Tuesday, February 6, 2018

it is a real case study-doctors and hospitals -Harmanpreet kaur

Please mr.vivek bindra and all Indian people ,see the link above,it is a real case study-doctors and hospitals,and see what is true-mr . viveks bindra’s case study or this one
Harmanpreet kaur

xii-med,student   
Big Picture: Face two

As the machine pulled her head back, it took just a few seconds for the skin of her face and scalp to tear off and come apart in two pieces.

Written by Rakhi Jagga | Updated: June 21, 2015 11:56 am
Next month, the world’s first full-face replant patient will become a mother. Rakhi Jaggameets Sandeep Kaur and her remarkable doctor Abraham Thomas
Face Replant: A face replant is a procedure that reconnects the blood vessels, nerves, bones, muscles and other supportive structures to the skin of a person damaged in a mishap. Unlike a face transplant, which relies on an external donor, a face replant uses the skin and grafts from the person undergoing the procedure.
The procedure: The damaged skin is first stored in ice and kept aside. The 8 cranial and 14 facial bones are shifted to specific positions if they have been damaged. A surgical microscope then connects the 17 major facial arteries and 7 primary veins to begin the blood circulation. Finally, the 40 facial muscles are connected and the skin is sutured back on. If the skin if severely damaged, grafts from the patient’s back, buttocks, thighs, or chest are used. The structurally complex eyelids and mouth are the toughest to replant and involve complications.
The risks: There is a risk of a clot blocking the blood supply to the newly sewn face and killing the replanted tissues. A series of recontructive surgeries are needed after the first operation, which takes between 2 and 10 hours.
The next step: The world’s first partial face transplant on a living human was carried out on November 27, 2005, in France. Isabelle Dinoire underwent surgery to replace her original face, which had been mauled by her dog. On March 20, 2010, a team of 30 Spanish doctors carried out the world’s first full face transplant, on a man injured in a shooting accident.
Sometime towards the end of July, Sandeep Kaur will become a mother. Twenty-one years after what the NYU School of Medicine calls “the world’s first full-face operation” came bleeding to Ludhiana’s Christian Medical College and Hospital with her face in two pieces, she will be wheeled into hospital for her first medical procedure that wouldn’t involve her face.
Dr Abraham Thomas will not be in the room, but he is unlikely to be far away. This is the story of a girl, a doctor, and a 21-year-long association to give her her old face and a new life.
It’s the scream that Sandeep remembers most vividly. And it wasn’t even hers. It was a July afternoon in their Chak Shekhupura Khurd village in Malerkotla, muggy and quiet. June 1994 had been very hot, and the temperature had just started falling. The only sound around at that time of the day on July 23, Saturday, was that of the thresher machine, kept in the open area of the house, next to which the nine-year-old and her cousin sat, cutting grass.


