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For private and limited circulation MEDICAL TIMES Vol: 04 Issue: 01 LILAVATI HOSPITAL June 2014 Emergency / Casualty : 2656 8063 / 2656 8064 Ambulance : 97692 50010 Hospital Board Line : 022-2675 1000 / 2656 8000 Hospital Fax : 022-2640 7655 / 2640 5119 Admission Department : 2656 8080 / 2656 8081 / 2656 8082 TPA Cell : 2656 8089 Appointment-OPD : 2656 8050 / 2656 8051 Billing-Inpatient Department : 2675 1586 / 2675 1585 Billing-OPD Department : 2656 8052 / 2656 8053 Blood Bank Department : 2656 8214 / 2656 8215 Health Check-up Department : 2656 8355 / 2656 8354 Report Dispatch Counter : 2675 1620 MRI Department : 2656 8066 X-Ray, Sonography Department : 2656 8031 CT Scan Department : 2656 8044 Physiotherapy Department : 2675 1536 / 2675 1537 IMPORTANT TELEPHONE NUMBERS Lilavati Hospital & Research Centre A-791, Bandra Reclamation, Bandra (W), Mumbai - 400 050 Tel.: +9122-2675 1000 Website: www.lilavatihospital.com

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Page 1: LILAVATI HOSPITAL MEDICAL TIMES · 2020. 1. 24. · Lilavati Hospital Medical Times, Lilavati Hospital & Research Centre, A-791, Bandra Reclamation, Bandra (W), Mumbai - 400 050,

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MEDICAL TIMESVol: 04 Issue: 01

LILAVATI HOSPITALJune 2014

Emergency / Casualty : 2656 8063 / 2656 8064

Ambulance : 97692 50010

Hospital Board Line : 022-2675 1000 / 2656 8000

Hospital Fax : 022-2640 7655 / 2640 5119

Admission Department : 2656 8080 / 2656 8081 / 2656 8082

TPA Cell : 2656 8089

Appointment-OPD : 2656 8050 / 2656 8051

Billing-Inpatient Department : 2675 1586 / 2675 1585

Billing-OPD Department : 2656 8052 / 2656 8053

Blood Bank Department : 2656 8214 / 2656 8215

Health Check-up Department : 2656 8355 / 2656 8354

Report Dispatch Counter : 2675 1620

MRI Department : 2656 8066

X-Ray, Sonography Department : 2656 8031

CT Scan Department : 2656 8044

Physiotherapy Department : 2675 1536 / 2675 1537

IMPORTANT TELEPHONE NUMBERS

Lilavati Hospital & Research CentreA-791, Bandra Reclamation, Bandra (W), Mumbai - 400 050

Tel.: +9122-2675 1000Website: www.lilavatihospital.com

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MEDICAL TIMESLILAVATI HOSPITAL

The views expressed in the times are not of Lilavati Hospital or the Editor or publisher. No part of the Lilavati Hospital Medical Times can be

reproduced in any form including printing or electronic without the written permission of the editor or publisher.

All the correspondence should be

addressed:

To,

The Editor

Lilavati Hospital Medical Times,

Lilavati Hospital & Research Centre,

A-791, Bandra Reclamation, Bandra (W),

Mumbai - 400 050,

Fax: 91-22-6407655

Website: www.lilavatihospital.com

Email: [email protected]

It has been a great delight to be part of the Lilavati Our idea of presenting Lilavati Hospital Medical Hospital Medical Times (LHMT) ever since it's times is on the similar lines where our doctors skills, creation in June 2013. techniques and many other informative articles are

shared with you. Your interest and feedbacks are “I am thankful to the readers and the doctors highly awaited and this is one way by which we who have enthusiastically taken part to be an would like to ensure the excellence of LHMT. This alliance of LHMT in many ways”. edition will provide classic write ups on many case

The fundamentals of LHMT lie in the fact that studies presented by our renowned clinicians; it throws an enormous light on the medical besides this there are number details related to compassion of the clinicians and it's their skills equipments and clinical images giving insight to lot which is helping all of us in making a healthier of development taking place at Lilavati Hospital. society to live in.

This edition includes a look at our new “Stop treating the symptoms of my condition, let physiotherapy set up; the state of the art finding a cure be the mission” Post Independence physiotherapy is designed keeping all the key era India has witnessed a drastic development in factors in mind and to facilitate the patients to the health care scenario; numerous illnesses have the utmost level. My participation in LHMT not been eradicated, numerous vaccines have made just oversees the eminence of it but it appeals to people healthy and strong. Two decades back all medical experts for their contribution as what was called a suffering has now become a your contribution will intensify the worth of the journey of well being. publication.

Of course clinical practices in India have achieved Lilavati Hospital and Research Centre has enormous heights but the urban health care is of achieved a lot and yet everyday the peak seems greater benefits to people contrasting the rural or to be a little ahead. LHMT is one of the steps as a matter of fact even semi rural, essentially it's towards this peak.the state of mind of the people which needs to be upgraded and a sense of faith needs to be established. It is imperative to wipe away the

Dr. Narendra D Trivedimyth in the people that the reason not found for cure is not because the money made from treating symptoms is greater.

India has been a Health care destination of repute and the Indian health care trend is a benchmark for many developed nations around the globe. Expert clinicians from India are treating everywhere; Nurses of India are the face of many ICU's and critical care, many other paramedics also are of key importance in many countries that's the way Indian medical proficiency goes.

EDITORIAL…

1

EDITORIAL TEAM

Dr. Narendra D Trivedi

Dr. Sanjay Kapadia

Mr. Ajaykumar Pande

CO-ORDINATOR

Mr. Kundan Singh

Changing Scenario: Health care In IndiaCONTENTS

Editorial ................................................................ 1

Lilavati Hospital & Research Centre ................... 2

Lilavati Hospital Today ........................................ 4

Equipment In Focus - Cathlab ........................ 4

Department in focus -Physiotherapy department .............................. 5

Straight from the heart .................................... 9

Case Reports........................................................ 10

Cardiovascular & Thoracic Surgery .............. 10

Chest Medicine ............................................. 13

Gastrosurgery ................................................ 15

Histopathology & General Surgery ............... 18

Nephrology ................................................... 21

Orthopaedics ................................................. 24

Benevolence ....................................................... 27

Save and Empower The Girl Child .................... 28

History of Modern Medicine .............................. 30

William Henry Welch ................................... 30

William Osler Quotes .................................... 30

Latest Feathers in Cap ........................................ 31

Services .............................................................. 32

Doctors Associated with Lilavati Hospital ......... 33

Important Numbers ............................................. 38

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LILAVATI HOSPITAL AND RESEARCH

CENTRE

supported by a committed staff. Lilavati Hospital

has focused its operation on providing quality care

with a human touch; which truly reflects the essence Late Shri Vijay Mehta had a wish to fulfill his of its motto, “More than Health Care, Human Care”. parents desire to build word-class hospital where Being a centre of medical excellence where everyone in need for relief from disease and technology meets international norms and suffering come in with a certainty to receive the standards, the hospital has got what it takes to be best possible medical care. His passion, attention the pioneering quality healthcare institute and to details and perseverance resulted in iconic hence is one of the most sought after and healthcare landmark called Lilavati Hospital. “Patient Friendly” hospital.

Lilavati Hospital & Research Centre is a premier Mission: To provide affordable healthcare of Multi Specialty Tertiary care hospital located in international standard with human care.the heart of Mumbai, close to the domestic and the

international airport. It encompasses modern health Motto: More than Healthcare, Human Care.

care facilities and state of art technology dedicatedly

LILAVATI KIRTILAL MEHTA MEDICAL TRUST

Lilavati Hospital and Research Centre is run and

managed by Public Charitable Trust - Lilavati Kirtilal

Mehta Medical Trust which was formed in 1978. The

Trust was settled by late Shri Kirtilal Manilal Mehta.

The Trust has engaged in innumerable charitable

endeavors across India.

OVERVIEW: LILAVATI HOSPITAL & RESEARCH CENTRE

Late Shri Kirtilal Mehta Late Smt. Lilavati Mehta

2

•HIGHLIGHTS

LILAVATI KIRTILAL MEHTA MEDICAL •

TRUST RESEARCH CENTRE

LATEST ADDITIONS

SOMATOM Definition Flash - CT SCAN

3 Tesla MRI with latest Philips Ingenia having digital technology

314 bedded hospital including 72 intensive

care beds. Philips Allura Clarity FD10 Low Dose

Cathlab12 state-of-the-art well equipped operation

theatres.

Full fledged Dental & Dermo cosmetology

clinic.

The Lilavati Kirtilal Mehta Medical Trust Research Modern Cathlabs having specialized SICU &

ICCU with highly trained cardiac care medical Centre is a Scientific and Industrial Research staff. Organization approved by Ministry of Science

and Technology (Govt. of India). The Research One of the highest nurses to patient ratio in

Centre under guidelines of Dept. of Science & India, which allows patient care in a more

prudent manner. Technology works in close collaboration in

evaluating and developing technologies for better Lilavati Kirtilal Mehta Medical trust is anhealth care to the sick people. The research centre approved research organization by Ministry

of Science & Technology having all modern have undertaken multidisciplinary researches in the

facilities necessary for conducting research fields of Cardiology, Radiology, Cerebrovascular

Diseases (Stroke), Ophthalmology, Chest More than 300 consultants and manpower ofMedicine, Nuclear Medicine, Pathology, Oncology, nearly 1,800.

