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Thoracoscopy/Pleuroscopy

Management Team

Thoracoscopy/Pleuroscopy

Overview

Thoracoscopy is a minimally invasive procedure that allows access to the pleural space (space between chest wall and lungs), using a combination of viewing and working instruments. It has become the second most important endoscopic procedure in respiratory medicine after bronchoscopy.

  1. Rigid Pleuroscope
  2. Semi-rigid Pleuroscope (similar to video bronchoscope)

  • Work-up and diagnosis of indeterminate pleural fluid (effusion)
  • Staging of lung cancer
  • Site-directed biopsy of parietal pleura
  • Staging of mesothelioma (pleural malignancy)

Absolute: Lack of pleural space

  • Refractory cough
  • Severe hypoxemia (low O2 saturation)
  • Coagulopathy including low platelet counts
  • Unstable comorbidities or hemodynamic status
  • Pulmonary arterial hypertension

  • Bleeding after a parietal pleura biopsy
  • Lung perforation and air leak
  • Infection in the pleural space

  • Fasting is required for 6‒8 hours
  • Stop blood thinners 3‒5 days before the procedure (after confirmation from the doctor)
  • Patient has to be admitted to the hospital for 3‒5 days
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Turner Syndrome

Management Team

Turner Syndrome

Overview

Turner syndrome refers to a genetic disorder which affects only females and arises due to one missing or incomplete X chromosome.

  • Ovarian insufficiency
  • Short stature
  • Learning difficulties
  • Heart defects

At times, distinguishing the signs and symptoms of Turner syndrome from those of other conditions can be challenging, making timely and accurate diagnosis essential.

Genetic testing and physical examination.

  • Growth hormone therapy to increase height
  • Oestrogen replacement therapy for puberty and menstrual cycles
  • Managing other health issues like heart defects and hearing problems.
  • Early intervention and regular monitoring are crucial for addressing the medical and developmental challenges associated with Turner syndrome, improving quality of life and health outcomes for affected individuals.
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Thyroid Cancer

Management Team

Thyroid Cancer

Overview

Thyroid cancer is a malignancy in the thyroid gland.

It often presents as a painless lump in the neck and may cause symptoms like difficulty in swallowing or breathing.

Blood tests, ultrasound, and fine-needle aspiration biopsy to confirm cancer.

Surgical removal of the thyroid gland, with radioactive iodine therapy to eliminate any remaining cancer cells, and thyroid hormone therapy to replace thyroid function. Regular follow-up is necessary to monitor for recurrence. Early detection and treatment improve outcomes, and ongoing research aims to develop more effective therapies for advanced thyroid cancer.

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Thyroid Nodule

Management Team

Thyroid Nodule

Overview

A thyroid nodule refers to a lump present in the thyroid gland. While most thyroid nodules turn out to be benign and typically harmless, it's essential to consult your doctor if you notice any unusual swelling in your neck, particularly if you experience difficulty in breathing or swallowing or changes in voice. It is crucial to assess the possibility of cancer in such cases.

A physical exam, blood tests to assess thyroid function, evaluation of nodule with ultrasound, and fine-needle aspiration biopsy (FNAB) to check for cancer.

Treatment depends on the nodule type and may include monitoring, medications to suppress nodule growth, or surgery to remove the nodule if it is cancerous or causing symptoms. Regular follow-up is important to monitor for changes in the nodule.

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Tuberculosis (TB)

Management Team

Tuberculosis (TB)

Overview

TB is an infectious disease which primarily affects the lungs but can also impact other parts of the body. Importantly, TB can be fatal if treatment is not done on time.

Based on the organ affected, TB is of two types:

  • Pulmonary TB, which has lung involvement, comprises approximately 85% of all TB cases.
  • Extrapulmonary TB, i.e., TB involving organs other than the lungs, e.g., lymph nodes, abdomen, genitourinary tract, skin, joints and bones or meninges, comprises 15% of all TB cases.

TB is caused by the bacterium Mycobacterium tuberculosis. Risk factors include:

  • Close contact with TB patients

    Transmission: TB spreads through air when a person with active TB coughs, sneezes or talks.

