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Hematologist

Sickle cell disease treatment in India.

What is Sickle cell disease?

Sickle cell anemia is a severe form of anemia caused by genetic mutation in the Red blood cells. It is a genetic disorder which is inherited by the patient from the two faulty hemoglobin genes from both the parents. Because of the genetic mutation,the shape of RBC ,which is flexible circular disc shaped changes to rigid sickle or crescent shaped rods. Hemoglobin a protein in RBCs,works as a transporter of nutrients and oxygen to cells all across the body.Normal RBCs are disc shaped,with the centers partially scooped out. They are flexible and soft and therefore have the capacity to squeeze through even the tiniest of blood vessels to reach every cell in the body.Due to genetic mutation the RBCs acquire the shape of a crescent moon or Sickle and become rigid and brittle.These Abnormal shaped RBCs which are not flexible get struck in small blood vessels causing slow or blockage of blood flow to other tissues of body and disrupt supply of Oxygen to those parts. Moreover the lifespan of abnormal sickle shaped RBCs is only 10-20 days as compared to 120 days of normal RBCs.Human body keeps on forming new RBCs to replace the old ones,but in a person with sickle cell disease the balance in formation of new RBCs and Destruction of existing RBCs is disturbed. This results in lower RBC count or anemia in a person suffering with Sickle cell disease.

What are complications of Sickle cell disease?

Sickle cell anemia may have different complications in different people at different stages of disease,but the major and severe complications for a person suffering from sickle cell anemia can be broadly classified as Acute and chronic.

Acute Complication:

Sickle cell crisis:

Sickle cell crisis or VAS ( Vaso occlusive crisis ) manifests as acute severe pain.Sickle cells disrupts blood supply through smaller capillaries resulting in ischemia. Sudden pain across body that may persist from a few hours to a few days.The pain usually occurs in limbs,chest and back.

Fever and infections:

Patients with sickle cell disease are prone to severe bacterial infections because of reduction or absence of splenic function. This may expose the patient to extremely high risk of septicemia and meningitis.Pneumonia is the most common infection ,meningitis,influenza and hepatitis are other infections occurring in sickle cell disease patients.

A Stroke:

Sickle cell disease may cause a a stroke in an affected person because of oxygen deprivation due to blockage in supply of blood to tissue of brain. Some of the sickle cell anemia patients may experience a Transient ischemic attack.

Acute Chest Syndrome:

Pneumonia like complications in a child or adult suffering from sickle cell disease. The reason could be an infection or sickle cells trapped in micro capillaries of lungs.

Hepatobiliary complications:

Hepatobiliary tract abnormalities are common in sickle cell disease patients.They may include cholelithiasis, acute cholecystitis, biliary sludge, and acute choledocholithiasis,acute Hepatic Sequestration and acute intrahepatic cholestasis.

Acute renal failure:

A decrease in kidney functions due to dehydration or obstruction or even because of intrinsic renal disease.

Acute Anemia:

May be because of Splenic sequestration.

Multisystem Organ failure:

A systemic failure of lungs,liver and kidney is a life threatening medical condition for sickle cell anemia patients.

Chronic Complications:

Vision Problems:

A sickle cell disease patient may develop vision problems over a period of time.It may include proliferative sickle retinopathy and vitreous hemorrhage. Complete vision loss is also possible.

Avascular Necrosis:

Avascular or aseptic necrosis can occur when capillaries are occluded by sickled erythrocytes at distal portions of a bone, near a joint, where hypoxia is maximal and collateral circulation is inadequate .The most common site for sickle cell anemia induced avascular necrosis is femoral neck.

Leg Ulcers:

Leg ulcers appear in patients of sickle cell anemia.

Pulmonary Hypertension:

Pulmonary hypertension occur in sickle cell disease patients.

Sickle cell anemia-Treatments:

Sickle cell anemia patients are usually referred to a Hematologist ( A doctor who has specialized in blood disease management). Treatment of sickle cell anemia may involve determining many factors by the treating hematologist.Treatment of sickle cell anemia includes regular monitoring and follow up with a hematologist,Medications for management of symptoms and complications,pain management,blood transfusions, oxygen supplementation and allogeneic Bone Marrow transplant.

