Successful Twin Hand Transplant at Aims

Abdul Rahim, who successfully underwent the twin hand transplant surgery at the Amrita Hospital, Kochi, with the wife and children of Joseph, the donor, and Dr Subramania Iyer of the AIMS

KOCHI: The Amrita Institute of Medical Sciences and Research Centre (AIMS) has set yet another milestone in organ transplant, with the second successful twin hand transplant.

Recipient of the second twin hand transplant is 30-year-old Abdul Rahim, a former army captain from Kandahar in Afghanistan who lost both his hands during de-mining operations in Kandahar three years ago.

This is the first case of twin-hand transplant on an Afghan citizen. The donor was Joseph, a 54-year-old accident victim from Kerala, who was declared brain dead. Manu, 30, the recipient of the first hand transplant, which was performed four months ago, is recovering well and is doing almost all the routine activities.

Abdul Rahim approached Amrita Institute of Medical Sciences four months ago, after scouting for hand transplant in several countries. The transplant was performed in a ‘marathon’ surgical procedure that lasted for around 15 hours, involving more than 20 surgeons and eight anaesthetics.

“Rahim has regained functioning of both his hands significantly, and is using them for day-to-day activities. He will need intensive physiotherapy for another nine-ten months, for which he will have to stay back in Kochi,” said Dr Subramania Iyer, professor and head of the plastic surgery department at Amrita. “Each hand required connecting of two bones, two arteries, four veins and about 14 tendons each. Immune suppressant drugs, which were started before the commencement of the surgery, are continuing,” said Amrita medical director Dr Prem Nair

The family members of the donor agreed to donate the hands after they were given counselling and were assured that the hands would be replaced with prosthetic limbs to reduce deformity.

The Amrita Institute of Medical Sciences, which has been in the forefront of organ transplant in the country, has already conducted 885 transplants, including two liver transplants, bowel transplants, two twin hand transplants, and a rare pancreas transplant.

“The hospital has been getting requests from across the country and abroad, especially in the Gulf, for hand transplant. We have been highly selective, even in providing counselling, as our experience is very limited,” Dr Iyer added.

Pancreatic Cancer Treatment (PDQ®)

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General Information About Pancreatic Cancer
Stages of Pancreatic Cancer
Recurrent Pancreatic Cancer
Treatment Option Overview
Treatment Options by Stage
Treatment Options for Recurrent Pancreatic Cancer
To Learn More About Pancreatic Cancer
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General Information About Pancreatic Cancer
Key Points

Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas.
Smoking and health history can affect the risk of pancreatic cancer.
Signs and symptoms of pancreatic cancer include jaundice, pain, and weight loss.
Pancreatic cancer is difficult to detect (find) and diagnose early.
Tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.

Pancreatic cancer is a disease in which malignant (cancer) cells form in the tissues of the pancreas.

The pancreas is a gland about 6 inches long that is shaped like a thin pear lying on its side. The wider end of the pancreas is called the head, the middle section is called the body, and the narrow end is called the tail. The pancreas lies between the stomach and the spine.
Enlarge
Anatomy of the pancreas; drawing shows the pancreas, stomach, spleen, liver, gallbladder, bile ducts, colon, and small intestine. An inset shows the head, body, and tail of the pancreas. The bile duct and pancreatic duct are also shown.
Anatomy of the pancreas. The pancreas has three areas: head, body, and tail. It is found in the abdomen near the stomach, intestines, and other organs.

The pancreas has two main jobs in the body:

To make juices that help digest (break down) food.
To make hormones, such as insulin and glucagon, that help control blood sugar levels. Both of these hormones help the body use and store the energy it gets from food.

The digestive juices are made by exocrine pancreas cells and the hormones are made by endocrine pancreas cells. About 95% of pancreatic cancers begin in exocrine cells.

This summary is about exocrine pancreatic cancer. For information on endocrine pancreatic cancer, see the PDQ summary on Pancreatic Neuroendocrine Tumors (Islet Cell Tumors) Treatment.

For information on pancreatic cancer in children, see the PDQ summary on Unusual Cancers of Childhood Treatment.
Smoking and health history can affect the risk of pancreatic cancer.

Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk.

Risk factors for pancreatic cancer include the following:

Smoking.
Being very overweight.
Having a personal history of diabetes or chronic pancreatitis.
Having a family history of pancreatic cancer or pancreatitis.
Having certain hereditary conditions, such as:
Multiple endocrine neoplasia type 1 (MEN1) syndrome.
Hereditary nonpolyposis colon cancer (HNPCC; Lynch syndrome).
von Hippel-Lindau syndrome.
Peutz-Jeghers syndrome.
Hereditary breast and ovarian cancer syndrome.
Familial atypical multiple mole melanoma (FAMMM) syndrome.

Signs and symptoms of pancreatic cancer include jaundice, pain, and weight loss.

Pancreatic cancer may not cause early signs or symptoms. Signs and symptoms may be caused by pancreatic cancer or by other conditions. Check with your doctor if you have any of the following:

Jaundice (yellowing of the skin and whites of the eyes).
Light-colored stools.
Dark urine.
Pain in the upper or middle abdomen and back.
Weight loss for no known reason.
Loss of appetite.
Feeling very tired.

Pancreatic cancer is difficult to detect (find) and diagnose early.

Pancreatic cancer is difficult to detect and diagnose for the following reasons:

There aren’t any noticeable signs or symptoms in the early stages of pancreatic cancer.
The signs and symptoms of pancreatic cancer, when present, are like the signs and symptoms of many other illnesses.
The pancreas is hidden behind other organs such as the stomach, small intestine, liver, gallbladder, spleen, and bile ducts.

Tests that examine the pancreas are used to detect (find), diagnose, and stage pancreatic cancer.

Pancreatic cancer is usually diagnosed with tests and procedures that make pictures of the pancreas and the area around it. The process used to find out if cancer cells have spread within and around the pancreas is called staging. Tests and procedures to detect, diagnose, and stage pancreatic cancer are usually done at the same time. In order to plan treatment, it is important to know the stage of the disease and whether or not the pancreatic cancer can be removed by surgery.

The following tests and procedures may be used:

Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances, such as bilirubin, released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
Tumor marker test : A procedure in which a sample of blood, urine, or tissue is checked to measure the amounts of certain substances, such as CA 19-9, and carcinoembryonic antigen (CEA), made by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the body. These are called tumor markers.
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A spiral or helical CT scan makes a series of very detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.
PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. A PET scan and CT scan may be done at the same time. This is called a PET-CT.
Abdominal ultrasound : An ultrasound exam used to make pictures of the inside of the abdomen. The ultrasound transducer is pressed against the skin of the abdomen and directs high-energy sound waves (ultrasound) into the abdomen. The sound waves bounce off the internal tissues and organs and make echoes. The transducer receives the echoes and sends them to a computer, which uses the echoes to make pictures called sonograms. The picture can be printed to be looked at later.
Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
Endoscopic retrograde cholangiopancreatography (ERCP): A procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes pancreatic cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken.
Percutaneous transhepatic cholangiography (PTC): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body. This test is done only if ERCP cannot be done.
Laparoscopy : A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. The laparoscope may have an ultrasound probe at the end in order to bounce high-energy sound waves off internal organs, such as the pancreas. This is called laparoscopic ultrasound. Other instruments may be inserted through the same or other incisions to perform procedures such as taking tissue samples from the pancreas or a sample of fluid from the abdomen to check for cancer.
Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. There are several ways to do a biopsy for pancreatic cancer. A fine needle or a core needle may be inserted into the pancreas during an x-ray or ultrasound to remove cells. Tissue may also be removed during a laparoscopy.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

Whether or not the tumor can be removed by surgery.
The stage of the cancer (the size of the tumor and whether the cancer has spread outside the pancreas to nearby tissues or lymph nodes or to other places in the body).
The patient’s general health.
Whether the cancer has just been diagnosed or has recurred (come back).

Pancreatic cancer can be controlled only if it is found before it has spread, when it can be completely removed by surgery. If the cancer has spread, palliative treatment can improve the patient’s quality of life by controlling the symptoms and complications of this disease.