Orthopedics etc, to cite a few. One of the important Hospital attends to around 300 In-patients and

aims of the Research Centre is to establish 1,500 Out-patients daily.Community based epidemiological researches in

Cerebrovascular disease in stroke. As a policy

Drug and Device Trials are not undertaken at the

Research Centre.

Lilavati Hospital has always striven to provide the

best in health care to patients and is always in the

front to adopt the latest technology available to its

repertoire.

MEDICAL TIMESLILAVATI HOSPITAL

OVERVIEW: LILAVATI HOSPITAL & RESEARCH CENTRE

3

The Lilavati Kirtilal Mehta Medical Trust is being managed and administered by:

Chairman

The Interim Board of Trustees

Mr. Justice J. N. Patel (Retd.)

and

Smt. Charu K. Mehta

Smt. Rekha H. Sheth

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LILAVATI HOSPITAL TODAY

4

MEDICAL TIMESLILAVATI HOSPITAL

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EQUIPMENT IN FOCUS - CATHLAB

A big leap towards creating safer, minimum The Allura Clarity FD10 is optimized for radiation environment for patients and treating complex PCI , s t ruc tu ra l hea r t and physicians. electrophysiology procedures.

A valuable insight and efficiency through a wide INTRODUCTION

array of advanced interventional tools can be achieved. Lilavati Hospital is now equipped with Philips

Allura Clarity the latest low-dose Cath lab which is The unique G-shaped stand increases speed

a highly advanced next generation interventional and provides excellent patient access. It allows

X-ray solution for safe Cardiac & Neurovascular easy reach to the groin without repositioning,

Interventions.facilitates a wide range of projections and provides full body coverageThe technology offers industry-leading image

quality at a fraction of the dose.It allows the flexibility and quality required to treat congenital heart disease and carry

BENEFITS out complex electrophysiology procedures. Dedicated Clarity IQ EPX dose settings Reduction of X-ray patient dose is possible up to help achieve low radiation dose and the 73 percent for Neuro-radiology interventions, excellent image contrast to visualize low up to 83 percent for vascular Interventions and inherent tissue contrast or tissue density of up to 50 percent for Cardiac Interventions patients.without affecting image quality.

It helps remove barriers for minimally invasive Patented Clarity IQ technology that will deliver interventionsexcellent image quality at fraction of a dose.

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LILAVATI HOSPITAL TODAY

DEPARTMENT IN FOCUS: PHYSIOTHERAPY DEPARTMENT The program is closely and clearly related to an

individual’s care and treatment and is tailored to Lilavati Hospital and Research Centre is proud the individual’s need. It includes education to introduce the Pulmonary and Cardiac about lung condition and self-management Rehabilitation program.techniques.

PULMONARY REHABILITATION

Pulmonary Rehabilitation is a program of education Evaluation of the patient’s progress is done as it and exercise classes that teaches you about your relates to the individual’s rehabilitation goals lungs, how to exercise and do activities with less and program.shortness of breath, and how to "live" better with your lung condition. The following devices are used in pulmonary

rehabilitation to aid lung expansion and airway Pulmonary rehabilitation may be beneficial in any clearance:patient with respiratory symptoms that result in

diminished functional capacity or decreased quality of life. This would include patients with not only obstructive lung diseases like Bronchiectasis COPD (chronic obstructive pulmonary disease): emphysema, chronic bronchitis, asthma but also patients with restrictive lung disease such as interstitial lung disease, pulmonary fibrosis, sarcoidosis and patients with lung cancer, neuromuscular diseases.

POSTURAL DRAINAGE BED COMPONENTS OF PULMONARY REHABILITATION PROGRAM Different positions can be given on the bed like

head low, bed flat and propped up positions, with is quarter turn and half turns (side lying position) done before beginning the program.for draining different lobes of lung. Along with postural drainage, chest PT maneuvers, nebulization and breathing techniques can be

It includes breathing exercises, chest clearance given. Suctioning is done if required.

techniques, use of assistive devices (like flutter, Acapella) conditioning and strengthening

AIRWAY CLEARANCE DEVICEexercises.

PEP (positive expiratory pressure) devices help Aerobic / conditioning exercise Trainingto facilitate removal of secretions and expansion modes used are level ground walking, of lung. It helps in opening up atelectatic airways treadmill, cycle ergo-meter and elliptical.and also prevents lung collapse.

Strengthening exercises are done withtherabands, weight cuffs and dumb bells.

lEducation and training:

lOutcomes Assessment:

lPostural Drainage Bed

lAcapella

lFlutter

lThreshold PEP

lIncentive Spirometry

lBIPAP and Portable oxygen cylinder

lAssessment: A “Six Minute Walk Test”

lCustom made exercise program:

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MEDICAL TIMESLILAVATI HOSPITAL

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Cardiac Rehabilitation Program consists of:

lBIPAP and Portable oxygen cylinder

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Cardiac Rehabilitation Program helps to: l

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Phase I

1. Monitored exercise program in ICU and wards.

This includes bronchial hygiene, lungexpansion exercises, gradual mobilizationfrom in-bed activity to walking and posturecorrection.

Progression of exercises and walkingdistance depends on the response of vitalissigns like BP, PR, RR, SPo2 and Rate ofavailable for patients on home therapy

to help them exercise better. perceived exertion based on BORG scale.

2. An Introduction to phase II program, education about Do’s and Don’ts and discharge counseling is done in Physiotherapy department prior to discharge.

Phase II

Risk factor stratification using ACSM (2010) guidelines.

CARDIAC REHABILITATION Assessment of functional capacity using 6 minute walk test (6MWT).The enhancement and main tenance of

cardiovascular health through individualized program designed to optimize physical,

Custom made exercise program:psychological, social, vocational and emotional status.

Warm up / stretching exercise

Walking on level ground based on result of 6 MWT.1. Understand present health condition

Free weight exercises / Theraband exercises.2. Recover from CABG, Angioplasty, MI and PVD.

Breathing exercises + airway clearance.

3. Modify lifestyle and reduce risk.

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LILAVATI HOSPITAL TODAY LILAVATI HOSPITAL TODAY

Flow Spiro Volume Spiro

lAcapella: lThreshold PEP:

lIncentive Spirometry:lFlutter:

It’s a small handheld oscillatory airway It incorporates a flow-independent one way clearance device. It has both resistive and valve to ensure consistent resistance with vibratory features, which helps to loosen and adjustable specific pressure settings. When clear secretions from chest. The equipment patient exhales through threshold PEP, consists of a detachable mouthpiece, cover resistive load creates positive pressure that and base unit (rocker assembly). When you helps open the airways and allows mucus breathe out through acapella the resistance to to be expelled during huff technique.airflow will keep your airways open to get air behind the sputum and help it move upwards. The vibrations will help to loosen secretions from airways and move them up more easily for effective chest clearance.

Incentive spirometry also known as sustained It’s an oscillatory mucus clearance device maximal inspiration is a technique used to shaped like a pipe with a mouthpiece at one end, encourage a patient to take a maximal a plastic perforated cover at other end and a high inspiration using a device to measure flow or density stainless steel ball resting in plastic volume. Two types of spirometer: volume circular cone on the inside. Principle of flutter-spirometer (Volydyne spirometer) and flow vibrates the airways, intermittently increases the spirometer (Hudson red ball). A maximal endobronchial pressures and accelerates inspiration sustained for 3 seconds may increase expiratory airflow.the transpulmonary pressures, thereby improving the inspiratory volume and inspiratory muscle performance. It is found that volume incentive spirometers increases chest wall volume more than flow spiro. It causes a larger increase in upper and lower ribcage and abdominal activity whereas flow spiro causes more increase in accessory muscle activity.

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MEDICAL TIMESLILAVATI HOSPITAL

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At the end of phase II, depending upon patient’s Phase IIIlevel of fitness and in co-ordination and consent of Continuation of aerobic exercise program.concerned cardiac team, patient can be trained on equipments like: Home exercises.

Helping patients to return to work / previousTreadmilllevel of fitness.

Elliptical

Cardio-pulmonary rehabilitation improves the Cycle ergo meter quality of life and helps to live life to the fullest.

The entire exercise program is under therapist supervision and is made safer by use of TELEMETRY monitoring, Polar Heart belt monitor and BORG scale.

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LILAVATI HOSPITAL TODAY STRAIGHT FROM THE HEART

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“When I was told that I had severe obstruction in “The excellent nursing staff who were always my lungs and I was diagnosed with COPD, I was smiling and ready to help.”devastated. I had always been fit, a walker, a

Samson Chackoswimmer, a scuba diver. How could I have a lung problem? Yes I had smoked for many years

“Staff & doctors are good in nature. They but then I had given up and started yoga! Surely provide good treatment and behave like a family that should count ? I walked into physiotherapy member.”set up at Lilavati hospital with great deal of

trepidation and concern. That was in early Diya Sachin Khanvilkar

January, 2014.

“Expert Doctors, Cleanliness & Right Today when I walk into the physiotherapy Suggestions.”section, it is like a wonderful familiar place. The

staffs from the receptionist to the therapists and Sanjay Umbarkarassistants are all friendly and welcoming. My therapist is an amazing motivator. She is “Best doctors and approach towards the patient. constantly energizing me to do more and to Care & loving nature towards the patient and push myself. When I first started therapy, understanding the patients kin.”my lung capacity was barely 750 ml, today

Namita Rozario I can breathe over 1500 ml and now the physiotherapist wants me to raise the bar. In less

“Excellent treatment with lots of patience and than 20 sessions my life has changed thanks to care.”the great team at Lilavati Physiotherapy

department.” Prachi Chandra

Miss Menon

“Caring, loving, trained staff with professional attitude making patient feel at home and confident”

Lata Shringarpure

“Nursing staff was kind and supportive. The on call doctors were very nice and humble. Compliments to room service staff.”

