eMedinewS30th January 2014, Thursday

Dr K K AggarwalPadma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, National Vice President Elect, Indian Medical Association; Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04);
For updates follow at
www.twitter.com/DrKKAggarwal
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Top 5 Pain Interventions to Avoid

In the latest response to the call from the American Board of Internal Medicine (ABIM) Foundation for recommendations on the most overused interventions, the American Society of Anesthesiologists (ASA) has issued its list of top 5 tests and therapies that are of questionable usefulness in the field of pain medicine.

The new list includes the following recommendations for doctors:

  1. Don’t prescribe opioid analgesics as first–line therapy to treat chronic non–cancer pain. Consider multimodal therapy, including nondrug treatments, such as behavioral and physical therapies, before pharmacologic intervention. If drug therapy appears indicated, try nonopioid medication, such as nonsteroidal anti–inflammatory drugs, or anticonvulsants, before starting opioids.
  2. Don’t prescribe opioid analgesics as long–term therapy to treat chronic non–cancer pain until the risks are considered and discussed with the patient. Inform patients of the risks of such treatments, including the potential for addiction. Review and sign a written agreement identifying both your and the patient’s responsibilities (eg, urine drug testing) and the consequences of noncompliance with the agreement. Be cautious in coprescribing opioids and benzodiazepines. Proactively evaluate and treat, if indicated, the nearly universal adverse effects of constipation and low testosterone or estrogen.
  3. Avoid imaging tests, such as MRI, computed tomography, or radiography, for acute low back pain without specific indications. Avoid these interventions for low back pain in the first 6 weeks after pain begins if there are no specific clinical indications (eg, history of cancer with potential metastases, known aortic aneurysm, progressive neurologic deficit). Most low back pain doesn’t require imaging, and performing such tests may reveal incidental findings that divert attention and increase the risk of having unhelpful surgery.
  4. Don’t use intravenous sedation, such as propofol, midazolam, or ultra–short–acting opioid infusions for diagnostic and therapeutic nerve blocks, or joint injections, as a default practice. (This recommendation does not apply to pediatric patients.) Ideally, diagnostic procedures should be performed with local anesthetic alone. Intravenous sedation can be used after evaluation and discussion of risks, including interference with assessing the acute pain–relieving effects of the procedure and the potential for false–positive responses. Follow ASA Standards for Basic Anesthetic Monitoring in cases where moderate or deep sedation is provided or anticipated.
  5. Avoid irreversible interventions for non–cancer pain, such as peripheral chemical neurolytic blocks or peripheral radiofrequency ablation. Such interventions may be costly and carry significant long–term risks of weakness, numbness, or increased pain

Is the Consent Given for a Diagnostic or Therapeutic Procedure or Both?

Diagnostic and therapeutic procedures are different and a separate consent is required for each. In this regard, the Supreme Court of India has observed: "32(iii): Consent given only for a diagnostic procedure, cannot be considered as consent for therapeutic treatment. Consent given for a specific treatment procedure will not be valid for conducting some other treatment procedure. The fact that the unauthorized additional surgery is beneficial to the patient, or that it would save considerable time and expense to the patient, or would relieve the patient from pain and suffering in future, are not grounds of defence in an action in tort for negligence or assault and battery. The only exception to this rule is where the additional procedure though unauthorized, is necessary in order to save the life or preserve the health of the patient and it would be unreasonable to delay such unauthorized procedure until patient regains consciousness and takes a decision. (iv) There can be a common consent for diagnostic and operative procedures where they are contemplated. There can also be a common consent for a particular surgical procedure and an additional or further procedure that may become necessary during the course of surgery."1 The Bolam test has also been applied to the issue of consent. Related to this is the question of miscommunication. A significant proportion of medical accidents are caused by deficiencies in communication as opposed to failure to exercise ordinary skill and competence.

Reference

1. SCI, Civil Appeal No. 1949 of 2004, 16.01.2008, Samira Kohli vs Dr. Prabha Manchanda and Anr, B.N. Agrawal, P.P. Naolekar and R.V. Raveendran, JJ.

Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV Dr K K Aggarwal on Zee TV

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

cpr 10 mantra
VIP’s on CPR 10 Mantra Video
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Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

Spiritual Prescription: You are born with a quota use it judicially

sprritual blog

Everyone is born with a passport with a defined battery life to live up to 100 years after which one has to go back to renewal or recharging of the batteries.

If the battery is overused or misused and is depleted early, one may have to go back prematurely for recharging, but this time when one comes back, he or she may come back with a different body which may not be the human one. There are 64 lac Yonis as described in the Vedic Literature.

According to the Vedic description if one dies prematurely there are chances that the rebirth will not be in the same species.

To live up to the time period defined at the time of birth by the Dharamaraja one has to follow the principles as described in Yogashastra.

The main principle is the principle of moderation and variety. It says that everything has to be used, if not used will get rusted and if over used well get wear and tear. The classical example is that GOD had made uterus in the women for producing a child if the same organ is not used at al it will produce a fibroid and if over used it may end up in a cancer.

