FMRI participated in Kuposhan Mukt Abhiyaan 2021, Gurugram. 'An ultimate fight against malnutrition and anemia'. Sincere efforts by ADC gurugram Mr Prashant Panwar for this apt cause .Let malnutrition not stop these kids from fulfuling there dreams and contribute in healthy and prosperous India. Attended by 150 anganwadi workers and knowledge sharing about early diagnosis of malnutrition and anemia.
Dr Biplab Das, Consultant Neurology and Interventional Neuroradiology under the guidance of Dr. Praveen Gupta, Director and HOD, Neurology. Fortis Memorial Research Institute (FMRI), Gurugram, and Dr Vijay Kant Dixit, Director, Interventional Neuroradiology, FMRI organised the National Stroke CME cum Stroke Preceptorship and Training Programme in Guwahati, Assam. The programme was endorsed by the Indian Stroke Association (ISA) and Indian Academy of Neurology (IAN). The academic event was attended by more than 250 delegates comprising of Neurologist, Neurointerventionist, Physicians and Paramedic stroke teams. Many national and international doyens of Stroke Neurology, including Prof M. V. Padma (AIIMS, Delhi), Prof Dheeraj Khurana (PGIMER, Chandigarh)and Dr Monica Saini (CGH, Singapore) graced the event.
Haryana Pulmocon 2019 was organized under the aegis of Haryana Chapter of Indian Chest Society in collaboration with the Association of Physicians of India, Haryana by Fortis Memorial Research Institute, Gurugram on 6th and 7th of April 2019 at Gurugram. Dr. Manoj K Goel, Director, Pulmonology, FMRI was the organizing chairman. Dr Ajay Kumar and Dr Gargi Maitra were the Organizing and Joint Organizing Secretary respectively. The conference was held at a seven-star facility, The Hotel Leela Ambiance; however, the registration was complimentary. There were also three workshops with Hands-on training and Simulation on EBUS Bronchoscopy, Medical Thoracoscopy, Mechanical Ventilation, and Sleep Medicine. A galaxy of renowned speakers from all over India shared their valuable knowledge and experiences during lectures, debates and panel discussions. Some of the Luminaries of Haryana were honoured with Prestigious Awards for their immense contribution to the field of Pulmonology. The theme of the conference was ‘Bringing Reality to Practice’. The conference was highly successful with over 500 registrations. This two-day event matched international standards in the arrangements, scientific content, and training of delegates during the workshops.
Dr Vivek Vij and team performed Dual Lobe living donor liver transplant, where one patient had two living donors.
Patient from Iraq came with recurrent complex chest wall draining Sinus for last 30yrs post Pneumonectomy. On CT scan patient has right side chest wall draining sinus for which the patient was mobilized and the remanant part of Latissimus dorsi muscle and the sinus wall was DE roofed to fill the sinus with muscle flap. Patient was discharged with no further complaints a& doing well after 4weeks of surgery.
Patient from Iraq with severe breathlessness came to Dr Manoj Kumar Goel for Treatment. The patient needed a lung biopsy, but was on a higher risk to life. A Video Assisted Thoracic Lung Biopsy was planned with the team of Anesthesia & Dr Narendra Aggarwal and the procedure was performed while the patient was awake on high epidural regional anesthesia. Patient underwent thoracic procedure and had no Intra operative or Post procedure complications and discharged with a confirmed diagnosis.
Baby Maryam from Tajikistan was born with a condition that caused her skull to swell
Doctors at Fortis Memorial Research Institute recently came across a highly complex case. It was the unique case of Baby Maryam from Tajikistan, who was suffering from Congenital Hydrocephalus with magalencephaly. She was two years old and was born with ‘hydrocephalus’, a condition in which the fluid is collected in the brain causing the head size to increase. For Maryam, mobility was next to impossible, and she had been struggling with this condition since she had been one month old. A team of doctors, led by Dr. Sandeep Vaishya, Executive Director – Neurosurgery, Fortis Memorial Research Institute, successfully diagnosed and operated the patient’s condition by carrying out an extremely risky and rare surgery.
The usual treatment for such a condition is to perform a VP shunt surgery. This involves installing a small tube in the brain to drain the excess fluid. This surgery was performed (in Tajakistan) when Marayam was just eleven months old. It reduced the circumference of her head from 72 cms to 64 cms. However, brain damage had already occurred and the bones had fused together because of which her brain size could not be reduced further. She was also unable to sit up or hold her head up.
Dr. Sandeep Vaishya said, “We were reluctant to perform the surgery as chances of improvement in such cases are extremely low and the risk factors are extremely high. However, the family was ready to give consent despite the risks. We performed eight surgeries on the patient over a period of five months. We managed to reduce the size of the head, but the surgery proved to be extremely challenging. At one point, we almost lost her, but she fought back. Though it is still early, we have noticed some positive changes. Her last CT scan showed good brain development and she has started to lift her head. While there are chances of brain damage, it is her best chance to live a nearly normal life.”
Dr. Ritu Garg, Zonal Director, Fortis Memorial Research Institute, Gurugram said, “It was a rare case, fraught with risk of complications and each course of action seemed dangerous. However, I was confident about the team handling the case. Dr. Sandeep Vaishya is a pioneer in his field and has previously handled numerous such cases. He is experienced and adept at intricately handling the elaborate nexus of the brain. Maryam’s post operation phase was smooth and we have been monitoring her closely.”
