Institute Rotary Cancer Hospital (DR. B.R.A. Institute Rotary Cancer Hospital) started functioning in 1983-84 on 35 beds with infrastructure of 2 floors. Recently it has been converted into a 200 bedded, 7^th floor building. Prime Minister of India Sh. Atal Bihari Vajpayee, inaugurated this centre on October 5, 2003.

Best of radiodiagnostic and radiotherapy machines including state of art linear accelerator, brachytherapy, stereotactic radiotherapy and intensity modulated radiotherapy are available at this centre. Vaccum assisted advanced mammography unit, first of its kind in India, has made stereotactic breast biopsy possible. Prostate cancer can be diagnosed at an early stage with help of tranrectal sextant biopsy. Radio frequency ablation of liver cancer has also been initiated.

DR. B.R.A. Institute Rotary Cancer Hospital is one of the few centres in the country to have established hematopoietic stem cell bone marrow transplant programme; more than 250 transplants have been performed. In collaboration with dept. of CTVS, stem cell transplant programme has been extended to treat myocardial ischemia also.

Medical Oncology has established modern techniques utilizing FISH and polymerase chain reaction (PCR) to prognosticate cancer patients. Also, innovative research by this department has demonstrated the liberation of hematopoietic cytokines from fetal liver, with the potential to treat aplastic anemia. This department has researched into our ancient wisdom also and has discovered that combination of yoga, pranayam, meditation and sudershan kriya-a rhythmic breating process induces positive changes in brain. These processes enhance antioxidant defence and immune functions of body, and thus may prevent onset and/or progression of cancer.

Preventive oncology programme to bring awareness about cancer masses has been initiated, also screening programme to detect cancer early, over 10,000 people have been screened so far.

CABG is not the permanent cure of your coronary artery disease.  It is a palliative procedure and your coronary arteries and grafts may get involved in the disease in future as a result of progression of atherosclerotic process. This progression can not be entirely prevented, but with careful lifestyle and proper drug therapy,  the rate of atherosclerotic progression can be slowed down. Thus, after surgery, it is important to follow the suggested guidelines. There are several risk factors which you can modify and thus reduce the risk of recurrence of the problem. 

1. Smoking:Quit smoking. It not only damages your lungs and causes cancer, it also accelerates the process of atherosclerosis and coronary artery disease. Smoking increases the risk of graft blockade, subsequent myocardial infarction and death.
2. Sedentary life style and lack of exercise:Change your life style. Physical exercises play a great role in your life. Perform regular exercises. For elderly people, brisk walking is the ideal exercise. You can perform light ‘Yoga’ under supervision. Exercise reduces ‘fat levels, in the blood and also increases circulation to heart muscles and other parts of body.
3. Obesity and excess weight :Obesity is one of the most important risk factors for development and progression of atherosclerosis. Thus weight reduction is an important aspect in long term care. Regular exercise and careful diet are two most important means of reducing the weight.
4. Diet : Diet rich in fats and carbohydrates may contribute to obesity, high fat levels in blood and thus to development of coronary artery disease. Consume  low calorie, fat free diet which is rich in minerals, vitamins, proteins and antioxidants. Antioxidants are substances which reduce progression of atherosclerosis. Fresh fruits, green vegetables and sprouted seeds are important sources of antioxidants. You are advised to use a cooking medium that contains Rice bran oil (Sundrop Heart). You mau avoid salt if you have high blood pressure and sweets if you have diabetes.
5. High fat levels in blood:Increased level of cholesterol predisposes to development of atherosclerosis. A balanced diet and regular physical exercise are required to keep cholesterol level under control. However, sometimes drugs are also required to keep the cholesterol level in check.
6. Diabetes mellitus:Diabetics is an important predisposing factor in development of coronary artery disease. Thus,  proper management of diabetes is essential. Regular physical exercise and dietary regulation help in great way to control the diabetes. Follow your doctor’s advice for diabetes control and maintain regular check-up.
7. Hypertension : Proper control of hypertension is essential to retard the progression of coronary artery disease. Decreased intake of salt, weight reduction and avoidance of stressful life also helps in control of  high blood pressure. Regular and closely monitored drug therapy is essential for the management of hypertension.
8. Stress:Stress is an important risk factor. Change your life style. Stress reducing exercises and meditation help in reducing the stress.

   Thus to sum up:

   1. Quit smoking
   2. Do regular physical exercise
   3. Reduce your weight, if you are obese
   4. Avoid fatty, high calorie food. Eat fresh vegetables and fruits.
   5. Avoid stress
   6. Control your diabetes and hypertension vigorously

You have been unfortunate to have this disease, but this is not an end of life. With your experience and knowledge, you can save your friends and relatives from the clutches of this disease. Tell them about your sufferings and also tell them the ways of prevention Encourage them to adopt an healthy, stress-free life style. Campaign against smoking and introduce the people to the hazards of smoking. Make the people understand that the prevention is always better than the cure, and also that there is no real cure.

• Principle :In CABG, a new route of blood flow is created by using a piece of blood vessel (graft). One end of the graft is attached to the aorta or one of its branches and the other end of the graft is attached to the diseased coronary artery beyond the blockage. Thus, the obstruction is bypassed.
• Types of Graft :The graft may be an artery or a vein. Arterial grafts are considered superior as these remain patent for a longer period. Commonly used arterial grafts are :
  1. Left internal mammary artery (LIMA) : This lies in the chest itself.
  2. Right Internal Mammary Artery (RIMA)
  3. Radial Artery : It is obtained from the forearm.
  4. Right Gastroepiploic Artery : It lies in the abdomen and is used less frequently

  Among the vein grafts, long saphenous vein is used most frequently. It is obtainedfrom leg and thigh of the patient. Selection of the grafts is based upon the nature of blockage, condition of coronary arteries and function of the heart.

• Approaches and techniques :The traditional the and commonly used technique involves an incision down the front of the chest through the breastbone or sternum. This incision is called a “median sternotomy”. Sometimes a smaller incision is used on the left side of the chest. This technique is referred to as “Minimally invasive coronary artery bypass” or MICAB. In MICAB, it is expected that patient will have less pain and faster recovery. Most commonly, the patient is attached to the heart lung machine and the heart is stopped during CABG. In selected cases, the heart lung machine is not used and CABG is performed on a beating heart
• Risks and complications:Though CABG is a safe operation, about 5% patients develop some form of complications. It is a major operation and depending upon the condition of the patient, there is a small but definite risk to the life. Other potential complications of CABG include bleeding or infection, stroke (which is primarily related to age and history of previous stroke), kidney failure (related in large measure to the kidney function before the surgery), and heart attack during or after the surgery. The risk of complications generally depends upon age, general health, smoking history, specific medical conditions, and most importantly, the heart function.
• The outcome of surgery and long term success:The operation abolishes angina in almost all patients and minimizes the risk of future heart attacks. However, some patients may have residual angina even after CABG, but it is of lesser severity. CABG is also known to prolong the expected survival (life-span) in a specific subgroups of patients. One should understand clearly that CABG does not abolish or retard the process of coronary artery disease. It only provides a remedy for the harmful effects of the disease. Thus, it is possible that a patient may develop symptoms again, either due to progression of coronary artery disease or due to involvement of the grafts in the disease process. Vein grafts are particularly susceptible for involvement in the disease process and about 50% of the vein grafts may be blocked by 10 years.