Aashmeen Sudhi

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MEDICAL TIMESLILAVATI HOSPITAL

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ABSTRACT vein was harvested. Routine cardiopulmonary bypass with bicaval cannulation was instituted.

Anomalous origin of Left Coronary Artery from Main pulmonary artery was opened after blood

Pulmonary Artery (ALCAPA) is a rare congenital cardiopledegic arrest and left coronary ostium

defect with reported incidence of 1 in 3 Lac live examined Fig. 5 from inside of MPA . It was found to

births comprising between 0.24% & 0.46% of be postero-lateral aspect of pulmonary root. Bovine

congenital cardiac diseases 1-4. Survival to 2 pericardial patch of 2.5 cm used to close the left adulthood is further more rare accounting for coronary ostium from inside of MPA. Fig. 6 MPA only 10-15% of these cases. 2 Here we report a Incision closed. LIMA to LAD & saphenous vein case of adult survivor of ALCAPA diagnosed & to first diagonal was anastomosed distally and operated at our institution. proximal anastomosis of SVG to Aorta done. Fig. 7 Patient successfully weaned off Cardiopulmonary

CASE REPORT Bypass. Sternotomy closure done. Post operative period was smooth and uneventful. Echo A 55 year old female (Mrs. Y. Patil) Fig. 1, cardiogram post operatively showed no hypertensive since last 5 years was admitted for deterioration of left ventricular function and MSCT evaluation of class II effort angina & dyspnoea on Scan showed patent conduits & closure of left exertion. Her physical examination was coronary ostium at MPA level. Fig. 8unremarkable except B.P. 150/90mmHg, & mild

systolic murmur in pulmonary area. X’Ray chest, was within normal limits. ECG showed T. Wave DISCUSSIONinversion in chest leads. 2D Echo & color Doppler

The clinical presentation of older ALCAPA patients revealed concentric left ventricular hypertrophy usually consists of exertional dysponea or angina & with preserved left ventricular functions with and cardiac arrhythmias. Clinical examination grade I MR Cardiac MS CT revealed Dilated reveals a systolic murmur in 70% cases. Diagnosis RCA originating from RCC with extensive apical is usually established by coronary angiogram collaterisation to the LAD (left Anterior descending showing dilated and tortuous right coronary artery artery) LMCA (Left main coronary artery) could with collateral filling of left coronary system. be traced to its origination to postero-lateral aspect Right heart catheterisation with oximetry shows of main pulmonary artery (MPA). Fig. 2 Coronary increase in oxygen saturation at the point where angiography revealed typical anatomy of ALCAPA blood from left coronary artery merges with blood Fig. 3 with absence of left coronary ostium in aortic from pulmonary artery. From the review of root shoot.literature it is agreed that surgical correction is the method of choice as soon as possible with The patient was taken for open heart surgery medical management as only supportive and correction of ALCAPA. After informed consent, temporary. One report describes a 72 years old routine cardiac anaesthesia was given and patient with ALCAPA who was managed sternotomy was done, Left internal mammary conservatively as the risk of cardiac surgery seemed artery (LIMA) harvested and blood flow was to outweigh the natural prognosis. The two accepted measured. Due to inadequate blood flow saphenous

ADULT TYPE ANOMALOUS LEFT CORONARY ARTERY FROM PULMONARY ARTERY (ALCAPA) - CASE REPORT

ADULT TYPE ANOMALOUS LEFT CORONARY ARTERY FROM PULMONARY ARTERY (ALCAPA) - CASE REPORT

Dr. Pavan Kumar, M.S.M.Ch, Dr. R. M. Bhatnagar, M.S.M.Ch, Dr. P. C. Jain, M.B.B.S., Dr. Bhupesh P., MD, Dr. P. Sanzgiri, MD, DM, Ms. Vaishali Sathe

corrective procedures for ALCAPA are ligation of REFERENCESthe anomalous left coronary artery and coronary 1. Keith JD. The anomalous origin of the left artery and reconstruction of a double coronary coronary artery from the pulmonary artery. artery system. The two coronary artery system can Br Heart J. 1959:21:149-161.be established in many ways-direct implantation of

2. Yamanaka O. Hobbs RE. Coronary artery anomalous left coronary artery to aorta, aorta - left anomalies in 126.595 patients undergoing coronary artery saphenous vein graft, left coronary coronary arteriography. Cathet Cardiovasc artery conduits using left common carotid artery Diagn. 1990:21:28-40.or subclavian artery or left internal thoracic artery

or by Takeuchi procedure (creation of an aorto 3. Hauser M. Congenital anomalies of the pulmonary window and an intra-pulmonary coronary arteries. Heart 2005;91:1240-1245tunnel extending from the anomalous ostium to the

4. Frescura C. Basso C. Thiene G. et al. Anomalous window. Alixi-Meskishvili et al studied four origin of coronary arteries and risk of sudden adult patients with ALCAPA aged 27,35,54 & 60 death: a study based on an autopsy population years in whom two coronary artery system was of congenital heart disease. Hum Pathol. established and found clinical improvement in 1998:29:689-695.all patients and concluded that the adult patients

with ALCAPA benefit from was establishment 5. Wilson CL, Dlabal PW, Holyfield RW, et al. of two coronary system. Other authors have Anomalous origin of the left coronary artery concluded that two coronary artery system from the pulmonary artery: a case report and appeared more physiological and should be the review of literature concerning teenagers and procedure of choice to be performed early. Wilson adults. J. Thorac Cardiovasc Surg 1977:73:et al after review of literature of teenagers and 887-893.adults with ALCAPA concluded that saphenous

6. Bland EF, White PD, Garland J. Congenital vein grafting should be the definitive means of anomalies of the coronary arteries: report of correction by restoring a dual coronary artery an unusual case associated with cardiac system. Schwartz et al in a study found that the hypertrophy. Am Heart J 1933; 8:787-801.degree of preoperative mitral regurgitation was

predictive of outcome in ALCAPA after dual 7. Cherian K M, Bharati S, Rao SG. Surgical coronary repair and that mild to moderate mitral correction of anomalous origin of the left regurgitation tended to improve without mitral coronary artery from the pulmonary artery. J. valvoplasty after establishment of dual coronary Card Surg 1994;9:386-391.artery with complete recovery of myocardial

8. Bunton R, Jonas RA, Lang P, et al. Anomalous dysfunction. In present patient dual coronary system origion of left coronary artery from pulmonary was established with LIMA & saphenous vein artery-ligation versus establishment of a two graft to anomalous left coronary system with coronary artery system J Thorac Cardiovasc closure of LCA origin in pulmonary artery Mitral Surg 1987;93:103-108.valve repair was not attempted as mitral

regurgitation was minimal. We conclude that dual 9. Shivalkar B, Borges M, Dacnen W, et al. coronary system should be established early in ALCAPA syndrome: an example of chronic patients with adult type ALCAPA to prevent myocardial hypoperfusion. J Am Coll Cardiol sudden cardiac death due to myocardial ischemia, 1994;23:772-778.arrhythmia and heart failure.

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10. Alexi-Meskishivili V, Berger F, Weng Y, et al. 13. Arciniegas E, Farooki ZQ, Hakimi M, Green Anomalous origin of the left coronary artery EW. Management of anomalous left coronary from the pulmonary artery in adults. J Card Surg artery from the pulmonary artery. Circulation 1995;10:309-315. 1980; 62:I 180-I 189.

11. Wollenek G, Damanig E, Salzer-Mufar V, et al. 14. Schwartz ML, Jonas RA, Colan SD. Anomalous Anomalous origin of the left coronary artery: a origin of the left coronary artery from the review of surgical management in 13 patients. J pulmonary artery: recovery of the left Cardiovasc Surg 1993; 34:399-405. ventricular function after dual coronary repair.

J Am Coll Cardiol 1997; 30:547-553. 12. Fierens C, Budts W, Denef B, et al. A 72 years

old woman with ALCAPA. Heart 2000; 83:e2-e2 (electronic pages).

ADULT TYPE ANOMALOUS LEFT CORONARY ARTERY FROM PULMONARY ARTERY (ALCAPA) - CASE REPORT

Pre operative CT Scan Images

Operative Image

Post operative CT Scan Image

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UNUSUAL EARLY PRESENTATION OF A MALIGNANT MESOTHELIOMA; NON ASBESTOS EXPOSURE RELATED

INTRODUCTION There were no complaints of chest pain, hemoptysis and loss of appetite.The most common primary malignant tumor of the

pleura is malignant mesothelioma, an insidious His Chest X-ray done 2 months back showed neoplasm with a dismal prognosis arising from the right sided pleural effusion with right basal mesothelial surfaces of the pleural (80%) and consolidation.peritoneal cavities, as well as from the tunica

1 Pleural fluid tapping was done which was vaginalis and pericardium. Inhalational exposure to asbestos has been clearly established as the

lExudative lymphocytic predominant cause of malignant mesothelioma in humans. there have also been instances of idiopathic lAcid Fast Bacilli - negativeand spontaneous mesothelioma that occur without

lCytology - negativeany exposure to asbestos. These have a spontaneous rate of about one per million in humans. First line anti-tuberculosis treatment

Isoniazid, Rifampicin, Pyrazinamide and CASE REPORT Ethambutol was started empiricilly by chest

physician for the patient at tertiary care hospital.36 year old male, resident of Mumbai, engineer by profession, presented to us with; HRCT done the showedd right pleural lInsidious onset of breathlessness since (Iamellar and fissural) effusion with

4 to 5 months, underlying consolidation and consolidation with minimal pleural effusion which was non lWeight loss of 8 kilograms in 6 months, tapable.

lFew episodes of low grade fever in last 2 months After two months when patient visited us,

his weight loss and breathlessness persisted lDry cough since 15 days.on AKT. Repeat pleural tapping was attempted but was not possible.

lHRCT Chest showed, diffuse markedthickening with abnormal soft tissue alongvisceral pleura with mediastinal adenopathyand volume loss of right lung, representingpleural based neoplastic disease.

