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By our staff writer (PUNE) APRIL 16, 2000: The growth process of a child is both physical and mental. Each stage is important to facilitate the full development of a child towards maturity. However, sometimes puberty related disorders can severely hamper both the emotional and physical growth of a child. To shed light on recent advances and research on puberty related disorders that Bhavan’s SPARC ‘Centre for Disorders of Growth and Puberty’ along with the Department of Obstetrics and Gynecology, B J Medical College and the Jehangir Medical Center, Pune held a “Multi–disciplinary awareness colloquium on growth, development and pubertal maturation with a focus on Turner syndrome” at the hotel Le Meridian today.

Dr. Ashok Vaidya, a speaker at the colloquium stressed on the “Need to create awareness about puberty related disorders in children”. Hyperthyroidism and growth hormone deficiency were some of the puberty related disorders discussed. Dr. Mrudula Phadke was the chief guest. The Turner syndrome which affects only females was also discussed in depth. This disorder occurs one in 2500 female births and results from a partial or complete absence of one X chromosome. So the extent to which individual patients exhibit physical characteristics typical of Turner syndrome vary but all patients are at risk from associated medical and psychological problems. Therefore, the management of a girl with Turner syndrome requires a multi–disciplinary approach. Growth failure, gonadal dysgenesis, inverted, widely spaced nipples, webbed neck, skin and nail deformities, defective dental development, renal dysgenesis, cardiac malformation, skeletal dsygenesis, otitis media and eye deformities are some of the physical abnormalities related to Turner syndrome.

The speakers included Dr. Aspi Irani, Dr. Rama Vaidya, and chairpersons Dr. Usha Sutaria and Lt Col M K Garg. The focus was on how best to foster self–confidence and enable the child to lead an emotionally stable and normal life. For this the management of the Turner syndrome needed to be tailored according to the individual needs and age of diagnosis. Ideally however, patients should be offered life–long comprehensive care, covering all aspects of their condition.

“Management of growth failure is another important aspect of patient care in most puberty related disorders. In addition to helping patients attain near normal adult heights, careful management of growth is integral to optimize management of sexual development and has beneficial effects both in terms of social and academic development”, said Dr Rama Vaidya. The treatment being offered is Growth Hormone (GH) Therapy. For girls afflicted with the Turner syndrome GH treatment can be started as early as two years of age with daily doses being adjusted over time as the girl grows. The therapy helps to increase height velocity and sustains growth to bring final height into the normal range. In fact GH therapy together with sex steroids management of puberty, affords patients with Turner syndrome a greater opportunity for normal growth and sexual development.

Gentropin is an artificial Growth Hormone made available by KIGS (Pharmica and Upjohn). Now there is even a Gentropin pen available which offers a simplification of GH therapy. In India, Gentropin is currently available in 16 I.U. (5.3 mg)–multi dose two–compartment cartridge (I+II) for Gentropin Pen 16.
Hysterectomy
Hysterectomy is a major surgical operation painful and expensive, but till recently it was the only way out for woman suffering from Menorrhagia (heavy bleeding during monthly periods), as continued heavy menstruation can lead to anemia, general feeling of weakness and more serious cases, cancer. For such patients Gehta or Ghosh’s Endometrial Hydro Thermal Ablation Technique will come as a welcome relief. This is a minimally invasive surgical procedure by which the inner–most lining of the uterus, known as the endometrium, is completely destroyed, resulting in total cessation of menstrual periods (Amenorrhea).

This innovative technique has been pioneered by Dr. Debdatta Ghosh, head of Gynecology and Obstetrics, Ruby Hall. Starting in March 1995, Dr. Ghosh has already used the technique on 104 patients had and reported a high degree of success. As Dr. Ghosh explains, ‘Removing a complete organ like the uterus results in morbidity. Attempts made in the sixties and seventies to destroy the endometrium with chemical or physical agents proved unsatisfactory. However, since the sixties several new methods, such as laser ablation and coagulation of resection of endometrium with electrocautery have proved effective and popular. Both these methods have certain limitations. They can cause trauma–causing complication like perforation and hemorrhage. Amenorrhea is achieved in less than 45 to 55%. There is also high cost of equipment maintenance and training.

The GEHTA procedure is relatively simple and the costs minimal. The materials required are the same as for dilatation and curettage. In addition, three balloons (made of high quality latex, usually condoms), three 25 ml plastic syringes, one three way stop cork, a stop watch, an electric kettle and a bowl full of ice water are all that are required.

