India PM undergoes heart surgery

Mr Singh’s surgery comes just months before a general election in India

Doctors have begun heart bypass surgery on Indian Prime Minister Manmohan Singh after he was admitted to hospital in Delhi, Indian media report.

A team of six to eight surgeons was expected to operate on the 76-year-old leader, after two blockages were found in his arteries, officials said.

Mr Singh previously had bypass surgery in 1990 and an angioplasty in 2004.

The ruling Congress Party says he will still lead the party in the forthcoming general election which is due by May.

Mr Singh underwent tests earlier this week after he complained of chest pains.

He will have “coronary artery bypass graft surgery” performed by doctors from the All India Institute of Medical Sciences, India’s top state-run hospital, and the Asian Heart Institute in Mumbai.

Doctors say that there is “very little risk” associated with Mr Singh’s surgery and that the prime minister should be fit to resume normal duties in three to four weeks.

Succession speculation

This is not a good time for the prime minister to be removed from the political fray, given the tense relations with Pakistan in the wake of the Mumbai attacks.

Will Rahul Gandhi emerge as a successor to Mr Singh?

Congress has so far dismissed concerns that Mr Singh’s health would interfere with its current election campaign.

But there has been widespread speculation that party chief Sonia Gandhi has been lining up her son, Rahul Gandhi, heir to India’s powerful Gandhi dynasty, as the country’s next prime minister.

Mr Singh has largely been in good health since he was sworn in as prime minister in May 2004, but he recently underwent prostate surgery and has also had cataract treatment.

Mr Singh, who studied economics at Cambridge and Oxford, became India’s finance minister in 1991 when the country was plunging into bankruptcy, and is widely regarded as the architect of the country’s economic reform programme.

The quietly spoken economist-politician is also seen as the cleanest politician in India, a subject dear to voters’ hearts.

Government officials said that Foreign Minister Pranab Mukherjee will take charge of cabinet meetings during the prime minister’s absence.

Mums ‘accept natural birth risks’

About a quarter of UK births are carried out by Caesarean section

First-time mothers-to-be will accept greater risks than clinicians for a natural birth, research suggests.

A Sydney, Australia study also found the women prepared to accept higher pain levels, reports the British Journal of Obstetrics and Gynaecology.

Researchers asked 102 pregnant women and 341 midwives, obstetricians and other doctors what complications would make them choose a Caesarean section.

The journal editor said doctors were “biased”, having seen things go wrong.

This indicates that experiencing labour and attempting a normal birth are two very important priorities in women’s decision-making Professor Philip Steer Editor in chief, BJOG

Approximately one in four pregnancies in the UK ends in a Caesarean section, and most are offered in the face of potential complications such as the baby lying in the wrong position for natural birth.

But the Royal Prince Alfred Hospital study suggested that women, given an informed choice, were less likely than the professionals treating them to take a more cautious approach.

A total of 102 women, 84 midwives, 166 obstetricians, 12 urogynaecologists and 79 colorectal surgeons were interviewed to find out whether different complications would prompt them to choose a Caesarean.

Researchers asked them about mild complications such as a prolonged birth and superficial tears to severe problems such as anal and urinary incontinence, vaginal prolapse and severe tearing.

In all categories, the pregnant women were far more likely to be prepared to put up with complications in order to have a natural birth than their midwives or doctors.

Priorities

Study author Catherine Turner said: “Our study found that pregnant women were more likely to aim for a vaginal delivery, and they accept a higher threshold of risks from vaginal delivery when compared with clinicians.”

Professor Philip Steer, the journal’s editor in chief, said: “This indicates that experiencing labor and attempting a normal birth are two very important priorities in women’s decision-making.

“It may also indicate that doctors are biased by their inevitable involvement in complex cases, or labours where things have gone wrong.”

Belinda Phipps, chief executive of the National Childbirth Trust, agreed that health professionals could let their own negative experiences influence the recommendations they gave to women.

“If they’ve seen a traumatic birth, or been involved in a tragedy, there is no debriefing for them.

“It can mean they are more judgemental about the risks involved.”

She added: “I recognise that this is very difficult to avoid, but they need to realise that for most women, this is something that they feel it is important to do for themselves.”

Face transplant ‘double success’

This man had been attacked by a bear

Successful results from two more face transplants will speed progress towards similar operations in other countries, say experts.

The Lancet journal reported operations involving a bear attack victim in China, and a French patient with a massive facial tumour had taken place.

The Chinese patient was given not just the lip, nose, skin and muscle from a donor, but even some facial bone.

Specialists in London are working towards the UK’s first transplant.

Frenchwoman Isabel Dinoire became the world’s first face transplant patient in 2005 after being savaged by a pet dog. She described the results of the operation as a “miracle”.

The latest operations were just as complex, but involved different challenges for French and Chinese surgeons.

Face transplantation has moved from ethical debate to surgical reality French transplantation team

The first operation took place in April 2006. The patient was a farmer from a remote village in Yunnan province in China, who had been attacked by a bear 18 months earlier, leaving a huge section of tissue missing from the right side of his face.

The operation, at Xijing Hospital in Xi’an City, used the face of a 25-year-old man who had died in a traffic accident.

Despite immune-suppressing treatment, the patient had to battle his body’s attempt to reject the new tissue on three occasions.

His doctors said they now believed that face transplantation was a viable long-term option.

The second operation, carried out in Paris in January 2007, involved a 29-year-old man disfigured by a neurofibroma, a massive tumour growing on his facial nerves.

Its removal was timed to coincide with a face transplant, and a year later, doctors again declared the operation a success.

The patient told them that previously he had been considered a “monster”, but now felt like an anonymous person in the crowd.

The procedure, they said, had moved “from ethical debate to surgical reality”.

Moving forward

In the UK, surgeons at the Royal Free Hospital in London are making preparations to carry out the operation if the right combination of patient and donor becomes available.

Professor Iain Hutchison, a consultant oral and maxillofacial surgeon at Barts and the London Hospital, and founder of the “Saving Faces” charity, said that the twin successes would offer more encouragement for surgical teams considering carrying out their own operations.

He said: “This takes a step forward in two ways – firstly the use of bone as well as skin – and next is carrying out this operation on someone with a benign tumour.

“There will always be limitations to this – the main one would be a societal constraint – a lack of suitable donors.

“However, there is certainly demand for this, with the major area being for people with facial burns.”

Roger Green, president of the British Association of Plastic, Reconstructive and Aesthetic Surgeons, said: “This particular surgery is a way of giving back a life to a patient who has been horribly scarred by burns, trauma or a tumour.

“However, we must acknowledge the long-term medical risks, such as transplant rejection and the need for life-long medication, associated with the procedure. There is also the potential of psychological impact following such a transplant.”