Sandeep was proud of how well she operated the manual handle starter that controlled the thresher’s speed. Around 3.30 pm, her attention slipped for a moment, there was the sudden pull of air pressure and a tug, and her long pigtails got swept into the motor of the thresher. As the machine pulled her head back, it took just a few seconds for the skin of her face and scalp to tear off and come apart in two pieces.
“I stood up. I had no idea what had happened. I was feeling no pain at all, my face totally numb,” Sandeep remembers. “I walked towards my mother who had her back towards me. Tapping her on the shoulder, I asked, ‘Mumma, meinu ki hoya hai (what’s happened to me)?’. She turned, saw my bleeding face with no skin, and screamed aloud.”
Within minutes, almost the entire village had gathered. Sandeep’s father Sudagar Singh, who worked in the Irrigation Department then, was away at office, having been summoned for some urgent work on his day off.
“Mumma was dazed, she didn’t know what to do. A neighbour wrapped my face in 
a sheet, while the village’s rural medical practitioner, Harjinder Singh, rushed me to Malerkotla Civil Hospital, a 15-minute drive, in his jeep,” Sandeep says. One of the doctors there showed a fortuitous presence of mind. He immediately sent Sandeep’s relatives back to fetch her peeled skin. Sandeep’s chacha Avtar Singh, also the sarpanch of the village, raced to the village and got the two pieces in a polybag. The doctors at the Civil Hospital put the pieces in ice and advised Sandeep’s family to take her to Dayanand Medical College and Hospital. From there, they were referred to the Christian Medical College and Hospital (CMCH), Ludhiana.
It had already been three hours since the accident by then. Around 6.30 pm, renowned microvascular surgeon Dr Abraham Thomas saw Sandeep for the first time. Over the next 10 hours, the surgeon and his team would reconnect Sandeep’s arteries and veins with her torn skin.
Dr Thomas, who is now the director of CMCH, was not sure Sandeep would survive the operation. No one present surely imagined they were about to make history as the first reported full-face replant.
A similar operation would be conducted next more then two years later, in the Australian state of Victoria. It would take another nine years for the world’s first partial face transplant to be done, in France, while the first full face transplant would have to wait till 2010, Spain.
In the section of the surgical ward at CMCH with the very critical cases, Sandeep works quietly and efficiently, adjusting the IV drip of a patient. In the third trimester of her pregnancy, the staff nurse has been given “easier” hours in the colourful paediatric OPD — located on the first floor of CMCH, just two floors down from where Sandeep has spent a large part of her life as a patient.
Nursing superintendent Reena Jairus is proud of her young ward. “Sandeep has details of patients on her fingertips, she is skillful and communicative, and her attitude is very positive. She counsels patients well,” says Jairus.
As for her past, Sandeep hardly discusses that, the superintendent adds. “The only time we spoke a little about her accident was when she sought leave for a week for a recontructive surgery.” Colleague Rose Mary, who used to work with Sandeep in the surgical ward, says the 30-year-old isn’t one to look for sympathy. “Once I asked her about the scars on her face. She just told me she had met with an accident at the age of nine. I never asked her anything after that.”
After the surgery in 1994 and through the years of recovery, Sandeep was never in doubt that this was where she would head after growing up.
In 2004, she took admission in a Punjab nursing college. When Dr Thomas moved south as principal of the prestigious Pondicherry Institute of Medical Sciences (PIMS), she shifted there. Since she needed successive recontructive surgeries to reduce her scar lines, this was agreed upon as the best course.
The doctor returned to CMCH in 2008 as director, and the next year, Sandeep, after completing her nursing degree, joined as a staff nurse at the hospital.
Says Jairus, “Most of the staff knows about Sandeep’s surgery. But it can happen to anyone; it was just an accident. Sandeep is like any another nurse.”
In the days that followed the July 1994 operation, Sandeep’s recovery was good, but unpredictable. “The doctors first re-attached the right part of the face, and then the left. Both started receiving good blood supply within three days; Sandeep responded well. Our daughter was back,” says Saudagar Singh.
Hailing the “miracle”, he adds, “At the time of the accident, my family or the villagers had no idea what to do with Sandeep’s torn skin. They left it at home thinking it was useless; a few even advised that it be thrown away. Thank God, we did not do so.”
Sandeep stayed in hospital for two and a half months. In the first 45 days, she could not speak or see, with stitches all over her face. Saudagar gave her a small notebook, in which she would scribble what she wanted to say or whom she wanted to meet. She would identify her visitors by touch.
Sandeep was also kept on IV fluids and had to take medicines by injection as she could not eat or drink. Even when the stitches came off after one-and-a-half months and she could see, she was still not allowed to eat or talk much.
It was by end-October 1994, that she finally started speaking and eating normally.
Within days, Sandeep recalls proudly, she was back at school. “I used to go to her home as well to teach her, and she picked up things fast. She stood first in Class IV like previous years. We are all proud of her,” says Parkash Singh,one of Sandeep’s teachers from then.
Her face was badly scarred at that time, and Sandeep admits many children couldn’t help but stare at her. However, soon, she said, they were treating her like any other child.



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