"Cartilage is a connective tissue layer that acts as a shock absorber (cushion) and decreases the friction between the bones of a joint. Lubrication of the joint is done by synovial fluid produced by the membrane lining the joint. The joint gets painful, swollen with restriction of movements when the cartilage gets damaged. In severe cases with complete loss of joint space, total joint replacement surgery is indicated. Advances in technology now allow the damaged cartilage to be regenerated by using the body’s cells to regrow new cartilage." These regenerative treatments are usually administered by arthroscopy (keyhole surgery). The surgery greatly decreases recovery time and complications by using small incisions. Sometimes bigger incisions are needed to properly expose the damaged cartilage for treatment. Currently, some of the procedures that are used for cartilage repair include arthroscopic (key hole surgery) debridement. This is performed with removal of the unstable damaged cartilage and stabilization of the healthy cartilage margins. This is not a permanent cure but helps to reduce the symptoms to a certain extent Micro-fracture surgery is another technique performed for injuries smaller than 2cm. In this procedure, multiple tiny holes are punched into the underlying bone, a stem-cell rich clot forms structure called fibrocartilage at the damage site and this material repairs the damaged cartilage by filling in the gaps. Autologous Chondrocyte Implantation (ACI) is a two-step procedure that takes several weeks. It is generally recommended for younger patients with single defects larger than 2cm. The procedure begins with obtaining and growing healthy cartilage cells from a structurally reclusive area of the knee. These cells are later surgically implanted into the damaged area. In Matrix-Induced Autologous Chondrocyte Implantation (MACI) procedure, articular cartilage damage is repaired using self-cartilage cells just like in ACI. But the cells are now expanded on a membrane and a few weeks later this membrane is implanted at the damaged site. Osteochondral autograft transplantation is a graft of healthy bone and tissue from the patients' unaffected joint to the damaged area. These are called plugs, and multiple plugs form a mosaic at the transplant site earning the name mosaicplasty. Mesenchymal Stem Cells (MSC) can form bone, cartilage, muscle and adipose tissue cells. They are found in the bone marrow and adipose tissues etc. These are employed to repair cartilage and have shown promising results in research and human clinical trials. However, before using stem cell therapy routinely long term studies are needed. After repair procedures, patients are advised to reduce pressure on the cartilage by using crutches for at least two months. Complete recovery could take up to 3 to 6 months. You must consult a specialist if you are suffering from chronic knee or joint pains and discuss the available treatments to find which will be the most beneficial in your case.

Cardiovascular Surgery procedures are surgeries done on the heart for various conditions like Coronary Artery Disease (blockages in the blood vessels around the heart), valvular heart disease (disease of the mitral and aortic valve etc.) Coronary Artery Disease The heart muscle like any other organ in the body needs blood supply as nutrition for continuous pumping. The heart beats tirelessly and continuously from the time the fetus conceives in the mother’s womb at about three weeks till the entire life span of the individual. The blood vessels that supply blood ad nutrition to the heart are called Coronary arteries. With growth and advancing age, as a result OF several modifiable and non-modifiable risk factors, cholesterol and calcium and other blood cells deposit inside the blood vessels of the heart causing narrowing of the lumen. These deposits are called atheroma or atherosclerotic plaque. Depending on the nature and location of the blockages and extent of blockages, patients can develop several symptoms ranging from chest pain (called angina) to breathlessness, fatiguability, low energy levels, heart attack and even sudden death. The blockages in the blood vessels around the heart (called Coronary Artery Disease) needs timely identification and treatment as it can be lifesaving. Commonly performed procedures include stenting (also called PTCA- for Percutaneous Transluminal Coronary Angioplasty) where Cardiologists pass wires through smaller blood vessels in the hand or groin up to the heart. The wires are passed inside the coronary arteries at the site of blockage and dilated with balloons and stents are deployed to open the narrowing to normal caliber. When there are multiple blockages or hard calcified blockages not amenable for stenting, option to treat the severe blockages include surgical procedure called Coronary Artery Bypass Grafting (CABG). CABG is a surgical procedure where the surgeon reaches the heart either through the breast bone or from the side of the chest and bypasses the blockages using either a segment of vein from the leg or segment of artery from inside the chest called Internal Mammary artery.   