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Author Arwyp Categories Neurosurgeon

Neurosurgery

Comprehensive Neurovascular Surgery at Arwyp Medical Centre

Neurosurgery is a type of surgery that treats disorders of the brain, spine, spinal cord, and peripheral nerves. Neurovascular surgery, a subspeciality of neurosurgery, involves comprehensive management of blood vessel and associated conditions and disorders of the brain and spinal cord. this includes. both surgical and endovascular treatment of patients with stroke, aneurysms, vascular malformation and carotid disease as well as management of complex vascular tumours. the word endovascular means “inside a blood vessel.” endovascular neurosurgery is also known as neuro-interventional surgery.

It is performed with the use of catheters and other small devices. Endovascular intervention is an alternative treatment to standard open surgery, which is more invasive. “The benefit of such therapy is that the lesion is treated less invasively, which frequently results in quicker recovery times and more successful treatment,” says DR G Horton a leading Endovascular Neurosurgeon at Arwyp Medical Centre. He treats cerebral aneurysms, stroke, carotid disease, arteriovenous malformations using minimally invasive neuroendovascular procedures as well as surgery involving microsurgical techniques.

Neuroendovascular Procedures

The following neuroendovascular procedures are performed at Arwyp Medical Centre:

-Thrombolytic therapy (intravenous and intra-arterial). This uses medicine to dissolve a clot in a blood vessel in the brain.

-Endovascular mechanical thrombectomy This uses a small catheter to remove a blood clot that is blocking the blood flow in a brain artery.

-Endovascular coiling This is done to treat a brain aneurysm. A brain aneurysm is a bulge in a weak spot in the wall of an artery in the brain that fills with blood. the bulge is at risk of a tear(rupture). this would cause bleeding on the brain. to prevent this, a surgeon puts a very thin metal coil inside the aneurysm. it blocks blood flow into the bulging area. it may also be closed with a clip.

-Cerebral angiography (DSA) This is a diagnostic radiological procedure. it demonstrates the circulation of blood in the brain.

-Carotid artery angioplasty and stenting (CAS) The carotid arteries send blood and oxygen to the brain. this procedure uses a small ballon to open a carotid artery that has become too narrow. A tiny mesh stent is then put in place to keep the artery open.

Surgical Management

Surgical management of neurovascular disorders involves brain and spinal surgery to directly address the patient’s condition. the following surgical neurovascular procedures are performed at Arwyp Medical Centre:

-Intracranial Aneurysm Microsurgical clip ligation A titanium clip(s) is placed at the base of the brain aneurysm to permanently exclude the aneurysm from the normal circulation and prevent future bleeding from the aneurysm. the surgery is performed using a high-powered microscope and microsurgical techniques.

-Microsurgical Resection of brain and spinal cord arteriovenous malformation (AVM) a blood vessel malformation in the brain or spinal cord is removed surgically using high powered microscope visualization and microsurgical techniques.

-Microsurgical ligation of brain and spinal Dural arteriovenous fistulas (DAVF) Abnormal connections of blood vessels in the brain or spine are surgically eliminated using high powered microscope visualization and microsurgical techniques.

-Carotid endarterectomy (CEA) an incision is made in the carotid artery to remove plaques and restore normal circulation to the brain. When possible, this surgery is performed without the need for general anaesthetic is given, allowing safer surgery as well as eliminating the risk of general anaesthesia. “Awake” CEA also allows for shorter hospital stay and recovery time after surgery.

-Microsurgical resection of brain and spinal cord cavernous malformation blood vessel-type lesions located within the brain or spinal cord are surgically removed using high powered microscope visualization and microsurgical techniques.

Author Arwyp Categories Medical

Haemorrhagic Stroke

Haemorrhagic Stroke

What is haemorrhagic stroke?

A haemorrhagic stroke happens when blood from an artery bleeds into the brain after a blood vessel bursts.

What causes haemorrhagic stroke?