Stem Cell or BMT for Sickle cell disease

Stem cell or Bone marrow transplant is a viable treatment option for those young sickle cell anemia patients where the diseases condition is severe and can not be managed with conventional methods. A sickle cell anemia child who is having a matching sibling donor is referred for a bone marrow transplant by the hematologist considering all the pros and cons. Risk involved is big but a stem cell or bone marrow transplant is the only cure for sickle cell anemia child or young adult.

Before the transplant, bone marrow cells  are taken from a close matching healthy brother or sister. The patient with sickle cell disease is then treated with chemotherapy and radiation that destroy his or her bone marrow cells. After that, the donated bone marrow stem cells are transplanted in the patient.

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Medical Oncology

Prostate Cancer – Treatment in India.

Prostate is a walnut size gland in human males located between the penile gland and the urinary bladder and in front of rectum.
Prostate is an important male sex organ. The basic function of prostate is to produce liquid part of semen.Prostate fluid nourishes and protects sperms during coitus and forms the bulk of volume of ejaculation.Prostate gland produces a protein called as prostate specific antigen (PSA). The functioning of prostate is dependent on male sex hormone testosterone.

Prostate Cancer is a one of the serious and life threatening medical condition affecting prostate. Prostate cancer usually affect elderly and above 65 year old men but it may affect younger men too.

Prostate cancer is the second largest cancer in men.Prostate cancer generally metastasizes to bones. Since the growth of prostate cancer is slow it may not affect or diagnosed in early stages but there are instances where the cancerous prostate cells have grown rapidly.

Who are at risk for prostate Cancer?

Prostate cancer affects men above 50 years of age.Over a period of time the survival rate in prostate cancer have improved dramatically from 30% in 1970's to 80% presently.
Prostate cancer may affect any men above the age of 50 years,but the African or African carribbean are at a three fold higher risk than white people.The man whose father or brother have been diagnosed with prostate cancer stand two and a half time higher chances than the men who never had a prostate cancer family history.
Black men are at three times higher risk of being diagnosed with prostate cancer as compared to white men.
Some studies suggest that men among the populations where consumption of "red meat" is more common are at a higher risk of developing prostate cancer.

Prevention of Prostate Cancer

Certain life style changes may reduce risk of prostate cancer. Quitting smoking and regular physical exercises at least for 30 minutes a day and five days a week can cut down risk of prostate cancer. Reduction in consumption of animal fat or red meat also cut down the risk for prostate cancer. A study although not confirmed that a diet high in tomatoes may also be helpful in reducing the risk of prostate cancer.
How Prostate Cancer is diagnosed?
Prostate cancer is usually diagnosed through screening as symptoms appear quite late in patients.The usual diagnostic procedures are a blood test called PSA or prostate specific antigen test. A higher PSA test result indicated possibility of prostate cancer. Although it may be non confirmatory too as Prostatitis may also cause elevated PSA levels.
DRE (Digital Rectal examination) may also suggest presence of prostate cancer, where a qualified and experienced doctor puts a gloved lubricated finger inside the rectum of the patient to feel any bump or hard surface on prostate suggesting a cancerous growth.
Transrectal ultrasound (TRUS) or Transrectal ultrasound guided biopsy are more confirmatory and reliable tests for diagnosing the presence of prostate cancer in a patient.