The family of the patient said, “Dr Sandeep Vaishya had in 2013 operated successfully a similar child – Baby Roona Begum (from Tripura, India) who had the largest recorded head (94 cms) in the word at 09 month age. That case was covered internationally by CNN and Discovery channel also made a documentary on the child. This was seen by us and we came here for the surgery. We were scared and had lost all hope. Maryam had previously undergone a shunt installation at Tojikistan but we knew she would eventually have to go through surgery again. I am hopeful that Maryam will be able to lead a better quality of life post the surgery.”
Fortis Memorial Research Institute in association with Center for Biomedical Engineering at Indian Institute of Technology Delhi conduct studies on differentiation of tumor grade. The purpose of the study was to evaluate the usefulness of MRI in discriminating among different grades of tumor. The study is already published in international reputed journals like JMRI (Journal of Magnetic Resonance Imaging), MRI (Magnetic Resonance Imaging), NR (Neuro Radiology), Pediatric Neurosurgery and Diagnostic International Imaging.
The study comprised of doctor from Fortis Hospital, Gurugram including Dr. Rana Patir, Dr. Rakesh Kumar Gupta, Dr. Pradeep Kumar Gupta, Dr. Sunita Ahlawat and Dr. Preeti Jain. The title of the studies are- “Differentiation of grade II/III and Grade IV glioma by combining ‘T1 contrast enhanced brain perfusion imaging and susceptibility weighted quantitative imaging” and “Characterization of breast lesion using T1 perfusion magnetic resonance imaging: qualitative vs Quantitative Analysis.”
New Delhi, 23 July 2018: In a shocking discovery, doctors at Fortis Memorial Research Institute found 100 tapeworm eggs in the brain of an eight-year-old girl. The patient was presented with obesity, headaches, epileptic seizures, breathlessness, difficulty in walking and swelling of brain. Dr Praveen Gupta, Director, Neurology at Fortis Memorial Research Institute and his team treated her for a period of six months using non-surgical techniques to remove the tapeworm eggs.
The patient had been on steroid treatment to tackle the epileptic attacks and headaches. As a result, she had gained weight and had gone from being 40 kilos to 60 kilos. However the headaches persisted. The scan of the brain showed more than a hundred white dots, formed due to tapeworms. Such an infection is caused by accidentally eating foods infested by tapeworms. When eggs reach the brain through the nervous system, they cause neurocysticercosis. They had reached her brain (from her stomach) through her blood stream.
According to Dr Praveen Gupta, "This was a very complicated case. The patient was unconscious at the time of admission. There were no surgical options available; and it was too risky to try anything experimental, considering her fragile condition. We first decided to reduce the swelling using decongestants and then we started anthelmintic therapy, which destroyed the parasitic worms. This was followed by course of steroids. She began to respond well to the treatment. Over a period of six months she recovered, free of any complications or side – effects. She is now 40 kilos, and is able to walk on her own and has gone back to school.
The father of the patient said, "We are so grateful that our daughter has recovered from this terrifying ordeal. Thankfully, she was treated in time and the eggs did not hatch. We were shocked when we found out that she was suffering from neurocysticercosis. We had no idea that such an infection could affect our child. I am extremely indebted to the doctors at the hospital for giving my child a second chance to live."
Neurocysticercosis is an infectious parasitic disease caused by solium, a tapeworm found in pigs. It occurs when cysts are formed within the brain causing neurological symptoms. It is caused when a person accidently eats improperly washed vegetables or fruits. It is also caused when uncooked meat is consumed. The symptoms result in the breakdown of the central nervous system or epileptic attacks. Immediate treatment in such cases is necessary.
A 97 years old male with life threatening, painful, irreducible, left sided groin hernia also suffering from multiple medical problems like heart disease, Parkinson’s disease, Lung disease, diabetes, hypertension etc underwent successful lifesaving surgery at Fortis Memorial Research Institute Gurugram. Know More
Dr Rahul Bhargava, Director Haematology, Haemato-oncology and Stem Cell Transplant at Fortis Memorial Research Institute, believes strongly in the power of education and the critical need to educate the Primary Health Care providers so that affordable, quality health care can be made available to all.
Towards this end, he has joined hands with the Government of Madhya Pradesh to educate the Medical Officers posted in the Primary Health Care Centres across the state, on the latest medical developments in the fields of Anaemia, Thrombocytopenia and Blood Cancer.
Thus, these Medical Officers are being equipped to serve the people at the grassroots of the state, turning Dr Bhargava’s vision of an anaemia free India and accessible, affordable, quality healthcare for all, into a reality, one state at a time.
A 35 years old female patient with complaints of breathing difficulty, difficult & painful swallowing, episodes of syncope & pain in right arm was diagnosed with a rare condition called Dysphagialusoria wherein, the right subclavian artery arises from the left side of arch of Aorta, becomes dilated & compresses the Esophagus & other neighboring structures. She could not diagnosed during her previous consultations & hospitalization & was treated by neurologists & Gastroenterologists for her complaints. It was by CTVS department under the guidance of Dr. Udgeath Dhir, which made a rare diagnosis & did a challenging surgery on her, in which her aberrant right subclavian artery was re-routed and attached to right common carotid artery. Patient is relieved of her symptoms now & is recuperating in the hospital.
