THE EXCHANGE | Newsletter December 2020
- 30 Dec 2020
- #Medanta Monthly Newsletter
Medanta Welcomes Leading Robotic Thoracic Surgeon,
Dr Arvind Kumar
Furthering its vision of delivering world-class, holistic healthcare, Medanta has appointed renowned Robotic Thoracic Surgeon, Dr. Arvind Kumar as Chairman, Institute of Chest Surgery, Chest Onco-Surgery and Lung Transplantation. He will also co-chair Medanta’s Robotic Institute. Dr Arvind Kumar along with his team of four consultant chest surgeons will help strengthen Medanta’s cohort driven approach of providing end-to-end diagnosis and treatment for thoracic diseases such as lung cancer, thymomas, pulmonary tuberculosis, empyema, chest wall deformity and chest trauma among others.
Dr Arvind Kumar pioneered Robotic Chest Surgery in India in 2008, when he was a Professor of Surgery and Head of Thoracic and Robotic Surgery Unit at the All India Institute of Medical Sciences (AIIMS). A keen academician and researcher, Dr. Arvind completed his MBBS and Masters in Surgery (M.S.) from AIIMS, New Delhi and served there as a faculty member for 24 years. An expert in key-hole thoracic and robotic chest surgeries, the leading surgeon, driven by the motto, “If you have a Chest Problem, we have a Solution”, has successfully conducted over 10,000 thoracic surgeries.
Prior to joining Medanta, Dr Arvind was the Chairman of the Centre for Chest Surgery and Lung Transplantation and Director of the Institute of Robotic Surgery at Sir Ganga Ram Hospital, New Delhi for eight years.
A recipient of the prestigious Dr B.C. Roy Award, Dr Arvind is globally renowned for his vast experience and exceptional success rate in surgeries for cancer of lung, thymus, food pipe and windpipe.
With the appointment of a senior doctor like Dr Arvind Kumar and his team, the focus is to further strengthen our capability and infrastructure to provide holistic treatment of chest disorders of international standards.
Dr Naresh Trehan
Multi-disciplinary Team Treats RareEndocrinology Disorder
Cushing’s disease is a rare endocrine disorder with an incidence of 10-15 people per million each year, most commonly affecting adults between 20-50 years of age. Women account for 70% of these cases. Most patients with Cushing’s disease have small functioning pituitary microadenoma which usually is a challenging diagnosis often causing a diagnostic delay and treatment failure due to difficult surgery.
Case Report An 18-year-old girl presented to the Department of Endocrinology with a history of weight gain, hirsutism and acne for one year. The patient was diagnosed to have adrenocorticotropic hormone (ACTH) dependent Cushing Syndrome. In order to localize the disease, MRI pituitary was done, as 80% of the cases are due to pituitary microadenoma. The MRI showed a small pituitary adenoma 2.7x3.7mm on the right side. Since the lesion was smaller than 6 mm, the possibility of an incidentaloma can not be ruled out. Hence, a CT scan of chest and abdomen was done which showed no abnormality, ruling out ectopic ACTH tumor.
Transvenous catheterisation and venography of bilateral inferior petrosal sinuses with a 2.5 French microcatheter (right) and a 2.7 French microcatheter (left). Arrows point to the tip of the catheters.
Despite finding an adenoma in pituitary and ruling out any chest or abdomen lesion, the gold standard test is to demonstrate excess ACTH production from the tumor by Bilateral inferior petrosal sinus sampling (BIPSS). The patient was referred to the Department of Interventional Radiology for BIPSS. A technically demanding procedure, BIPSS is done only in a few hospitals in the country. The procedure is usually done with CRH stimulation with pre and post stimulation timed sampling. As CRH is not available in India, it was done under vasopressin stimulation. The procedure requires a team of six doctors working in a very co-ordinated manner to take simultaneous samples from both inferior petrosal sinus and IVC, with precise collection in pre-chilled EDTA tubes, with proper timing, labelling and quick transportation to the Biochemistry department for processing, as the ACTH sample is very labile.
Proper interpretation of results helped the treating team localize the lesion to the pituitary but lateralization was inconclusive. A repeat MRI was done which showed a 20-30% increase in size of the lesion over six months (delayed due to COVID pandemic) with central location, which most likely causednon-lateralization with BIPPS.
Upon confirmed diagnosis of Cushing’s disease with pituitary microadenoma, the patient was referred to a Neurosurgeon with immense experience in endoscopic pituitary surgeries. She underwent Transnasal transsphenoidal endoscopic pituitary surgery, with post procedure serum cortisol and serum ACTH levels showing desired decline suggestive of biochemical remission.
Three months post-op, the patient is symptomatically better and continues to be in remission.
This case reveals to us the significance of multi-disciplinary team work required to diagnose and manage difficult and rare endocrinology cases.
Medanta and Moolchand Collaborate to Launch Medanta Moolchand Heart Centre
In order to improve access to world-class cardiac care in South Delhi, Medanta and Moolchand have collaborated to launch Medanta-Moolchand Heart Centre, a super-speciality Cardic Care Institute at Moolchand Medcity, South Delhi. The centre offers comprehensive, best-in-class expertise in cardiac care including emergency cardiac services.
The Medanta Heart Institute in Gurugram housessub-specialities of Cardiac Surgery, Electrophysiology & Pacing, Clinical & Preventive Cardiology and Interventional Cardiology, led by an integrated team of medical experts. These super-specialists will now additionally provide specialised services to a larger number of patients in South Delhi, ensuring holistic cardiac care.
Dr. Naresh Trehan, Chairman and Managing Director, Medanta said, “We have been committed to delivering world-class affordable healthcare in India. The Medanta-Moolchand Heart Centre allows easier access to the highest end of cardiac care to patients in South Delhi. We have always taken immense pride in our expertise in the field of cardiac sciences, and we are happy to collaborate with Moolchand Hospital with its long history of serving patients in South Delhi.”
Healthcare Delivered at the Doorstep
Catering to medical needs of citizens in a safe and protected environment within their close vicinity,Medanta is launching eClinic cum Nursing stations in RWAs in Gurugram. These facilities will address medical needs of residents by connecting them with Medanta’s super specialist doctors through remote consultation.
“Even though people are adapting themselves to the new normal amidst the COVID-19 pandemic, the fear to step out of their homes still remains. The eClinic will provide specialised medical care to RWA residents within the comfort of their premises so that safety concerns do not come in the way of seeking medical treatment,’’ says Dr. Naresh Trehan.
The eClinic will provide the members of the society with trained medical staff, support for medical emergency and virtual consultations.
Three such eClinics have been set up at M3M GolfEstate - Sector 65, Orchid Petals - Sector-49 and Park View City-1, Sector-48, Gurugram.
Medanta is in discussion with other RWAs to providesimillar services.