Doctors at Mulund ,Mumbai Fortis Hospitals, has successfully removed a  tumor via  minimal access surgery.The tumor had resulted into complications like diabetes and hypertension leading to Cushing Disease – a rare hormonal disorder.Studies show a probability of 50% mortality rate if the patient does not receive proper treatment in around 5 years.Cushing Disease affects around 10,000 people every year in India.

Crushing Diseases affects women five times more often than men

November 25^th 2010, Thane: In a rare & complicated case expert team of Endocrinologist and Neurosurgeon at Fortis Hospitals successfully treated a 32 year old lady from Thane who suffered from pituitary gland tumour and resulting complications, using minimally invasive surgery through nasal cavity (nose).

The tumour, situated in pituitary gland at the base of the brain,  triggered excessive production of ACTH hormone by the adrenal glands leading to complications like diabetes, hypertension and sudden weight gain, a condition which is normally referred to as “Cushing disease,” which could be fatal if left untreated for long

Ms Nayan Palan, almost a year ago, started experiencing a rapid weight gain (around 15- 20 kg in 2-3 weeks). She was also detected with diabetes. She also experienced acute headache, swollen face and pimples on her face leading her to consult a local dermatologist. The dermatologist recommended a few medical tests that confirmed high levels of the hormone “cortisol” in her body. She later consulted Dr Sudhendra Kulkarni, endocrinologist at Fortis Hospital, Mulund. This led to the detection of “cushing disease”. Later, an MRI scan of her Pituitary gland confirmed a tumour that was responsible for her condition.

“It is very important to detect the disease on time. If left undetected, it can lead to many comlication. Studies have shown that there is a probability of 50% of patients to die in 5 years as a result of complications if left untreated. With timely detection and right expertise, the disease can be diagnosed and treated early” Dr Deepu Banerji, Neurosurgeon at Fortis Hospital Mulund.

“This disease normally affects ladies of young age of early 30s and is accompanied with symptoms including diabetes, hypertension and obesity. Normally, people limit the treatment mode to the cure of these illnesses only, without thinking there could be something more to it. Here lies the importance of correct diagnosis, disease detection and treatment at the hands of an expert who had enough experience of treating such cases. The disease is such that it cannot be instantly diagnosed and the correct cause of the ailment could only be arrived through step by step diagnostic process.” Dr Sudhendra Kulkarni, endocrinologist Fortis Hospital, Mulund

Dr. Deepu Banerji used an endoscope to reach the tumour through her nostrils. He used both the nasal openings to reach the tumour to avoid incision or scar. Dr Banerji took special care to remove every bit of the tumour, to achieve cure & preserve the normal pituitary gland. The patient also had bits of tumour not seen on MRI. This too was identified and removed.

After the surgery, patient’s condition showed substantial improvement and was discharged within few days. Follow up tests confirmed that her diabetes and hypertension was completely cured and her weight was restored to normalcy.

“I was worried and reluctant initially as I thought a surgery for removing a tumour had to be a major one. However, when the doctor told me that my tumour could be removed through nose, my reluctance faded,” said Ms Palan, who was operated in the Fortis Hospital, Mulund. “I thought my diabetes can never be cured. However, thanks to the expert team of doctors, it was cured automatically with the removal of tumour. Today, technology and medical science have advanced so much that any ailment could be cured without any side-affects.” she added.

Team of cardiac specialists at Fortis Hospitals performs two complex cardiac procedures in one patient giving him a new lease of life”

A complex combination of cardiac and cerebrovascular procedure was done on 50 year old Mr. Veerandra Gowda who was diagnosed with coronary artery blockage. Team of cardiac specialists led by Dr. Mohammed Rehan Sayeed, Consultant Cardiothoracic Surgeon and Dr. Gopi, Consultant Interventional Cardiologist performed the complicated and life saving procedure giving a new lease of life to Mr. Gowda