When using the principles of moderation and variety when should remember that each one of us is born with a fix quota of everything, a quota of diet, respirations, heart rate and thoughts.

According to swara yoga one is born with pre defined number of respirations to be taken during life. If one consumes them early he will depart for refueling early from the life. To reduce the respiratory rate is therefore the basis of postponing aging and prolonging life. Stimulating para sympathetic nervous system by learning and practicing pranayama, which is slower and deeper breathing, does the same.

One breathes 15 times a minute or 21600 breaths in a day, or 7884000 (78.84 lac) a year or 788400000 (78.84 crores) during life (assuming it to be 100 years). Some yoga books say that a person is born with 33 crore breaths, the same if taken at the rate or 15 per minute would last for 42 years.

Infect Pranayama originated on the concept that the breaths of everyone of us are numbered, that our life–span is dependent on how many times we shall breathe in a given life, and that, as a consequence of this fact, we must reduce the number of breaths so as to live longer.

In Gorakshapaddhati (I.93), it is written that "Due to fear of death even Brahma, the Lord of creation, keeps on practicing pranayama, and so do manyyogisand minis. It is recommended that a student of yoga must always control his breath."

Hathayoga–pradipika (II.39) also writes: ‘All the gods including Lord Brahma became devoted to the practice of pranayama because they were afraid of death. We the mortals should follow the same path and control the breath."

Similarly one is born with a quota of heartbeats. The same is at an average of 70 per minute. Many studies have shown that people who’s resting heart rate is higher have more chances of sudden death. The aim therefore is to keep the heart rate at a lower pace. The same can be achieved either by regular exercise, meditation, AUM Pranayama, or by meditation. People who indulge in marathons or athletic activities, the temporary increase in the heart rate during exercise is compensated by the body by adapting the cardio vascular system in such a way that the basal heart rate reduces. The marathon runners may have a heart rate of only 50 per minute.

The less one eats the more he lives is an Yogic saying, It is said that people who eats once a day are Yogi, twice a day are Bhogi and thrice a day are Rogi. There are enough studies now, which say that 25% reduction in the calories content can increase the life span. Many studies in rodents have also shown the same effect.

The moderation in exercise is to walk 10000 steps a day. No exercise will end up with obesity and over use with osteoarthritis.

Stress is the excess of thoughts in the mind. Controlling the mind forms the basis of meditation. Samadhi is the state of no thoughts. Practicing meditation 20 minutes twice daily helps in the restrain of the mind with resultant state of Turya where the mind has controlled limited positive thoughts.

cardiology news

Benefits of Struggling

A man found a cocoon of a butterfly. One day a small opening appeared, he sat and watched the butterfly for several hours as it struggled to force its body through that little hole.

Then it seemed to stop making any progress. It appeared as if it had gotten as far as it could and it could go no farther. Then the man decided to help the butterfly, so he took a pair of scissors and snipped off the remaining bit of the cocoon. The butterfly then emerged easily.

But it had a swollen body and small, shriveled wings. The man continued to watch the butterfly because he expected that, at any moment, the wings would enlarge and expand to be able to support the body, which would contract in time.

Neither happened!

In fact, the butterfly spent the rest of its life crawling around with a swollen body and shriveled wings.

It never was able to fly.

What the man in his kindness and haste did not understand was that the restricting cocoon and the struggle required for the butterfly to get through the tiny opening were God’s way of forcing fluid from the body of the butterfly into its wings so that it would be ready for flight once it achieved its freedom from the cocoon.

Sometimes struggles are exactly what we need in our life. If God allowed us to go through our life without any obstacles, it would cripple us. We would not be as strong as what we could have been.

And we could never fly.

News Around The Globe

USICON 2014: 29th Basic to Hitech as applied to Urology

USICON 2014: Highlights

India has achieved a considerable success in healthcare. Achievements have been no less but equally unacceptable is the fact that several planned health goals have simply failed to keep pace with the changing times. USICON 2014 is a humble effort in this direction to address the needs and challenges. It is destined to play a pivotal role in Indian healthcare scenario

Here are some reasons to cultivate optimism

USICON 2014 is a platform for urologists from across the globe. It will be attended by over 3000 scientific delegates and this will include over 100 dignitaries representing leading associations

of Urology form US, Europe, Australia and Asia. These dignitaries include Dr. Per Anders Abrahamsson, the Secretary General of European Association of Urology, Dr. Ajay Nehra, the President of International society of men’s Health, Dr. Michael Marberger, the President of Societe Internationale d’ Urologie, Dr. Badlani, President of EndourologySociety and Dr. Winkle, the President of the Urological Society of Australia and New Zealand.

Over 2500 participants are going to interact on newer advances and common problems in urology. The event will comprise of over 80 sessions spread across 4 days covering 10 major sub specialties of Urology. The event will comprise of over 80 sessions spread across 4 days covering 10 major sub specialties of Urology.