Treatments for Prostate Cancer

The treatment options for prostate cancer depend on stage and overall general health of patient.
It may involve watchful waiting or active surveillance.
Prostatectomy the surgical removal of part or whole of prostate.
Laparoscopic or robot assisted surgeries are the latest surgical techniques for smaller incision,quicker healing and precise results. Doctors do consider nerve sparing surgical removal of part or whole prostate that does not affect the normal sexual capacity and active sexual life of patient.
 We at Complete Medicare Solutions. are associated with the most experienced cancer surgeons and well equipped hospitals for prostate cancer treatment of our global guests.Expertise of a urological cancer surgeon is very crucial for treatment outcome of prostatectomy.
Other treatment options are Radiation Therapy, it could be external beam radiation therapy. With a 3D conformal radiotherapy assisted with CT scans and MRI for precise results with optimum dose to cancerous cell within the prostate gland.
IMRT or Intensity modulated radiation therapy give more flexibility of dose modulation to Radiation doctors thereby more precise results and avoiding side effect of radiation on bowel and bladder overtime.
Proton therapy is considered superior to external beam radiation therapy for more precise and less side effect associated radiation therapy for prostate cancer treatment.
Brachytherapy can be used for patients who want to avoid daily visit to radiation therapy center or do not want to stay in India for long.
The expertise of Radiation Oncology doctor is again vital for treatment outcome. CMCS Health is associated with the most experienced Radiation oncology doctors and hospitals with latest diagnostics and radiation therapy machines for better treatment outcome of prostate cancer for our global guests.
Hormonal therapies are also used along with surgical and radiation therapies for better treatment options and results for prostate cancer treatments.
Chemotherapy is used for hormone resistant and metastatic or advanced prostate cancer. A combination of chemotherapeutic drugs or single agent therapy are used for better results and lower side effects.
Targeted chemotherapy for prostate cancer holds big promise for recurrent and advanced or prolapsed prostate cancer treatment.
Dr. Deepak Singla - Medical Oncologistis Unit Chief and consultant Medical Oncologist at Dept. of Medical Oncology at Paras Hospitals,Gurgaon,Haryana,India.
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Spine Treatment In India

Spine Treatment In India

Spinal stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Spinal stenosis occurs most often in the lower back and the neck.

Some people with spinal stenosis may not have symptoms. Others may experience pain, tingling, numbness and muscle weakness. Symptoms can worsen over time.

Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves.

Types of spinal stenosis

The types of spinal stenosis are classified according to where on the spine the condition occurs. It's possible to have more than one type. The two main types of spinal stenosis are:

  • Cervical stenosis. In this condition, the narrowing occurs in the part of the spine in your neck.
  • Lumbar stenosis. In this condition, the narrowing occurs in the part of the spine in your lower back. It's the most common form of spinal stenosis.

Spinal stenosis care at CMCS Health care

Symptoms

Many people have evidence of spinal stenosis on an MRI or CT scan but may not have symptoms. When they do occur, they often start gradually and worsen over time. Symptoms vary depending on the location of the stenosis and which nerves are affected.

In the neck (cervical spine)

  • Numbness or tingling in a hand, arm, foot or leg
  • Weakness in a hand, arm, foot or leg
  • Problems with walking and balance
  • Neck pain
  • In severe cases, bowel or bladder dysfunction (urinary urgency and incontinence)

In the lower back (lumbar spine)

  • Numbness or tingling in a foot or leg
  • Weakness in a foot or leg
  • Pain or cramping in one or both legs when you stand for long periods of time or when you walk, which usually eases when you bend forward or sit
  • Back pain

When to see a doctor

See your doctor if you have any of the symptoms listed.

Causes

The backbone (spine) runs from your neck to your lower back. The bones of your spine form a spinal canal, which protects your spinal cord (nerves).

Some people are born with a small spinal canal. But most spinal stenosis occurs when something happens to narrow the open space within the spine. Causes of spinal stenosis may include:

  • Overgrowth of bone. Wear and tear damage from osteoarthritis on your spinal bones can prompt the formation of bone spurs, which can grow into the spinal canal. Paget's disease, a bone disease that usually affects adults, also can cause bone overgrowth in the spine.
  • Herniated disks. The soft cushions that act as shock absorbers between your vertebrae tend to dry out with age. Cracks in a disk's exterior may allow some of the soft inner material to escape and press on the spinal cord or nerves.
  • Thickened ligaments. The tough cords that help hold the bones of your spine together can become stiff and thickened over time. These thickened ligaments can bulge into the spinal canal.
  • Tumors. Abnormal growths can form inside the spinal cord, within the membranes that cover the spinal cord or in the space between the spinal cord and vertebrae. These are uncommon and identifiable on spine imaging with an MRI or CT.
  • Spinal injuries. Car accidents and other trauma can cause dislocations or fractures of one or more vertebrae. Displaced bone from a spinal fracture may damage the contents of the spinal canal. Swelling of nearby tissue immediately after back surgery also can put pressure on the spinal cord or nerves.

Risk factors

Most people with spinal stenosis are over the age of 50. Though degenerative changes can cause spinal stenosis in younger people, other causes need to be considered. These include trauma, congenital spinal deformity such as scoliosis, and a genetic disease affecting bone and muscle development throughout the body. Spinal imaging can differentiate these causes.

