Home' Trinidad and Tobago Guardian : December 9th 2015 Contents BB
Three local doctors have made medical
The trio --- urologist and lead surgeon Dr
Lall R Sawh, general vascular surgeon Dr
Steve Budhooram and Dr Peng Ewe, anes-
thetist and intensivist --- removed an eight-
pound tumour from a 52-year-old man at
the Southern Medical Clinic, San Fernando,
last week Wednesday.
According to medical records, this is the
largest tumour removed in the western
hemisphere and the second largest ever in
Medical records which the doctors used
to base their feat, show that the largest
tumor successfully removed from a patient
weighed 5.018 kilos (approximately 11
pounds) and was done during a five-and-
a-half-hour surgery at the All India Institute
of Medical Sciences in New Delhi, India,
breaking the previous record of a 5.5-pound
tumour removed at Sir Gangaram Hospital,
also in India.
The operating time for the local surgery
was two hours whilst theatre time was three
hours, allowing one hour for anesthetic
preparation and monitoring by Ewe prior
to the knife to skin start time.
The three doctors sat down for an inter-
view with members of the media at Sawh s
medical office yesterday and described the
surgery as "touch and go" because of a
number of pre-existing medical conditions
the patient, whom they did not name, had.
Among them were cardiac issues and
scoliosis, which caused the bending of his
spine. All together, they said, that left limited
space for the doctors to work to remove the
Sawh equated the eight-pound growth
to that of the size of a woman s stomach
when she is some months pregnant.
He said the growth may have developed
over a year but the patient s "self-diagnosed"
used a regimen of herbal medicine to cure
his sudden weight loss and extending stom-
ach. He said strangely, the patient said he
had no pain nor did he pass blood in his
urine as is usual with a tumour.
"It is amazing somebody could actually
carry that around for a year and not see
something is wrong. I am loosing weight,
not feeling my usual self, in this day and
age people still take things for granted,"
Only a few weeks ago, when the patient
started experiencing severe abdominal pain,
he sought Sawh s services. Sawh said from
the moment he saw him he knew if the
growth was not removed from the patient s
left kidney he would have died.
"When we saw his scans, we realised we
had big challenges and for the first time in
my 35-year medical career, I made a man
sign a consent form that he could die on
the operating table," Sawh said.
Budhooram added; "The tumour was so
huge it was pushing the diaphragm, the left
lung and the heart up. The growth was also
going down into his pelvis, so this thing
occupied the entire left half of the abdomen
and even pushed his major blood vessels,
which are normally in the middle, to the
He said the vein of the tumour was actu-
ally larger than the vein going to the heart,
which posed another challenge.
Sawh interjected: "So the challenge was
space and as Dr Budhooram explained, if
you make one error with the blood vessels
that is death on the operating table."
Anaesthetist Ewe said he too faced a num-
ber of challenges to put the patient to sleep
because the patient had a large mass com-
pressing on the heart and a pre-existing
"So we had to get the cardiologist to come
in and see him and do and ECHO so I could
assess and anticipate what problems I would
face with him.
"Also, with the big mass pressing against
the diaphragm, squashing the base of the
lungs, you had to adjust how you ventilate
him because the lungs would not have much
room for expansion after that big mass
"So to put him to sleep, we obviously
had to do a lot of invasive monitoring. We
had to put in a lot of lines to monitor the
blood pressure and the fluid status. Because
of the pre-existing heart condition we could-
n t overload him with liquid because his
heart would not have been able to take the
strain," Ewe added.
The doctors said they had to wait for the
right time to operate as a result of those
Nevertheless, on December 2, after Ewe
was able to prepare and put him to sleep,
Sawh and Budhooram, ably supported by
scrub nurse and head operating theatre
nurse, Susan Maharaj, and her team of
Moncy Mathew and the theatre staff, went
to work on the patient from east Trinidad
for three hours to undertake one of the
riskiest challenges of their careers.
"We did him on Wednesday, he was kept
in the Intensive Care Unit (ICU) for the first
24 hours and by Saturday, he was home,
three days post-operatively," Sawh said.
The removed tumour specimen was
weighed and sent to the labs for analysis.
In terms of his survival, Sawh said they
have to wait for the histology from the labs
and if all his organs were fine then that
would be a sign he was cured. However, if
the capsule has been breached then he may
have to do additional chemotherapy.
The doctors said the case would be pub-
lished in an international medical journal.
8 Wednesday, December 9, 2015 www.guardian.co.tt Guardian
Police were still tak-
ing statements yester-
day from relatives of
Khristha Knutt, who
died from head
injuries and electro-
cution in what police
believe was a botched
attempt to resuscitate
Police told the T&T
Guardian last evening
that all four members
of the household where
the incident took place remain in custody and have
Police have so far detained the child s 23-year-
old mother, 33-year-old stepfather, a member of
the Coast Guard, and two teenagers, an aunt and
an uncle, of the dead child.
Investigators said that during the interrogation
one relative said he saw in a movie someone resus-
citated by shock therapy and tried it out.
The officers said they intend to consult further
with forensic pathologist Dr Hughvon Des Vignes
to determine which of the two listed causes of death
on the post mortem report would have contributed
more to the death of the toddler.
According to the autopsy report, the child died
as a result of blunt cranio cerebral trauma and elec-
trocution. Evidence of injuries to three separate
places on the child s head were found. Her brain
was also swollen and there was also evidence of
her choking on food particles.
Police said yesterday they have not yet classified
the death as murder.
According to police reports, the child was elec-
trocuted at her Upper Erica Street, Laventille home,
after a relative used live wires, cut from a fan, to
try to resuscitate her after she was found unre-
sponsive around 2.30 am Monday.
When the child was not revived she was taken
to the Port-of-Spain General Hospital where she
was pronounced dead on arrival.
Hospital sources said that her body was already
cold when she was brought in for treatment.
The T&T Guardian was informed that were it
not for the suspicion of the Casuality Department s
house officer, Dr Janet Charles, the baby s death
would not have been fully investigated. Sources
said Charles noticed what appeared to be scratches
near the child s nipples and overheard a mortuary
attendant saying that someone had tried to resus-
citate her at home. Charles examined the body
closer and saw what appeared to be rectangular
shaped impressions on the child s chest.
As a result, hospital authorities called in the
police and a forensic examination was ordered.
... Remove world's 2nd largest kidney tumour from patient
Doctors make history
n y n
for 08TH DECEMBER, 2015
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