Mr. Gowda presented with recurrent chest pain and his cardio angiography revealed a critical left main stenosis (main blood supply to the heart) for which he needed an urgent bypass surgery. His pre-OP evaluation revealed 100% block in his left internal carotid artery and 90% block in his right internal carotid artery. (Carotid is an artery on each side of the neck called the carotid artery. This artery brings needed blood to your brain and face. The blood flow in this artery can become partly or totally blocked by fatty material called plaque. A partial blockage is called carotid artery stenosis (narrowing). A blockage in your carotid artery can reduce the blood supply to your brain. A stroke can occur if your brain does not get enough blood).“This posed a high risk for the patient to have a stroke during the surgery. One option was to do a combination surgery for both at the same time but unfortunately patient had received radiation in the neck for cancer of the larynx (voice box) and had a permanent tracheostomy done and thus the surgery in the neck was very difficult because the tissue would be very hard. Hence we decided to do a hybrid procedure of angioplasty to the carotid artery followed by bypass on the same day as the heart surgery could not wait for the usual 2 weeks needed after an angioplasty. During a carotid angioplasty there is a tendency of the blood pressure to fall temporarily but that would have been dangerous for the patient as this would have dealt to a significant reduction to the blood supply to the heart. Hence the angioplasty was done with stand by anesthesia and surgical back up for any emergency” said Dr. Gopi, Interventional Cardiologist, Fortis Hospitals.
After the angioplasty the patient was then shifted to the Operation Theatre immediately where he had to undergo triple vessel bypass. Mr. Gowda had a critical left main coronary artery blockage as left main is instrumental in supplying blood to the heart it was crucial to revive the blood flow as fast as possible. “It posed a major challenge to us to perform the coronary artery bypass surgery (CABG) on Mr. Gowda as the patient had a hole already due to the tracheostomy done earlier to treat his throat cancer. We had to opt for minimal invasive method to correct his blockage” which in a case of left main block is challenging and cutting edge said Dr. Rehan Sayeed, Cardiovascular Surgeon, Fortis Hospitals.

To perform a minimal invasive surgery one needs to undergo training and have to acquire certain skill sets. Dr. Rehan specializes in minimal invasive surgery and did the above complex procedure successfully. The patient was on his legs the day after his operation and was discharged within four days after his surgery.
“As the patient had a hole in his wind pipe and the doctors had to go for minimally invasive surgery inspite of critical left main block and since the cut was swollen and it was a challenge for us to sustain the blood pressure of the patient during the angioplasty and as well as during bypass surgery. Both surgeries were completed successfully without requirement of life saving machines like IABP and heart lung machine” said Dr. Dharmesh, Anesthesiologist, Fortis Hospitals.

Case highlights-
• Once angioplasty is done it takes at least 2 weeks to perform bypass surgery but as the patient left main coronary artery was blocked it was clear that the patient could not take it for 2 weeks and the doctors at Fortis successfully did 2 complex procedures in a single day
• As the patient had throat cancer and had under gone tracheostomy it was challenge for the doctors to put the patient on anesthesia
• The patient had block in both of his carotid arteries with one 100% block and the other 99% block it was challenge to perform angioplasty on this patient as the procedure had to be done in a short time as his blood supply to the brain was minimal
• The other challenge was to perform bypass on the patient, but this could not be performed in the traditional open heart surgery as the patient had a hole due to his previous complication where he had under gone tracheostomy and the surgery had to be performed minimal invasive way which requires high expertise.

A severely curved backbone with 67 degree curvature was straightened by specialists at Fortis Hospitals Mulund

Case Highlights:-
•    13 year old girl had increased curvature of her backbone two years back
•    No history of any major illness or any trauma. She had normal birth and normal growth
•    On examination Spine showed kypho-scoliotic (Rt) sided curve, with prominent rib hump, curve was not balanced and shoulder was not aligned with pelvis. Curve was partially correctible on bending on sides and rib hump was pronounced on bending forwards
•    Her MRI and CT scan was also done to Rule out any associated congenital abnormalities and to assess spinal cord status.
•    Curve being 67 degrees and progression of curvature, it was decided to operate on her and posterior corrective surgery was planned
•    Doctors performed complex technique for passage of pedicle screws and for scoliosis corrections as it is a permanent solution compared to techniques in which hooks and rods are used

Spine specialists at Fortis Hospitals, Mulund have performed a complicated scoliosis correction surgery on a 13 year old girl from Kuwait. The team led by Dr. Vikas Gupte, Consultant Spine Surgeon Fortis Hospitals has done a complicated corrective surgery to straighten the 67 degree curvature.

