.
Addressing a press conference on Tuesday, Dr. Rajkumar Palaniappan, consultant, Apollo Hospital, said that robotic surgery provided good or even better results than laparoscopy. The downside was it would cost at least Rs.1.75 lakh more than a laparoscopic procedure.
Advantages
The advantages included high precision, increased ergonomic flexibility of the robotic arm inside a patient’s body, lesser blood loss, a pain score of 4/10 as compared to 6/10 for laparoscopy and quicker turnaround time for the patient.
Robotic-assisted surgery has applications for all three standard bariatric surgery protocols – gastric band, sleeve gastrectomy and gastric bypass. The hospital is also looking to tap into the other advantage of robotic surgery – remote location procedure – by having a surgeon sitting at the computer console in Chennai operate upon a patient in Kolkata.
Apollo Hospitals, which has already introduced robotic-assisted procedure for urology and gynaecology, is also aiming to set up robotic equipment at more of its centres.
“”Training in this speciality is easier with a surgeon able to pick robotic-assisted surgery skills in a year or so while it takes five to six years for an open procedure surgeon to master laparoscopy””, Dr. Palaniappan said. A training programme in robotic bariatric surgery has also been proposed to be started. Michael Cameron, a patient from Scotland, said that he decided to undergo robotic bariatric surgery at Apollo as his efforts at dietary control failed to provide a lasting solution to his obesity.
Clinical Excellence
Apollo Hospitals Delhi performed a successful transplant using an incompatible kidney !
Pyaare Lal, a 54-year-old man who was suffering from kidney failure, is a health man now! His elder brother offered to donate one of his kidneys. However, a blood group mismatch rendered their kidneys incompatible. But for doctors at Indraprastha Apollo Hospital, Delhi, that was not a restraint at all ! They conducted the transplant using the incompatible kidney, successfully and gave the patient a new lease of life !
“”We used a special technique to prime the recipient’s defence system to accept an organ with a mismatched blood type. The process involved blood cleansing through plasma exchange that rids the system of cells that would have rejected the previously incompatible kidney. We administered the patient with a drug called Rituximab to reduce antibodies in his blood. Pyaare’s blood type is O while his brother’s is type B,”” said Dr Sanjiv Jasuja, Senior Consultant Nephrologist at Apollo. Numerous patients with kidney failure are not able to undergo transplant due to the non-availability of donors with a matching blood group, he said.
Dr Gaurav Sagar, another senior doctor, said transplants involving incompatible kidneys have been carried out successfully in Mumbai and Ahmedabad and foreign countries like Japan. “”The five-year survival rate of patients in such cases is almost as good as in regular transplants with matching donors,”” Sagar claimed.
Meanwhile, Lal, who was on dialysis for a year, couldn’t be happier. “”My wife and sister-in-law have the same blood group as me. However, they couldn’t donate their kidneys because of health problems like high blood pressure. I had lost all hope and thought that I was going to die. Even my brother, though willing, could not donate the organ. The doctors have given me a new lease of life,”” said the patient, a farmer based in Ghazipur, Uttar Pradesh. The surgery cost Rs 10 lakh approximately.
In India, approximately 1,75,000 kidneys, 50,000 hearts and 50,000 livers are needed for transplantation every year, said Dr Anupam Sibal, Group Medical Director, Apollo Hospitals. “”There is a need to promote organ donation,”” he said. At present, only 0.1% of all donations are from cadavers.
Events
Women’s Health Screening Camp, organized by Apollo Hospitals Delhi, inaugurated and a special issue of A...
On the occasion of International Women’s Day, Delhi Chief Minister Smt. Sheila Dikshit today inaugurated a Women’s Health Camp, organized by Apollo Hospitals aimed to raise awareness about breast cancer as well as other cancers, including issues related to prevention and early diagnosis. To commemorate the occasion, she also released the special edition of Apollo Life Oncology at the Delhi Secretariat. The Apollo Life special issue highlights the dangers of various cancers, including breast cancer, and emphasizes preventive steps
Speaking about the event, the Hon’ble Chief Minister Smt. Sheila Dikshit said: “”Every year, tens of thousands of new cancer cases occur in India. The rise of various cancers is all the more worrying because of the high death toll exacted, as well as due to the disruption of people’s lives caused by stress and the heavy burden of medical expenses. Preventing a dangerous ailment like cancer is therefore is critical. I applaud the sustained efforts of Apollo Hospitals in raising awareness about cancer and its preventive measures among patients and the public.””
With 800,000 new cancer cases every year in India, its impact painfully devastates the lives of cancer patients and their families. With many patients belonging to the productive age group – a significant number being breadwinners in the family – the impact transcends what mere statistics convey.