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Dr. Sanjeev K. Mehta (MD, FCCP, Chest Medicine), Dr. Miti M. Maniar (MBBS, 3rd year resident, DNB, Respirator Diseases),Dr. Fatima Mamnoon (MBBS, 3rd year resident, DNB, Respirator Diseases)

Dr. Abhijeet Khadelwal (M.B.B.S, DNB)

We hereby reproduce a poster that was presented at NAPCON (National Chest Conference-2013, Chennai) by our doctors. We are pleased to announce that this poster was shortlisted in top 20 posters at the conference.

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UNUSUAL EARLY PRESENTATION OF A MALIGNANT MESOTHELIOMA; NON ASBESTOS EXPOSURE RELATED

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CYSTIC DYSTROPHY OF THE DUODENUM DUE TO HETEROTROPIC PANCREAS (CDHP) CASE REPORT AND REVIEW OF LITERATURE

Dr. Dattaprasanna Kulkarni, M.S. (General Surgery), Fellow in Hepato Pancreato Biliary Surgery & Liver Transplantation (Hong Kong & France), Dr. Chandralekha Tampi, MD Pathology, Dr. Aniruddha Phadke, DM, Gastro

INTRODUCTION After the imaging a diagnosis of Groove Pancreatitis was made. Unable to exclude a CDHP is a condition characterized by cysts, neoplasm, the patient was subjected to a inflammation and fibrosis with intermingled Pylorus Preserving Pancreatoduodenectomy heterotopic pancreatic tissue in the submucosal

1-3 (PPPD). Histopathological examination (Fig. 2) and muscular layer of the duodenal wall. It was 1 revealed islands of heterotopic pancreatic tissue first described by Potet and Duclert. We report

and cystic dilated ductules in the muscularis a rare case of this pathology and review the propria of the duodenum and extensive relevant literature. Brunner gland hyperplasia in the submucosa. The duodenal muscle hypertrophy, which contained CASE REPORTthe heterotopic pancreatic tissue and the

47-year-old male with history of alcohol abuse for submucosal widening due to the Brunner gland

10 years was referred to us for recurrent attacks hyperplasia probably led to narrowing of the

of acute pancreatitis, weight loss and postprandial duodenal lumen. fullness. CT scan revealed bulky head of pancreas

with a hypodense area between pancreatic head and second part of duodenum (Fig.1), prominent pancreatic duct, dilated common bile duct (CBD) (15mm), distended gall bladder, and stenosis of second part of duodenum. Endoscopic Ultra Sound (EUS) confirmed CT findings. An FNAC showed only inflammatory infiltrate and no malignancy. Liver function tests and blood level of CA19-9 were normal.

Fig. 2 Low power microphotograph showing Brunner’s gland hyperplasia (long arrow) with heterotopic pancreas (short arrow) and dilated ductule (arrowhead) in duodenal wall. (Hematoxyline

and Eosin stain, original magnification X 40).

The postoperative course was uneventful. The patient is asymptomatic five years after the surgery.

Fig. 1 Intravenous contrast enhanced CT scan showing hypodense area (black arrow) between pancreatic head &

second part of duodenum.

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(2,3) 85%. However, Mesothelioma can also result from para-occupational exposures and non industrial environmental exposures [Simian virus-40, genetic predisposition, therapeutic irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates such as erionite].

Typically, presentation is either with chest pain, (4,5) dyspnoea or both. Progression of the disease

may be variable. Some patients have periods of apparent stability while others have relentless rapid deterioration. Median survival varies from 8 to 14 months in diffrent studies. The disease is inexorably progressive with a very poor 5-year survival. Epithelioid tumours have a better Right sided thoracotomy with pleural biopsy

(6)with intercostal tube insertion was done. prognosis than other cell types.Histopathology**** was confirmatory of

CT features used to distinguish malignant from Malignant Mesothelioma-Epitheloid Variant.benign pleural disease are

1) circumferential pleural thickening,

2) nodular pleural thickening,

3) parietal pleural thickening > 1 cm, and(7)4) mediastinal pleural involvement .

All these classical findings were present in our patient. The earlier CT scan done outside missed these features.

Our case is unique in that::Immuno - histochemistry, showed positivity for

It is extremely rare to have Malignant Calretinin, WT-1, CK-7 CK5/6. This confirmed the Mesothelioma in a young person, in the diagnosis of malignant mesothelioma.absence of asbestos exposure

Patient now comes for follow up chemotherapy. He The CT features were typical of malignant has finished 2 cycles of chemotherapy and his pleural diseaseclinical condition is stable.

It was mistreated as TB in another super specialty hospital

DISCUSSION This treatment was persisted with in spite of

Asbestos fibers, is the cause of most cases of CT findings and the lack of response to TB mesothelioma. Evidence from various studies treatment.suggests that the proportion of men with

Our case highlights the need to think beyond TBmesothelioma directly attributable to occupational asbestos exposure may be about

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DISCUSSION Endoscopic cyst fenestration is useful for large and 12superficial cysts. Recurrence is likely to be higher Cystic dystrophy is a peculiar complication of

4,10,12if cysts are numerous, small and deep. Surgery heterotopic pancreas situated in the medial border is preferred for severe symptoms at primary of the second part of duodenum close to the presentation, failure of medical and / or endoscopic papilla and is predominant in caucasian males in

134 treatment and suspicion of underlying malignancy. their fifth decade of life especially alcoholics.

Bi l ia ry and gas t ro in tes t ina l bypass or cystogastrostomy can resolve symptoms of biliary CDHP is a chronic pancreatitis that evolves in the and duodenal obstruction and are useful for patients ectopic gland since the excretion ducts of the

5ectopic gland are too small and develop recurrent without pain and malignancy. However, flare-ups obstructive acute pancreatitis, retention cysts and of pancreatic pain or adenocarcinoma can occur in gradually chronic pancreatitis. The rest of the future. All these problems are tackled with long-

13pancreas may be healthy or develop chronic term relief by PD. Pancreatic resection carries high 5pancreatitis. Rarely existing chronic pancreatitis morbidity and mortality. Hence a limited duodenal

14secondary to alcohol extends to a heterotopic resection is proposed as an alternative to PD. 6pancreas.

CONCLUSIONPatients present with epigastric pain, postprandial fullness, vomiting, weight loss, obstructive jaundice CDHP, a rare cause of chronic pancreatitis, needs or recurrent acute pancreatitis. Diagnosis relies on high degree of clinical suspicion combined with MDCT, MRCP & EUS. MDCT shows multiple CT, MRCP and EUS for diagnosis. Medical and cysts in the thickened wall of the duodenum with endoscopic therapy is useful but may have post contrast enhancement. The thickness of recurrence. PD gives long-term relief from a duodenal wall often correlates to the presence of the potentially malignant problem.

7 heterotopic pancreas. Duodenal dystrophy may 8appear solid if cysts are small. MRCP provides all CONFLICT OF INTEREST

the information provided by CT scan and All the authors listed declare that there are no additionally gives information about biliary and

9 conflicts of interest and that no financial pancreatic ducts. The three specific components in sponsorship was accepted in producing and the duodenal wall dystrophy i.e. wall thickening, presenting this article. Each of the authors listed is in presence of cysts, and a network of channels around agreement with the content of the paper.5,8,10 the cysts are picked up by EUS. Groove

pancreatitis and CDHP have similar clinical picture, REFERENCES:imaging findings and histopathology. Therefore

they are grouped together by Adsay and Zamboni 1. Lai EC, Tompkins RK. Heterotopic pancreas. 2as Paraduodenal Pancreatitis. Review of a 26-year experience. Am J Surg.

1986; 151:697-700. When CDHP is diagnosed preoperatively somatostatin analogue octreotide along with

2. Adsay NV, Zamboni G. Paraduodenal parenteral nutrition is useful with a variable effect

pancreatitis: a clinico-pathologically distinct 4,11 on pain, reduction in cyst size and weight gain.

CYSTIC DYSTROPHY OF THE DUODENUM DUE TO HETEROTROPIC PANCREAS (CDHP) CASE REPORT AND REVIEW OF LITERATURE

entity unifying "cystic dystrophy of heterotopic 9. Tison C, Regenet N, Meurette G, Mirallié E, pancreas", "para-duodenal wall cyst", and Cassagnau E, Frampas E et al. Cystic dystrophy "groove pancreatitis". Semin Diagn Pathol. of the duodenal wall developing in heterotopic 2004; 21:247-254. pancreas: report of 9 cases. Pancreas. 2007;

34:152-156. 3. 3 Potet F, Duclert N. Cystic dystrophy on

aberrant pancreas of the duodenal wall. Arch 10. Andrieu J, Palazzo L, Chikli F, Doll J, Chome Fr Mal App Dig. 1970; 59:223-238. J. Cystic dystrophy on aberrant pancreas.