Complications

Rarely, untreated severe spinal stenosis may progress and cause permanent:

  • Numbness
  • Weakness
  • Balance problems
  • Incontinence
  • Paralysis
Treatment From Mayo Clinics
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Cardio-Thoracic Surgeries In India

Cardio-Thoracic Surgeries In India

Cardiothoracic Surgery involves surgical procedures involving organs in the thoracic cavity,i.e. heart ,lungs,esophagus and other organs in chest.

At CMCS Health ,we offer the best and most cost-effective Cardio - thoracic surgery in India with most experienced Indian cardiac surgeons at best equipped and well managed Hospitals.

The Cardio - Thoracic surgeries we offer for our Global guests includes :

CABG ( By pass Heart Surgery ) :

Valve Replacement Surgery :

Heart failure Surgery:

Minimally Invasive Surgery:

Thoracic Surgery:

 

Dr Rajneesh Malhotra is the chief of cardiac surgery at Max Super speciality hospital ,Saket,New Delhi. Dr Rajneesh has specialized in minimally invasive cardiac surgery ,CABG (Bypass Heart surgery),Mitral valve replacement and repairs,Aortic valve replacement and repair and Atrial septal defects .

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Multiple Myeloma – Treatment in India.

Multiple Myeloma Treatment In India

Multiple Myeloma is a diseased medical condition involving plasma cells. Normal plasma cells are found in the bone marrow and form an integral God gifted immune system for a healthy Individual.

At CMCS Health we are associated with Best Hematologist and BMT specialist from India for cost effective treatment of hematological malignancies in India. We Offer cost effective Multiple Myeloma -  Treatment in India for our Global guests seeking specialized medical treatment in India.

What is Multiple Myeloma:

Multiple Myeloma is a diseased medical condition involving plasma cells. Normal plasma cells are found in the bone marrow and form an integral God gifted immune system for a healthy Individual.

In Multiple Myeloma patients the normal plasma cells are converted into Malignant plasma cells. These Myeloma plasma cells produce large quantities of abnormal immunoglobulins called M Protien.

The large quantities of this abnormal immunoglobulin hampers the production of normal blood cells in Multiple myeloma patients.

Symptoms of Multiple Myeloma:

Although many of the patients suffering from multiple myeloma may not exhibit or feel any symptoms and it is diagnosed because of some lab. tests recommended by a clinician for other health complaints of the patients.

The common symptoms of Multiple myeloma experienced by patients are:

  • Pain in bones ,which could be in all skeleton system but more prominent in skull,back or hips. Patients of multiple myeloma can easily fracture their bones even with a slight stress or injury because of weakening of bone (osteoporosis ) either in the entire skeletal system or at a place of plasmacytoma.
  • A routine CBC recommended by a physician to rule out a health complaint reveals low RBC , WBC and platelets.Low RBCs cause fatigue , a general feeling of malice and not being well, difficulty in breathing and dizziness. Low WBCs will make patient prone to frequent infections and some patient may have pneumonia. Low blood platelet count may culminate  in delayed blood clotting time and excessive bleeding even with a minor cut or bruise .
  • Hypercalcemia or excess calcium in blood may cause extreme thirst and drinking of plenty of fluids and frequent urinating, dehydration,kidney problems,severe constipation, loss of appetite ,a feeling of drowsiness and confusion.
  • Spinal cord compression in multiple myeloma patient because of weakening of bones and collapsing of spinal vertebrae may cause muscle weakness and numbness in legs or sudden severe back pain.
  • Other more severe symptoms may include congestive heart failure, enlarged liver and spleen ,enlarged tongue ,skin changes, persistent diarrhoea and numbness and weakness in hands called carpal tunnel syndrome.

Diagnosis Of Multiple Myeloma:

Once a clinician suspects that a patient is having multiple myeloma ,he recommends certain blood ,urine , a bone marrow biopsy , Xrays ,CT scans and MRIs to confirm the diagnosis.

 Multiple Myeloma - Treatment in India:

The treatment of multiple myeloma depends on staging done by a hematologist. Usually treatment of multiple myeloma consists of chemotherapy and supportive care , radiation therapy ,surgery in certain cases and Bone Marrow or Stem cell Transplant.