Another feather in the cap of CTVS department led by Dr. Udgeath Dhir, as they successfully removed a 9 kg tumour from mediastinum of a 41 years old male, patient who came with complaints of difficulty in breathing and chest pain. It was a challenging case as the tumour was compressing the right ventricular outflow tract, other adjoining structures & great vessels. Tumour was also making his breathing difficult as it was causing expansion of lungs difficult. After a 4 hours surgery, it was total removed from the mediastinum with an uneventful intra-operative course.
Patient was greatly relieved from his symptoms after the surgery and behaved well post operatively. He was discharged from the hospital after 5 days with normal parameters. Biopsy showed an atypical carcinoid, which in itself is a rare entity KUDOS to CTVS Team, FMRI
Gurgaon Obstetrics and Gynae society organised the annual conference of Indian menopausal society and showed keen interest in robotic surgery live workshop. They wanted to observe how the robot works, docking of the robot and the surgery of hysterectomy and sentinel node mapping when possible. They also wished to understand how robotic surgery is different from laparoscopic. Dr Rama Joshi, Director, Gyanea-Oncology & Robotic Surgery conducted this workshop at Lemon Tree hotel in Gurgaon. Around 350 delegates attended the conference from all over the country.. International faculty from Sri Lanka, Pakistan, Bangladesh and United States participated as well.
Robotic Head-Neck Surgery Masterclass-2018: Department of Head-Neck and Thoracic Surgical Oncology, FMRI Gurgaon conducted the Robotic Head-Neck Surgery Masterclass – 2018 on 26th February, 2018 at FMRI Gurgaon. Under the mentorship of Dr. Surender Dabas, Director, Department of Head-Neck and Thoracic Surgical Oncology. 22 dedicated Head-Neck surgeons from North India attended and benefited from the programme. The program included live robotic surgery (Trans-oral Robotic Surgery); Interaction with the expert on the finer nuances of robotic surgery and live hands on training on the Si Da Vinci Surgical system. The programme was highly appreciated by all the delegates.
Dr Aniruddha Dayama’s poster on Autologous Stem Cell Transplant in Adult Multiple Sclerosis Patients: A Pilot Study from North India that was submitted for the 2018 BMT Tandem Meetings, was selected for Poster Presentation at salt lake city Utah on Feb 21, 2018.
Neelam Babbar a 56 year female was suffering from a rare disease in which there was a large collection of abnormal proteinaceous material in her lungs, a condition called Pulmonary Alveolar Proteinosis. This abnormal protein collection had led to severe lung dysfunction and she was in severe respiratory distress with very low oxygen concentration in her blood. She had to be ventilated and had very little chance of survival. She was managed by the Pulmonlogy and Critical Care Teams at Fortis Memorial Research Institute. Dr Manoj K Goel, Director, Deptt. of Pulmonology, Sleep and Pulmonary Critical Care did washing of her both the lungs with more than 20 litre of saline, a procedure called whole lung lavage. This procedure resulted in removal of this abnormal protein from her lungs and her life could be saved. She is now breathing normally with good oxygen saturation in her blood.
Invasive bladder tumor in a female patient is a serious ailment with debilitating surgical outcomes. In majority of cases, the bladder and genital organs (uterus/ovaries) are removed and urine is diverted by an ileal conduit. A handful of centers in the world are performing genital organ sparing open-radical cystectomy, for younger women who want to preserve their fertility.
At FMRI, Dr Sanjay Gogoi and his team performed Genital Organ Sparing Robotic Radical Cystectomy with Orthotropic Neo Bladder on a young patient from Mauritius thereby preserving her ability to bear children in future. This is the first such surgery done robotically in India.
A 35 year old male patient from Lucknow was admitted with Respiratory distress under Dr Manoj Goel, Director & Unit Head, Pulmonology & Sleep Medicine. He was diagnosed with massive acute on chronic pulmonary embolism condition in which there is clotting in the blood vessels to the lungs.
The patient also developed a drop in his blood pressure. He was immediately given thrombolytic which helps in dissolving the clots and was put on a ventilator. During the course of treatment, the patient had a cardiac arrest and was successfully revived. He also developed altered sensorium and severe acute kidney injury which required dialysis a number of times. He also developed severe lung and gut infection which was also treated successfully.
This patient had multiple life threatening episodes since his admission all of which were taken care of by our expert pulmonologists, nephrologist and critical care team. Such cases are extremely difficult to tackle and survival after a cardiac arrest is very rare. The patient was discharged and he went back home in a healthy condition.
An underlining heart condition that emerged for 66-year-old Arif Abd Allateef (a resident of Baghdad) in 2015 came as a shock for the cancer survivor who was living with just his left lung post an onco-surgery done in on account of removal of his entire right lung for cancer surgery in 2005 in Iraq. Since surgery under the current circumstances was not possible factoring his age cardiologists back home put him on medical management.
However, since June this year, Allateef developed severe chest pain and his health progressed downhill from then. Cardiologists back in his country suggested a surgery but with his single lung, they were not very sure whether the patient would be able to survive.
"The alternative for me, looking at cost effectiveness along with a good surgical outcome was to travel to India," said Allateef.
The patient was thoroughly examined for his condition and evaluated for surgery by Dr Udgeath Dhir, additional director, CTVS at FMRI and his team.