More than 1000 urologists in training are also going to participate in the conference. Special courses have been arranged for them by leading teachers to help them update and advance in this field.Over 150 hours of pure academic brainstorming sessions have been planned. Interaction and exchange of experiences on difficult situation and public health with regards to urology are going to take the main–stage. The event will begin with the pre conference live workshop which will feature robotic and laparoscopic surgeries in 3D, a new advance to more precise surgical care transmitted in high definition for delegates to appreciate.

Focus of attraction will be the technological advances like Fusion Biopsy and Photodynamic therapy for focal ablation of prostate cancer, pharmacological advances in terms of

newer molecules that can be disease altering. We have received over 600 research articles from all corners of the country which represent original work at leading institutions. USICON 2014 will also witness the participation of many new members who are active in the field of urology

and allied sciences. Over 100 companies spread over 150 halls will showcase the best of what industry has to support and sustain urology.

Concept Note: USICON 2014 – Changing Face of Indian Urology

Dr Rajeev Sood, Organising Secretary, USICON 2014

The 47th Annual Conference of the Urological Society of India is being held at New Delhi, India from the 29th of January to 2nd February 2014. The conference addresses numerous important issues of national concern like organ donation, urinary and genital cancers (including bladder and prostate cancer) and contemporary Men’s health apart from focussing on other common Urological Ailments and increasing accessibility of Indian patients to Uro–Specialists progressing from basics to Hi–Tech. Extensive scientific program and live skills will be on display as detailed and updated time to time on conference website.

Till now in our National Health Programs we have focussed on Communicable Diseases, Child and Woman Health. Men’s Health remains neglected and is not a focus of any National Program till date. We are largely unaware of the fact that average life span of man is 5 years shorter than woman in India. Cancer, stone disease, suicides, heart diseases, life style diseases grip men 2–4 times more commonly than women. For the first time in the country this issue shall be catered to, on a national scale. Health programs that can be framed for this cause will be brought forward and discussed.

The present scenario of Organ Donation & Transplantation in India is dismal and lacs of patients, in need of organs for survival, are left waiting and ultimately succumb to the disease. On the contrary, we have more than the required number of suitable Donors but a lack of awareness and resources continues to maintain the void. This event will emphasize on the strategies to reduce the gap and will organize an unprecedented Organ Donation Campaign which will feature celebrities from diverse fields and doctors pledging their organs and helping in increasing awareness to this issue of grave concern. Introduction of the Laparoscopic and Robotics have added to the acceptance of the organ donation, extensive training programs and training of trainers (ToT) of which will be emphasized during the event. India needs to emulate countries like Spain in cadaveric Organ Donation Program.

Cancer which grips millions of patients each year is also spreading its tentacles especially in the ageing population of India. It will also be an important highlight of this congress which will be supported by various National and International Organizations. Issues related to prevention, early detection and management should be the focus area of this meeting with global representatives strategising in regards to applied scientific technologies to suit Indian patients.

USICON 2014, to be held after 31 long years in the National Capital i.e. New Delhi, will feature many other causes that concern basic health issues related to urology and this global interaction will be instrumental in bringing a change in the public health perspectives.

The field of urology is a dynamic field and advancing technology is contributing to growth on a daily basis. This overwhelming increase in the options available for optimal patient care often goes unnoticed. There is presently a pressing need to provide awareness regarding newer equipments and drugs available which is another objective of this congress. During USICON 2014 doctors will get access to over 150 medical companies working in the field of urology which will be a unique opportunity to upgrade skills and patient care.

Global organisations related to the field of urology like the European Association of Urology, American Urological Association and other international bodies will be participating actively in USICON 2014. It is thus an important event to highlight and portray our potential and research work in front of the whole world in the field of Urology and allied sciences.

With a population of over 1.3 billion there are only a handful of Urologists to cater to urological problems in India. Usicon2014 is also an opportunity to sensitize and train the potential surgeons with regards to these issues so that patients who do not have access to urologists get the same services through the relatively accessible general Surgeon.

We look forward to your support and active participation as a major partner for the Congress and/or themes for the causes mentioned above and hope that together we will be able to create a better tomorrow.

Urology: From Basics to Hi–tech

Dr Devashishn Kaushal, New Delhi

Dear Friends,

As we all gather for a weekful of urological summit in the form of 47th annual conference of Urologic society of India, it gives me immense pleasure to be able to communicate with you through this note. USICON is being organized in the national capital after a long gap of 31 years and it has given us the opportunity to be a part of most advanced scientific, social and surgical extravaganza.

The conference and associated workshop brings to you a powerpacked academic programme along with dedicated themes towards benefit reaching to the civil society at large. Urology as a science has evolved from ancient descriptions of butchers and barbers to the advanced biotechnology, robotics and proteomics. It is perhaps one surgical speciality which has been most impregnated with the advances of technology with proven clinical benefits on most fronts. Various forms of lasers and electrosurgical units are now available, starting with usage in benign prostate enlargement to the present day usage for stones, malignancy suiting to the needs of individual cases.