What is dysphagia?

Dysphagia is the medical term for the symptom of difficulty swallowing, derived from the Latin and Greek words meaning difficulty eating.
Mechanism of swallowing

Swallowing is a complex action.

Food is first chewed well in the mouth and mixed with saliva.
The tongue then propels the chewed food into the throat (pharynx).
The soft palate elevates to prevent the food from entering the posterior end of the nasal passages, and the upper pharynx contracts, pushing the food (referred to as a bolus) into the lower pharynx. At the same time, the voice box (larynx) is pulled upwards by muscles in the neck, and, as a result, the epiglottis bends downwards. This dual action closes off the opening to the larynx and windpipe (trachea) and prevents passing food from entering the larynx and trachea.
The contraction of the muscular pharynx continues as a progressing, circumferential wave into the lower pharynx pushing the food along.
A ring of muscle that encircles the upper end of the esophagus, known as the upper esophageal sphincter, relaxes, allowing the wave of contraction to push the food from the lower pharynx on into the esophagus. (When there is no swallow, the muscle of the upper sphincter is continuously contracted, closing off the esophagus from the pharynx and preventing anything within the esophagus from regurgitating back up into the pharynx.)
The wave of contraction, referred to as a peristaltic wave, progresses from the pharynx down the entire length of the esophagus.
Shortly after the bolus enters the upper esophagus, a specialized ring of muscle encircling the lower end of the esophagus where it meets the stomach, known as the lower esophageal sphincter, relaxes so that when it arrives the bolus can pass on into the stomach. (When there is no swallow the muscle of the lower sphincter is continuously contracted, closing off the esophagus from the stomach and preventing contents of the stomach from regurgitating back up into the esophagus.)
After the bolus passes, the lower sphincter tightens again to prevent contents of the stomach from regurgitating back up into the esophagus. It remains tight until the next bolus comes along.

Considering the complexity of swallowing, it is no wonder that swallowing, beginning with the contraction of the upper pharynx, has been “automated,” meaning that no thought is required for swallowing once swallowing is initiated. Swallowing is controlled by automatic reflexes that involve nerves within the pharynx and esophagus as well as a swallowing center in the brain that is connected to the pharynx and esophagus by nerves. (A reflex is a mechanism that is used to control many organs. Reflexes require nerves within an organ such as the esophagus to sense what is happening in that organ and to send the information to other nerves in the wall of the organ or outside the organ. The information is processed in these other nerves, and appropriate responses to conditions in the organ are determined. Then, still other nerves send messages from the processing nerves back to the organ to control the function of the organ, for example, the contraction of the muscles of the organ. In the case of swallowing, processing of reflexes primarily occurs in nerves within the wall of the pharynx and esophagus as well as the brain.)

The complexity of swallowing also explains why there are so many causes of dysphagia. Problems can occur with:

the conscious initiation of swallowing,
propulsion of food into the pharynx,
closing of the nasal passages or larynx,
opening of the upper or lower esophageal sphincters,
physical blockage to the passage of food, and
transit of the bolus by peristalsis through the body of the esophagus.

The problems may lie within the pharynx or esophagus, for example, with the physical narrowing of the pharynx or esophagus. They also may be due to diseases of the muscles or the nerves that control the muscles of the pharynx and esophagus or damage to the swallowing center in the brain. Finally, the pharynx and the upper third of the esophagus contain muscle that is the same as the muscles that we use voluntarily (such as our arm muscles) called skeletal muscle. The lower two-thirds of the esophagus is composed of a different type of muscle known as smooth muscle. Thus, diseases that affect primarily skeletal muscle or smooth muscle in the body can affect the pharynx and esophagus, adding additional possibilities to the causes of dysphagia.
Odynophagia and globus sensation

There are two symptoms that are often thought of as problems with swallowing (dysphagia) that probably are not. These symptoms are odynophagia and globus sensation.
Odynophagia

Odynophagia means painful swallowing. Sometimes it is not easy for individuals to distinguish between odynophagia and dysphagia. For example, food that sticks in the esophagus often is painful. Is this dysphagia or odynophagia or both? Technically it is dysphagia, but individuals may describe it as painful swallowing (i.e., odynophagia). Moreover, patients with gastroesophageal reflux disease (GERD) may describe dysphagia when what they really have is odynophagia. The pain that they feel after swallowing resolves when the inflammation of GERD is treated and disappears and is presumably due to pain caused by food passing through the inflamed portion of the esophagus.