"There were several challenges in this case starting from his age to the history of his illness and his overall health. The patient had a blockage in one of the main arteries supplying blood to the muscles of the heart but stenting was not viable because of the anatomy of the blockage. They decided to conduct a bypass surgery (CABG - Coronary artery bypass grafting). According to available literature, there have been only 29 such cases of CABG conducted on a patient with a single lung reported world over with mortality of 16%.
The bypass surgery was carried out on a beating heart by carrying out a sternotomy (surgical procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided) to reach the chest cavity.
"We also had to ensure that the patient did not face difficulty in breathing post-surgery so we stopped his antiplatelet and put him on high thoracic epidural catheter to ease normal breathing for which special medications and techniques had to be used. The patient was discharged on day 7 of his surgery.
When a patient is diagnosed with a tumour of the bladder, the general procedure is to remove the whole bladder and to reconstruct the urinary tract in order to allow urine to leave the body. There are a few ways to do the same, first being urinary conduit, in which the surgeon uses a piece of the intestine to create a tube that runs from the kidneys to the abdominal wall. A bag on the abdomen collects the urine. Second being the Indiana pouch in which a tube is created that runs from the kidneys to a small reservoir that's attached to the inside of the abdominal wall. A catheter is used to empty the reservoir through the bellybutton several times a day. And the most advanced technique is the "Neobladder" in which a part of the intestine is used to create a new bladder that allows the patient to urinate through urethra in a relatively normal fashion.
Not more than 10 centers in the world perform neobladder surgeries. Dr Sanjay Gogoi, Director-Urology & Renal Tranaplant and his team has performed around 40 Radical Cystectomy with Intracorporeal Neobladder in the last three years at FMRI. In the month of July six surgeries were performed, which is the highest number ever done in a span of 30 days.
The first Robot-assisted Radical Cystectomy with Intracorporeal Neobladder surgery was performed on 9th July, 2017 on a 66 year old male patient from Samoha islands. The surgery was successful and the patient was discharged within a couple of days. The potential advantages of a complete intracorporeal procedure are less intraoperative blood loss, decreased bowel manipulation and exposure, reduced insensible losses, decreased morbidity from smaller incisions, reduced postoperative analgesic requirements, shorter hospital stay and earlier return to normal activities.
FMRI has emerged as one of the few centres in the world to perform both robotic kidney transplants as well as robotic intracorporeal neobladder surgery.
A Master class in Robotic Gynae Onco surgery was organised by the department of Gynae Oncology on 26th and 27th July 2017 at FMRI by the Department of Gynae Oncology. The event was inaugurated with a lamp lighting ceremony by eminent international faculty Dr. Walter Gotlieb, Dr. Bishnu Panigrahi, Head Medical operations, Dr. Simmardeep Singh Gill- Zonal Director, Dr Yash Pande- Medical Director & Dr. Rama Joshi Director- Gynae oncology & robotic surgery. The event was honored by the presence of Dr. Walter Gotlieb who is the head of the department of gynae oncology at Segal cancer centre, Canada, a renowned robotic surgeon and president association of gynaeoncologists of Canada. The event was also graced by the presence of distinguished national faculty from various part of the country and attended by students from many distinguished hospitals and medical colleges from Delhi NCR and other cities. Various issues concerning current and emerging surgical technologies in Gynae Onco surgery were discussed in this meeting.
On 29th July 2017, Fortis Organ Retrieval & Transplant (FORT) & Department of Pediatrics, Fortis Memorial Research Institute organised India’s first summit with the objective to bring together experts in the field of Paediatric Critical Care, Paediatric Neurology and Organ Donation from public and private healthcare players across the globe. It was the first national level meeting on pediatric organ donation in India endorsed by International Society of Organ Donation and Procurement. Several esteemed dignitaries of international and national stature also participated. The discussion revolved around issues namely - Finer aspects of performing tests for brain death in children, Case based studies on difficult situations, Role of ancillary tests, Challenges in counseling of families for organ donation, Donor optimization in children and challenges in pediatric heart, lung, liver and kidney retrieval and transplantation.
Fortis Memorial Research Institute piloted a first of its kind study on patients suffering from early stage oropharyngeal carcinoma. Trans -oral robotic surgery (TORS) was conducted on 57 patients under the leadership of Dr. Surender Dabas, Director, Head, Neck and Thorax Surgical Oncology. 57 patients suffering from early stage oropharyngeal carcinoma underwent TORS Robotic Surgery conducted with assistance of a surgical robot to remove a tumor from the mouth or throat. The common site of involvement was the base of tongue (BOT) in 31 patients. 24 patients were stage I and 33 were stage II at presentation. 43 patients were disease free with an overall survival of 93.8% at a mean follow-up of 29 months. This novel and path-breaking surgical technique is instrumental in healing patients suffering from HPV negative cancers which are caused mostly due to tobacco consumption
Renowned orthopedic surgeon and Padmashree recipient Dr. Ashok Rajgopal at the Fortis Bone and Joint Institute, Gurugram conducted the first successful robot aided joint replacement surgery on a 61-year-old patient, who had been suffering from severe left knee pain for many years. The robot-assisted system eliminates the possibilities of human error and this leads to perfect alignment, leading to the longevity of the joint implant. FMRI has established itself as a Centre of excellence for robot-assisted surgeries in the fields of Urology, Oncology and Gynaecology with the latest Da Vinci Robotic System that was introduced in the year 2015 and hundreds of patients have benefited from it in the past.