Endoscopic surgery has become even more equipment intensive with smaller calibre and flexible instruments t o c a t e r t o t h e increasing demand and benefits of minimally invasive surgery. No corner of the urinary tract is left unapproachable to the videscopic approach. 3D laparoscopy and robotics are now gathering momentum in other surgical fields riding only on their success in the field of urology over the last decade.

Dr Gagan Gautam: Gurgaon

Due to the combination of a large case mix of complex medical conditions and the inherent ability to get comfortable with modern technology, the Indian surgeon may be in a unique position to provide international leadership in certain disciplines of robotic surgery in the times to come.

Basic to Hi Tech: Organizing Committee

Dear Friends

As we all gather for a week of urological summit in the form of 47th Annual Conference of Urologic Society of India, it gives me immense pleasure to be able to communicate with you through this note. USICON is being organized in the national capital after a long gap of 31 years and it has given us the opportunity to be a part of most advanced scientific, social and surgical extravaganza. The conference and associated workshop brings to you a power-packed academic programme along with dedicated themes towards benefit reaching to the civil society at large. The first day theme of ‘Urology: From Basics to Hi–Tech’ is perfectly apt in modern urology practice. Going with this theme, the present conference has also imbibed advanced internet and media through a lively and very active internet site along with a first of its kind internet app allowing for a seamless and live virtuoso experience of the conference interconnected on with all other social media to suit individual tastes and preferences. It provides all information necessary and of help to the delegates to assist them in best optimization of their own conference experience.

Urology as a science has evolved from ancient descriptions of butchers and barbers to the advanced biotechnology, robotics and proteomics. It is perhaps one surgical speciality which has been most impregnated with the advances of technology with proven clinical benefits on most fronts. Various

forms of lasers and electrosurgical units are now available, starting with usage in benign prostate enlargement to the present day usage for stones, malignancy suiting to the needs of individual cases. Endoscopic surgery has become even more equipment intensive with smaller calibre and flexible instruments to cater to the increasing demand and benefits of minimally invasive surgery. No corner of the urinary tract is left unapproachable to the videscopic approach. 3D laparoscopy and robotics are now gathering momentum in other surgical fields riding only on their success in the field of urology over the last decade. The pre-conference surgical workshop showcases the latest advances spanning over a large spectrum of urological diseases, and provides an opportunity to all to discuss benefits and problems of these advanced surgeries.

The occasion provides a chance for interaction with the experts in the field and watching them live while performing these surgeries. The goal shall be to further improve or fine-tune the skills of the urologists which need constant upgradation in the present day world and also to be able to create awareness about them among the general public for the improved health care of the masses as such

USICON 2014: A Step Ahead

Dr Raman Tanwar Web and IT Coordinator USICON 2014

Efforts have been made to bring technology a step closer to Uro-practitioners through the mobile application, which will be another unique feature of USICON 2014. The mobile application is intended to assimilate academics, interaction, information, tourism, business and latest advances- all rolled into one. It has over 20 features which will help delegates to organize themselves and make the maximum out of USICON. These applications will allow the delegates to see the complete program organized neatly by day, location and sub specialty. One can add various activities going on during the conference to his ‘to do list’. A simplified and unified search comes handy when sessions and events have to be filtered based on specialty, field of interest and name of speakers and chairpersons.

The complex layout of the venue has been simplified using the inbuilt maps which help delegates find their way in time. It is easy to personalize the application by using your social media profile to log in. Once authenticated the delegate can exchange virtual business cards with other delegates and contact them at the preferred contact using email, social media or voice number.

A rich collection of abstracts is available offline within the app, which are searchable and represent the latest and leading research projects going on in the country. The conference also features a unique delegate tracking system using Radio frequency tags. The unique ID tag will also serve as a USI membership card which will simplify attending future conferences. Large numbers of e–posters will be linked to the mobile application and web portal for viewing even after the conference.

Ultra–mini percutaneous nephrolithotomy

Ultra–mini percutaneous nephrolithotomy (UMP) is a very safe and effective method of removing renal calculi up to 20mm. The use of consumables and disposables is minimal and the patient recovery was fast. Further clinical studies and direct comparison with other available techniques are required to define the place of UMP in the treatment of low–bulk and medium–bulk renal urolithiasis. It may be particularly useful for lower calyx calculi and pediatric cases. Desai J, Zeng G, Zhao Z, et al. A novel technique of ultra–mini–percutaneous nephrolithotomy: introduction and an initial experience for treatment of upper urinary calculi less than 2 cm. Biomed Res Int. 2013;2013:490793.

