HEALTH & FITNESS

So, what is beating heart surgery?
Dr Harinder Singh Bedi

With the beating heart surgery of the Prime Minister in the news, the general public is a bit confused about what exactly this kind of operation is. Most of us are aware of the fact that bypass surgery involves the delicate sewing of a tube to bypass the block in the heart artery.

EYESIGHT
Botulinum toxin in ophthalmology
Dr Mahipal Sachdev

Everybody is aware that penicilline is a boon to the world and it had begun the era of antibiotic discovery. Penicilline is derived from a fungus “Penicillium Notatum”. Similarly, Botulinum is a toxin produced by the bacterium Clostridium Botulinum. It is the causative agent of the deadly food poisoning, “Botulism”.

Managing ulcerative colitis
Dr R Vatsyayan

A chronic inflammatory disorder of the large intestine (colon), ulcerative colitis, is a worldwide health problem. Closely related to another inflammatory condition of the intestine called Crohn’s disease, ulcerative colitis (UC) most commonly begins during adolescence and early adulthood but can also strike during childhood and even in the later life.

Health Notes
You may catch obesity bug from other people’s sneezes

London: You may find it a bit surprising, but an Indian-origin researcher in the US has revealed other people’s coughs, sneezes and dirty hands can infect you with an obesity bug.

  • Protective facemasks can defend against flu pandemic

  • Men more likely to become alcoholics than women

  • New study aims to cut childhood leukaemia risk

 

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So, what is beating heart surgery?
Dr Harinder Singh Bedi

With the beating heart surgery of the Prime Minister in the news, the general public is a bit confused about what exactly this kind of operation is. Most of us are aware of the fact that bypass surgery involves the delicate sewing of a tube to bypass the block in the heart artery.

In conventional surgery the surgeon puts the patient on a sophisticated machine called a heart-lung machine, stops the heart by administering a potent paralysing agent called cardioplegia, and performs the delicate repair on a motionless heart. The heart is then revived and the machine slowly weaned off as the patient’s heart takes over. While this was a very elegant, scientific and time-tested procedure, it was realised that the heart-lung machine, in spite of all its technological advances, could not match the working of the human heart.

Some inherent imperfections caused problems to the patient. The wayout was to avoid the heart-lung machine. The obvious problem was of how to make a small area of the heart — 2 X 2 cm — motionless where the bypass was to be conducted, leaving the rest of the heart to pump blood. This was achieved by a device with octopus-like suction pods which stuck to a small part of the heart and made it still — the devices go by the interesting names of Octopus and Starfish. To allow some blood to flow in the vessel which is opened, a small plastic tube called a shunt is inserted during the time of sewing.

The technique of multivessel beating heart surgery was first developed in Punjab. The idea came in 1998 when a patient from Sirsa with severe heart disease could not be operated on, as he would not have tolerated the heart-lung machine. The new technique used devices to immobilise a small area at a time. The technique was duplicated in 100 such high-risk cases and presented at various international conferences. The paper was published in the most prestigious journal, the Annals of Thoracic Surgery in January 2000 (Global Myocardial Revascularisation Without Cardiopulmonary Bypass Using Innovative Techniques for Myocardial Stabilisation and Perfusion) . It was accepted as a World Record and published in the Limca Book of World Records 2000. Since then this technique has been used successfully in thousands of cases worldwide.

Over time (about 15 years) due to progression of the disease the first surgery grafts or stents can get blocked and the patient may now need a second operation. This obviously carries a higher risk as the patient is now older . Beating heart techniques had not been used so far in such cases. A similar technique was then used for the second time or in redo-surgeries --- again in patients from Punjab operated for the first time in the UK and the US — and presented at the 14th Annual Conference of the European Association for Cardiac Surgeons in Frankfurt on October 11, 2000 (multivessel redo CABG on a beating heart) as a video film. This was the first presentation in the world of multivessel beating heart re-do CABG. Since then this technique has been used to save many lives by surgeons all over the world.

It is especially useful in people over 65 years of age where otherwise surgery will not be possible. It is this method which was successfully used in the case of the Prime Minister by the talented team of surgeons in Delhi.

The advantages to the patient are manifold. Now 75 per cent of the patients are discharged within three-five days of a major multivessel bypass. Blood usage is reduced to none in up to 80 per cent cases.The rate of infection and kidney, liver and lung dysfunction is markedly reduced, making it a especially useful operation for patients with pre-existing derangements in these organ systems.