Cystic Fibrosis is a chronic, life limiting, pulmonary disease in which children are destined to die early, remains largely undiagnosed in our country. In its commitment to serve these children, the Division of Pulmonology, Fortis Memorial Research Institute, Gurgaon, hosted its Fifth Annual Cystic Fibrosis (CF) Meet. Patients were also given free consultations/ annual reviews and free relevant investigations were done for diagnosed patients and those with chronic respiratory infections.
Baby Azariah Malala Semikueva Sua, Age: 7 Month, Resident of Samoa, came to Fortis Memorial Research Institute for consultation with Dr. Vivek Vij, Add. Director, Liver Transplant & GI Surgery at the end of March 2017. After detailed investigation and evaluation, baby was diagnosed to have extra-hepatic bile duct obstruction with a chronic liver disease. Hence was advised for urgent living donor liver transplant surgery. The baby’s father Semikueva Sua, 37 years old gentleman was chosen as a voluntary liver donor. Eventually, baby underwent the surgery on 8th May 2017 and both father and son are recovering well.
Targeted Alpha Therapy (TAT) is a novel radiopharmaceutical therapy where alpha emitting radio-isotopes like Bismuth 213 are conjugated with specific tumor directed ligands and used to treat various kinds of cancer. Currently the two cancers being targeted are metastatic prostate cancer and neuroendocrine tumors. FMRI would be the first organisation in Asia to start this therapy. Currently this therapy is available in a few selected centers in Germany and the US only. The targeted alpha therapies offer a ray of hope to patients who have failed many other lines of treatments. The clinical success of TAT has already been proven in various studies worldwide. Patients can be treated as day care requiring admission for 6 hours. Each patient will require two admissions in day care on alternate days. Our first TAT generator is scheduled to arrive on 3rd of July 2017.
A patient with adenoid cystic carcinoma of nasopharynx underwent a surgery at FMRI a couple of days back .
The only treatment option which was given to the patient at other hospitals was an open surgery which meant separation of maxilla to reach the tumor. Dr. Surender Dabas and his team performed the surgery through the mouth opening to remove the tumor. This ensured that no scar was left on the neck and the facial region.
A middle aged lady who was a liver transplant recipient underwent laparoscopic nephron sparing surgery for recurrent kidney tumor which was performed by Dr. Sanjay Gogoi, Director Urology and Renal Transplant and his team. She was having a familial disease known as Von Hippel Lindau Syndrome in which recurrent renal tumor was a common problem. Her left kidney was removed for a large tumor a few years back. And now she was operated at FMRI for tumor in the right kidney for which laparoscopic partial nephrectomy was done.
In a rare feat attempted by Dr Udgeath Dhir, Additional Director and Head Adult-CTVS and his team at FMRI, a 50-year-old international male patient suffering from “Myasthenia Gravis” successfully underwent a minimally invasive surgery for Thymectomy (removal of the thymus gland). The removal of the thymus gland is a usual technique to improve such conditions in most patients, as was also recommended in this case. To take this organ out as a whole, usually patients have to undergo sternotomy (vertical long incision on the sternum to reach chest cavity). This leads to a longer stay in the ICU and a lengthy recovery. In this technique used by Dr. Dhir, a small incision (5 cm) was made on the right chest and using special retractors and with the help of long instruments, thymectomy was carried out. The entire organ was “cut” away from its neighbouring tissues and extracted as a whole without using a scope to view inside. The challenge in such a surgery is that no part of the affected gland can be left behind else the condition will recur. The patient was extubated on the table itself and was discharged on day 5th of the surgery.
Fortis Organ Retrieval & Transplant(FORT) and Department of Ophthalmology, FMRI are hosting a workshop on ‘Revisiting Contraindications to Cornea Donation’ at FMRI, on 21st Jan 2017. The workshop is being organized along with National Programme for Control of Blindness (NPCB), Eye Bank Association of India (EBAI), NOTTO, MOHAN Foundation, SightLife and Dr Shroff’s Charity Eye Hospital. Dr Promila Gupta, DDG, NPCB, MOHFW shall be the Patron and Chief Guest. The Advisory Committee is being led by Dr Radhika Tandon, President EBAI, Co-chair National Eye Bank, Prof of Ophthalmology, AIIMS. Experts in the field of cornea donation and transplantation from most government and private hospitals of the NCR gathered to put their shoulder to the wheel. The guidelines prepared shall be uploaded on the website of Min of Health & FW for comments of experts from rest of the country.
The topics covered includes:-
Young Iraqi woman suffering rare genetic disorder gets new lease of life
As a child, Mala was always fatigued and often experienced abdominal pain. After several check-ups and tests back home, doctors diagnosed her with the genetic condition. Due to the blockage in the hepatic vein which obstructed the outflow, her liver was gradually “dying”.
“By the time Mala reached here, her liver was completely black and shrunken. The main vein (IVC) draining blood from the abdomen and lower limb was blocked. She required urgent transplant in order to save her life. Her brother, 27-year-old Bzhar, matched for a donor in Mala’s case. All necessary tests were done and Mala underwent the transplant on December 28th,” explained Dr Vivek Vij, Director – Liver Transplant, Fortis Memorial Research Institute.