  • Uncontrolled high blood pressure
  • Overtreatment with blood thinners (anticoagulants)
  • Bulges at weak spots in your blood vessel walls (aneurysms)
  • Protein deposits in blood vessel walls that lead to weakness in the vessel wall (cerebral amyloid angiopathy)
  • Ischemic stroke leading to hemorrhage (infarct with haemorrhagic transformation)

 

The warning signs of stroke are:

  • Sudden onset of weakness or numbness on one side of the body.
  • Sudden speech difficulty
  • Sudden difficulty seeing in one or both eyes or double vision(diplopia)
  • Sudden onset of dizziness, trouble walking or loss of balance.
  • Sudden, severe headache with no known cause

However, symptoms can vary based on the location of the haemorrhage in the brain.

Management of haemorrhagic stroke

A patient who suffered haemorrhagic stroke needs to be seen at the emergency unit.

Author Arwyp Categories Orthopaedic Surgeon

Arwyp specialist addresses scoliosis

Arwyp specialist addresses scoliosis

Dr Fred UN Ukunda is an orthopaedic surgeon who practices at Arwyp Medical Centre. One of his areas of interest involves the correction of the condition known as scoliosis.

What is scoliosis?

Scoliosis is a rare complex 3D deformity of the spine which is also known as “hunchback” by lay people. In the general population, up to 3% of people are affected, with almost 10% of patients requiring some form of treatment and up to 0.1% undergoing surgery.

The cosmetic aspect of the deformity is the biggest concern to the patient and is often accompanied by psychosocial distress.

There are different types of scoliosis according to the age of presentation:

  1. Early onset scoliosis – from birth until 9 years of age.
  2. Adolescent scoliosis – Between 10 years until end of growth i.e. 14-15 years (girls) and 15-16 years (boys) although treatment will only begin from 19-21 years.
  3. Adult scoliosis

Dr Ukunda stresses that you do not delay if you suspect that you or your child suffer from scoliosis. Visit your family doctor or the local clinic so that they can refer you to the right place or specialist for care.

Diagnosis begins by talking to the patient, parent(s) or guardian(s). Patient birth, milestones, immunisation, medical or surgical and family history is crucial in determining what type of scoliosis the patient has.

How does scoliosis present?

Scoliosis patients present with a deformity of the back (S-shaped or C-shaped), unequal shoulder levels, unequal breasts sizes, waistline asymmetry and rib hump, so-called “hunchback”. Occasionally, patients report back pain.

Further physical examination will be undertaken to ascertain that there are no scoliosis effects on normal functioning of the heart, lungs, kidneys, etc.

Confirmation of diagnosis is made through the right type of spine x-rays. Preferably they are performed at an institution which understands what is expected by the treating scoliosis specialist. Depending on its severity, scoliosis can be classified as mild, moderate or severe. Once the type and severity are established, the right treatment is applied.

Often the condition is mild and, if this is the case, scoliosis can be monitored by observation (active observation by parent and/or patient) and followed up in three months to assess progression. If the problem is slightly worse, i.e. moderate, the young patient will have to wear a brace. The  brace will be fashioned and fitted to the patient, with three-monthly follow-ups to assess correction and progression. If the condition is severe, the patient will have to be operated on although Dr Ukunda stresses that the decision is not always that straight-forward and each case must be individually assessed.

During surgery, one of the ways to correct or straighten the spine, requires that screws and rods be inserted into the vertebrae of the spine. The rods act as splints to hold the corrected spine in position while the fusion process takes place.

Once the fusion process has completed itself, the spine is kept from curving abnormally by the recently fused bone.

Back pain experienced from scoliosis can simply be due to rapid increase in curvature size, or muscle spasm as the body is trying to adjust to the new spine shape.  It can also be as a result of early wear and tear of spinal intervertebral disks or facet joints

X-rays taken at Arwyp Medical Centre of a scoliosis patient before and after surgery. Images taken using PACS medical imaging technology.

Once the fusion process has completed itself, the spine is kept from curving abnormally by the recently fused bone.

Back pain experienced from scoliosis can simply be due to rapid increase in curvature size, or muscle spasm as the body is trying to adjust to the new spine shape.  It can also be as a result of early wear and tear of spinal intervertebral disks or facet joints

Although rare, it is not unusual to observe lower limb weakness or pain, when the spinal cord or nerves is / are stretched or irritated by the curvature.

Furthermore, it is important to watch for changes in your bladder and bowel function and report them without delay to your doctor.

Surgery can go a long way towards alleviating pain caused by scoliosis.

