|
The city center is treating all
types of diseases under one roof. All OPD’s including Medicine, Surgery, Gynae &
Obst., Orthopedics, Eye, ENT, Chest & TB, Skin, Pediatrics, Dental, Family
Planning Clinic and Well Person Clinics are running on regular basis.
The centre is open for the public from Morning till Evening for giving quality
treatment. Basic diagnostic facilities like X-ray, Ultrasound Abdomen, ECG and
all routine Lab Investigations are done at center.
The city center is also having a day care surgery operation theatre. Those
patients who
|
|
will require admission and specialized
investigations are being referred to Mohan Dai Oswal Cancer Treatment & Research
Foundation and are being given 25% or more discount in needy cases.
 The Sr. Doctors from the ma main hospital are
visiting the center for expert advise on regular basis.
|
|
Menorrhagia i.e. excessive bleeding
during periods is one of the common gynecological problems. More than 1 in 5
women around the globe suffer from menorrhagia. It is the most common indication
for hysterectomy which has a primary success rate of 100% in this problem. 20%
of British women after the age of 55 have undergone hysterectomy with
menorrhagia as an indication in 35-64%. Regardless of the route it is performed,
Hysterectomy is a major surgical procedure with associated risks of anesthesia,
blood loss, injury to nearby organs, sepsis and post operative ambulation and
recovery. In patients with menorrhagia who don’t have any anatomical lesion
(with a normal uterus) the site of disease is primarily in the endometrium, so
that removal of myometrium i.e. uterus is not required. With emergence of this
concept various new surgical techniques are coming up in practice where only
endometrium is being destroyed. Uterine balloon therapy relies on a concept of
the combination of heating under pressure within the uterine cavity to achieve
the destruction of endometrium and superficial myometrium. The distensibility of
the balloon allows it to take the shape of the endometrial cavity.
The preoperative evaluation of these patients involves the work up to exclude
other causes of menorrhagia. A pelvic ultrasound including a transvaginal scan
is done to measure the endometrial cavity (optimum 8 cm) endometrial thickness
(3-5 mm) and exclude the presence of any fibroids and endometrial polyp as a
cause of menorrhagia. Routine Pap smear and endometrial curettage with
histopatholgical examination of the curettings for exclusion of malignancy is
mandatory. The procedure
is carried only in patients who have already completed their family and not
desirous of future pregnancy.
The thermachoice balloon therapy which is the currently available balloon
therapy system consists of a 16 cm long by 4.5 mm wide catheter with a latex
balloon at its distal end which houses the heating element. The catheter is
connected to a control unit that monitors, displays and controls preset
intrauterine balloon pressure, temperature and duration of therapy. The therapy
is given over a period of 8 min at a pressure of 160-180 mm of Hg and
temperature of 870C. Measurement of serosal temperature and depth of thermal
injury at these parameters have been studied in various in vivo and experimental
studies.
|
|
 In vivo, serosal
temp from 12 different serosal locations did not exceed 39.90c with a mean of
36.10C. Histological examination revealed deep endometrial and superficial
myometrial damage to all areas. The greater depth of myometrial injury occurred
in fundus (3.4 mm). No thermal effect could be demonstrated in myometrium beyond
15 mm. In a large observational multicentre study, no intraoperative
complications were observed.
The advantage of balloon therapy is that it requires less time, minimal
anesthesia, little if any cervical dilation and no hospitalization. Considering
the period of post op recovery, the total cost of treatment is much less than
hysterectomy. 88% of women develop amenorrhea and at 3 years follow up high
percentage (93-96%) of patients show satisfactory results. Failure in therapy
may occur due to associated morbid
conditions e.g. fibroids, adenomyosis and endometriosis which go undetected.
With increasing size of uterus and increase in degree of menorrahagia, lower
success rates are observed.
Under the present scenario, endometrial thermal ablation therapy is well
established alternative to hysterectomy in well selected group of patients. It
should always be offered to all women who have completed their family wishing to
have a surgical procedure for the treatment of menorrhagia in the absence of
associated pelvic lesions. The facility is at present available at Mohan Dai
Oswal Cancer Treatment & Research Foundation at low cost
Dr. Mrs. Veena Jain, MD, FICS, FICMCH
Chief of Obst. & Gynae and Gynaecology Oncology
|