Odynophagia also may occur with other conditions associated with inflammation of the esophagus, for example, viral and fungal infections. It is important to distinguish between dysphagia and odynophagia because the causes of each may be quite different.
Globus sensation

A globus sensation refers to a sensation that there is a lump in the throat. The lump may be present continuously or only when swallowing. The causes of a globus sensation are varied, and frequently no cause is found. Globus sensation has been attributed variously to abnormal function of the nerves or muscles of the pharynx and GERD. The globus sensation usually is described clearly by individuals and infrequently causes confusion with true dysphagia.

Heart Disease: Symptoms, Diagnosis, Treatment

Most heart attacks happen when a clot in the coronary artery blocks the supply of blood and oxygen to the heart. A blockage that is not treated within a few hours causes the affected heart muscle to die.
Image: National Heart, Lung, and Blood Institute, Diseases and Conditions Index
Click to view a larger version of the image
Symptoms

It is very important to learn the signs of a heart attack. Fast action can save lives—maybe your own.

Chest pain or discomfort—it may feel like pressure or a squeezing pain in your chest. It may feel like indigestion. You may also feel pain in your shoulders, arms, neck, jaw, or back.
Shortness of breath—often comes along with chest discomfort but can also occur before.
Other symptoms—breaking out in a cold sweat, nausea, or light-headedness, upper body discomfort in one or both arms, the neck, jaw, or stomach.

Diagnosis

Key heart tests include:

Electrocardiogram (ECG or EKG)—This records the electrical activity of the heart as it contracts and relaxes. The ECG can detect abnormal heartbeats, some areas of damage, inadequate blood flow, and heart enlargement.
Blood test—Checks for enzymes or other substances released when cells begin to die. They are “markers” of the amount of damage to your heart.
Nuclear scan—Reveals the damaged areas of the heart that lack blood flow. It also can show problems with the heart’s pumping action. The test uses radioactive tracers to study how blood flows in your heart.
Coronary angiography (or arteriography)—A test that uses dye and special X-rays to show the inside of your coronary arteries.

Treatment

You will need to change your lifestyle to help prevent or control coronary heart disease (CHD) and so reduce the risk of a first or repeat heart attack. Sometimes, though, you may need medicines.

Antiplatelet drugs, such as aspirin, keep blood clots from forming. These drugs help to keep arteries open in those who have had a previous heart bypass or other artery-opening procedure, such as coronary angioplasty.
Anticoagulants (blood thinners) prevent blood from clotting or prevent existing clots from getting larger. They can keep harmful clots from forming in your heart, veins, or arteries. Clots can block blood flow and cause a heart attack or stroke. Common names for anticoagulants are “warfarin” and “heparin.”
Digitalis makes the heart contract harder when the heart’s pumping function has been weakened. It also slows some fast heart rhythms.
ACE (angiotensin converting enzyme) inhibitors stop production of a chemical that narrows blood vessels. They help control high blood pressure. You may also take an ACE inhibitor after a heart attack to help the heart pump blood better. People with heart failure, a condition in which the heart is unable to pump enough blood to supply the body’s needs, may also take them.
Beta blockers slow the heart and make it beat with less contracting force, so blood pressure drops and the heart works less hard. They are used for high blood pressure, chest pain, and to prevent repeat attacks.
Nitrates (nitroglycerin) relax blood vessels and stop chest pain.
Calcium channel blockers relax blood vessels. They are used to treat high blood pressure and chest pain.
Diuretics decrease fluid in the body. They treat high blood pressure. Diuretics are sometimes referred to as “water pills.”
Blood cholesterol-lowering agents decrease LDL (“bad”) cholesterol levels in the blood.
Thrombolytic agents (clot busting drugs) are given during a heart attack to break up a blood clot in a coronary artery and restore blood flow.

