It’s time for minimum-invasive surgery
Dr B. S. Aggarwal

Minimum-invasive surgery (MIS) is fast emerging as the winner as compared to invasive surgery. The world over, surgeons are developing minimum-invasive techniques for the benefit of patients. The invasive surgery means more of bone and tissue cutting during an operation while the minimum-invasive surgery means minimum bone cutting and tissue damage by using micro-endoscopic techniques and other procedures.

Neuro and orthopaedic surgeons are switching on to this new endoscopic technique for the removal of most common lumber or cervical discs. The main advantages of this micro-endoscopic technique are:

1) Patient satisfaction

2) Two days to one week of hospitalisation

3) A small linear scar on the back (2 inches)

4) Lesser tissue damage and bone cutting

5) Accurate and minimum number of complications

6) Faster healing, recovery and back to work

7) No superficial bone deficit, and the spine maintains full strength

Dr Jean Destandau, the French Neuro-surgeon from Bordeaux, developed this micro-endoscopic approach to the spine using a mobile endospine operating tube in the early 90s. The mobile endospine, with fine instrumentation and HD Image-1 Camera, gives the surgeon liberty to operate at two adjacent levels of herniated discs at the same time. The technique offers a 45 minute surgery if one disc is involved. Everything is possible through this endoscope with light source, bone and tissue nibbling, irrigation and suction, cauterisation in the case of bleeding besides removing the affected disc. The lumber canal stenosis (narrowing) requires removal of excess bone and tissue to release and decompress the trapped nerves and the spinal cord. This is also possible through the endospine insert.

The live surgery by Dr Jean Destandau, relayed through a satellite link from Bordeaux, France, was an audio-visual academic feast for the delegates participating in an first international symposium held on December 7, 2007, at Chandigarh. The surgery was performed for the difficult lumber spinal canal stenosis.

Lumber canal disc herniation or prolapsed disc and lumber canal stenosis occur very frequently because of sedentary lifestyle and adopting bad postures at rest or at work. The cervical spine also suffers because of bad sleeping postures and lack of exercise for the neck and back muscles. Sometimes sudden injury or lifting of weights suddenly without warm up also contributes to lumber disc disease.

When all the conservative modules of treatment for lumber disc disease are exhausted only then surgery is advisable. It is unnecessary to delay surgery if the diagnosis is made using the MRI and there is a severe herniation of the disc or lumber stenosis which cannot be treated by conservative methods. The current disc surgery by the Laminectomy approach is termed invasive as there is a lot of bone sacrifice and it is done under direct vision while the surgery performed by micro-endoscope scores over the open method as it is less invasive and the high-definition camera captures magnified images with a resolution of 1920x1080. (16:9 formats for input and output enlarges the field of vision)

This has been made possible by improving the imaging system six times more than the standard definition format. The endoscopic image system has been provided by world famous German company Karl Storz.

The minimum invasive surgery facility is available in some of the hospitals in and around Chandigarh. The cost of simple disc surgery by MIS varies from Rs.30,000 to Rs.50,000, but it may come down as more and more centres open up.

The technique pioneered by Dr. Jean Destandau gives more patient satisfaction, helps in accurate performance and is less invasive to the human body. It is more beneficial to the patient as it allows early movements and reduces the loss of working days.

The writer, a senior orthopaedic surgeon based in Chandigarh, was earlier associated with the PGI and the NHS, Liverpool, UK.

eYESIGHT
Now i-Lasik for vision correction
Dr Mahipal Sachdev

For some people who are seeking an alternative to traditional Lasik laser now that the i-Lasik procedure is available, there’s really little reason to put off having laser vision correction. Doctors have been doing Lasik for a decade. Nearly 32 million Lasik procedures have been performed to-date, making it the most common elective vision procedure in the US. In fact, all branches of the US military and NASA recently approved Lasik for their servicemen and women thanks to studies using i-Lasik technology.

The introduction of the i-Lasik procedure (the combination of today’s most innovative laser vision correction technologies) means the wait is over and it’s simple:

1. Most people are candidates

2. i-Lasik technology is safe and proven

3. The i-Lasik procedure is fast and simple

You’re probably a candidate

The reality is that the majority of people who meet the age and general health requirements are, in fact, good candidates for the i-Lasik procedure. There are some conditions that exclude certain patients, but whether you have nearsightedness, farsightedness or an astigmatism, there’s a good chance you can still have the i-Lasik procedure.

The basic criteria are:

You are at least 18 years old

You are in good general health

You have had a stable vision prescription for at least one year

You have no existing eye disease

What are the steps for the i-Lasik procedure?

When you have the i-Lasik procedure, you’ll get a completely integrated and personalised procedure based on advanced vision correction technology at every step.

• Step 1 — creating your personal vision profile

Ayurveda & You
Saffron an ancient remedy
Dr R. Vatsyayan

Famous for its medicinal and culinary properties, saffron is one of the costliest herbs and spices. Originally belonging to Persia (now Iran), saffron was brought to Kashmir in India centuries ago, and from there it travelled to the countries of the Mediterranean belt. Known as Kumkum and Rudhir in Sanskrit and corcous sativus scientifically, it is commonly referred to by many other names as keshar, kesar or zafran.

