LAPAROSCOPIC HERNIA Repair (LHR)
New Delhi, June 15
It is a non-invasive hernia surgery done through a thin: telescope was done in Delhi for the first title in 1994. But this non-invasive and painless procedure has still not caught on because of lack of awareness and trained doctors. Hernia, according to Dr M. C. Misra of the All India Institute of Medical Sciences (AIIMS), is one of the commonest diseases needing surgery. An estimated 5 lakh operations are done every year. In conventional surgery for, say abdominal hernia, the abdomen has to be cut open, the contents pushed up and sutured. "Recurrences are very common. In fact, too many" says Dr Misra. That's where LHR comes in, as it cuts down the recurrence rate to a minimum, says Dr. Pradeep Chowbey, chairman of the Minimal Access Surgery at Sir Ganga Ram Hospital. He has been doing laparoscopic hernia operations for nine years now. "In LHR, two to three 5 mm incisions are made in the groin. A telescope is inserted through a hole, first for visualizing the defect. Then a mesh is inserted, which opens up like an umbrella inside which holds back the contents. The mesh is around 15 cm by 15 cm in size," Dr Chowbey. The procedure takes 45 minutes. The advantages of this procedure are quite a few. "Hospital stay is cut to a maximum of three days, whereas in conventional surgery; the patient is out of action for six to 12 weeks. Second there is no restrictions and normal activities such as driving can be resumed from the next day" Dr Chowbey says. Both Dr Misra and Dr Chowbey agree that there is a lack of doctors trained to do the operation. Besides AIIMS and Ram Manohar Lohia Hospital, few government hospitals offer LHR. In most private hospitals this procedure is done, but its cost varies between Rs 15,000 and Rs 40,000, depending on the kind of rooms taken.

HRT CAUSES DEMENTIA
Washington, June 15
LAST SUMMER, hormone replacement therapy (HRT) was linked to heart trouble. Now, it's Alzheimer's disease and other forms of dementia. The latest data suggests that estrogen-progestin pills double the risk of dementia in women aged 65 and older, a development that "is very shocking," said Dr Barbara Soltes, a reproductive endocrinologist at Chicago's Rush Presbyterian St. Luke's Medical Centre. Soltes said many of her patients who continued taking hormones after last year's bad news on heart troubles did so thinking they were helping stave off Alzheimer's and other memory problems associated with aging. While many likely now will quit - as millions of women already have - Soltes said she likely will continue to prescribe the supplements for relief of change-of-life symptoms. "I'm sure it's not the last word," Soltes said. The study appeared in yesterday's Journal of the American Medical Association. The participants in the study who took hormones for an average of more than four years faced double the risk of developing Alzheimer's or other forms of dementia, compared with those on dummy pills. That means in one year, for every 10,000 women taking hormones, 23 more cases of dementia will develop. Researchers also found that hormones did not protect against less severe mental decline, such as mild memory loss. The belief that the supplements could help women keep their minds sharp was based on smaller, less rigorous studies. But this one was part of the US government's gold standard Women's Health initiative study a portion of which was halted last summer after finding an increased risk of breast cancer, heart attacks and strokes in women who took one type of combined hormone pill. "It's another nail in the coffin" for the use of hormones during and after menopause, said gynecologist Dr Robert Blaskiewicz from Saint Louis University; Some experts say that based on what is now known about supplements, women past menopause should not take hormones at all. Others say women needing relief from night sweats and other menopausal symptoms should take the lowest possible dose for the shortest time. Cindy Yeast, a 50-year-old Washington-area publicist, says she began taking supplements two years ago in part to avoid mild dementia that affects her elderly parents. She said she may not give up on the pills just yet. An arm of the government study involving estrogen-only supplements in women who have had a hysterectomy is continuing. Estrogen alone is not recommended for women with intact wombs because it increases the risk of uterine cancer.