Alicina Casteliono, a tall well built young girl has been quite active in sports and cultural activities since her childhood. Two years ago her parents noticed an increasing lateral curvature of her backbone which gradually got more pronounced during the past six months. “We were so worried and confused after seeing a sudden and substantial curvature with Alicina’s backbone. She had also started limping due to the problem. After an x-ray at a local hospital in Kuwait, we came to learn that her backbone was growing uncontrollably. Surgery being complicated, we were not able to find any local hospital at Kuwait to treat our daughter’s case.” said Mr Alphonous Casteliono, Alicina’s father.
Alicina’s school mate, who suffered from a similar problem and underwent surgery at Fortis Hospital, Mulund, Mumbai suggested taking Alicina to India and getting an opinion from the specialists. Seeing Alicina’s friends progress after sugery and the drastic improvements she had Alicina’s family decided to came down to Mumbai to consult Dr. Vikas Gupte.
A thorough examination by Dr Gupte and his team confirmed a case of Scoliosis. Scoliosis is a condition that can affect the spines of many children, teenagers and adults.
“On examination, her Spine showed a kypho-scoliotic (right) sided curve, with a prominent hump. Medically it is termed as Adolescent onset idiopathic scoliosis. The Curve was not balanced and shoulder was not aligned with her waist. Curve of the backbone being 67 degrees, we decided to operate on her and posterior corrective surgery was planned. We used techniques for passage of pedicle screws and for scoliosis corrections as it is a permanent solution compared to techniques in which hooks and rods are used.” said Dr Vikas Gupte.
She underwent a successful surgery on July 1, 2010 which lasted for 4 hours. Within seven days of surgery Alicina was able to walk properly. “Doctor has asked me to exercise regularly for at least three months. I am very keen to start my dancing lessons as early as possible. All thanks to Dr. Vikas Gupte and the whole team of Fortis Hospital who helped me walk tall again.” says Alicina Casteliono.

Why was the surgery complicated?

Scoliosis surgery requires lots of planning before surgery. Length of fixation, level of fixation has to be decided before hand. This has to be accurate. Over correction or under correction will give disastrous results. Surgery is to be done by surgeon who is trained in spine surgery. Even though many ways of fixation are used, pedicle screws fixation is scientifically proper way of fixation since it fixes all 3 columns of vertebra and helps in proper correction. However pedicle screw fixation is complex surgery since in thoracic spine size of pedicle is small, anatomy is deformed and any Mal placement of screw can cause injury to neurological structures and lung and vessels. In present case we have passed pedicle screws in all levels on both sides of curve.

Alicina required 1 blood transfusion which was given immediate post operatively. She was allowed mobilisation in bed immediate postoperatively, was allowed to sit with backrest from 2nd post op day. Plastic moulded brace was fitted after dressing and drain removal. By 4th post op day patient was standing and walking with help from physiotherapist and was independent from 6th post-op day. Post operative x-rays showed good correction and residual curve measured 23 degrees. Due to correction of scoliotic curve, patient gained in height of 2 cm. She is very keen to start her dancing lessons as early as possible.

Scoliosis is curvature of spine in coronal plane. There are many causes of scoliosis and type of scoliosis is classified accordingly as, congenital, paralytic, and neurofibromatic. Commonest being adolescent onset idiopathic scoliosis (AIS). Incidence is almost 5 percent. According to Dr. Gupte, most people suffering from acute scoliosis, especially in smaller towns, are not aware about the treatment options now available at specialized centres. Ten years back, some complicated scoliosis treatments would have been impossible. However, today people having curvature in their backbones can be efficiently treated by such minimally invasive surgeries.