Coronary Artery Bypass Graft (CABG)

Coronary Artery Bypass Graft is one of the most common surgery practiced to restore the blood flow to the heart.Coronary artery is the artery which supplies oxygenated blood to the heart muscle. If these arteries have too much plaque built up, it can narrow or even block the blood from passing through. Therefore the heart can’t get enough blood or oxygen it needs, resulting a heart attack or sudden cardiac death.

If the coronary arteries are dangerously blocked, you are advised to get around, or “bypass” the blockage .

This surgery is called Coronary Artery Bypass Graft(CABG).

 Risk Factors Trigger CAD

• Obesity
• Smoking
• Lack of exercise
• Stress
• Hypertension
• Unhealthy diet

Above factors can be controlled through lifestyle changes and/or medications.

Non controllable factors include:

• Age
• Family history
• Medical history
• Gender
• Ethnicity .

The condition affects men more commonly than pre-menopausal  woman. However, post  -menopause, the incidence in women increases to be virtually same as men Men older than 45 years and women older than 55 years are at increased risk.

PREVENTION

There are a number of lifestyle changes or self-management steps that can be taken to prevent or reduce the risk of developing coronary heart disease. These include:

• Eating a healthy, balanced diet .
• Quit smoking
• Exercise regularly
• Being aware of risk factors
• Monitoring blood sugar, cholesterol, blood pressure with medication
• Monitoring healthy body weight.

Leukemia is a blood cancer caused by a rise in the number of white blood cells in your body. Those white blood cells crowd out the red blood cells and platelets that your body needs to be healthy. The extra white blood cells don’t work right.

Types of Leukemia:

1. Acute leukemia happens when most of the abnormal blood cells don’t mature and can’t carry out normal functions. It can get bad very fast.
2. Chronic leukemia happens when there are some immature cells, but others are normal and can work the way they should. It gets bad more slowly than acute forms do.

Symptoms:

1. Anemia
2. A tendency to bruise or bleed easily, including bleeding from the gums or nose, or blood in the stool or urine.
3. Bronchial pneumonia
4. Swollen lymph nodes, typically in the neck, armpits, or groin.
5. Loss of appetite and weight.
6. Discomfort under the left lower ribs (caused by a swollen spleen).
7. Very high white blood cell counts may result in visual problems due to retinal hemorrhage, ringing of the ears (tinnitus), mental status changes, prolonged erection (priapism), and stroke.

Treatments options are

• Some patient will get cure from Chemotherapy
• Some patients with acute myeloid leukemia(AML) may require an allogeneic stem cell transplant.

Squint or strabismus surgery is performed on extra ocular muscles to correct eye misalignment.

A squint or Strabismus, which affects one in 20 children, is a common eye condition in which the eyes are pointing in different directions, instead of moving and focusing together in the same direction. Squints typically develop before the patient reaches five years old, but there are also cases when the condition develops later in life.

Symptoms of a squint can easily be observed. One of the patient’s eyes might turn outwards, inwards, downwards, or upwards, while the other eye looks forward. However, it is important to note that not all squints are constant—there might be instances when the eyes look normal. Minor squints are not obvious and might be misdiagnosed as another condition.

Specialized testings such as forced ductions, force generation, and saccadic velocities can distinguish excessive scarring, lost or slipped muscles, and fat adherence. Pupillary reactions are also assessed and a dilated exam performed to determine the presence of other retinal or vitreal problems that may require additional treatment. Based on the diagnosis, the condition can be managed with optical treatments, (such as a change in refraction), medical treatment (which may involve the use of corticosteroids and anti-inflammatory medications) and surgical treatment (which may involve the release of scar tissue, excisional biopsies, and treatment of retinovitreal disorders).

Possible Risks and Complications

Squint surgery has various risks and complications although most of them rarely occur. These include:

• Double vision, which usually goes away a week after the procedure
• Eye infection
• Excessive bleeding
• Perforation of the eye and nearby structures
• Change in refraction, which is managed through optical therapy
• Allergic reaction to the anaesthetic, suture material, or post-operative medications
• Conjunctival scarring
• Anterior segment ischemia, which occurs when the procedure resulted in impaired blood flow to the anterior segment
• Ptosis on the vertical rectus muscles

Neuromuscular scoliosis is one of three main types of scoliosis that cause an irregular curvature of the spine. It is the second most common form of scoliosis and is associated with disorders of the nerve or muscular systems such as cerebral palsy, spina bifida and spinal cord injury.

These types of neuromuscular conditions cause muscles to become weak, spastic, or paralyzed. Without full support from the muscles of the back, the spine can develop an abnormal curve as it grows.

Symptoms:

The most common symptom of scoliosis is an abnormal curve of the spine. Often this is a mild change and may be first noticed by a friend or family member or physician doing routine screening of children for school or sports. The change in the curve of the spine typically occurs very slowly so it is easy to miss until it becomes a more severe physical deformity. It can also be found on a routine school screening examination for scoliosis. Those affected may notice that their clothes do not fit as they did previously, they may notice an uneven waist, or that pant legs are longer on one side than the other.

Treatment:

Non-surgical treatments

Non-surgical treatments such as bracing, wheelchair modification, physical therapy, and environmental adaptation can help your child adapt to everyday environments and improve their mobility. Bracing can prevent your child’s spinal curvature from getting worse during periods of growth, but bracing will not correct the curve. Depends on curves below treatment options

1. Observation(curves less than 20 degree)

2. Braces (between 25 degree & 45 degree)

3. Surgery(greater than 45 degree)

Spinal fusion surgery

Stabilizing the spine with spinal fusion surgery is the most common treatment for neuromuscular scoliosis. Using metal rods, hooks, screws, and wires, known as instrumentation, the procedure straightens the spine and solidifies the bone so it will no longer curve abnormally. For 6 to 12 months after surgery, the spine fuses in much the same way that a broken bone heals. The child will need to wear a brace during this time. The instrumentation typically remains in the back without causing any problems.