Contribution of ultrasound-endoscopy. 4. Pessaux P, Lada P, Etienne S, Tuech J, Lermite Gastroenterol Clin Biol. 1989; 13:630-633.

E, Arnaud JP et al. Duodenopancreatectomy for cystic dystrophy in heterotopic pancreas of 11. de Parades V, Roulot D, Palazzo L, Chaussade S, the duodenal wall. Gastroenterol Clin Biol. Rautureau J, Coste T et al. Treatment with 2006; 30:24-8. octreotide of stenosing cystic dystrophy on

heterotopic pancreas of the duodenal wall. 5. Fl jou JF, Potet F, Molas G, Bernades P, Gastroenterol Clin Biol. 1996; 20:601-4.

Amouyal P, Fkt F et al. Cystic dystrophy of the gastric and duodenal wall developing in 12. Beaulieu S, Vitte RL, Le Corguille M, Petit heterotopic pancreas: an unrecognized entity. Jean B, Eugene C. Endoscopic drainage of Gut. 1993; 34:343-7. cystic dystrophy of the duodenal wall: report of

three cases. Gastroenterol Clin Biol. 2004; 6. Leger L, Lemaigre G, Lenriot JP. Cysts on 28:1159-64.

heterotopic pancreas of the duodenal wall. Nouv Presse Med.1974; 3: 2309-14. = 4 13. Thomas H, Marriott P, Portmann B, Heaton

N, Rela M. Cystic dystrophy in heterotopic 7. Vullierme MP, Vilgrain V, Fléjou JF, Zins M, p a n c r e a s : a r a r e i n d i c a t i o n f o r

O'Toole D, Ruszniewski P et al. Cystic pancreaticoduodenectomy. Hepatobiliary dystrophy of the duodenal wall in the Pancreat Dis Int. 2009; 8(2): 215-7.heterotopic pancreas: radiopathological correlations. J Comput Assist Tomogr. 2000; 14. Marmorale A, Tercier S, Peroux JL, Monticelli I, 24:635-643. = 4 Mc Namara M, Huguet C. Cystic dystrophy in

heterotopic pancreas of the second part of the 8. Procacci C, Graziani R, Zamboni G, Cavallini duodenum. One case of conservative surgical

G, Pederzoli P, Pistolesi GF et al Cystic procedure. Ann Chir. 2003; 128:180-184dystrophy of the duodenal wall: radiologic findings. Radiology. 1997; 205(3): 741-7. = 4

CYSTIC DYSTROPHY OF THE DUODENUM DUE TO HETEROTROPIC PANCREAS (CDHP) CASE REPORT AND REVIEW OF LITERATURE

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MUCOCELE OF THE APPENDIX - A REPORT OF TWO CASES

Dr. Abhijit Bhanji, MD Pathology, Dr. Gauri Chavan, MD Pathology, Dr. Asha George, MD Pathology, Dr. Chandralekha Tampi, MD Pathology, Dr. Narendra Trivedi, MS (General Surgery)

INTRODUCTION the appendix was not identified separately from it. A right hemicolectomy was done, excising 6 cms of Mucocele of the appendix is an uncommon ileum, 9 cms of caecum and ascending colon, along finding, with an overall incidence of 0.2% to 0.7% with an intact enlarged appendix 8x 6.5 cms with of appendicular pathologies. It is characterized by tenacious mucoid material within. Microscopy a diffuse or localized distension of the appendix revealed an intact mucinous cystadenoma, with due to a mucus-filled lumen. Simple mucocele morphology similar to case 1.(inflammatory / retention cyst) is rare, and needs to

be distinguished from the commoner adenomatous DISCUSSION proliferations. It may be complicated by rupture or

by pseudomyxoma peritonei.Two cases of Mucocele of the appendix is a descriptive term given Mucocele of the appendix are hereby presented. to a group of appendicular lesions characterized by

dilatation of the lumen due to intraluminal mucous. Mucinous cystadenoma and cystadenocarcinoma CASE REPORTaccount for 60-70% of all mucoceles. The smaller

A 60 years old female was detected to have a retention cysts are due to obstruction by mucosal

retroperitoneal cyst in the right flank during a routine hype rp l a s i a , c a r c ino id , append i co l i t h ,

health checkup, mesenteric cyst or mucocele of endometriosis, adhesions, post inflammatory

appendix was suspected. At surgery, grossly scarring, congenital obstruction of Gerlach’s valve,

enlarged intact appendix, 10x 4.5 cms, with smooth extra-mural compression and volvulus [1], and their

and glistening serosal surface was excised. On diameter rarely exceeds 2 cms.

cutting open, tenacious mucoid material was seen filling the appendicular lumen and the wall was Approximately 23-50% of pat ients are distended and thin. asymptomatic, and discovered incidentally (2),

while the rest present with right lower quadrant pain, Microscopy revealed dilated appendicular lumen

altered bowel habits, per rectal bleeding or a filled with mucoid material with foci of dystrophic

palpable mass [3].calcification (Figure 1). The stretched epithelial lining was extensively denuded with scattered foci Mucocele of appendix, in women, may be confused of flattened, mildly dysplastic adenomatous on imaging, with right ovary and fallopian tube epithelium (figure 2). The muscle wall was thinned pathologies. Differential diagnosis also includes out, fibrosed and infiltrated by few lymphocytes enteric duplication cyst, mesenteric cyst, and and plasma cells. No malignant transformation Meckel’s diverticulum. or rupture was seen. The diagnosis of a benign

The underlying pathology, i.e. the adenomatous Mucinous Cystadenoma was made.change in the appendix is usually not focal or stalked

A 72 years old male presented with pain in as in the rest of the colon. It is sessile, the right iliac fossa of 3-4 months duration. CT scan circumferential, mucin secreting and often villous in revealed a cystic mass at the ileocecal junction and morphology. These neoplasms follow the adenoma-

Case 1:

CASE 2:

carcinoma sequence seen in the rest of the colon, CONCLUSIONSwith the only difference being that accumulated Mucocele of the appendix represents a spectrum of mucin, causes distension of the appendix, and histopathological alterations from benign to pressure fibrosis of the wall .The mucin, under malignant. pressure often ruptures through the walls, and strips and bits of the extruded dysplastic epithelium are Associated pseudomyxoma peritonei can change its trapped in the fibrous wall of the mucinous otherwise good prognosis.cystadenoma mimicking the wall invasion of a bona

REFERENCEfide adenocarcinoma. Differentiating this from the focal invasion of a true adenocarcinoma, is

1. Ekinadoese Juliana Aghahowa, et al. sometimes impossible, as the stromal desmoplasia of Appendicular Mucocele - A Case Report. malignancy is indistinguishable from the fibrosis Kuwait Medical Journal. Mar. 2008; 40(1):already present in the wall of the mucoceles (4). 78-80.Mucinous tumors of the appendix are often

associated with borderline mucinous tumors of the 2. Persaud T, Swan N, Torreggiani WC. Giant ovaries in women. mucinous cystadenoma of the appendix.

Radiographics. 2007;27(2):553-557. [PubMed]Though mucinous adenocarcinomas are low grade well-differentiated neoplasms, it is the sometimes 3. Ciprian Bartlett, et al. Mucocele of The concurrent pseudomyxoma peritonei that gives this Appendix - A diagnostic dilemma: A case report. lesion its adverse prognosis. Journal of Medical Case Reports. 2007;1:183.

doi: 10.1186/1752-1947-1-183. [PMC free Mucin in the peritoneum is known clinically as article] [PubMed]pseudomyxoma peritonei. However at microscopy,

it is differentiated by the grade and amount of the 4. Parakrama Chandrasoma, Gastrointestinal epithelial cells in the mucin Periappendicular Pathology. Connecticut, Standford: Appleton localized mucin with no cells-good prognosis. and Lange; 1999, Chapter 9, pg 239-246.

1. Dissseminated mucin containing few (<10%) strips of low grade well differentiated mucinous epithelium-Intermediate prognosis

2. Mucin containing high grade adenocarcinoma cells-Poor prognosis.

Therapy is predominantly surgical, with appendectomy and removal of all visible peritoneal mucin and now more recently with addition of intraperitoneal chemotherapy.

MUCOCELE OF THE APPENDIX - A REPORT OF TWO CASES

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MUCOCELE OF THE APPENDIX - A REPORT OF TWO CASES

Figure 2: Mildly dysplastic adenomatous epithelium

Figure 1: Lumen filled with mucoid material with foci of dystrophic calcification

CONTRAST INDUCED ACUTE KIDNEY INJURY (CI - AKI)

Dr. L H Suratkal, M.D (Medicine), DNB (Nephrology)

INTRODUCTION retrospective analysis of 16208 patients undergoing radio contrast procedures, in-hospital mortality

An increased number of individuals are being for patients who develop CI-AKI was 34%

exposed to iodinated contrast media (CM) due compared with 7% of matched controls, who

to both technical advances of imaging in the received contrast but did not develop AKI.

diagnostic and therapeutic arena and the changing The 2-yr. survival for patients who develop

demographics of the population i.e. more elderly CI-AKI requiring dialysis following coronary

individuals with a burden of chronic diseases angiography is 18.8%.

including hypertension, diabetes, kidney and heart disease. In a small percentage of patients it could

PATHOPHYSIOLOGYlead to worsening of the renal disease. It is the leading cause of in-hospital renal dysfunction and is Hypoxia, vasoconstriction and cytotoxic effects associated with increase in morbidity and mortality of the CM all play a significant role. Oxygen as well as increase length of hospital stay and costs. delivery to the outer medulla is compromised due

to vasoconstriction of the descending vaso recta TERMINOLOGY by the CM. Vasodilatory nitric oxide is reduced

while vasoconstrictive superoxides increase. CM is It has been called by various names including

directly cytotoxic to the endothelial and renal contrast induced nephropathy (CIN). However

tubular cells. This cytotoxicity is putatively iodine the latest nomenclature is contrast induced acute

mediated. Viscous properties of CM exacerbate the kidney injury (CI-AKI).

vasoconstrictive and cytotoxic effects.