A new liver transplant team headed by Dr. Vivek Vij has joined FMRI in December 2016. Dr Vievk Vij is a pioneering liver transplant surgeon credited with developing living donor surgery and standardising safety protocols to achieve a 100% donor safety profile since the time of its inception in the country. He is the founder of Liver transplantation and Hepatobiliary Sciences in Fortis group of Hospitals, starting a highly successful liver transplant programme initially at its Noida centre and then at Mohali. Dr. Vij and his team has a cumulative experience of performing more than 2500 liver transplants.
Dr Rama Joshi, Director – Gynea Oncology, Fortis Memorial Research Institute, Gurgaon has become the first Robotic Surgeon in Northern India to reach the 50th surgery milestone using the Da Vinci Robot in the shortest time. As per the record of Vatticuti Technologies, Dr Rama Joshi is the first Gynae Onco surgeon to perform 50 fastest DaVinci robotic Gynaecology procedures in Northern India successfully. The patients have ranged in age from 9 to 81years, and the cases have been varied – from complex hysterectomies to radical surgeries for endometrial cancer, and completion surgical staging for ovarian cancers, as well as surgeries for suspected malignancy and pre-malignant conditions. All the patients walked out the very next day of the surgery due to minimal blood loss, barely 7mm incisions (instead of long vertical ones) which helped them becoming mobile quickly.
A young patient married for last 7 years, was looking forward to having a baby. Her first pregnancy in 2011 ended in a spontaneous miscarriage. She conceived again in 2012 and unfortunately miscarried at 7 weeks. She was advised certain tests and it came to light that the patient was infected with HIV.
The couple came to Fortis Hospital (Gurgaon) to meet Dr. (Prof.) Suneeta Mittal and was evaluated completely and offered assisted conception. Couples who are discordant for some transmissible infection can still have a baby with this technique. Having a child through natural conception was not an option as this would risk the husband of acquiring the same infection. So an intrauterine Insemination was planned. The husband’s semen was collected, processed and washed and injected directly into Mrs. A’s uterine cavity at the right time of cycle, synchronising the process with egg rupture. The destiny favoured this time and she got pregnant in very first cycle. The pregnancy was followed up for 9 months in liaison with ART (Anti-Retro Viral Therapy) specialist. She continued to have the anti-retro viral drugs throughout pregnancy and was delivered by elective lower segment caesarean at 38 weeks, giving birth to a healthy baby boy weighting 2.85kgs.
With the advent of assisted conception, having a pregnancy and child birth is now a reality for such couples. Without any Intervention the risk of transmission of HIV from infected pregnant women to her child is around 25-40%. The risk however is reduced to less than 1% by treating the mother with highly active anti-retroviral therapy (HAART) during pregnancy, delivering by elective LSCS at 38 weeks and totally avoiding breast feeding. The baby is also given prophylactic anti retro viral therapy and baby’s blood is tested after birth on D1, 6 weeks, 12week and at 18months of age to ensure the child has not contracted the infection.
A young lady from Zimbabwe with total blindness in both eyes due to an acid injury was treated by the ophthalmology team at FMRI. She had multiple scarring on face and her left eye had suffered severe damage with melting of the globe with nil chances of visual recovery. The right eye showed dense corneal opacity and tight scarred eyelids with absent lid movement. The Ophthalmology team headed by Director and Oculoplasty specialist Dr Anita Sethi and Cornea Specialist Dr Srilathaa Gunasekaran planned the surgical correction in a staged manner. Eyelid reconstruction was done by skin grafting over both upper and lower lids. Corneal transplantation was done 2 weeks after the lid procedure. At final follow-up, the patient had a stable corneal graft with good eyelid movement and eye closure. She had gained ambulatory vision and was independently able to perform her basic tasks.
A 6 month old baby from Iraq suffering from congenital UreteroPelvic Junction obstruction was successfully treated by Laparoscopic Pyeloplasty at Fortis Memorial Research Institute, Gurgaon. The team that carried out the procedure was headed by Dr. Vikram Sharma, Director – Urology and Head Robotic Urology. UPJ obstruction is a rare genetic disorder, occurring in 1 in 2000. Newborns and babies with this condition are at a risk of rapid kidney deterioration and failure. The patient was in constant pain due to the obstructed kidney and had been crying incessantly since birth. The surgery was performed via 3 tiny incisions – one 5mm camera port and two 3mm instrument ports giving a combined incision length of 1.1cm – less than half an inch. The baby made a remarkable recovery and the mother was ecstatic. She said it was the first time she had seen her child smiling since he was born.
A pre-pubertal girl usually has a uterus measuring around 7 cms. A patient was carrying an ovarian tumor measuring 9cmX10cm which was resting on the uterus. It was a medical emergency since the tumor was highly vascular containing old blood and had ‘coiled’ around the left ovary and her left fallopian tube several times. The ovary and fallopian tube were deprived of fresh blood supply leading to rapid cell death in the region. A robotic surgery was carried out by Dr Rama Joshi, Director, Gynea-oncology, FMRI and her team on October 20th to remove the ovarian tumor, left ovary and fallopian tube. The large mass, filled with old collected blood’ was excised as a single piece through a 15 mm incision in her stomach. Her right ovary and uterus has been salvaged and she will be able to have a normal married life. She was discharged the next day of her surgery with minimal pain.