The cost is markedly reduced as the expensive heart-lung machine is not used, as these machines are all imported. The country saves a lot in foreign exchange.

Thus, the advantages are:

l No problems about whether the patient will come back to life or not from the heart-lung machine
l Less time-consuming and simple.
l Less neurological problems
l Less blood usage
l Less stay in the ICU and hospital
l Patients do not feel run-down
l Faster recovery and return to work

The technique can be used in most patients — up to 100 per cent in most centres.

The writer is Director & Chairman, Cardiac Sciences, Sigma New Life Heart Institute, Ludhiana. His name appears in the Limca Book of World Records for being the first in the world to conduct multivessel beating heart surgery.

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EYESIGHT
Botulinum toxin in ophthalmology
Dr Mahipal Sachdev

Everybody is aware that penicilline is a boon to the world and it had begun the era of antibiotic discovery. Penicilline is derived from a fungus “Penicillium Notatum”. Similarly, Botulinum is a toxin produced by the bacterium Clostridium Botulinum. It is the causative agent of the deadly food poisoning, “Botulism”. For the past three decades it has been commercially produced as preparations that have found wide application in medical therapy.

Since 1989 botulinum toxin has been demonstrated to be a safe and effective therapy for more than 100 clinical disorders. Novel applications in neurological and non-neurological disorders continue to emerge at an exponential rate.

The use of botulinum toxin in ophthalmology spearheaded its use for widespread application in medical therapy. Ophthalmic and aesthetic conditions continue to head the list of its current uses.

The fundamental mode of action of botulinum toxin is to inhibit neuromuscular transmission. This inhibition is temporary and neurotransmission is eventually restored. Effects of botulinum toxin last an average of three months.

Lid spasms or benign essential blepharospasm is a disorder involving the eyelid and forehead muscles. It manifests as involuntary eyelid muscle contraction resulting in increased frequency and forceful blinking. In severe cases, blinking may be so repetitive and forceful that the patient is unable to open his/her eyes, resulting in functional blindness. Botulinum toxin, used in the treatment of blepharospasm since 1983, has become the treatment of choice, and is very successful in controlling these eyelid spasms.

Hemifacial spasm is characterised by one-sided recurrent twitches of the face.

The basis for the spasms is usually a mechanical irritation of the facial nerve at its exit root by a sagging blood vessel. Although neurosurgical treatment is available, most patients opt for medical management with botulinum toxin, which is highly successful.

Corneal exposure resulting from a poor blink or incomplete eye closure may require a surgery to partially close the eye. Similarly, upper eyelid retraction associated with thyroid eye disease may result in corneal exposure, and in some cases corneal ulceration. It also is a major contributor to the aesthetic deformities associated with this disease. Botulinum toxin may be beneficial in producing a temporary drooping of the upper eyelid to cover the cornea without surgically altering the eyelid margin.

Botulinum is also useful in various other conditions like the following:

l Eyelid myokymia — uncontrollable twitching of the orbicularis muscle, typically involving the lower lids, and less commonly the upper lid.
l Apraxia of eyelid opening — inability to raise the upper eyelid.
l Hyperhidrosis — exaggerated sweat production by the sweat glands.
l In certain varieties of squint.
l Watery eye — where it is because of increased tear production.

In recent years the utility of botulinum toxin in facial aesthetics has been growing rapidly. Many areas of the face, including ‘’crows feet’’, brow and forehead furrows, ‘’smokers lines’’ and ‘’marionette lines’’, can all now be treated with few simple injections only.

The incidence of complications with botulinum toxin is generally low, and rarely significant enough to make the patient discontinue treatment. Temporary drooping of eyelid, double vision and dry eye are some of the reported complications. The use of botulinum toxin in ophthalmology has not only altered our ability to manage a number of difficult medical problems but has also allowed us to restore some of the changes produced during the course of aging. When properly delivered, botulinum toxin can provide safe and gratifying results.

The writer is Chairman and Medical Director, Centre for Sight, New Delhi. Email: drmahipal@gmail.com

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Managing ulcerative colitis
Dr R Vatsyayan

A chronic inflammatory disorder of the large intestine (colon), ulcerative colitis, is a worldwide health problem. Closely related to another inflammatory condition of the intestine called Crohn’s disease, ulcerative colitis (UC) most commonly begins during adolescence and early adulthood but can also strike during childhood and even in the later life.

