GUEST COLUMN Dr. G. ELANGOVAN M.D., (Gen. Med.), D.M., (Card.), Consultant Cardiologist Dr. SUMATHY ELANGOVAN M.D., (Paed), D.M., (Card.), Consultant Cardiologist Primary Angio Plasty - The Treatment of Choice for Acute Myocardial infarction (AMI)                  The incidence of AMI is growing in epidemic proportions in India, especially due to the habit of using tobacco and the stressful life that everybody leads. AMI is treated with streptokinase, but still some die of cardiogenic shock where the mortality is 85% to 90%. It has been found that if primary angioplasty(PTCA) with stenting is done, the chances of the patient dying are reduced considerably, especially if the procedure is done within a few hours of a AMI. If PTCA is done early, the mortality rate is converted into survival rate, i.e., 85% of the people will die without angioplasty and 85% of the people will live with angioplasty. Recently, an 84 years old retired School Teacher came with chest pain and the ECG showed a AMI. An angiogram done within 15 minutes showed a blocked RCA, which was opened up using a wire and a balloon followed by a stent. Such treatment, which was given for VIP patients, is now available for common people. Back <<

GUEST COLUMN Dr. K. AYYAPPAN M.S., M.Ch., Consultant Surgeon Specialist in Paediatric Surgery The child is constipated if one or more of the following are true 1. He or She has fewer than 3 bowel movements in a week. The stools are hard, dry and unusually large. The stools are difficult to pass and painful. CAUSES Familial Dietary Manipulations Anorectal malformations like stenosis, ectopic anus etc. Neuromuscular abnormalities-Intrinsic or Extrinsic Acute anal conditions like fissure, perianal boils etc. Functional Presacral masses DIAGNOSIS Detailed bowel history focusing on age of onset, frequency and description of stools and therapeutic intervention Perineal inspection Digital rectal examination Contrast enema Anorectal manometry Rectal tissue biopsy TREATMENT Revolve around 3 basic principles Empty the large intestine-Enemas, Suppositories etc Re establish regular bowel movement by Stool softeners-lactulose, Senna, mineral oil, fibres etc Dietary advice-increase fluids, vegetables Toilet training Eliminate the pain associated with passing bowel movements >> Page 6