The robotic programme at FMRI is focused on Urology, Uro-oncology, Onco gynecology & Thoracic surgery. The 100th procedure was done by Dr. Vikram Sharma on Sept 15, 2016 . Da Vinci robotic programme was initiated by Dr. Sanjay Gogoi in FMRI in Dec. 2015. With multispecialty trained team of surgeons, robotic programme took a leap after February when all the eminent surgeons started doing procedures with the latest Da Vinci technology. Dr Vikram Sharma did a total of 38 procedures and Dr. Rama Joshi contributed another 38 robotic oncogynecology procedures. The established teams of Dr. Sanjay Gogoi, Dr. Vikram Sharma and Dr. Rama Joshi are the pioneers in establishing this landmark in FMRI Center of robotic surgery.
In a rare surgery performed on a 6-month-old patient from Iraq, the Paediatric Surgery team at Fortis Memorial Research Institute, Gurgaon headed by Dr Arvind Sabharwal (Director) performed a successful Whipple’s procedure for a rare genetic condition “Persistent Hyperinsulinemic Hypoglycemia of Infancy (PHHI)”. PHHI or nesidioblastoblastosis is an extremely rare hereditary disorder affecting 1 in 50,000 live births and is characterized by severe hypoglycaemia with elevated insulin levels due to excess secretion of insulin. If left untreated it causes irreversible brain damage or death due to hypoglycaemia in infants. Most babies are unresponsive to medical therapy and surgery in the form of near total pancreatectomy(removal of the pancreas in totality or practically) is the only cure.The Paediatric surgical team including Dr. Arvind Sabharwal and Dr. Anand Sinha decided to perform a complex Whipple’s surgery to remove the head of pancreas along with distal common bile duct and the duodenum (first part of the small intestine immediately beyond the stomach). The surgery lasting 4 hours was well tolerated by the child. The baby was discharged on full oral feeds, maintaining normal glucose levels without any supplements.
Under the dynamic leadership of Dr Ashok Rajgopal, Executive Director and Chairman, The Fortis Bone and Joints Institute, FMRI has achieved the remarkable feat of performing. procedures in the last two months. The Fortis Bone and Joints Institute is a super specialty unit providing one stop solution for all orthopaedic and musculoskeletal problems. The institute has one of the most proficient and prolific orthopaedics teams in the country and is known for its innovative approach.
A dedicated interventional spine and pain clinic was set up in FMRI this month under the guidance of Dr H H Dash, Director and HOD, Anaesthesia and Dr Vaibhav Bhola, Consultant, Anaesthesia. The interventional pain management programme is run by well qualified multi-disciplinary team of physicians that are involved in patient care include interventional pain physicians, orthopaedic surgeons, neurosurgeons and spine surgeons. The clinic caters to patients suffering from chronic neck and back pain, cancer pain, shoulder pain, craniofacial pain syndrome, post spine surgery pain, sciatica pain and neuropathic pain. More than 50 patients have walked in for consultation and 30 IPD procedures have already been performed since its launch.
Rhenium lipiodol is a radioactive substance which is injected into the hepatic artery of a patient of liver cancer, where it helps in destroying the tumour. Earlier transarterial radioembolisation used to be done with an imported agent called Sirsphere, which would cost the patient 10 - 12 lakhs for the procedure. This new agent brings the same cost down to 2.5 lakhs. This radioactive substance is developed and promoted in India by the International Atomic Energy Agency and FMRI along with Kovai Medical Centre and Tata Memorial Hospital are the first to perform this procedure in the country. Dr Vineet Pant, Associate Consultant, Nuclear Medicine and Dr Jagdeep Shekhawat from Interventional Radiology, are driving this team at FMRI.
A 47-year-old patient, Alok Badola, underwent a liver transplant at the FMRI, on July 9. Alok was one of the four recipients, who was fortunate to receive a deceased organ from a road traffic victim, brought in to Fortis Hospital Vasant Kunj earlier.
Badola, a resident of Dehradun, was suffering from liver cirrhosis, after he had contracted jaundice twice in the last six months. His wife was deemed unfit to donate due to a mismatch. According to Dr Anupam Saha, Director, Liver Transplant & Hepato-Pancreato Billary & GI Surgery at FMRI, the recipient had less than a year to survive had he not undergone the transplant. Further, he said that while shortlisting a patient for transplant, it is important that the patient has been evaluated thoroughly. According to studies world-wide, the chances of survival for a liver transplant patient in 15 years post-transplant is as high as 60%. This is because liver as an (donated) organ has the inherent tendency to fight rejection even when in a foreign body.
Speaking about things that could possibly go wrong during or immediately after a liver transplant, Dr Saha said that the most common could be a technical complication arising due to incorrect joining of blood vessels which could lead to the “death” of cells of the transplanted organ, the second can be excessive bleeding due to innumerable small and big blood vessels connected to the liver while the third is a condition where the donated organ is unfit as in the case of a fatty liver disease when a transplant could possibly fail.
Doctors at Fortis Healthcare achieved yet another milestone recently, by performing a successful surgery on a six year old international patient, Lyaan from Oman. She had come to Fortis this year with a condition called, Crouzon syndrome, a rare genetic disorder found 1 in 60,000 live births. This condition presents itself in the form of a severely deformed upper face. According to her father, Lyaan looked normal when she was born, but at 4-5 months of age, her upper face started showing deformity, with a retruded upper jaw. She even had to undergo cranial surgery since her head size was not increasing.