The patient is given sedative to induce sleep followed by a local anesthesia administered intravenously. A thorough curettage of the endometrial cavity is made. Then the heated resistant balloon attached to one end of a flexible plastic tube is slowly inserted into the uterine cavity. The tube is injected with boiling hot water, which fills up the balloon. The hot water is maintained at a temperature of 840C to 860C. As it cools, every 30 seconds it is flushed out and fresh hot water injected. The procedure is completed after a total of 40–50 refillings, depending on the size of the uterus. A bowl of ice–cold water is kept in readiness for spraying in case of a balloon burst. The entire procedure takes just 45 to 60 minutes. The patient arrives in morning and is discharged by the evening. The underlying principal behind this procedure is that the heat destroys the inner lining of the uterus (endometrium), which is actually responsible or menstrual periods and, thus, there is an end to these monthly cycles. There is a mild pinkish discharge for a couple of days, followed by a watery discharge for two weeks and a complete cure by the fourth week. The patient does not require any bed rest and can resume her normal chores within a day or two. The cost of operation is very reasonable, just about one fourth of what is required for a Rs. 20,000–25,000 hysterectomy.

There are some other medical advantages which Dr. Ghosh points out, Because GEHTA does not require the use of general anesthesia, it can also safely be performed on women who have added medical problems such as hypertension, diabetes, lschemic heart, disease and renal diseases, “However, an ultrasound examination is done to rule out thyroid dysfunction, fibroids, tumors cysts and excessive enlargement of the uterus, in which case this procedure would not have the required effect. Out of the 104 cases that Dr. Ghosh has performed GEHTA, follow–up data is available for 100, 95 have proved completely successful. 86 have reported total cessation of the menstrual cycle while 9 have reported minimal bleeding, a very good success rate indeed compared to the other forms of oblation techniques.

Mrs. Anne Rosario, a school teacher, who underwent this procedure, is all praise for it. “I went to Dr. Ghosh’s clinic at 8 ‘o’ clock in the morning. Within half an hour, I was in the OT and fast asleep. I awoke at 4 ‘o’ clock and went home after an hour. I lived on the third floor and was able to climb up on my own, there was no problem at all. I even did the cooking the next day and in a few days I was back at my school. In fact, no one in school even knew that I had undergone this operation. The only discomfort was a slight cramp like pain for a couple of days and that was far less than what I had to suffer before. I am really happy that I came to know of this procedure from a friend”. It is more than two and a half years now since Dr. Ghosh has applied this procedure and there have been no complaints of any negative side effects. On the positive side, the ovaries remain intact and hence there is no hormonal imbalance.
Bank For Milk Of Human Kindness
INFANTS forced to feed on artificial milk can now look forward to a Human Milk Bank that will bring them mother’s milk–through not necessarily their own mother’s. The bank and the concept–is taking shape at K.G. Patel Children’s Hospital in Karelibaug. The only other bank in India is working at L.T.M.G. Hospital in Sion, Mumbai. The bank will collect milk from mothers who are ready to donate surplus milk. The milk will be sterilized, pasteurized and preserved in a deep freezer, where it can remain for up to one month.

It will be given to newborns brought to the hospital who have been separated from their mothers for one reason or the other. It will also be a boon for children born to mothers who can’t lactate.

The hospital receives between 40 and 50 infants everyday, all of whom are given artificial milk while their mothers take treatment elsewhere for complications during childbirth. Though not advisable, artificial milk is the only option. Dr. Nirupama Munshi will leave for Mumbai next week to learn more about the equipment needed for the bank. She told The Indian Express, “It may not be easy to convince mothers with surplus milk to donate it”. Dr. Munshi has been working with Dr. Arun Phatak and Dr. V. C. Patel to popularize breast feeding. She says, the experience the team has gathered during the campaign will come handy. Dr. Phatak and Dr. Munshi said though the concept of a milk bank was not new, it had never taken root in Gujarat. The practice of ‘wet nursing’ was prevalent mostly in rural areas.

In the hospital itself, many mothers donate extra milk produced to needy babies. But the supply is erratic and the shelf life of milk less than 24 hours. The milk bank can pool, preserve and provide safe human milk. The hospital spokesman said K. G. Hospital treated thousands of neonates born in other hospitals, some as far as Chhotaudepur and Dahod. The bank will enable babies to get their own mother’s milk though they would remain at different places. “Many mothers feel frustrated when they learn they can’t suckle their babies”, Dr. Munshi said. Now they will have the satisfaction of feeding their babies with their own milk.

Dr. Phatak, a well–known pediatrician attached to the hospital, has prepared a project report for the bank. Dr. Bhupendra and Dr. Leelaben Patel, two philanthropists, have already donated Rs. 1.5 Lakhs to the Lions Club of Baroda (Main), to be given to the hospital authorities.