Marked by intermittent rectal bleeding and diarrhoea, UC produces a wide range of symptoms as loose or mucous accompanied stools, abdominal cramps, retention of gas, acidity, occasional fever and general weakness. The symptoms and pathology of this disease closely resemble the condition mentioned as “raktatisar” by ayurvedic masters.

Though no one is quite sure about what triggers UC, modern scientists overwhelmingly view that abnormal activation of the immune system in the intestines may be responsible for this disease. Among the aggravating factors, stress and dietary aberrations come on the top, but certain studies also show that the genetic make-up may have a contributory role in it. According to ayurveda, it is the disorder of vitiated “pitta” where wrong diet and other lifestyle mismatches can become a predisposing cause.

From the prognosis point of view, ulcerative colitis is known to run into an unpredictable course and most of the times the active treatment continues for years. Patients of UC undergo phases when they complain of relapses and remissions of its symptoms even without any noticeable cause. The ayurvedic approach regarding the treatment of the disease is to evolve a favourable diet plan supported by a regime of medicines to control bleeding and diarrhoea, reduce swelling in the colon, relieve spasm and gas and by improving digestion. This gives an overall feeling of wellbeing to the patient.

On the dietary front, ayurveda recommends that the patients of UC should eat small, light and easily digestible meals. Chapatis of whole cereal atta of wheat and maize or made by mixing these two accompanied by non-fried dishes of vegetables and light lentils are good for them. Rice and its combination with lentils or khichdi also make a good meal for such patients. Use of curd and buttermilk, instead of other dairy products like milk and cheese, gets overwhelming recommendation. Fruits like banana, mango, anar and apple can also be taken.

Ayurveda believes that moderate use of certain digestive herbs like zeera, ajwain and hing helps allay intestinal spasm and relieve gaseous conditions.

The writer is a Ludhiana-based senior ayurvedic physician. Email-yourhealth@rediffmail.com

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Health Notes
You may catch obesity bug from other people’s sneezes

London: You may find it a bit surprising, but an Indian-origin researcher in the US has revealed other people’s coughs, sneezes and dirty hands can infect you with an obesity bug.

Professor Nikhil Dhurandhar, of Pennington Biomedical Research Centre in Louisiana, believes that an airborne “adenovirus” germ may be causing the fat plague that is blighting Britain and other countries.

He reckons that about one in three obese people might have become overweight after falling victim to the highly infectious cold-like virus, known as AD-36.

The researcher says that the virus —which is known to cause coughs, sore throats, diarrhoea and conjunctivitis—has of late been found to make fat cells multiply, leading to weight gain. — ANI

Protective facemasks can defend against flu pandemic

London: Respiratory infections like flu can be guarded against if people use protective facemasks, according to a study led by British and Aussie scientists.

In their study report, the researchers also say that protective facemasks can even be helpful in defending against a pandemic.

Researchers at Imperial College, London, and the University of New South Wales, however, have also found that persuading people to wear a mask and to fit it properly is a difficult task, which could limit their effectiveness.

In a clinical trial of the effectiveness of masks, the researchers studied 280 adults from 143 families living in Sydney during the winter flu seasons of 2006 and 2007.

When a child in the household was ill with flu, the volunteers were asked either to wear a mask or not, on a random basis. The researchers observed that people who wore a mask while their children were sick were four times less likely to become infected by their sick children than non-wearers. — ANI

Men more likely to become alcoholics than women

London: A new study by a team of American researchers has revealed that men are twice as likely as women to become alcoholics.

The study, conducted by researchers at the University of California, San Diego, claims that men have a 20 per cent risk developing a drink problem in their lifetimes, and 10 per cent chance of becoming hooked.

According to the researchers, the seeds of abuse and dependence on alcohol often begin in the late or mid-20s. — ANI

New study aims to cut childhood leukaemia risk

Washington: A new study is being conducted at the University of Leicester to find out if consuming caffeine during pregnancy affects the unborn baby’s risk of developing leukaemia in childhood.

According to lead author, Dr Marcus Cooke, the study is a unique opportunity to determine the sources of chromosomal alterations during pregnancy, with the ultimate aim of reducing the risk of childhood leukaemias.

Leukaemia is a cancer of the bone marrow and white blood cells. “We want to find out whether consuming caffeine could lead to the sort of DNA changes in the baby that are linked to the risk of leukaemia. This is an important area of research because it is vital that mothers are given the best advice possible,” said Cooke. — ANI

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