BMT or Stem Cell Transplant for Multiple Myeloma:

 

Follow up Post Multiple Myeloma Treatment:

 

 

Dr. Pawan Kumar Singh - Blood Cancer | BMT specialists is well qualified and well trained in field of Hemato Oncology and Bone Marrow Transplant among Indian clinical hematologists.

Dr Pawan Kumar Singh currently heads the Hematology and Bone Marrow Transplantation department at Artemis Hospital in Gurgaon, India

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Diagnosing Liver Health – Fibroscan

Diagnosing Liver Health - Fibroscan :

Fibroscan is  a pain free,risk free and convenient way for diagnosing Liver fibrosis. A fibroscan can monitor the progression of an individual's liver disease and gives an accurate quantitative measure of success of treatment. It can also suggest life style modifications required for maintaining a healthy liver and ensure stopping further damage to already damaged liver.

Diagnosing Liver Health - Fibroscan :

Fibroscan is the latest technology for assessment of liver stiffness. Liver tissues are spongy naturally but in a diseased liver the spongy tissues undergoes fibrosis. A fibroscan is an instant ,non-invasive and painless diagnostic test for knowing liver health. The newer and latest versions of A Fibroscan machine can also measure Liver fat.

Advantages of Fibroscan Over normal ultrasound scan:

A normal ultrasound of liver can detect only tumors of liver ,Cysts, abscesses , structural lesions of liver and gallstones. Whereas a fibroscan can detect significant liver fibrosis even in early stage. It can also estimate liver fat accurately ,even in early stage.

Who can benefit from Fibroscan :

A fibroscan can diagnose liver health accurately for everyone but those who stand a high risk of liver tissue degeneration can benefit tremendously from a fibroscan.

  • People known to have chronic liver disease.
  • Frequent Alcohol consumers.
  • Obese or overweight people ( When body mass index is more than 23.5)
  • Abnormal liver function test.
  • Enlarged liver.
  • Diagnosed with fatty liver.
  • Diagnosed with hepatitis-B or Hepatitis-C infection.
  • Diabetics.
  • Family history of liver disease.
  • A possible Liver Donor.

Duration of Fibroscan:

No Hospitalization is required for fibroscan. It takes approx. 10 minutes and reports are printed immediately. A person can go to home immediately after a fibroscan as it is pain free and done without sedation.

How Fibroscan is done:

A person undergoing fibroscan lie on his/her back with right arm raised behind the head. The Technician operating Fibroscan applies a waterbased gel to skin of the person undergoing fibroscan.

A fibroscan probe is placed with a little pressure at the abdomen of the person. The fibroscan probe sends a sheer wave into liver and the on board computer registers the data and values. Ten such readings are noted by placing the probe at different places and the average gives the result.

Who should be advised to not undergo a Fibroscan:

A Fibroscan is a generally safe diagnostic tool for diagnosing liver health but

  • Anyone who has implantable device such as a pacemaker or defibrillator.
  • Pregnant Females.
  • People with abdominal ascities.

Dr Pawan Rawal MBBS , MD, DM Gastroenterology  is Unit Head -Department of Gastroenterology , digestive and liver diseases at Artemis Hospital ,Gurgaon.

 

 

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The Inaugural CHS Program at AHH,Kabul.

Afghan Youth service Organization ,an NGO of Afghanistan, Registered with Islamic Republic of Afghanistan , started conducting A CHS ( Continuous health Support) Program with an Indian,Government of India and ministry of commerce registered medical and healthcare consultancy firm CMCS Health, to create awareness for medical and healthcare among the Afghan Nationals.

The Inaugural CHS Program was conducted at The Capital city of Afghanistan,Kabul, Under the banner of AYSO, AHH ( Afghan Health Hospital ) and CMCS Health on 17th November 2016.

The program was well attended by doctors from Various Government and private hospitals of Afghanistan.

Presentations were made from attending Afghan Doctors ,Chairman of Taroon Group Dr Wahid Taroon and CMCS Health MD Mr. Arshad J. Ahmad about the current state of Medical and healthcare segment in Afghanistan and the corrective measures required for short term and long term improvement.