  • Weakened immune system due to HIV/AIDS, diabetes, or any other immunocompromised condition
  • Malnutrition

  • Persistent cough (lasting more than three weeks)
  • Chest pain
  • Coughing up blood
  • Fatigue
  • Fever
  • Night sweats
  • Loss of appetite
  • Unintentional weight loss

Individuals should seek medical attention if they have symptoms like prolonged cough, fever and unexplained weight loss, as early treatment for TB can help stop the spread of disease and improve their chances of recovery.

Individuals should get tested for TB infection if they are at increased risk, i.e., if they have HIV or are in contact with people who have TB.

  • Chest X-ray is used to check for infection patches in the lungs.
  • Sputum test is used to examine mucus samples for TB bacteria.
  • USG, CT scan, MRI are also useful for diagnosing pulmonary and extrapulmonary TB.

Antibiotics: A combination of antibiotics (usually isoniazid, rifampin, ethambutol and pyrazinamide) taken over a period of 6‒9 months can help treat TB.

Drug-resistant TB requires treatment for 2 years. Patients should complete the full course of anti-TB treatment.

Prevention: TB infection can be controlled by wearing masks and ensuring good ventilation.

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Type 1 Diabetes

Management Team

Type 1 Diabetes

Overview

Type 1 diabetes refers to an autoimmune disorder in which the immune system of the body mistakenly targets and destroys insulin-producing cells in the pancreas, causing little or no insulin production.

  • Frequent urination
  • Weight loss
  • Excessive thirst
  • Fatigue

Blood tests to measure blood sugar levels and check for antibodies.

  • Lifelong insulin therapy through injections or via an insulin pump, along with regular blood sugar monitoring. Managing type 1 diabetes involves a balanced diet, regular exercise, and education on managing blood sugar levels.
  • Early diagnosis and appropriate disease management are critical to prevent complications and lead to a good quality of life.
  • Please talk to a paediatric endocrinologist if you notice any of the above-mentioned symptoms in your child.
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Theranostics

Management Team

Theranostics

The term "theranostics" is derived from two words - therapy and diagnostics. Molecular targets on cancer cells are first imaged using radioligands tagged with imaging tracers like F18 or Ga68 on a PET scanner. This imaging allows doctors to assess whether the receptors on the cancer cells are sufficiently overexpressed to be able to serve as targets for therapeutic delivery. If suitable, the same ligand used to “see” the target is then used to “treat” it, delivering Beta or Alpha particles directly to the cancer cells. This “see and treat” approach is the foundation of highly personalised, targeted cancer therapy.

For therapies involving Lu177 and Ac225, treatment is administered through an intravenous injection. It is a painless procedure with minimal or no side effects. Patients are usually admitted for a day for the purpose of administering amino acid infusions or saline along with the TRT, better monitoring of patient post therapy, and acquiring a post therapy scan at 24 hours.

Radio-iodine therapy for thyroid cancer is given orally as a small liquid dose. It is painless, and the admission is done for one or two days primarily for the sake of radiation safety and avoiding exposure of patients’ family to the radiation.

The Department of Nuclear Medicine at Sir H. N. Reliance Foundation Hospital (RFH) has recently inaugurated its dedicated Targeted Radionuclide Therapy ward with experienced specialists offering comprehensive guidance, follow-up care, and the highest standard of care in molecular radiotargeted therapies.

Patients receiving high dose Iodine I-131 therapy are housed in specially designed isolation rooms for one or two days after therapy. The therapy wards meet the strict safety requirements approved by the Atomic Energy Regulatory Board (AERB) while ensuring patient comfort during their stay.

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Targeted Radionuclide Therapy: A Precision Tool for Cancer Therapy

Management Team

Targeted Radionuclide Therapy: A Precision Tool for Cancer Therapy

Overview

Radiation has been a powerful tool for treating cancer for many decades. There have been challenges in delivering radiation specifically to tumour cells while not damaging surrounding normal tissues. Targeted Radionuclide Therapy (TRT) circumvents this problem.

 TRT leverages the unique overexpression of specific receptors or biomolecules on cancer cells. First, imaging techniques like PET-CT identify these target molecules.  Then, radioactive particles (Beta or Alpha particles) are tagged to specific conjugates that bind directly to the cancer cell targets.