Clubfoot is a birth defect that causes a child’s foot to point inward instead of forward. The condition is normally identified after birth, but doctors can also tell if an unborn baby has clubfoot during an ultrasound. Although the condition usually affects only one foot, it’s possible for both feet to be affected. Clubfoot can sometimes be corrected through stretching and bracing, but surgery may be necessary in severe cases.

Optic neuritis occurs when swelling (inflammation) damages the covering (myelin) of the optic nerve. The optic nerve is a bundle of nerve fibers that transmits visual information from your eye to your brain. Common symptoms of optic neuritis include pain with eye movement and temporary vision loss in one eye.

Causes:

The exact cause of optic neuritis is unknown. It’s believed to develop when the immune system mistakenly targets the substance covering your optic nerve, resulting in inflammation and damage to the myelin. Normally, the myelin helps electrical impulses travel quickly from the eye to the brain, where they’re converted into visual information. Optic neuritis disrupts this process, affecting vision.

1. Multiple sclerosis.
2. Neuromyelitis optica.
3. Infections. Bacterial infections, including Lyme disease, cat-scratch fever and syphilis, or viruses, such as measles, mumps and herpes, can cause optic neuritis.Other diseases. Diseases such as sarcoidosis, Behcet’s disease and lupus can cause recurrent optic neuritis.
4. Drugs and toxins.

Treatments:

Optic neuritis usually improves on its own. In some cases, steroid medications are used to reduce inflammation in the optic nerve. Possible side effects from steroid treatment include weight gain, mood changes, facial flushing, stomach upset and insomnia.

Steroid treatment is usually given by vein (intravenously). Intravenous steroid therapy might speed vision recovery, but it doesn’t appear to affect the amount of vision you’ll recover. Steroid treatment is also used to reduce the risk of developing multiple sclerosis or slow its development.

Kidney removal or nephrectomy is a major surgery that removes a part of the entire kidney. Donor nephrectomy removes a healthy kidney from a donor to be placed in another person whose both kidneys have failed (end-stage renal disease), a procedure known as kidney transplantation.

Those considering donating one of their kidneys to a loved one can read about the criteria involved in selecting the right donor, surgical procedure involved, and what one can expect after the surgery. These will help in understanding if it is really safe to donate a kidney to a loved one.

The Right Donor

There are two types of donors for a kidney transplant:

1. Living (related or unrelated)
2. Deceased

For someone to be considered as a potential donor, s/he must meet a number of criteria:

• Be 18 years of age or above
• Be in good health and free of chronic illnesses like heart disease, cancer or diabetes
• Have two normal functioning kidneys
• Compatible blood and tissue type with the recipient
• Pass all physical tests before the surgery
• Be of stable mental health

It is suggested that a kidney transplant from a living donor has better survival rates than a transplant from a deceased donor. Further, transplantation results are best if the donor is related to the loved one (as parent, child, sibling, or relative).

Relative as a donor: A transplant from a related donor greatly increases the chances of the kidney being accepted by the recipient because body tissues and blood groups are more likely to be matched. The donor will be tested for similarity in the white blood cell HLA antigen and blood group antigen on red blood cells with the loved one. The compatibility pattern within the family is as follows:

1. Parent and child: 50 % (because a child carries half of each parent’s genes)
2. Siblings: 25 %

However, in case a person is not genetically related, he can still donate his kidney if their tissue type and blood groups match and they pass the required criteria for donors.

What One Needs To Know About The Surgery

Surgical advances have made it possible to perform nephrectomy as a hand-assisted laparoscopic procedure, in which a surgeon will create two to three small puncture sites and a small incision of about seven centimeters (compared to 25 centimeters in open surgery). It will take about three hours for the entire procedure that is performed under general anesthesia.

The donor will require a hospital stay for two to three days. Some pain will be experienced but can be tackled with medication. The person will be encouraged to resume light activities as soon as s/he feels comfortable but must refrain from strenuous activities for several weeks post surgery.

The doctor will ask the prospective donor to visit for frequent check ups initially, but only annual tests will be needed gradually. The following will be checked:

• Blood pressure
• Urine protein level
• Kidney waste filtration rate

Are There Risks Involved?

Research studies have not shown any long-term risk involved in kidney donation, as long as the candidate screening was thorough and matched well with their loved one.

As far as the surgery is concerned, the donor might be affected by some complications like bleeding or infection that may occur in any major surgery. Adequate recovery time, initially in the hospital and later at home, is required to allow the other kidney to expand in order to take upon additional blood supply and filter wastes in the absence of the other one.

Regular check ups at the hospital will monitor blood pressure and kidney function. Kidney donation will not change the donor’s quality of life, risk to kidney failure in the future, and survival rate in the long-term any more than that for a non-donor.

Care After Surgery

Donors will need to take care of their remaining kidney for its normal functioning through:

• A balanced diet.
• Following doctor’s prescription of medicines (if any) carefully.
• Avoiding foods rich in proteins that may overwork the kidney.
• Drinking alcohol and caffeinated drinks moderately.
• Limiting salt intake.
• Following an exercise routine.

Any concerns a person may have regarding kidney donation must be discussed with a Nephrologist and one should go ahead with the procedure only when all the necessary criteria for kidney transplant are met.