MRI fusion prostate biopsy

A 12–core systematic biopsy that incorporates apical and far–lateral cores in the template distribution allows maximal cancer detection, avoidance of a repeat biopsy while minimizing the detection of insignificant prostate cancers. MRI–guided prostate biopsy has an evolving role in both initial and repeat prostate biopsy strategies, as well as active surveillance, potentially improving sampling efficiency, increasing the detection of clinically significant cancers, and reducing the detection of insignificant cancers. Bjurlin MA, Taneja SS. Standards for prostate biopsy. Curr Opin Urol. 2014 Jan 20. Epub ahead of print

mini–PCNL

Minimally invasive percutaneous nephrolithotomy (mini–PCNL) technique, which uses ureteroscope and pneumatic intracorporeal lithotripsy, is a effective treatment for pediatric kidney stones refractory to extracorporeal shock wave lithotripsy, including stones induced by melamine–contaminated milk powder. It is a safe and feasible modality for treating renal calculi in preschool age children. Yan X, Al–Hayek S, Gan W, et al. Minimally invasive percutaneous nephrolithotomy in preschool age children with kidney calculi (including stones induced by melamine–contaminated milk powder). Pediatr Surg Int. 2012 Oct;28(10):1021–4.
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Minimally invasive approach changed the face of surgery in last century, apart from advancements in anaesthesia and antibiotics. Urology has always been at forefront of minimally invasive surgery advances, starting with endourology, through etroperitoneoscopy and laparoscopy, and now modern day robotic surgery. I salute the pioneers.

–Dr Rajesh K Ahlawat, Chairman, Division of Urology & Renal Transplant, Medanta, The Medicity
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Keeping pace with the medical advances, the use of technology in Urology has expanded exponentially during the last two decades. ‘Robotic surgery’, ‘Lasers’, Molecular markers, ‘Genomics and Targeted Therapy for Cancer’ are just a few examples."

– Dr Rajiv Yadav, Sr. Consultant, Uro–Oncology & Robotic Surgery Medanta–The Medicity, Gurgaon
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In India there is a need to promote deceased organ donation as donation from living persons cannot take care of the organ requirement of the country. Moreover there is also an element of commercial transaction associated with live organ donation which is not permitted under the Law."
– Dr Anup Kumar, HOD, Dept. of Urology and Renal Transplant, Vardhman Mahaveer Medical College & Safdarjang Hospital, New Delhi
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The ever widening gap in supply and demand for organs can potentially be met by voluntary cadaver organ donation. Hence education of the population on brain stem death and organ donation is paramount. Doctors too need to be counselled to recognise patients in ICU s of brainstem death.”
– Dr Aditya Pradhan, Sr. Consultant, Dept of Urology & Renal Transplantation, BLK Super Speciality Hospital, New Delhi

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Penile prosthesis surgery

Indications

  • Failure or rejection of first– and second–line therapy of erectile dysfunction
  • Peyronie disease with severe erectile deformity
  • Irreversible organic cause of ED
  • Penile fibrosis
  • Post priapism, not responding to nonsurgical treatments
  • Phalloplasty, following penile penectomy or gender change
  • Psychological impotence, after failures of all other treatment

Relative contraindications

  • Spinal cord injury (due to increased risk of infection and erosion)
  • Diabetes mellitus (due to increased risk of infection)
  • Genital sores and dermatitis

Complications

  • Mechanical failure
  • Infection
  • Erosion
  • Others, e.g., inadequate cylinder length, pump⁄reservoir kink and change in position, and autoinflation

Al-Enezi A, et al. Three–piece inflatable penile prosthesis: surgical techniques and pitfalls. J Surg Tech Case Rep 2011;3(2):76–83.

DELEGATE SPEAK

I am here to present a Poster in USICON 2014 and to learn From Eminent Facilities. Dr Shajidhl Mazumder, Guwahati
It is an academic conglomeration where you get to know the latest technique, the approach to management, get to meet the stalwarts of urology. Dr. Somor Jyoti Bora, Guwahati

USICON provides ample opportunity to keep abreast of the latest developments in the field of urology. In keeping with tradition, the pre conference workshops are a wholesome learning experience. Dr. Hrishikesh Bordoloi, Guwahati

My aim to attend USICON is to learn new techniques. I am also look for new products. Dr. Prashant Mulawkar, Akola, Maharashtra I am here to know the latest innovations in Urology Dr. Mandeep Phukan, Guwahati

Excellent CME… It is an opportunity to see the works of excellent Urologists from India & Abroad. Dr. Abhay Shah, Akola, Maharashtra

Dr. David Kimani, Nairobi, Kenya

  • There is still a role for perineal prostatectomy in this era.
  • Diode laser is greatly versatile; it can vaporize and enucleate at the same time. The question of operative time and length of surgery is worrying.
  • Lymphadenopathy at robotic prostatectomy is pretty neat – question on whether to do posterior dissection first or later.
  • 3–piece penile prosthesis for erectile dysfunction offers hope for select ED patients.