If you notice that one of your shoulders is higher than the other, you have an uneven waist or one shoulder blade seems to stick out more than another, you should see a specialist to be evaluated.

To make an appointment or should you wish to refer any patient to Dr Ukunda, contact his rooms at Arwyp on 011 922 1071.

Scoliosis – a case history

Princess Eugenie of York, granddaughter of the queen, famously and proudly showed off her scoliosis scar by wearing a low-backed dress on her wedding day.

At the age of 12, Eugenie had undergone successful surgery to correct the curvature of her spine – a problem which would have most likely have led to pain and deformity in later life. More recently, in February 2021, Engenie was safely delivered of a healthy baby boy.

Interestingly, Eugenie is not the only royal to suffer this problem. Her ancestor, King Richard lll was referred to by Shakespeare as a ‘bunchback’. When remains were found under a Leicester carpark in 2012, archaeologists confirmed that they were Richard’s by the distinctive curve in the spine. Examination of the skeleton showed that he had suffered from adolescent idiopathic scoliosis.

Sources:

https://www.self.com/story/princess-eugenie-x-ray-scoliosis,

https://edition.cnn.com/2014/05/29/health/richard-iii-spine-scoliosis/index.html

Author Arwyp Categories Uncategorized

Loving your Kidneys

Loving your kidneys

 

Your kidneys are responsible for removal of toxins and control of the environment in your body. The kidneys filter blood and remove products of metabolism and toxins ingested. They also excrete excess water and minerals and make sure the body remains in balance. Kidneys also produce hormones like erythropoietin- which stimulates the bone marrow to make red blood cells. Bone and mineral balance also depend heavily on good kidney function.

Normally each person is born with two kidneys. Each kidney can function on its own and people can survive with one kidney (although it’s better to have two!). Kidney failure occurs when both kidneys are severely damaged and the toxins, fluids and electrolytes accumulate to abnormal levels. When a person has end stage kidney failure there is a risk of life-threatening complications. At this stage dialysis or a kidney transplant may be needed to preset life and wellbeing.

Risk factors and Causes of kidney failure

In South Africa and many other areas of the world the commonest risk factors for kidney failure are Diabetes Mellitus and Hypertension. Often these conditions occur together in the same person. Lifestyle, dietary issues and our stressful way of life have markedly increased the number of people struggling with these conditions. If someone is diagnosed with Hypertension or Diabetes they should attend regular follow up and be screened for kidney disease. This is done by testing urine for protein and blood for a kidney function test. Early detection of kidney disease can allow adjustments in treatment and advise to reduce the risk of progression.

Other causes of kidney disease include autoimmune disease, genetic conditions and damage to kidneys by medication-especially anti-inflammatory pain killers (NSAIDS). Use of medication should be under the supervision of a medical practitioner to prevent long term complications.

The following general tips are useful to protect one’s kidney (and general) health.

  1. Eat a healthy diet including lots of green leafy vegetables. Avoid take aways and foods with a lot of salt. Drink sufficient water especially on hot days or when exercising. Your thirst will guide you.
  2. Avoid energy drinks and sugar containing soft drinks and prefer water.
  3. Keep your weight down with a healthy lifestyle. Avoid fad diets and stimulants for weight loss
  4. Avoid unnecessary medicines. If you need painkillers for more than a few days consult your doctor.
  5. Report any changes or abnormalities in your urine output or composition to your doctor.
  6. Your health practitioner should regularly check your blood pressure, sugar and urine – even during routine visits
Author Arwyp Categories COVID-19, General

COVID-19: FAQ

What is COVID-19

Human coronaviruses are common throughout the world. The name corona refers to a crown because these viruses have crown-like spikes on their surface when viewed under an electron microscope. There are many different coronaviruses identified in animals but only a small number of these can cause disease in humans. Some coronaviruses such as 229E, NL63, OC43and HKU1 are common causes of illness, including respiratory illness, in humans throughout the world. Sometimes coronaviruses infecting animals can evolve to cause disease in humans and become a new (novel) coronavirus for humans. Examples of this are theMiddle East Respiratory Syndrome Coronavirus (MERS-CoV), first reported from Saudi Arabia in 2012, and the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV), first recognized in China in 2002. On 7 January 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed as the causative agent of coronavirus disease 2019 (COVID-19). The majority of the case-patients initially identified were dealers and vendors at a seafood, poultry and live wildlife market (Huanan Seafood Wholesale Market) in Jianghan District of Hubei Province. This suggests that the novel coronavirus has a possible zoonotic origin. However, there has been ongoing sustained transmission of COVID-19 in countries to date. The specific source of the virus is not yet known.