Commenting on rising cancer morbidity and mortalities, in a personal message Apollo Hospitals’ Chairman, Dr. Prathap C. Reddy said: “With improving lifestyles and rising disposable incomes, the traditional diets of most Indian families has undergone a drastic change. Given the high proportion of processed food in the diet, cancer cases are increasing across the spectrum. Modern conveniences have also been promoting sedentary lifestyles, exacerbating health issues and driving up cancer rates. I appeal to all people, particularly women, to embrace the necessary lifestyles changes, including consuming healthy foods and exercising regularly. Prevention is the best means to overcome the ominous threat of cancers.”
New Initiatives
An Idea whose Time has come : the Health Camp at Ajmer !
In a perfect combination of healthcare and technology, a unique health camp has caught the attention of people of Rajasthan. This unique effort saw renowned doctors travelling to Ajmer and treating people with the help of latest Information and Communications Technology (ICT) tools.
“”Though the basic idea behind the entire project, which took us weeks to prepare, was to ensure presence of leading doctors at Ajmer so that poor and rural people could get basic treatment and consultancy from them, and only patients who require advanced healthcare are taken to Delhi or other places, we wanted to prove that India is ready with its ICT tools to be utilised for medical care,”” said Mr. Sachin Pilot.
“”In two days we showcased the prowess of telemedicine and how it can change the way people gets treated in India without travelling to cities…we roped in telemedicine units of various hospitals like Apollo and also technology companies like the Department of Information Technology’s Centre for Development of Advanced Computing, Cisco and Tulip Telecom. We combined their capabilities to set up a unique health camp and help leading doctors provide latest medical care with all possible diagnostic paraphernalia required,”” Mr. Pilot pointed out.
In the camp, the telemedicine division of the Apollo Hospitals facilitated virtual consultations using a well-equipped hospital on wheels (HoW) sourced from its Hyderabad unit. Each of the five cubicles in the HoW were connected to Apollo Hospitals in Chennai, Hyderabad, Delhi, Bhubaneshwar and Ahmedabad simultaneously. Some of the cubicles had telemedicine enabled peripheral medical devices for transmitting ECGs, heart sounds, blood pressure and pulse rate oxygen saturation, thus helping doctors to treat a patient on real-time basis.
For the record, in just two days over 70,000 people from Ajmer and surrounding areas were given medical consultancy and treatment, while 5,000 reading glasses and spectacles and 800 hearing aids were; distributed to the needy. Over 300 tricycles and wheel-chairs and 200 crutches were also given free of cost, while almost 30,000 various medical tests were conducted. Another 20,000 medical kits comprising antiseptic cream, oral rehydration solution, de-worming tablets, vitamins, over-the-counter medicines were distributed a t the camp.
Events
Largest Multi Speciality Tele-health camp from a Hospital on Wheels !
In a first of its kind initiative in India, the Apollo Hospitals Group provided 535 tele-consults from 65 different specialists in 2 days in 13 different specialities from 5 Apollo Hospitals simultaneously at a general mega-health camp at Ajmer ranging from neurology, cardiology, paediatrics, orthopaedics, dermatology, oncology to sexual medicine.
Various subspecialities were covered including Asthma, Spine, pediatric neurology etc using a well equipped Hospital on Wheels, patients were connected to Chennai, Hyderabad, Delhi, Ahmedabad and Bhubaneshwar. Consultants interacted and virtually examined the patients at the camp and give the necessary e- advice thro an e -prescription. Details of the examination were stored in special electronic records. With prior consent the entire consultation was recorded in some of the tertiary centres.The telemedicine division of the Apollo Hospitals ( Apollo Telemedicine Networking Foundation and Apollo Telehealth Services Ltd. ) facilitated these virtual consultations using high speed broad band connectivity. Each cubicle had dedicated 1MBPS connectivity. 1MBPS connectivity was also made available at the registration/ prescription dissemination counter. Chennai based neurosurgeon Prof K. GANAPATHY, President of Apollo Telemedicine Networking Foundation and immediate Past President of the Telemedicine Society of India led the 30 member Apollo Telehealth team ably assisted by Vikram Thaploo CEO Apollo Telehealth Services Ltd.
Awards & Accolades
Critical Care Units from India recognized for the first time in an International Nutrition Survey ! Units of A...
The Critical Care Units of Apollo Main Hospital, Chennai and Apollo Speciality Hospital, Madurai were ranked as ‘Best of Best’ for applying evidence based nutrition practices for managing critically ill patients. This award was based on International Nutrition Survey conducted across 183 Critical Care Units worldwide.
This is the first time that a unit from India has received this recognition. The accomplishment is a true reflection of team effort involving doctors, clinical dieticians and nurses. Dr. N.Ramakrishnan, Director, Critical Care Services and Dr. Bhuvaneshwari, Group Chief Dietician represented the team and received the award during the 35th Annual International Conference of American Society of Parenteral & Enteral Nutrition (ASPEN) held in January 2012 at Orlando, USA.
Events
A unique celebration of Love !
A unique celebration of love at Delhi organised by Dr. Anupam Sibal, Group Medical Director, Apollo Hospitals. Even as thousands exchange cards and roses, 40 couples from across the country, where one partner has donated a vital organ such as a kidney, or a part of the liver to their spouse, come together to raise a toast to their partner’s ‘new life’.