Penile prosthesis insertion – Highlights: Mahmood Hai

  • In patients with erectile dysfunction, penile prosthesis implantation offers the highest satisfaction rates among all treatment options, including pharmacologic therapy. They allow men to have effective, reliable, cosmetically acceptable erections, as well as an acceptable appearance when flaccid.
  • Cosmesis and function are the factors that determine the type of prosthesis to be used in most cases. As a rule, men prefer the capability of inflatable prostheses to mimic the normal penis, both for its usual state of flaccidity, and for its ability to become rigid for sexual activity.
  • Older men, in contrast, especially those with limited mental or manual dexterity, may prefer a semi–rigid rod, as they may find it difficult to manipulate the pump and deflation mechanisms of the inflatable devices.
  • Penile implant infection is the most serious complication of penile implants, and most often requires complete removal of the device and intravenous antibiotic therapy. In selected patients, penile implant salvage can be considered.

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Lap Nephroureterectomy: How to keep Oncological principle intact?: NI Bhuiyan, Asstt. Professor, Dept. of Urology, Bangladesh Medical College Hospital, Dhaka, Bangladesh

Introduction: Nephroureterectomy with cuff of urinary bladder is the treatment for upper tract Transitional cell carcinoma. To maintain oncological principle it is important to close lower ureter first. There are so many methods of closing the lower ureter. Among those methods Pneumovesicum approach have superiority to close lower ureter for keeping oncological principle intact. Here we reported initial experiences of Pneumovesicum approach to en-bloc laparoscopic nephroureterectomy with bladder cuff excision for upper tract urothelial in comparison to other method.

Method: From January 2010 to July 2012, 7 patients with upper tract urothelial cancer were underwent Pneumovesicum approach for Laparoscopic Nephroureterectomy with bladder cuff. 7 patients were underwent incision around the ureteric orifice by Collins knife. For Pneumovesicum approach Laparoscopic ports were inserted into the bladder via a suprapubic route, and carbon dioxide Pneumovesicum was induced. First ureteric orifice of dissection site closed by vicryl running suture then Laparoscopic dissection of the lower ureter and excision of the bladder cuff were performed. The bladder defect was closed by laparoscopic suturing, and standard Laparoscopic Nephroureterectomy was followed. Those cases where periureteric bladder cup dissected by Collins knife lower ureter pushed outside bladder then conventional laparoscopic Nephroureterectomy performed after clipping lower ureter.

Results: Age range was 50–75 years. Among the 14 patients 8 had renal pelvic tumor, 4 had upper ureter tumor, 2 had midureter tumor. 10 patients had T1 and 4 patients had T2 diseases. All of the patients had Grade II (GII) diseases. Average operation time was 180 minutes. Average hospital stay was 3 days. Analgesic requirement was single dose of inj. Pethedine as per body weight. One patient develop urinary bladder Tumor in follow up period among those lower ureter dissected by Collins knife. No significant per operative and post operative complication were observed.

Conclusion: Pneumovesicum approach for Laparoscopic Nephroureterectomy with bladder cuff is safe and effective. Pneumovesicum approach strictly maintains the oncological principle. Hospital stay and return to normal activity is faster than open procedure. Studies of large number of cases in different institutes are required for further comment.

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Welcome Message: Prof (Dr) Rajiv Sood, Organizing Secretary, USICON 2014
I welcome you all to Delhi, the national & culture capital for the 47th Annual Conference of the Urological Society of India from 30th January to 2nd February, 2014. Delhi is hosting this event after 31long years.

The USI is directly organizing USICON 2014 in coordination with the Delhi Urological Society, for the very first time, through USI headquarters at New Delhi.

I am sure that you all had an enriching day at the state of art pre–conference workshop with legends in the field coming from all over the globe to demonstrate their skills and interacting face to face and via satellite with the delegates.

We have also organized an extensive scientific program that addresses several topics of significance to urology.

In our endeavor to make this trip to Delhi, a city with rich historical & cultural heritage a memorable experience for you and your family, we have planned tours to explore the 7 ancient cities of Delhi and the modern Lutyen’s Delhi.

And, of course, Delhi known for its warm hospitality will display India’s exquisite, lip smacking culinary skills to suit all tastes.

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President Message
Prof. (Dr) R M Meyyaappan
President 2013–14, Urological Society of India

Dear Members

On behalf of Urological Society of India and organizing committee, I extend a warm welcome to the esteemed members of our society. We have worked hard to rope in the best National and International faculty for the conference. As our conferences are forever improving in content and quality, I am sure that USICON–2014 would not fail to deliver us a rich and up to date scientific program. I hope it would greatly benefit our residents as well as consultants. The scientific session and trade exhibition will give an opportunity to update our knowledge with the advancing technology.

Delhi was the erstwhile Mughal capital and is the present capital of India. Hence, to experience Delhi is to soak in the glory of the past interlaced with the fire of the present and the hope of the future. This is well evident from the architectural marvels of the Mughals mingling seamlessly with ultramodern shopping malls and high rise buildings. So, the conference would surely be an experience of a lifetime for all delegates and their families.

I am confident that the local organizing committee, Delhi Urological Society headed by Dr P N Dogra–Organizing Chairman, Dr Rajeev Sood–Organizing Secretary and members with their collective efforts will make your visit and stay at New Delhi a memorable one.

Welcome to New Delhi, USICON–2014.