CABG procedure is now a days routinely performed for patients with multiple heart blockages with good results and successful outcomes. Patients typically stay for about a week in the hospital and are discharged home. Recovery after open heart surgery typically happens in 6-8 weeks for most patients. After CABG surgery, patients can lead a near normal lifestyle when they are on regular follow-up. Valvular Heart Diseases The heart is a four chambered organ that has valves guarding each chamber - 2 on the right called Tricuspid and Pulmonary valve and 2 on the left - called mitral and aortic valves. The valves permit flow of blood in one direction only. Any disturbance in the flow dynamics caused by either narrowing of the valve (called stenosis) or backflow of the blood (called regurgitation) puts strain on the normal functioning of the heart and major symptoms like breathlessness, swelling of feet, increased pressures in the lung and irregular heart beat etc. Narrowing of mitral valve is called mitral stenosis while narrowing of the aortic valve from degeneration or calcium deposition is called Aortic stenosis. Similarly, leakage of blood flow resulting in backflow is called Mitral regurgitation when it involves the mitral valve and Aortic regurgitation when it involves the aortic valve. The treatment of valvular heart disease is initially medical for control of symptoms and when there is no progression of the valve disease. However, in advanced stages, patient will need open heart surgery that will replace the defective valve with a new valve - either mechanical or tissue valve. The surgery is usually called Mitral valve replacement and aortic valve replacement. Some patients have two of the valves in the heart damaged - and will need both of the valves replaced. Valve repair is an option for selected patients when the valves are feasible to be repaired. In valve repair, native valve is preserved and the defect is usually repaired instead of replacing with a new valve. Coronary Artery bypass and valve repair and replacement are the most commonly performed cardiovascular procedures and account for 80% of heart operations performed. There are other surgeries performed for rare conditions when the entire heart is not functioning well and dilated - condition called Dilated Cardiomyopathy: Heart Transplant or Left Ventricular Assist Device is the option. Also for enlarged blood vessels of the heart called Aortic aneurysm, procedure to replace the blood vessel along with the valve is performed - called Aortic Root replacement or Bentall Procedure. RISKS ASSOCIATED WITH HEART SURGERY Any procedure carries with it certain risks like risk of death and complications. Heart operations are performed routinely now a days with acceptable risk of death and complications. Some of the complications that can occur after open heart surgery include - Bleeding - Increased bleeding after surgery occurs in 1-2% of patients and is usually managed with blood and blood products like fresh frozen plasma, platelets etc. Most of the bleeding usually settles down with the above measures. Very rarely, the surgeon may choose to take the patient back to the operation theater to identify the source of bleeding and fix it. Stroke - Stroke is another potential complication that can occur after open heart surgery ina small percentage of patients (1-2%). Stroke occurs when one half of the body is paralyzed and patient is unable to move the hand or leg due to defect in blood supply to the brain. Kidney Injury - Patients who have long standing diabetes or high BP have borderline low kidney function which can temporarily worsen after heart operation. More than 95% of the patients recover uneventfully in a few days. However, some patients may develop severe kidney injury needing dialysis in the post operative period till the kidney recovers eventually. Infection - Infection is another risk after any surgery more so after open heart surgery in patients with diabetes and other immunosuppressive conditions.

A nagging cough or slight wheeze may barely register in the course of our busy days, but it's critically important to pay attention to even mild symptoms. Sometimes people think having trouble breathing is just something that comes with getting older. Knowing the early warning signs of lung disease can help you receive treatment before the disease becomes serious or even life threatening. If you experience any of the following warning signs, make an appointment with your pulmonologist. 1. Chronic cough: A cough that you have had for for weeks or longer is considered chronic. This is an important early symptom that tells you something is wrong with your repository system. 2. Shortness of breath: It's not normal to experience shortness of breath that doesn't go away after exercising or that you have after little or no exertion. Labored or difficult breathing-the feeling that it is hard to breath in out--is also a warning sign 3. Chronic mucus production: Mucus, also called sputum or phlegm, is produced by the airways as a defense against infections or irritants. If your mucus production has lasted a month or longer, this could indicate lung disease 4. Wheezing: Noisy breathing or wheezing is a sign that something unusual is blocking your lungs airways or making them too narrow 5. Coughing up blood: If you are coughing up blood, it may be coming from your lungs or upper respiratory tract. Wherever it's coming from, it signals a health problem. 6. Chronic chest pain: Unexplained chest pain that lasts for a month or more-especially if it gets worse when you breathe in or cough-also is a warning sign 7. Fever, weight loss, loss of appetite, night sweats: with or without any of above mentioned symptoms should prompt you to consult Pulmonologist at earliest   Why Continental? Continental Hospitals is a 550 bedded Joint Commission International (JCI) accredited super speciality hospital with 30+ specialities spread out across 18 floors (1.3 million sq ft located in IT and Financial District of Hyderabad, Gachibowli Department of Pulmonary medicine at Continental Hospital has state of art infrastructure and all modern facilities available for diagnosis and treatment of any problem related to Pulmonology with 24 hour backup from Emergency and ICU services. Resource: www.lung.org/lung-heath-diseases/waming-signs-of-lung-diesease