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How off-pump bypass surgery offloads mortality
The way HIV virus ‘exhausts’ body’s immune system EYESIGHT HEALTH NOTES
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How off-pump bypass surgery offloads mortality Beating heart surgery or off-pump coronary artery bypass surgery (OPCAB) has changed the total perspective of heart surgery. The main factor that led us to think that when we are not opening any chamber of the heart in the conventional procedure — the coronary artery bypass surgery (CAB) then why not develop something which could reproduce the stillness of the surface of the heart produced by the heart-lung machine with a chemical arrest. To achieve this, a simple principle was applied first that if something is jumping, hold it firmly down and the movements of that thing will decrease. Thus came the first device which was called stabiliser. A horseshoe-shaped device which when applied on the surface of the heart in the region where the coronary artery was running will reduce its movements to a significant extent with compression. Now once the localised area of the heart has been made “still”, the bypass procedure could go on in the same way as with the help of the heart-lung machine. But there was a big difference — here we were not using any “caretaker” for the rest of the body. As the heart is full and beating in this procedure, it is receiving and pumping blood in its natural way. This produced a big difference in the outcome. As the use of the heart-lung machine was done away with, the inflammation produced by it and its side-effects vanished. Recovery was fast and the patient hardly felt the trauma of this “Big Surgery”. It was a big achievement for surgeons as it benefited in two ways. It increased the acceptability of this procedure from the patient point of new and, secondly, it competed with the results of a less invasive procedure done by cardiologists — angioplasty. Most patients who favoured angioplasty to surgery did so because of the less incapacitation in the former, though surgery has always scored in the long run. Only recently drug-coated stents came to the market because here we are not using anything artificial. The technique was adopted but with a pinch of salt, as it was demanding and technically difficult. Preservation of the heart muscle during surgery was the most crucial part of the whole exercise. This procedure started with the occlusion of the vessel at both ends to create an anastomosis with another artery or vein but it used to make the haemodynamics unstable in some cases, which was a big cause for worry. The reason was that when we were interrupting the supply line of the heart muscle, it will fail to work or work erratically or sub-optimally for want of blood. This was very easily solved. Open the vessel and put a stunt inside which will carry blood from the proximal part of incision to the distal part of the vessel and at the same time will keep the field clear for creating a perfect anastomosis. Now this major hurdle was gone, but still many of our colleagues were not accepting it for two reasons and the main one being that whatever you do to control the movement of the heart, it cannot be eliminated in all three directions and will leave the field still bumpy as compared to a perfect still-surface achieved with the help of the heart-lung machine. Most of surgeons thought why get into something more demanding when the same could be achieved with ease. So, acceptability remained low. But another group was thinking differently. When the two techniques were compared it was found that in the new technique there were the following advantages:
But to achieve all this, one had to apply one’s total concentration so that the anastomosis created with this would last in the same manner as done on the heart-lung machine. Here the surgeon’s skills play a great role. In India, this procedure is applied widely. At many medical centres 100 per cent bypass surgeries are being done off the pump (without the heart-lung machine). With the passage of time, the technique has improved considerably. But if we look at Western countries, still there is a dilemma in the minds of many there. Not more than 30-35 per cent of the total CAB surgery is being done off the pump there. There are two reasons: the will to exert and accept a technique and tide over the learning curve in a safe manner. The writer is a Senior Consultant, Cardiothoracic Surgery, Fortis, Mohali.
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The way HIV virus ‘exhausts’ WASHINGTON: In a path-breaking study American and South African scientists have found out the reason behind the failure of the human body’s immune system to fight against the HIV virus. The scientists have discovered that the human immunodeficiency virus (HIV) exhausts T cells that would otherwise attack the virus, by turning off fully functional T cells by flipping a molecular switch on them. Subsequently in test tube studies, they showed that the killer T cells could be re-invigorated by blocking that inhibitory switch. The study’s senior author, Bruce Walker, a Howard Hughes Medical Institute researcher at Massachusetts General Hospital, said that clinical testing of drugs that block the switch could begin very soon, since such drugs exist already. However, he cautioned that these kinds of drugs could cause serious side effects, including auto immune reactions that trigger the immune system to attack the body. “It’s long been known that people with HIV infection have a lot of HIV-specific immune cells that one would think would be actively combating the virus. But a major puzzle has been that even in late-stage illness, when one can still measure great numbers of these immune cells, they don’t seem to be controlling the virus at all”, Walker said. The researchers said that though this discovery could lead to immediate clinical application, they cautioned against over- optimism. “Obviously, the big question is whether you could manipulate this pathway in HIV-infected people to turn these T cells back on and better control the virus”, the researchers said.