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High power Holmium laser: A Revolution in Urology: Dr Anil Varshney

Dr Anil Varshney is Director Urology, Max Hospital, Pitampura, New Delhi. He has operated and supervised treatment for more than 45,000 patients including 17,500 ureterorenoscopies, 14,500 PCNLs and 4,500 laser prostatectomies. Dr. Varshney has done more than 100 workshops in India & abroad. His efforts in establishing Holmium Laser Enucleation of Prostate as the procedure of choice for managing BPH in India & abroad are praise worthy. He has chaired many scientific sessions on lasers, endourology and lithotripsy at USICON and its various zonal chapters. He has published and presented several papers in various national and international conferences and journals.
 

1. How has High Power Holmium Laser changed the practice of Urology?

High Power Holmium Laser has revolutionized the practice of urology in the last three decades. Earlier, open surgery was the dictum. ECSW lithotripsy was the first major advance, and then from ’96 onwards, the lasers came into picture. The introduction of holmium laser was a major boon to the armamentarium of the urologist. It has proved to be the most multifunctional urological tool for treating a wide range of conditions from all kinds of stones, prostate, tumors to strictures. With increasing number of patients with large prostates, patients on anticoagulants and patients demanding minimally invasive treatment, the need for this laser is on a rise. This laser has revolutionized the BPH and stone disease treatment.

2. What are the applications of High Power Holmium Laser in urology?

High Power Holmium Laser is a gold standard treatment for a host of diseases from the kidney to the ureter to the urethra. Holmium

Laser has a specific role in enucleation of prostate. The largest I have done is a prostate weighing 539 gm. Holmium Laser is the endoscopic equivalent of open surgery. There is complete enucleation without blood loss. No blood transfusion is required; there is no cut. You can discharge your patient in 1-2 days.

It can also treat all kinds of stones. It can be combined with RIRS in complex kidney stones. It is flexible and can reach any part of the kidney. Soft tissue diseases also can be treated with Holmium Laser. These include tumors of the bladder, kidney and ureter, urethral and ureteral strictures, diverticulum and PUJ obstruction.

It is also used in interstitial cystitis, a very stubborn disease. You can fulgurate the ulcers with High Power Holmium Laser. Hence, this laser will only strengthen the armamentarium of the urologist as it is a one laser, which has multiple applications.

3. How does the high power Holmium laser compare with other laser systems?

The Lumenis 100 Watt Holmium laser offers more than 200 combinations of different laser settings. Different permutations and combinations of energy and repetition rate are thus possible and you can choose the energy and the frequency according to your choice. The unique power settings allows for a high frequency of 50Hz, which in combination with high pulse energy pulverizes the hardest of calculi into small fragments It plays a versatile role in treating all kinds of stones. 4 generator laser engines is another USP of the system which is not available with any other laser. Also this laser is time tested. All over the world this technology has been used for more than 15 years. Lumenis 100 Watt Holmium Laser is undoubtedly the most precise and efficient tool in urology practice.

4. How do you envisage the future of high power Holmium laser as a technology in Urology?

High Power Holmium laser has a huge potential to replace all other lasers. There are more than 240 Holmium Laser installations in India. There is lot of demand for this laser worldwide. This technique has stood the test of time and is here to stay.

CPR 10 success stories

1. Hands–only CPR 10 English

2. Hands–only CPR 10 (Hindi)

3. Ms Geetanjali, SD Public School Successful Story

4. Success story Ms Sudha Malik

5. BVN School girl Harshita does successful hands–only CPR 10

6. Elderly man saved by Anuja

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Rabies News (Dr. A K Gupta)

Is washing of animal bite wound(s) essential?

The risk of rabies reduces by about 50% by just washing of wounds and application of antiseptics.

The maximum benefit of the wound washing is obtained when the fresh wound is cleaned immediately. It is important to remove saliva containing rabies virus at the site of bite by physical or chemical means. This can be done by prompt and gentle thorough washing with ordinary soap or detergent and flushing the wound with running tap water for at least 15 minutes.

Washing of the wound must be done as long as the wound is raw; irrespective of the time elapsed since the exposure. Care must be taken not to disturb the scab, if formed.

After washing with water and soap, disinfectants like Povidone Iodine or Surgical Spirit must be applied.

In extraneous circumstances, other alcoholic (>40%) preparations like Rum, Whisky or aftershave lotion may be applied on the wound. If soap or antiviral agent is not available, the wound should be thoroughly washed with water.

cardiology news

Neck Artery Wall Thickness and Plaque Area – a new test to diagnose early heart diseases

Treadmill, stress echocardiography, Thallium and Angiography do not detect early blockages. Treadmill can miss blockages up to 70%; stress echocardiography up to 60%, angiography upto 40%.

Most heart attacks occur because of a plaque rupture in patients with blockages of less than 50%. If the blockage is more than 70% the patient usually presents with heart pain and not massive heart attack.