Dr. Anupam Sibal, organising the bash at India Habitat Centre said, “What can be a bigger symbol of love than giving a part of yourself to the one you love? We thought why not honour such selfless love by inviting these couples. Transplant is like rebirth, and people who have gone through it owe their lives to their partners.”
Interestingly, in all 40 couples attending the party, the wife has donated the kidney or liver to the husband. “Wives strongly outnumber husbands as donors, and are the first to offer their organ to save the husband’s life,” says Dr Sibal.
One such woman, 35-year-old school teacher Anju Verma from Delhi, who has donated half her liver to her husband, says, “”My world came crashing when I found out that my husband’s liver is badly damaged. But, when I got to know about liver transplant, my hope returned. Despite my husband’s resistance, I went ahead. That was the only way to get him back, and I could not have been happier.”” She adds that she is excited about attending the Valentine’s Day party with her recovering husband.
Another invitee, Satpal, 29, will come to the party with his wife Mandeep Kaur, 28, who donated a part of her liver to him last year. “”This will be our best Valentine’s Day celebration, as we will spend the evening with couples like us who know what we’ve been through. I have no words to express my love for Mandeep. All I can say is that we were one soul, and we have become one body now,”” says the young automotive mechanic in a choked voice.
Lawyer RP Goel, 55, whose wife donated him her kidney, shares Satpal’s sentiments, “”It may not be our age to celebrate Valentine’s Day but I am really looking forward to joining the party, as it’s a celebration of a different kind. Love makes you do the bravest of things. My wife’s unconditional love made her give me her kidney. My life is hers, and that’s what I am going to tell her in front of everyone ,”” he says.
Technology
Apollo Hospitals announces the launch of the MRI-HIFU, a breakthrough, non-invasive technology, for treatment ...
Apollo Hospitals Group today unveiled a breakthrough MRI-guided high intensity focused ultrasound (HIFU) solution from Philips at its Hospital in Chennai. This was announced by Dr. Prathap C. Reddy, Chairman, Apollo Hospitals Group and Mr. Krishna Kumar, President, Philips Healthcare, India, here, today.
MRI Guided HIFU offers a non-invasive alternative to the traditional treatments for uterine fibroids in women. It combines magnetic resonance (MR) imaging, with high-intensity focused ultrasound (HIFU). The benefits for women include – no surgery, no radiation, no scar, no anesthesia, quicker recovery, more precise image guided treatment and only little stress. The technology has tremendous applications in the non-invasive treatment of benign and malignant tumors.
The MRI Guided HIFU system was first clinically approved for the treatment of non-cancerous tumors like uterine fibroids. Uterine fibroids are non-cancerous growth of the uterus that often appears during childbearing years. Also called myomas, uterine fibroids aren’t associated with an increased risk of uterine cancer and almost never develop into cancer. As many as 1 out of 4 women have uterine fibroids sometime during their lives, but most are unaware of them because they often cause no symptoms. The doctor may discover them incidentally during a pelvic exam or prenatal ultrasound.
In women who have symptoms, the most common symptoms of uterine fibroids include heavy menstrual bleeding, prolonged menstrual periods (seven days or more of menstrual bleeding), pelvic pressure or pain, frequent urination, difficulty emptying your bladder, constipation, backache or leg pains.
Existing treatment options for women included medication or surgical removal of fibroids. In contrast to the existing treatment options of surgery to remove fibroids, MR guided HIFU is a non invasive ablative procedure that helps all women especially those in the reproductive stage. It offers good symptomatic relief with no post operative complications, no scarring and reduced hospital stay. Hence this procedure can be performed on an outpatient basis, with the patient leaving the hospital the same day and almost fully recovered within a few days.
The MR-HIFU system uses safe and focused ultrasound waves to heat and coagulate benign or cancerous tumor tissue deep inside the body without damaging intervening tissues. Apollo Hospitals is the first chain of hospitals to introduce MRI- HIFU system in India.
Speaking on the occasion, Dr. Prathap C Reddy, Chairman, Apollo Hospitals, said “Apollo has always adopted the latest in technology to provide the very best care to the patients, HIFU is one such which is safe, radiation-free, and a boon for women with fibroids. The new MR-guided HIFU offers an extremely doctor and patient friendly treatment option. It is guided by magnetic resonance for three-dimensional planning of the procedure and offers real time temperature monitoring during the ablation to control the amount of energy delivered to the tissue by the HIFU machine. Apollo will have this technology at all its hospitals.”
Mr. Krishna Kumar, President, Philips Healthcare India, said, “The future of medicine in our view will be image-guided, non-invasive and without radiation, and MRI-HIFU represents the convergence of these 3 principles for improving the lives of women with uterine fibroids and people with malignant tumors. The launch of MRI-HIFU is yet another testimonial to Philips’ commitment to bring cutting-edge innovations to solve key healthcare challenges like tumors that face India.”
Best Hospital Near me Chennai