A team of specialists from Fortis Healthcare – Dr. Rashmi Taneja, Sr. Consultant, Plastic & Cosmetic Surgery, Fortis, Vasant Kunj; Dr. Gagan Sabharwal, Maxillofacial Surgeon, Department of Dentistry & Maxillofacial Surgery and Dr. Amitabh Singh, Consultant, Cosmetic & Plastic Surgery, FMRI performed the complex surgery. Dr Taneja, shared that in this case, the team performed the Lefort III Osteotomy with application of rigid external distractors, also called ‘RED Device’ as part of the treatment on the patient. Lyaan has recovered well, four days after Lyaan’s consolidation was performed at FMRI, the jaw was pulled forward @ 1 mm a day. This distraction was done by her mother. The upper jaw was pulled 35 mm in 35 days after which the family returned to their country for the bones to heal completely. A significant point to be noted is that the patient’s family chose to come to Fortis Memorial Research Institute in India to get this rare surgery conducted when they had the choice of opting for a hospital in Europe.
This rare feat was also covered in major publications.
https://www.fmri.in/six-year-old-oman-born-crouzon-syndrome-given-new-lease-life-fortis
A complicated surgery for chronic osteomyelitis (infection of the bone) was performed on a 53 year old retired Commander in FMRI, on May 30. The patient had undergone a bypass surgery in 2006 to treat three blockages. However, since the pacing wires were not removed post-surgery, they had gradually pierced the skin just above the heart. The exposure led to a sinus track formation, causing infection and pus in the soft tissues and sternum (breastbone). The patient, on undergoing evaluation tests for surgery, was found to be unfit for general anaesthesia due to his existing heart condition as well as poor ejection fraction (capacity of heart to pump blood). Dr. Anil Behl, Director- Reconstructive Surgery and his team made the decision to go ahead with local anaesthesia which is rarely used to operate on the area around the heart. The heavily infected soft tissue around the pacing wire and a big chunk of the lower sternum bone was removed and by the end of the surgery, the beating heart was visible through the gap created on removal of the infected bone. Three weeks later, the wound healed and the patient was absolutely infection free.
A rare spinal surgery was performed by Dr Sandeep Vaishya, Director, Neurosurgery and his team on a 43 year old patient from Punjab. The disorder that the patient suffered from left him paraplegic with a very crooked spine and with minimal bladder and bowel control. It was a case of one of the largest meningomyelocele removed, according to Dr Sandeep Vaishya, measuring 85 cms in circumference. Doctors drained out seven liters of spinal fluid post-surgery. The swelling in the patient’s lower back only kept increasing with each passing year. The surgery was successful and the patient was discharged “seven kilos lighter” on June 21.
A 25 yr old Iraqi girl with a very rare condition called congenital anomaly Mayer-Rokitansky Kuster Hauser (MRKH) syndrome in which she was born without a vagina, was treated in FMRI by Dr Sanjay Gogoi, Director- Urology and Renal Transplant and his team. The incidence of this syndrome is 1 in 5000 and very few cases have been reported till date. She also did not have internal genital organs like the Uterus and fallopian tubes. Reconstructing a new vagina for these patients is a very challenging job. In most cases new vagina is made using skin graft after making a tunnel in perineum which is associated with very high incidence of complications and subsequent failure. A part of large bowel (Sigmoid colon) was used to reconstruct a new vagina (Sigmoid Neo-vagina).
FMRI conducted their 50th free surgery at the Cleft Lip and Palate Centre for Children by carrying out a successful cleft repair surgery on a six-month old infant, Akansh, from Mewat. The Centre was launched at FMRI in collaboration with Fortis Foundation and Mission Smile India in February 2015 to initiate a comprehensive Clinic for Cleft Lip, Palate and other facial deformities exclusively for children from the economically weaker sections of society. Baby Akansh had a congenital deformity called cleft lip due to which there was opening in the upper lip that extended till his nose. At that time the child was too small to be operated. A regular follow up was planned and when the baby turned six months old the cleft repair surgery was conducted on Monday, May 16th by Dr Amitabh Singh, Consultant Cosmetic and Plastic Surgeon.
Aiming at improving the quality of life of underprivileged children, Fortis Foundation in association with Being Human Foundation has conducted six heart valve replacement surgeries between April 20th- 25th 2016 at FMRI. The surgeries were performed by Dr Sandeep Attawar and his team, together with Dr. Vibhu Khsettry, internationally renowned cardiac surgeon. The children underwent this replacement absolutely free of cost under the Fortis Foundation’s UMEED programme.
A very rare and complicated surgery was performed by Dr Sanjay Gogoi and his team on a 25 yr old young girl from Iraq on the 5th of April. The patient was found to have two urethras, two vagina’s and two anus. Further evaluation revealed that urinary bladder was divided in to two by a middle cleft. Distal part of small bowel and whole of large bowel was also duplicated. Sigmoid-colo-colic anastomis surgery was done on this patient followed by a genitoplasty.
99% of the doctors would refuse a case like this but Dr Sanjay Gogoi and his team took up the challenge of saving this life. A 10 year old kid with V.P shunt and a past history of Meningo- myelocele with hydrocephalus was operated in the first week of April at FMRI. Augmentation Cystoplasty surgery was performed and it was a success. The risk involved in the surgery was the danger of infection spreading to the brain due to the shunt. The patient is healthy and recovered well and was discharged on the 26th of April.
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