Ancient ayurvedic master Charaka only gave a passing reference to it. Later Ayurvedic scholars and Unani physicians diligently explored its medicinal properties and incorporated it in their respective pharmacopeias. Bitter-sweet in taste and hot and unctuous in effect, saffron contains proteins, amino acids and nitrogen compounds besides many types of minerals and volatile components. It is the stigma of the plant that constitutes the drug and it requires two lakh flowers (picked by hand) to produce 1 kg of saffron.

Primarily saffron is an aromatic and anti-vata herb, but in many cultures and traditions it is extensively used as an aphrodisiac and re-vitalising agent. Additionally, saffron also has excellent anti-colic, anti-cough and stimulant properties. It improves blood circulation, regulates menstruation, reduces fever and inflammation and alleviates fatigue and depression. In Tibetan medicine, saffron is considered a very good heart tonic and is also given in disorders of the nervous system.

Scientific studies are underway to explore its benefits in inhibiting the growth of cancer cells. Hindu and Budhist beliefs see saffron to be an auspicious herb and use it in their religious rites.

As a household remedy, saffron is used in many ways. In common cases of cough and cold, taking two or three of its dried stigmas given after mixing in warm milk reduces mucosal congestion and inflammation and acts as a freshening aid. To reduce cold-related muscular pains saffron is also applied externally mixed with clove and jaiphal. In conditions like painful periods, it is added with a herb that promotes menstruation and is given two or three days before the commencement of menses. Rural people also use saffron in child diarrhoea and chronic sprue.

Many of the classic Ayurvedic preparations like chyavanprash are nowadays sold fortified with saffron. Since it is also used externally to treat muscular pains and inflammations, saffron is added to many message oils. The Unani medicine is replete with uses of saffron and many of its preparations are given to treat the loss of libido, frigidity, depression and anxiety. Royal physicians of the bygone era devised many formulations where saffron was used to treat not only sexual insufficiency but also the disorders of the cardiovascular system, nervousness and general debility. Use of saffron in the cosmetic industry is also widespread. The famous kumkumadi tailam is a classic medicine to remove skin scars.

Saffron has also been used since times immemorial as a subtle and aromatic flavour and natural dyeing agent in the Indian kitchen. For adults its per day therapeutic dose is only 250 mg. As a higher dose may cause nausea, restlessness and tachycardia, it should be given with caution to pregnant women and hypertension patients. For purity, it should be purchased only from a reliable source. Pure saffron is shelf-stable for several years and remains potent if stored in a tightly closed container.

The writer is a Ludhiana-based senior ayurvedic physician. 

Drug promises end to migraine misery
Jeremy Laurance

A British doctor is leading a drugs trial that could spell the end of the misery endured by thousands of migraine sufferers. John Chambers, a consultant cardiologist at Guy's Hospital London, says that when, on a mere hunch, he tested clopidogrel, a simple clot-busting drug, on five patients plagued by migraines, it worked, in some cases, "spectacularly well" .

Now a wider trial on 280 patients is under way with the results expected next year. If the drug proves similarly effective, it could mean an end to the throbbing head, nausea and flashing lights that characterise a typical attack.

Migraines affect at least one in 10 people in the UK and attacks can last as long as three days. Sufferers often feel drained of energy for a couple of days after an attack and, on average, experience 13 attacks a year.

Currently, migraines are treated with beta blockers, to lower blood pressure and regulate the heart, as well as anti-depressants. Other treatments include aspirin, paracetamol and stronger pain killers, such as Migraleve, which contains paracetamol, codeine phosphate and buclizine hydrochloride.

Dr Chambers's treatment is based on the hypothesis that migraines can be caused by tiny blood clots that form in the heart and travel to the brain, disrupting the blood flow and causing the typical symptoms of one-sided headache, nausea and photophobia (sensitivity to light).

Clopidogrel is prescribed to heart patients to make their platelets less sticky. Platelets are, after the red and white blood cells, the main constituent in blood that helps to make it clot when a blood vessel is damaged. However, if the the platelets are too sticky, there is a risk of unnecessary clots forming in the blood vessels, breaking off and travelling to the lungs or the brain where they could trigger a potentially fatal stroke or embolism.

Dr Chambers believes platelets play a crucial role in the genesis of migraines in some patients. "No one quite knows what causes migraine. It is very common affecting maybe 10 per cent of the population and it can be debilitating and difficult to treat. To have another class of treatments would be very useful," said the cardiologist.

Migraine attacks

•  1 in 10 people in the UK suffers from migraine attack, an average of 13 times a year
•  Attacks last up to 72 hours
•  An attack involves a throbbing headache with at least two other symptoms: nausea, raised sensitivity to light, sound or smell
• The pain is made worse by movement and sufferers want to rest and keep still in darkness
•  Some sufferers have neurological disturbances, or auras, before the headache starts such as flashing lights, blind spots and zig-zag patterns but also including tingling, pins and needles and numbness
•  Some people experience the auras only, or with only a mild headache
•  Migraine is more common among women and is often linked to hormonal changes .