The only way to detect heart blockages before they cause symptoms or are detected in conventional tests is to measure the wall thickness of the neck artery or the leg artery. Normally, the wall thickness is less than 0.5mm. If the wall thickness is more than 0.75mm, it is suggestive of underlying heart blockages and if it is more than 1mm, it is suggestive of blockages in all three arteries of the heart.

Any thickness of more than 1mm is called as a plaque and a plaque area calculated by high resolution ultrasound is a new marker for heart blockages, progression as well as regression.

If the artery wall is thick in both the neck artery and the leg artery, it is very likely that the patient will also have blockages in the arteries of the heart.

All high risk individuals, therefore, should have their neck and leg artery wall thickness checkup done. Only 2% of patients with blockages in all three arteries of the heart have a neck artery wall thickness of less than 1mm and 94% of patients with a neck artery wall thickness of more than 1.15mm will have multiple blockages in the heart.

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Total CPR since 1st November 2012 – 84500 trained

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press release

Promotion of hygiene as important as deworming tablet

It is just not enough to give children deworming tablets to reduce worm infestations, it is also important to improve hygiene and sanitation, says a study published in the February 2013 issue of the journal PLoS Neglected Tropical Diseases

Elaborating on this, Padma Shri & Dr. B C Roy National Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Senior National Vice President, Indian Medical Association said that deworming agents can easily treat intestinal worms, reinfection is common because of lack of adequate hygiene and sanitation to control re–exposure. Also, at times, the human body may not be capable of developing a protective response against re–infection by the intestinal worms. According to the study, if infection persists, deworming agents should be given to children every year till hygiene and sanitation are improved so that re–infection does not occur.

The common intestinal worms are roundworms and hookworms. These are transmitted via contaminated soil. Worm infestations impair the physical growth of children and affect their mental development. They also cause anemia, diarrhea and pain in abdomen.

All the common worm infections in school–age children can be treated effectively with deworming agents such as albendazole, mebendazole, which can be given as a single tablet to all children.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National Commemorative stamps and one cancellation stamp, and who has conducted one to one training on" Hands only CPR" of 84500 people since 1st November 2012.

The CPR 10 Mantra is – "Within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

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1000 school children at Guru Harkrishan Public School, Hargovind Enclave in cardiac first aid

press release

Monitoring LFT in a patient on statins

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today video of the day20th MTNL Perfect Health Mela Press Conference with Marwadi Yuva Manch, Faridabad

20th MTNL Perfect Health Mela Press Conference at Marwah Studio, Noida

Cultural Evening at IMA

eMedi Quiz

Which one of the following conditions may lead to exudative pleural effusion

1. Cirrhosis.
2. Nephrotic syndrome.
3. Congestive heart failure.
4. Bronchogenic carcinoma.

Yesterday’s Mind Teaser: An anxius mother brought her 4 year old daughter to the pediatrician. The girl was passing loose bulky stools for the past 20 days. This was often associated with pain in abdomen. The pediatrician ordered the stool examination which showed the following organisms. Identify the organism:

1. Entamoeba histolytica
2. Giardia lamblia
3. Cryptosporidium
4. E. Coli

Answer for yesterday’s Mind Teaser: 2. Giardia lamblia

Correct answers received from: Dr AK Gajjar, Dr Ajay Gandhi, Raju Kuppusamy, Dr PC Das, Anil Bairaria, Dr KV Sarma, Dr Jainendra Upadhyay, Dr Chandresh Jardosh, Sangeetha Raja, Dr Jella, Dr Avtar Krishan, Dr B K Agarwal.

Answer for 27th January Mind Teaser:3. Atherosclerosis.

Correct answers received from: Dr Jella, Dr Avtar Krishan, Dr B K Agarwal.

Send your answer to ijcp12@gmail.com

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medicolegal update

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Boss

A man entered a pet shop, wanting to buy a parrot. The shop owner pointed out three identical parrots on a perch and said, "The parrot to the left costs 500 dollars."

"Why does that parrot cost so much?" the man wondered.

The owner replied, "Well, it knows how to use a computer."

The man asked about the next parrot on the perch.

"That one costs 1,000 dollars because it can do everything the other parrot can do, plus it knows how to use the UNIX operating system." Naturally, the startled customer asked about the third parrot.

"That one costs 2,000 dollars."

"And what does that one do?" the man asked.

The owner replied, "To be honest, I’ve never seen him do a thing, but the other two call him boss!"

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medicolegal update

Situation:: A patient with hiatus hernia developed severe symptoms after eating a ‘Paan’
Reaction: Oh my God! Why was he given a peppermint?
Lesson: Make sure sure patients with reflex esophagitis are not given any food which can relax GI sphincter.

medicolegal update

Selfishness is not living as one wishes to live, it is asking others to live as one wishes to live- Oscar Wilde

medicolegal update

Dr KK Aggarwal: Stable CAD and type 2 diabetes.............Among patients with stable CAD and type 2 diabetes.... http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: There is a fine line between a dedicated employee & a workaholic. Where does one end & the other begins?http://bit.ly/15QdVeB #Health

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