DEFINITION RISK FACTORS

Recently the Kidney Disease Improving Global Risk factors may be non-modifiable or modifiable.

Outcomes (K-DIGO) group have endorsed the Non-modifiable influences include low baseline

definition initially proposed by the Society for GFR, impaired LV function, diabetes, advanced

Urogenital Radiology. They define CI-AKI as a age, hyperviscosity syndromes like multiple

rise of S.Cr > 0.5 mg/dl or 25% of baseline.myeloma or route of administration. Modifiable factors are hydration status, type of CM, dose

HISTORY of CM and use of drugs that impair renal blood flow like nsaids, RAAS blockers or diuretics. The first case of CI-AKI was described 60 yrs. ago Intra-arterial contrast administration has greater in a patient of multiple myeloma undergoing IVP.risks than IV.

EPIDEMIOLOGYMehran risk score involves eight variables (hypertension, intra-aortic balloon pump, Intravascular contrast agents are the third most congestive heart failure, CKD, diabetes, age > 70 common cause of AKI in hospitalized patients, yrs., anaemia and volume of contrast) that were accounting for 10-13% of cases. In a large

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CONTRAST INDUCED ACUTE KIDNEY INJURY (CI - AKI)

assigned a weighted integer. The total score was of it’s lack of side-effects and low costs, K-DIGO calculated as the sum of each of the weighted guidelines permit the use of the oral form, inspite integers. This score has been shown to predict of the lack of clear cut evidence.not only CI-AKI but also poorer short and long

Ascorbic acid has been shown to benefit in some term outcomes in patients undergoing primary studies. Other therapies tried are statins, adenosine percutaneous coronary interventions (PCI).antagonists theophylline and aminophylline,

The CM used can also influence the risk of vasodilators, forced diuresis and renal replacement CI-AKI. The use of high osmolar contrast has therapy.been shown to be more nephrotoxic than low or iso-osmolar agents in patients with pre-existing

Less than 1% of patients with CI-AKI ultimately CKD. Some studies have shown that iso-osmolar go on to require dialysis, however in patients agents reduced the risk as compared to low with diabetes and severe renal failure the number osmolar agents.can be as high as 12%.Patients who get dialysed do considerably worse with in hospital mortality PREVENTIONrates of 35.7% compared with 7.1% in the non-dialysis group and a 2 yr. survival rate of only 19%.

One should ensure that intravascular volume is In patients already on dialysis the commonly cited replete, thus correcting any decreases in renal issues with contrast administration include volume blood flow. Oral water loading was associated load and direct toxicity of contrast to the remaining with an increased risk of CI-AKI as compared to nephrons and non-renal tissues. Damage to residual IV saline (35% vs 4% resp.).IV fluids maybe given renal function is of special concern in patients on 1ml/kg/hr. 6 hrs. prior to CM exposure or peritoneal dialysis. It has been found that 70-80% of 3 ml/kg/hr. 1 hr. pre-CM and should be continued contrast can be removed by a 4 hr. HD treatment at 1 ml/kg/hr. for 6 hrs. post-CM..High flux dialysis can remove about 50% of contrast in 1 hr. and about 80% in 4 hrs. Better In 1620 low risk patients isotonic saline was outcomes were found in patients who received found to have a lower risk of CI-AKI as compared pre and post CM veno-venous haemofiltration.to hypotonic saline (0.7% vs 2.0%). Isotonic

sodium bicarbonate was found to be superior to However an excellent meta-analysis by cruz et al isotonic saline.indicated that that periprocedural extracorporeal blood purification does not significantly reduce the incidence of CI-AKI as compared to standard Initial studies with N-acetyl-cysteine (NAC) medical therapy. But a study by Lee et al showed showed good benefits in a dose of 600 mg twice that in patients of stage 5 CKD (not yet on dialysis) a day for 3 days starting one day prior to contrast undergoing coronary angiography HD can improve exposure. Subsequent meta-analysis failed to renal outcomes.support the use of this agent. Higher doses have

been shown to benefit in some studies. Because

RENAL REPLACEMENT THERAPY

HYDRATION

ANTIOXIDANTS

DOSE OF CM rare complication of PCI, but it increased dramatically at a ratio of 3.0. Other groups

IN 1989, Cigarro et al described how adherence have suggested that grams of Iodine to the eGFR

to a formula for a contrast material limit could ratio (g-I/eGFR) would be superior because

be used to significantly reduce the rates of there is a wide range of iodine concentrations

CI-AKI. Using Cigarro’s formula (contrast available (140-400 mg-I/ml). Over a wide range of

material limit = 5 ml of contrast per kg body wt. / renal dysfunction (eGFR 30-90 ml/min), in

S Cr.mg/dl) for 3122 patients undergoing CAG, it patients with no shock and normal LV function,

was found that only 2% of those who remained a 1:1 I/eGFR ratio gave a reassuringly low risk of

under the limit developed CI-AKI while 21% of CI-AKI (6%). This jumped to 80% in presence of

those exceeding the limit developed it.shock and LV dysfunction.

Laskey et al advocated the use of a volume of Thus limiting contrast material dose to a ratio of 1:1

contrast to creat clearance ratio (V/Cr Cl). The I/egfr and hydration seem to be the only proven

cut-off point of the ratio was 3.7. Gurm et al found means of prevention of CI-AKI.

that below a ratio of V/CrCl of 2.0, CI-AKI was a

CONTRAST INDUCED ACUTE KIDNEY INJURY (CI - AKI)

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RECURRENT SHOULDER DISLOCATION WITH GLENOID BONELOSS. LATARJET PROCEDURE - THE ARTHROSCOPIC TECHNIQUE

Dr. Sanjay Garude, MS; DNB Orth; MCh Orth (Liverpool, UK); FCPS Orth; D Orth.

Recurrent shoulder dislocation is a fairly common Latarjet procedure was described in 1952. It has been an extremely popular technique, performed condition primarily affecting the young active open in situations with significant bone loss. The individuals.surgery consists of transferring the coracoid

It is usually post traumatic and the basic pathology process along with the conjoint tendon, through a split in the subscapularis and is then fixed on the is identified to be a tear in the glenoid labrum or anterior aspect of the glenoid.one of its variant (Bankart, ALPSA etc).

This torn labrum often fails to unite at the correct anatomical location. With the passage of time, this in turn leads to a recurrent shoulder dislocation with lesser and lesser provocation. There is a reported incidence of greater than 90% chance of recurrence in patients who suffer a traumatic shoulder dislocation for the first time under the age of 20 years.

Fig 1. Coracoid process with attached conjoint tendon transferred This recurrent instability then causes secondary to anterior glenoid through a split in the subscapularis.

problems. Every time the humeral head dislocates, it erodes the anterior aspect of the glenoid. This The Latarjet procedure works due to the bone loss on the anterior glenoid, further potentiates following 3 effects: the ease with which the dislocations occur. Once

1. Restoration of glenoid bone deficiency. the bone loss on the glenoid crosses approximately 15%, the instability rapidly worsens and patients 2. Dynamic sling effect of conjoint tendon which may dislocate with actions as trivial as sneezing or buttresses the humeral head and even in their sleep!

3. Inferior subscapularis remains below equator of Arthroscopic repair of the torn glenoid labrum is glenoid and provides additional stability. now the accepted gold standard (Bankart repair).

Arthroscopic Latarjet procedure has been described However, once the glenoid bone loss has crossed by Dr Laurent Lafosse from Annecy, France. It has about 15%, a soft tissue repair done open or often been thought to be a daunting procedure as arthroscopically has been reported to have failure it involved performing an arthroscopic coracoid rate as high as 61%.process osteotomy, which in itself is in close

In these cases with such significant glenoid bone proximity to the brachial plexus. The wide array loss, it is necessary to restore the glenoid bone of specialized jigs, cannulae and consumables deficiency with a bone graft. have also pushed the cost out of the reach of the

common man.

We have devised a technique of performing this 3. Predrilling of coracoid and osteotomy procedure with minimal use of specialized jigs

4. Axillary nerve identification and splitting of with a high degree of safety, predictability and

subscapularisreproducibility. Use of expensive cannulae and consumables has also been obviated, hopefully 5. Fixation of coracoid on anterior glenoid neck bringing it within reach of the masses. after passing through the split subscapularis

18 cases underwent this procedure over a period of 12 months. 17 males and 1 female. All patients underwent a preoperative evaluation of their bone loss by comparative CT scans of both the shoulders. The average glenoid bone loss was 23.4%. All patients had their shoulders scored with the modified Rowe system pre and 6 months postoperatively.

Fig 3. Portals for arthroscopic Latarjet.