Once injected, these radionuclides are homed rapidly onto the target cancer cells, remaining for the next few days to deliver targeted radiation to the tumour, over micro-metre to millimetre range. This focused radiation impacts cancer cells precisely, sparing nearby healthy tissues.

Conventional Radiotherapy (RT): Delivered via specialised machines, conventional RT provides high radiation doses over multiple sessions and is a standard of care for initial treatment of a variety of tumour masses, including Head and Neck cancers, Breast, Lung, and Genitourinary malignancies. These deliver high radiation over days for quick and effective cure of cancers.

Targeted Radiation Therapy (TRT): Beneficial for tumours that have metastasised to multiple places in the body or those not responsive to chemotherapy or standard systemic therapies.

This method offers molecular-level precision targeting, reducing radiation exposure to surrounding healthy tissue. Unlike conventional RT, which treats specific areas, TRT allows for the treatment of cancer cells throughout the body with a single dose, offering a superior safety profile.

TRT has long been used for treating thyroid cancer (I-131 Therapy) and is an established standard of care after surgery and in metastatic situations. It was also used for neuroblastomas, phaeochromocytomas, and other cancers with I-131mIBG therapy.

Recent developments in molecular targeting and radioconjugates have expanded TRT’s reach, notably in

  • Metastatic castrate resistant prostate cancer: treated with radionuclide therapy with Lu177 PSMA and Targeted Alpha therapy with Actinium 225 PSMA.
  • Neuroendocrine tumours: addressed with PRRT (Peptide Receptor Radionuclide Therapy) using Lu177 or Ac225 DOTATATE.
  • Emerging therapies: Newer ligands like FAPI are paving the way for TRT applications across an even wider range of cancers.
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Thyroid scans (Tc-99m)

Management Team

Thyroid scans (Tc-99m)

Overview

A Tc-99m thyroid scan is a nuclear medicine procedure that uses a small amount of radioactive material (Technetium-99m) to evaluate the structure and function of your thyroid gland. This scan assists in diagnosing thyroid issues such as nodules, goitres, or abnormalities in thyroid function.

Your doctor may recommend this scan for:

  • Diagnosing hyperthyroidism (overactive thyroid)
  • Detecting thyroid nodules
  • Evaluating the size, shape, and position of the thyroid gland
  • Identifying ectopic (abnormally located) thyroid tissue
  • Assessing thyroid function
  • Monitoring thyroid treatment outcomes

  • Fasting: not required
  • Medications: Inform your doctor of all medications you are taking, particularly thyroid medications, iodine-containing medications, or contrast agents from prior scans. These may need to be stopped for a certain period before the test.
  • Pregnancy and breastfeeding: If you are pregnant, suspect you may be, or are breastfeeding, inform your doctor, as the test might not be suitable for you.

  1. You will receive an injection of a small amount of Tc-99m, a radioactive tracer, into a vein in your arm.  
  2. After the injection, a waiting period of 15-30 minutes allows the tracer to concentrate in your thyroid gland.
  3. While lying on a table, a gamma camera will capture images of your thyroid. The procedure is painless and typically takes 30-45 minutes.

  • You can usually resume normal activities immediately after the scan.
  • Drink plenty of water over the next 24-48 hours to help flush out the radioactive tracer from your body.

The amount of radioactive material used is minimal and generally leaves your system within 1-2 days, presenting low risk. However, as with any medical procedure, discuss any concerns or allergies with your healthcare provider.

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Trans-urethral resection of the prostate (TURP)

Management Team

Trans-urethral resection of the prostate (TURP)

Overview

Trans-urethral resection of the prostate (TURP) is widely used surgical procedure to effectively treat symptoms of urinary system associated with prostate enlargement.

TURP is typically used for patients with moderate-to-serious urinary problems that have not responded to pharmaceutical treatment. It is worthwhile to remember the following things about TURP: 

  • The effects of TURP may last for 15 years or longer
  • Follow-up treatment may be needed several years after treatment to reduce recurring symptoms

Since the prostate surrounds the urethra (the tube that carries urine out of the body), enlargement tends to restrict urine flow. Removing excess prostate tissue helps unblock urine flow.

  • During the procedure, an instrument called a resectoscope is inserted through the urethral opening at the tip of the penis
  • The surgeon views and trims away excess prostate tissue through the resectoscope
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