Afghan Health Hospital ( AHH) proposed start of a state of art ,video conference facility for Tele consultation of Afghan patients coming to India for specialized medical treatment with Indian medical specialists.

Training and exchange of ideas program through video conference of Afghan Doctors with their Global counterparts.

OPDs of Indian Medical specialists doctors at Afghan Medical Hospital for Afghan patients on regular basis.

Conducting workshops and training programs for Afghan Medical doctors , paramedical and nursing staff  At Afghan Medical Hospital for improvement in services for Afghan patients.

Regular CMEs with international faculties at Afghan Health Hospital.

 

 

 

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Robotic assisted Pyeloplasty | dr.anant-kumar

da vinci Robotic Prostatectomy In India.

da vinci robotic prostatectomy has considerable advantages over conventional laproscopic prostatectomy as it not only empowers the surgeon  to overcome shortcomings associated with both open prostatectomy and laproscopic prostatectomy but also offers better patient compliance.

Dr ( Prof.) Anant Kumar has good experience of performing da vinci robotic prostatectomy in India.

da vinci robotic prostatectomy offers higher resolution images and enhanced field of vision that empowers the surgeon with very precise movements inside the incision and thus less chances of residual malignant tissues and damage to surrounding healthy tissues. It not only reduces the recovery period for patient post surgery but also decreases chances of relapse of the disease because of the possibility of residual malignant tissues.

As the incisions made during the da vinci robotic prostatectomy are much smaller in size,they reduces chances of any post surgery infections and lesser hospital stay for patients.

 

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Arthroplasty

Knee Replacement surgery in India.

Knee replacement surgery

Knee joint replacement surgery is recommended for those who suffer from severe arthritis pain. Doctors recommend a knee joint replacement surgery usually for patients above 60 years but younger patients may also require a knee replacement surgery if all other treatments options are unable to bring in desired results.

In younger patients who undergo a knee replacement surgery the chances of an early wear out are high because of hectic life styles that put additional stress on the artificial knee.

Know your Knee:

Human knee joint is the largest joint in human skeletal system. Knee joint is also referred as "Hinge Joint" because it is able to flex , bend and straighten like a door hinge.Like all bone ends  in the human skeletal system,the knee joint bones are also covered with a layer of cartilage.

This cartilage acts as shock absorbing cushion to prevent wear and tear to bone ends because of continuous friction created by movements. In addition meniscus is a unique cartilage  between the joint surface of leg and thigh. Meniscus does not have a nerve ending or blood supply.

Meniscus receives it's nutrient from a lubricant fluid called synovial fluid contained within the knee joint. Knee joint bones are surrounded by synovial lining that produces this moisturizing lubricant. In the absence of synovial fluid ( reasons may be due to a damage because of natural ageing or degenerative disease like arthritis or rheumatism ),meniscus is not able to repair itself from the wear and tear of continuous friction of knee movement.

Ligaments,which are strong fibrous tissues link the bones of knee joint ,hold them in place,thus adding stability and elasticity for the knee movement.Muscles and tendons also support knee joint movements and keeping them stable.

 What Makes a person need Knee Joint replacement surgery ?

The major reasons for a knee joint replacement are severe arthritis,knee damage due to trauma or injury and knee pain.

Knee Joint Replacement Surgery:

Depending about severity of knee joint condition ,age,requirement of patient various surgical interventions are available to give the best treatment option to patients.

  • Arthroscopic debridement is removal of tissues of wear and tear by inserting a telescope in affected knee.
  • High Tibial Osteotomy is cutting of Tibia ( shin bone ) at the upper end and re aligning it to distribute the weight on knee joint. This is done for arthritic knees.
  • Unicondylar Knee replacement also called partial knee placement is a surgery performed by qualified and well experienced knee joint replacement surgeons ,where only the partially damaged portion of the knee is replaced or resurfaced and knee ligaments and unaffected cartilage is preserved.
  • Total knee joint replacement Surgery  is done for usually for patients with rheumatoid arthritis and when the entire knee joint is affected.

 

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Robotic assisted Pyeloplasty | dr.anant-kumar

Pyeloplasty – UPJ obstruction treatment.

Dr ( Prof.) Anant Kumar - Urologist | Kidney Transplant Surgeon is regarded as the best and most experienced Kidney Transplant Surgeon of India and Director-Urology,Kidney Transplantation and Robotics at Max Hospital,Saket,New Delhi,India.