We have developed a technique of reattaching the coracoid on the glenoid with the use of a simple reusable triple sleeve which makes the procedure easier and accurate; thus obviating the need to use Fig 2. Comparison of normal versus affected side

by CT scan evaluation expensive jigs and cannulae.

TECHNIQUE:

All surgeries were performed in the beach chair position. Inter scalene block and controlled hypotensive anaesthesia was administered.

The surgical steps were divided into five segments :

1. Diagnostic gleno humeral arthroscopy, marking the extent of the glenoid defect and exposure of lateral aspect of coracoid. Fig 4. Reusable triple sleeve.

2. Coracoid dissection, creation of the medial portal and dissection of the brachial plexus.

RECURRENT SHOULDER DISLOCATION WITH GLENOID BONELOSS. LATARJET PROCEDURE - THE ARTHROSCOPIC TECHNIQUE

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CONCLUSION:

The early results of arthroscopic Latarjet are certainly encouraging. It offers a good mix of cosmesis with safety and accuracy.

Arthroscopic Latarjet procedure may well possibly be the future of shoulder instability surgery.

Fig 5. Post op Xray showing good graft position.

All patients recovered uneventfully. There were no neurological or vascular complications. The graft position was assessed postoperatively with Xrays and found to be excellent in 15 cases and good (less than 2 mm overhang) in 3 cases. 15 patients had recovered full range of movement by 3 months post op. 3 patients failed to recover the last 20 degrees of external rotation.

Fig 6. Result at 3 months.

Each and every of the 18 patients felt subjectively completely stable. Return to active sports was allowed at 6 months.

RECURRENT SHOULDER DISLOCATION WITH GLENOID BONELOSS. LATARJET PROCEDURE - THE ARTHROSCOPIC TECHNIQUE

BENEVOLENCE

The social service wing of the hospital-SEWA - BENEFICIARIESserves to the health requirements of the needy people. This department seeks to bridge the gap between the needy patients and the fast evolving medical technology. Various social activities 2011-2012 16327 23010such as Free OPD, services to senior citizen, sending mobile vans to Adivasi areas to 2012-2013 14965 24211organizing free health checkup camps are

2013-2014 14301 30232undertaken as an on-going process. The Roshni Eye bank managed by Lilavati Hospital is a well equipped comprehensive centre for cornea removal, supplying, processing, storing, and corneal transplantation.

Year Free OPD Sewa Mobile Clinic

Free OPD

Mobile Medical Clinic

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MEDICAL TIMESLILAVATI HOSPITAL

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SAVE AND EMPOWER THE GIRL CHILD

Doctors of Lilavati hospital feel that they need to play a significant role in protecting Girl Child from deliberate harm to ensuring her well-being, from conception to adulthood. They as concept formers and advice givers play a major role in correcting the distorted views that parts of society have formed and are passing on to their future generations.

Hence in April, 2012 in line with the urgent need to first create awareness of several concerns relating to girl children in Indian and then address them, Doctors and Management of Lilavati Hospital launched its most ambitious campaign, ”SAVE AND EMPOWER GIRL CHILD”. This initiative was aimed at bringing the treatment of girl child by individuals and society at par with the boy. The event was a great success with dignitaries from the various fields came in to support the noble cause and grace the occasion. Leading Fashion designer Manish Malhotra paid tribute to this cause with his spectacular fashion show.

This year on 5th Feb, Cineyug Group joined hands with Lilavati Hospital to show their solidarity in celebrating the girl child. The event highlighted Lilavati Hospital’s efforts and achievements so far and the plans for the future whereby doctors and management of Lilavati Hospital has taken pledge to conduct free health checkup camps for 50,000 girl children.

At the onset of this year, we have conducted following camps for girl children:

Sr. Date Placeno.

th- th1 24 25 Jan, 2014 Municipal School, Lonavala

nd rd2 22 -23 Feb, 2014 Ashram School, Sanegaon & Pali

th3 26 Feb, 2014 Kamraj High School, Dharavi

th4 28 Feb, 2014 Ganesh Vidyamandir, Dharavi

st5 1 March, 2014 HR School, Dharavi

th6 7 March & Hamara Sapna NGO, Dharavith 19 March, 2014 & Tardeo

th7 10 March, 2014 Divine Touch NGO, Jogeshwari

nd8 22 March, 2014 Raja Shivaji Vidyamandir, Thane

th th9 27 & 28 March, Anjuman School, Kurla2014

th10 10 April, 2014 Indira Gandhi Vidyamandir,Thane

SAVE AND EMPOWER THE GIRL CHILD

Divine Touch NGO, Jogeshwari

Anjuman School, Kurla

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3130

MEDICAL TIMESLILAVATI HOSPITAL

HISTORY OF MODERN MEDICINE

“The greater the ignorance the greater the dogmatism”

“Medicine is a science of uncertainty and an art of probability”

“Variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease”

“It is much more important to know what William Henry Welch sort of a patient has a disease than what sort

(April 8, 1850 - April 30, 1934) of a disease a patient has”

He was an American physician, pathologist, bacteriologist and medical school administrator. He was one of the "Big Four" founding professors at the Johns Hopkins Hospital. He was the first dean of the Johns Hopkins School of Medicine and was also the founder of the Johns Hopkins School of Hygiene and Public Health. In his lifetime he was called the “Dean of American Medicine”.

HONORS

The William H. Welch Medical Library at Johns Hopkins, which opened in 1929, is named for him.

Welch Road, in the vicinity of Stanford University Medical Center in Stanford, California is named in his honor. arguably among the most common and best known surgical instruments ever.

WILLIAM OSLER QUOTES

l

l

l

l

l

l

Father of Modern Medicine

Hospital is an official ESMO (European Society for Medical Oncology) Asia CME Partner Centre in Colorectal Cancer program in India.

Quality Council of India (QCI) has accredited Lilavati Hospital & Research Centre with NABH in February 2011.

In order to ensure that entire system is process

driven and not person / individual driven we

decided to get Lilavati Hospital and Research

Centre, NABH (National Accreditation Board for

Hospitals and Healthcare) accredited.

NABH is need of the hour. It broadly focuses on

Structure, Processes and Outcomes. NABH

accreditation helps in enhancing Patient

Satisfaction, Employee Satisfaction and

Operational Efficiency by: ensuring ownership of

clinical and non-clinical functions at all levels by

suitably qualified and experienced professionals,

ensuring that employees follow laid down policies

and procedures and by monitoring key indicators

for continual improvement.

LATEST FEATHERS IN CAP…

·

·

·

In 2013; ‘THE WEEK’ magazine has rated Hospital as ‘Number 1 Multispeciality Hospital in Mumbai’.

Hospital has been rated amongst ‘Top 10 Hospitals of India’ 2013 by ‘THE WEEK’ magazine.

Hospital is Gold Winner of “Reader’s Digest Trusted Brand Award 2012” in c a t e g o r y ‘ S p e c i a l i t y Hospital’.

Winner in the category “Most Popular Maternity Hospital (All-India)”

ndin the 2 edition of Child Most Popular Awards, 2014, Child India Magazine.

Hospital emerged as the Runner-Up in the category India’s Most Popular Maternity Hospital; in the inaugural edition of Child Best Awards 2013 by Child India Magazine.

Efforts and hard work put in by team Lilavati Hospital has resulted in various awards and accolades:

H o s p i t a l h a s b e e n recognized as “India’s best Multi Speciality Hospital-Megapolis” by ICICI Lombard and CNBC TV 18 in India H e a l t h c a r e a w a r d s 2013.

H o s p i t a l h a s b e e n recognized as “India’s best Multi Speciality Hospi ta l -Metro” by ICICI Lombard and CNBC TV 18 in India Healthcare awards 2012.

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32

SERVICES

MEDICAL SURGICAL

Anesthesiology Bariatric Surgery

Audiology and Speech therapy Cardiothoracic Surgery

Cardiology Colorectal Surgery

Chest Medicine ENT and Head & Neck Surgery

Chronic Pain management Gastro Intestinal Surgery

Dental General Surgery

Dermo Cosmetology Gynecology, Obstetrics & IVF

Diabetology & Endocrinology Transplant: Corneal & Kidney

Gastroenterology Minimal Invasive Surgery (Laproscopic Surgery)

Haematology Neuro Surgery

Hair Transplant Spine Surgery

Internal Medicine Onco Surgery

Infectious diseases Ophthalmology

Nephrology Orthopedics, Sports Medicine

Neurology Pediatric Surgery

Head and Migraine Clinic Plastic & Reconstruction Surgery

Psychiatry / Psychology / Neuropsychology Urology, Andrology

Medicine Oncology Vascular Surgery

Pediatrics DIAGNOSTICSPediatric CardiologyImaging ServicesRheumatologyCTSleep MedicineMRI

LABORATORY SERVICES X-ray

Pathology BMD

Microbiology OPG

Histopathology Sonography (USG)

Blood Bank Mammography

Nuclear Medicine CRITICAL CARE Interventional RadiologyIntensive Care Unit (ICU)

24 HRS SERVICESIntensive Cardiac Unit (ICCU)AmbulanceSurgical Intensive Care Unit (SICU)EmergencyPaediatric Intensive Care Unit (PICU)Pharmacy Neo-Natal Intensive Care Unit (NICU)

Paralysis & Stroke Unit

DOCTORS ASSOCIATED WITH LILAVATI HOSPITAL

Gastro Surgeons

Dr. Bharucha ManojDr. Kulkarni D. R.Dr. Mehta HiteshDr. Varty PareshDr. Wagle Prasad K.Dr. Zaveri Jayesh P.