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EYESIGHT A middle-aged woman walks to the clinic. She is disturbed as she finds difficulty in threading the needle. A 75-year-old man is concerned as his vision is getting blurred day by day. What is happening? Yes, their eyes are showing the effects of aging. Like my other part of the body — graying hair and crackling knees — our eyes also age. Aging affects the eyes in various ways. The common complaints may be: 1. Difficulty in near work — yes, the focusing power of the eye goes down with age called presbyopia. At around 40 years one needs the reading glasses to see clearly. 2. Black spots in front of the eye — these are called floaters. These are tiny specks that float across the field of vision. Some may describe them as cobwebs or black dots or flies. They are more prominent on white background or in bright light. They are normal and one has to ignore them. Only if they increase in number suddenly or are associated with flashes of light, one should get the retina examined. 3. Blurred vision — it is a common complaint after 40-50 years. It can be because of different reasons like cataract, age-related macular degeneration and glaucoma. a. As age advances, age-related cataract is the commonest thing to appear. The natural lens which is transparent becomes cloudy with age. This may cause blurred vision for near or distance and one needs to undergo cataract surgery to see clearly. b. Age-related macular degeneration (ARMD) is another common reason for blurred and distorted vision. This is presenting more nowadays as life expectancy is increasing. AMD occurs when the area of the retina, which produces sharp vision i.e. macula, gets affected. c. Other causes can be glaucoma and diabetic retinopathy. 4. Watering of eyes and drooping lids related to lid laxity is common in old age. There are so many changes which are occurring because of aging, but do we have to succumb to it or accept it? No. We can at least slow down these age-related changes. Simple good diet rich in antioxidants like Vitamins A, C, E helps in slowing down the age-related changes. Research has shown that they prevent these changes in about 25 per cent cases. Antioxidant-rich foods include:
Aging eyes may benefit from changes in the environment and the lifestyle of the individual. Increased lighting and colour contrast, coupled with reduced glare, may aid residual vision, increase effectiveness in the performance of talks, and enhance safety. Adaptive aids may improve or enhance the remaining vision, aid in the performance of skills and independence. To catch these changes occurring earliest, one should get biannual eye examination done from the age of 40 years. This is how we can treat or prevent them in a better way. The writer is Chairman and Medical Director, Centre for Sight, New Delhi. E-mail:
[email protected]
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HEALTH NOTES LONDON: Scientists have developed a chewing gum containing friendly bacteria, which they say can help prevent tooth decay. The good bugs in the gum prevent other harmful mouth bacteria from sticking to and attacking the teeth. Toothpastes and mouthwashes containing Lactobacillus anti-caries are also in the pipeline, German chemical company BASF told Chemistry and Industry. Friendly bacteria, normally found in live yoghurt, are already purported to be good for treating bowel conditions.
— ANI Diabetic kids have heart-disease risk factors
NEW YORK: Children and adolescents with diabetes commonly have additional risk factors for cardiovascular disease (CVD), according to a new report. This research emphasises the importance of prevention, recognition, treatment and control of these risk factors, Dr Beatriz L. Rodriguez from the University of Hawaii at Manoa, Honolulu, told Reuters Health. The prevalence of CVD risk factors was higher among ethnic minorities. Rodriguez and colleagues investigated the prevalence of CVD risk factors in a multiracial population-based sample of over 2.000 children and adolescents with diabetes, CVD risk factors specifically assessed were related to the metabolic syndrome cluster — high cholesterol, triglycerides, blood pressure and increased waist circumference. One-fifth of the subjects with diabetes for at least one year had to least two additional CVD risk factors, the authors report, including 23 per cent of girls and 19 per cent of boys.
‘Night-eating syndrome’ is risky
New York: Diabetics who eat large amounts of food at night may be raising serious complications, a study suggests. Researchers found that of 714 patients at their diabetes clinic, about 10 per cent said they ate more than one-quarter of their daily calories after dinnertime. These patients were two to three times more likely to be obese, have poor blood sugar control or have multiple diabetes complications, including heart disease, kidney dysfunction and nerve damage. The findings appear in the journal Diabetes Care. Researchers believe night-eating syndrome may be part of a reaction to stress. And in the current study, diabetics with such eating habits more frequently reported depression or said they ate in response to anger, sadness and other negative emotions.— Reuters |
Beating heart surgery or off-pump coronary artery bypass surgery (OPCAB) has changed the total perspective of heart surgery.
The main factor that led us to think that when we are not opening any chamber of the heart in the conventional procedure — the coronary artery bypass surgery (CAB) then why not develop something which could reproduce the stillness of the surface of the heart produced by the heart-lung machine with a chemical arrest. To achieve this, a simple principle was applied first that if something is jumping, hold it firmly down and the movements of that thing will decrease.