What Is Acute Coronary Syndrome (ACS)?

Many people hear the term “acute coronary syndrome” related to heart attack. But just what is it? Acute coronary syndrome (ACS) is a life-threatening form of coronary heart disease (CHD) that occurs when the heart muscle does not receive enough oxygenrich blood. ACS includes myocardial infarction (MI), also known as a heart attack, and unstable angina, or sudden, severe chest pain that typically occurs when a person is at rest.

Every year, ACS affects an estimated 1.4 million people in the United States and another 1.4 million people in Europe. Even though patients receive intense ACS management while in the hospital, new treatments are needed to reduce the risk of acute heart attack, stroke, and cardiovascular death. ACS patients receive anticoagulant drugs but this treatment is limited to the hospital.

Orthopedics Definition

Orthopedics is the field of medicine concerned with the study and treatment of the musculosketetal system, particularly the spine, joints, and muscles. Orthopedics mainly deals with correction of disorders and deformities related to the musculosketal system; hence, orthopedics is central to the treatment of back pain.

Orthopedic care can employ various pain management techniques, manual treatment, physical therapy, and bracing to treat a variety of spinal dysfunctions including chronic back pain, scoliosis, and sacrioiliac joint dysfunction.

Sinusitis:

• Sinusitis refers to the inflammation of the sinus passages
• Sinus passages are present around:
o Forehead
o Cheeks
o Eyes
o Nasal bones
• These passages produce mucus which prevents infections

Symptoms to look for:

• Excessive sneezing
• Nasal congestion
• Runny nose
• Headache
• Pressure around head, eyes and face
• Lack of appetite
• Low-grade fever
• Difficulty in breathing

Causes:

• Inflamed sinus causes mucus to collect resulting in bacterial growth

Natural home remedy using black cumin seeds:

1. Take a clean cloth
2. Add 1 tsp black cumin seeds
3. Wrap the cloth
4. Place near the nose and inhale

Natural home remedy using cumin seeds and honey:

1. Roast 1 tsp cumin seeds
2. Crush them
3. Add 1 tbsp honey
4. Mix well
5. Consume every day

Natural home remedy using fenugreek seeds:

1. Take 1 tsp fenugreek seeds
2. Add 4 cups of water
3. Boil the mixture till water level reduces to half
4. Strain the liquid
5. Drink 4 cups of this liquid every day

• This provides relief from fever and eliminates toxins

Tips:

• Consume garlic and onions as a part of diet

These remedies are based on the principles of Ayurveda, the ancient Indian science of healing, and are completely natural, non-invasive, and can be prepared at home. Consult your doctor if the symptoms persist. Refer to the terms of use.

Acupuncture is the insertion of high quality disposable sterile stainless steel needles into the skin.

Amanda Roth Acupuncture treatmentAt the AHC the policy is one needle per acupuncture point which is disposed of after it is withdrawn. The needles are designed to insert with minimum sensation moreover, many patients, after the needles have been inserted are unsure if the needles are there. Needles insert into acupuncture points which are gateways into channels of energy in your body. These channels or meridians of energy keep you well and balanced.

Your acupuncturist may apply manual (i.e. twisting) or an electrical stimulation (Electroacupunture) to the needles. Sensations may be experienced after insertions normal sensations include warmth and or tingling, dull ache and/or a feeling of heaviness.

Please inform us immediately if you feel a sharp and or burning pain. Acupuncture is used to keep the body, mind and spirit balanced, to heal specific disease and as preventive medicine to strengthen the body.

Auricular (ear) Acupuncture is a microsystem (small system) whereas the body as a whole is considered a macrosystem (large system) moreover, the whole body is represented in the ear and can therefore treat a variety of conditions. Small needles or seeds may be taped on to specific ear points to enhance and prolong the treatment.

Three-edge needle is a procedure whereby the acupuncturist allows or promotes blood to escape from the acupuncture point in order to bring the required effect to a body area or condition.

Plum blossom needling or Seven star needling, utilizes a tapping instrument, containing seven tiny needles, the intention is to stimulate the channel/meridian overtop of the area to be treated.

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