What is Uretero-pelvic junction Obstruction?

Uretero-pelvic junction obstruction occurs when the flow of urine from the renal pelvis to proximal ureter have an obstruction. The condition may lead to Hydronephrosis. Hydronephrosis is a medical condition ,where the kidneys are swollen with urine because of narrowing or blocking of ureters. Ureters empty the urine from kidneys into urinary bladder. The resultant back pressure within the renal pelvis may cause progressive kidney damage or deterioration of kidney function.

Uretero-pelvic junction obstruction may appear in children due to a congenital abnormality or even in adults following any previous surgery or any other medical condition that causes inflammation of upper urinary tract.

What causes pediatrics UPJ Obstruction ?

The exact cause of pediatrics uretro pelvic junction obstruction is still not known. Many times the defect is present in an unborn baby and is termed as congenital defect. It is diagnosed during routine prenatal ultrasound.

There may be many reasons for UPJ obstruction during the gestation period. some of them are:

  • During the developing phase the child's ureter is not fully formed resulting in a narrowed section of ureter which may be blocked later on.
  • A faulty muscle in ureter wall which may not squeeze normally.
  • Formation of a "Crossing Vessel" ,i.e., an additional artery feeding the kidney of developing fetus. This may result in kinking or blocking of the ureter.

It can have a genetic component,i.e., it runs in families .Although the responsible gene is not identified yet.

What are symptoms for pediatrics UPJ Obstruction?

Sometimes a UPJ Obstruction in a child does not have any symptoms. A UPJ Obstruction in a developing fetus is usually observed during a routine prenatal ultrasound. It is detected because of hydronephrosis. In majority of cases it is corrected on its own after the child birth.

But in moderate to severe condition the following symptoms may occur and they do need a medical attention as if left untreated,it may cause a permanent damage to kidney or urinary system of child.

  • The renal pelvis or kidneys or both are dilated (hydronephrosis).
  • Abdominal,back or flank ( sides) pain.
  • Frequent UTIs ( Urinary tract infections).
  • Edema
  • Swelling around eyes.
  • Lump in abdomen ( Abdominal mass).
  • Poor or retarded growth in infants.
  • Fever.
  • Rashes.
  • vomitting.
  • Bloody urine or diarrhea.
  • Abnormal urine output.

How UPJ Obstruction is diagnosed?

If Hydronephrosis is observed in a developing fetus during a routine prenatal ultrasound , doctor in charge for delivery of child will do more periodic ultrasound to keep a close vigil on any complications arising of the present medical condition.

Many times this medical condition is resolved on it's own ,once the child is born. But the doctor may do following tests after a few week of birth of child.

  • Creatinine clearance.
  • BUN ( Blood urea Nitrogen).
  • CT Scan.
  • Electrolytes.
  • CT- Urogram.
  • Nuclear scan of Kidneys.
  • Voiding cystourethrogram.
  • Ultrasound.

What causes UPJ Obstruction in adults?

The reasons for UPJ obstruction in adults may be due to scar tissues,infection,any previous surgery or renal calculi (Kidney Stones).

The other reasons may be:

  • A previous renal pelvic trauma.
  • Obstructing calculus immediately distal to PUJ.
  • Previous pyelitis with scarring.
  • Intrinsic malignancy,e.g. upper tract urothelial carcinoma.
  • Extrinsic ureter compression due to

 

1. Fibrosis.

2. Crossing vessel at PUJ.

3.An underlying malignancy.

Symptoms of UPJ Obstruction in adults:

Adults may experience following symptoms because of UPJ Obstruction:

  • Renal colic.
  • Chronic back pain.
  • Other non specific signs may be hematuria,Urinary tract infections and pyelonephritis.

Treatment Options:

Treatment line depends on presence of underlying cause.In Majority of congenital cases,no intervention is required and the condition subsides after some time however in case of a definite structural obstruction ,surgical intervention in the form of pyeloplasty or stenting may be needed.

Surgery is also inevitable in case of deterioration of renal function or when associated symptoms are severe and progressive.Aim of treatment is to normalize renal drainage and if possible,improve if  reversing the damage to kidneys is not possible.

 

 

 

 

 

 

 

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