Gastroenterologists

Dr. Barve Jayant S.Dr. Gupta RaviDr. Kanakia Raju R.Dr. Khanna SanjeevDr. Phadke Aniruddha Y.Dr. Parikh Samir S.Dr. Shah Saumil K.

General Surgeons

Dr. Garud T. V.Dr. Mehta NarendraDr. Shastri Satyanand B.Dr. Shetty Sadanand V.Dr. Trivedi Narendra

Gynaecologist

Dr. Agarwal RekhaDr. Coelho Kiran S.Dr. Dhanu Ranjana V.Dr. Dhanu Vilas R.Dr. Nanavati Murari S.Dr. Pai Rishma D.Dr. Palshetkar NanditaDr. Pai HrishikeshDr. Shah Cherry C.Dr. Goyal Swarna

Haematology Clinical

Dr. Agarwal M. B.Dr. Bhave Abhay

Headache & Migraine Clinic

Dr. Ravishankar K.

Infectious Diseases Consultant

Dr. Nagvekar Vasant C.

Intensivist

Dr. Vas Conrad RuiDr. Ansari AbdulDr. Jiandani Prakash

Dr. Shah ChetanDr. Sharma Anil K.Dr. Suratkal VidyaDr. Vijan SureshDr. Vyas Pradeep R.Dr. Vora AmitDr. Vaishnav SudhirDr. Mehta Haresh G.

Chest Medicine

Dr. Mehta Sanjeev K.Dr. Prabhudesai P. P.Dr. Parkar Jalil D.Dr. Rang Suresh V.Dr. Chhajed Prashant

Colorectal Surgery

Dr. Chulani H. L.

Dentistry / Dental Surgeons

Dr. Bhavsar Jaydeep P.Dr. Deshpande DilipDr. Gala DhimantDr. Joshi P. D.Dr. Khatavkar ArunDr. Kamdar Rajesh J.Dr. Parulkar B. P.Dr. Parulkar Darshan

Department of Imaging

Dr. Bajaj AnitaDr. Deshmukh ManojDr. Kulkarni MakrandDr. Mehta MonaDr. Ingule AmolDr. Chauhan SonalDr. Sobti Shyam K.

Dermatologists

Dr. Goyal NileshDr. Oberai ChetanDr. Mehta NimeshDr. Parasramani S. G.

Diabetologists

Dr. Joshi Shashank R.Dr. Panikar Vijay

ENT Surgeons

Dr. Chaturvedy GauravDr. D’souza Chris E.Dr. Kapadia Sanjay P.Dr. Pusalkar A.Dr. Parasram Kamal S.

Andrologist

Dr. Shah Rupin S.

Anaesthesiologist

Dr. Mascarenhas OswaldDr. Merchant AmiDr. Barot HemanginiDr. Bakshi VaibhaviDr. Budhakar ShashankDr. Gandhi NishaDr. Gaiwal SuchetaDr. Gawankar PrakashDr. Kharwadkar MadhuriDr. Kulkarni Satish K.Dr. Mahajan AnjulaDr. Khatri BhimsenDr. Shah Falguni

Audiology & Speech Therapists

Dr. Bhan SatyanDr. Gorawara PoojaDr. Parulkar BakulDr. Patadia Rajesh

Cardiovascular Surgeons

Dr. Bhattacharya S.Dr. Jaiswal O. H.Dr. Kaushal PandeyDr. Kumar PavanDr. Rachmale G. N.Dr. Nand KumarDr. Mehra Arun P.Dr. Shetty MohanDr. Joshi SureshDr. Honnekeri Sandeep T.

Cardiologists

Dr. Ballani Prakash H.Dr. Bang VijayDr. Dargad Ramesh R.Dr. Gokhale Nitin S.Dr. Hemant KumarDr. Jhala DarshanDr. Kothari Snehal N.Dr. Lokhandwala YashDr. Mehan VivekDr. Mehta Ashwin B.Dr. Merchant S. A.Dr. Menon Ajit R.Dr. Nabar AshishDr. Punjabi Ashok H.Dr. Samuel K. MathewDr. Sanzgiri P. S.

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MEDICAL TIMESLILAVATI HOSPITAL

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DOCTORS ASSOCIATED WITH LILAVATI HOSPITAL

Pain Management

Dr. Baheti DwarkadasDr. Jain Jitendra

Physicians / Internal Medicine

Dr. Ballani A. G.Dr Bandukwala S. M.Dr. Nair C. C.Dr. Dalvi Sunil G.Dr. Jadwani J. P.Dr. Gidwani Vinod N.Dr. Medhekar Tushar P.Dr. Shimpi Shrikant

Plastic Surgeons

Dr. Kumta SamirDr. Pandya NarendraDr. Purohit Shrirang

Psychiatrist

Dr. Deshmukh D. K.Dr. Shah Bharat R.Dr. Vahia Vihang N.

Psychologist

Dr. Chulani Varkha

Physician / Rheumatologist

Dr. Sangha MilanDr. Kalke Shubhada

Physiotherapist

Dr. Garude Heena

Spine Surgeon

Dr. Bhojraj ShekharDr. Mohite Sheetal

Urologists

Dr. Pathak Hemant R.Dr. Raina ShaileshDr. Sanghvi NayanDr. Shah Sharad R.Dr. Vaze Ajit M.Dr. Raja Dilip

Urological Laparoscopic Surgeon

Dr. Ramani Anup

Vascular Surgeons

Dr. Patel PankajDr. Pai Paresh

Orthopaedic Surgeons

Dr. Agrawal VinodDr. Archik ShreedharDr. Chaddha RamDr. D’silva Domnic F.Dr. Desai Sanjay S.Dr. Deshmukh NiranjanDr. Garude SanjayDr. Joshi AnantDr. Kohli AmitDr. Mukhi Shyam R.Dr. Nadkarni DilipDr. Padgaonkar MilindDr. Panjwani Jawahar S.Dr. Vengsarkar Nirad S.Dr. Vatchha Sharookh P.Dr. Warrier SudhirDr. Thakkar C. J.

Pathologists

Dr. Chavan Nitin Dr. Dhunjibhoy Ketayun R.Dr. George Asha MaryDr. Rangwalla FatemaDr. Mehta KashviDr. Saraswat ShubhangiDr. Tampi Chandralekha

Paediatric Surgeons

Dr. Karmarkar Santosh J.Dr. Redkar Rajeev G.Dr. Nathani Rajesh

Paediatricians

Dr. Ali UmaDr. Avasthi BhupendraDr. Chittal RavindraDr. Gupta PriyamDr. Kanakia Swati R.Dr. Lokeshwar M. R.Dr. Mehta KaminiDr. Shah Krishnakumar N.Dr. Sharma ShobhaDr. Ugra Deepak

Paediatric Cardiology

Dr. Changlani Deepak K.

Paediatric Neurology

Dr. Shah K. N.

Interventional Radiologists

Dr. Sheth RahulDr. Warawdekar GireeshDr. Limaye Uday S.

Joint Replacement Surgeons

Dr. Maniar Rajesh N.

Nephrologists

Dr. Mehta Hemant J.Dr. Shah ArunDr. Suratkal L. H.Dr. Upadhyaya Kirti L.

Neurologists

Dr. Chauhan VinayDr. Sirsat Ashok M.Dr. D’souza CherylDr. Dalal P. M.Dr. Vyas Ajay

Neuropsychologist

Dr. Panjwani Siddika

Neuro Surgeons

Dr. Ramani P. S.Dr. Goel AtulDr. Dange NitinDr. Shah Rajan

Nuclear Medicine

Dr. Lele R. D.Dr. Luthra Karuna

Oncologists

Dr. R. GopalDr. Smruti B. K.Dr. Pendharkar Dinesh

Oncosurgeons

Dr. Deshpande Ramakant K.Dr. Chabbra DeepakDr. Jagannath P.Dr. Parikh DeepakDr. Sharma SanjayDr. Shah Rajiv C.

Ophthalmology

Dr. Agrawal VinayDr. D’souza RyanDr. Mehta SalilDr. Nadkarni ShivramDr. Nagvekar Sandip S.Dr. Shah ManishDr. Vaidya Ashish R.Dr. Mehta Himanshu

34

Gift YourLoved Ones“ ”HEALTH

You’ve gifted them with things that adds

happiness to their life. Now, gift them

something that takes care of their health.

To know more kindly contact on

Timings:

log on to www.lilavatihospital.com

+ 91-22-26568242 / 43

9.00am to 5.00pm or

NABH Accredited Healthcare Provider

Page 20: LILAVATI HOSPITAL MEDICAL TIMES · 2020. 1. 24. · Lilavati Hospital Medical Times, Lilavati Hospital & Research Centre, A-791, Bandra Reclamation, Bandra (W), Mumbai - 400 050,

LILAVATI HOSPITAL

For Appointment Call

+91-22-26751536 (OPD - 8.00am to 8.00pm)

Introducesa

new state-of-the-art

PHYSIOTHERAPY DEPARTMENT

Cardiac

Rehabilitation

Lifestyle

ModificationLazer

Therapy

Ozone

Therapy

Sports Medicine

Rehabilitation

&

Fitness TrainingVestibular

RehabilitationGeriatric &

Osteoporosis

Management

Lymph-oedema

Management

Balance Control

& Gait Training

Core Training

& Pilates

Pulmonary

Rehabilitation

Prior Appointment is Compulsory.

For more info contact:2656 8236

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