Who is the most at risk for COVID-19?

Currently travellers to areas where there is ongoing sustained transmission of COVID-19 including Mainland China (all provinces), Hong Kong, Japan, Republic of Korea, Singapore, Vietnam, Taiwan, Italy and the Islamic Republic of Iran are at greatest risk of infection with COVID-19. Furthermore, the elderly, individuals with co-morbidities and healthcare workers have been found to be at a higher risk of morbidity and mortality associated with the SARS-CoV-2. Please consult the latest guidance for information on which countries are experiencing outbreaks of COVID-19. Information can be accessed at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports.

What are the signs and symptoms of SARS-CoV-2 infection in humans?

Current symptoms reported for patients with COVID-19 have included mild to severe respiratory illness with cough, sore throat, shortness of breath or fever [≥ 38°C (measured) or history of fever (subjective). The complete clinical picture with regard to COVID-19 is still not fully clear. Reported illnesses have ranged from infected people with little to no symptoms to people being severely ill and dying.

How is COVID-19 diagnosed?

COVID-19 is diagnosed by a laboratory test, polymerase chain reaction (PCR) molecular test, on a respiratory tract sample (e.g. sample from nose, throat or chest). For specific guidance on sample collection and transport please visit the NICD’s website: http://www.nicd.ac.za/diseases-a-z-index/covid-19/

How is COVID-19 treated?

Treatment is supportive (e.g. provide oxygen for patients with shortness of breath or treatment for fever). There is no specific antiviral treatment available. Antibiotics do not treat viral infections. However, antibiotics may be required if a bacterial secondary infection develops.

How can COVID-19 infections in humans be prevented?

Currently, there is no vaccine for COVID-19. Officials in China have intensified efforts to contain the spread of the virus. There are no specific measures currently recommended to prevent COVID-19 but the following can provide protection against infection with coronaviruses and many other viruses that are more common in South Africa:

  • Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitiser.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.•Avoid close contact with people who are sick.
  • Stay at home when you are sick and try and keep distance from others at home.
  • Cover your cough or sneeze with a flexed elbow or a tissue, then throw the tissue in the bin.
  • Clean and disinfect frequently touched objects and surfaces.
  • Avoid contact with farm or wild animals (alive or dead), animal markets, and products that come from animals (such as uncooked meat).

How can COVID-19 infections in humans be prevented?

Currently, there is no vaccine for COVID-19. Officials in China have intensified efforts to contain the spread of the virus. There are no specific measures currently recommended to prevent COVID-19 but the following can provide protection against infection with coronaviruses and many other viruses that are more common in South Africa:

  • Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitiser.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.•Avoid close contact with people who are sick.
  • Stay at home when you are sick and try and keep distance from others at home.
  • Cover your cough or sneeze with a flexed elbow or a tissue, then throw the tissue in the bin.
  • Clean and disinfect frequently touched objects and surfaces.
  • Avoid contact with farm or wild animals (alive or dead), animal markets, and products that come from animals (such as uncooked meat).

What measures have been put in place in South Africa to minimise the risk of transmission should cases be imported?

Fever screening is in place at international airports. If there is a suspected case, procedures are in place for case isolation and management as well as rapid specimen collection and transport so that the diagnosis can quickly be made. Suspected cases will be managed at designated hospitals with isolation facilities. Protocols are in place for follow up of case contacts to ensure that the virus does not spread.

Should I travel to China now?

It has been recommended that travelers should avoid all nonessential travel to areas with ongoing sustained transmission of COVID-19 including Mainland China (all provinces), Hong Kong, Japan, Republic of Korea, Singapore, Vietnam, Taiwan, Italy and the Islamic Republic of Iran. People who travel to China or areas ongoing sustained transmission of COVID-19 should avoid visiting the animal markets (avoid contact with farm or wild animals), products that come from animals (such as uncooked meat) and avoid contact with sick people.

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