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Entries in surgery (83)

Thursday
Apr192012

New Device May Lessen Need for Surgery for Kids with Scoliosis

Hemera Technologies/Thinkstock(NEW YORK) -- Ashley Crane, 24, had her first scoliosis surgery when she was 14.

“I had two surgeries, a week apart,” she said.  “I remember my spine was very unstable…then I had the rods and screws placed.”

For Crane, who today is a nursing student as well as a competitive tap dancer, two operations were enough.  But for most younger patients with scoliosis, many more surgeries await.

Scoliosis is an abnormal bend or curve in the spine that usually affects children and young adults.  For up to 80 percent of scoliosis cases, the cause is unknown.  More than 4 percent of the population is affected by scoliosis; however not all will require surgery.  For those who do, surgery can be extensive.

The reason spinal fusion doesn’t work well in young patients is that they are still growing.  Instead, doctors use adjustable rods that they can lengthen as time goes by.

It works, but it has a price -- these children and teens must undergo surgery every six months to lengthen the rods appropriately.  Because of this, these young patients may require half a dozen operations -- or even more.  Each of these surgeries requires full general anesthesia and re-opening of the old wounds to access the rods.

While this technique has proven successful and beneficial for many children afflicted by the disease, it is invasive, painful and requires multiple hospitalizations, which often keeps these children in the hospital and out of school.  With multiple procedures also comes an increased risk of complications and infections.

But hope may be on the horizon for these kids.

A new study released in the journal Lancet reports the results of a new device that has been developed to minimize the number of operations required to help straighten the spine of young children affected by severe scoliosis.

This device uses the same concept of the growing rod, but instead of relying on surgery for adjustments, the rods instead are lengthened non-surgically using magnets -- thus eliminating a great deal of pain and recovery time.

In the new study, researchers from Hong Kong report its use in five patients.  So far, two of these patients have gone two years after the initial surgery with good results and no complications.  The device was able to straighten their spines by an average of 38 degrees.

Most importantly, they required no additional operations.

“This is a huge advantage for kids because this technology does not require any additional surgery,” said Dr. John T. Smith, professor of orthopedics at the University of Utah.

Smith said that this technology is not yet being tested in the United States because of excessive Food and Drug Administration barriers, requiring much of this research to be done in other countries.

As of yet, there is no indication as to whether or when this technology will be available in the U.S.

Copyright 2012 ABC News Radio

Tuesday
Apr172012

Weight-Loss Surgery Cuts Type 2 Diabetes 

iStockphoto/Thinkstock(ROME) -- Bariatric surgery may be the best treatment for obese people who suffer from Type 2 diabetes, according to a new study published in the Archives of Surgery that found that the procedure improved diabetes outcomes when compared to patients who received standard medication therapy for the disease.

Researchers from the University of Rome in Italy conducted a study that included 60 morbidly obese patients with Type 2 diabetes. Half the patients underwent sleeve gastrectomy, a surgical procedure in which the stomach is reduced to about 25 percent of its original size.  The other half of the study participants received conventional medical therapy for type 2 diabetes.

Eighty percent of patients who underwent the surgery were cured of diabetes 18 months after the surgery, and their BMI, which averaged 41.3 before the procedure among the participants, was reduced to 28.3 after the study period.  A BMI of 30 or above is considered obese. But patients who received medication for the disease did not show improvement, and remained diabetic during and after the study period.

Researchers also noted that patients who underwent surgery saw improvements in blood pressure, cholesterol levels and obstructive sleep apnea.

Medically treated patients required more medication for blood pressure and cholesterol control over time.

“Midterm and long-term results are needed to confirm the positive effect (remission and/or improvement) of [laparoscopic sleeve gastrectomy] on diabetes and, overall, on the chronic complications of the disease,” the authors wrote in the study. “Most importantly, the longer-term results will allow us to compare the costs and benefits of bariatric surgery vs conventional medical treatments.”

But the patients in the study who simply received medication for treatment were not newly diagnosed patients, and Dr. Vivian Fonseca, president of the division of Medicine and Science with the American Diabetes Association, said it would have been better to see how newly diagnosed patients responded to the medications versus the bariatric candidates.

“They selected people who were already obviously not doing well on medication therapy, so it’s unrealistic expectation that the medication therapy is going to be able to stop after a while,” Fonseca said. “It would have been better to see newly diagnosed patients who seemed to be doing well on medications.”

The Italian study comes on the heels of two studies published last month that found bariatric surgery lowers blood sugar levels almost immediately in patients with type 2 diabetes even before patients lost weight. One study found 42 percent of patients who underwent the gastric procedure showed no evidence of diabetes one year later, compared to 12 percent who received medication.

There are currently 25.8 million adults and children in the United States living with diabetes, according to the American Diabetes Association, and about 1.9 million new cases of diabetes were diagnosed in people 20 and older in 2010.

By 2020, the ADA estimates that the annual cost in caring for diabetic patients will near $192 billion. A typical bariatric surgery runs between $10,000 and $15,000 in the United States.

Only about 2 percent of these patients are currently treated with bariatric surgeries, but experts say the cost-effectiveness must be studied further to understand whether these surgeries are appropriate for the masses.

“There are a variety of treatments available in terms of altering the GI tract,” said Dr. Gerald Bernstein, director of the Diabetes Management Program at the Friedman Diabetes Institute at New York’s Beth Israel Medical Center.

Nevertheless, Bernstein said, given the tens of millions of people who have diabetes, it is economically impossible to offer the surgery to everyone. But it is important for primary care physicians, endocrinologists and surgeons to work together to decide which Type 2 diabetes patients would benefit most from these surgeries.

“Doctors need to be sure they find patients who will make this surgery worthwhile,” Bernstein said. “If you’re going to do something like this that significantly changes the body, you need to make sure they have the motivation to follow doctor’s recommendations.”

“Right now, this is another tool and option in the arsenal for diabetes treatment,” he said.

Copyright 2012 ABC News Radio

Monday
Mar122012

Prescription Painkillers for Small Surgeries May Lead to Long-Term Use

iStockphoto/Thinkstock(TORONTO) -- Older adults who receive pain medications after surgery may be at higher risk of becoming addicted, according to a new study published in the journal Archives of Internal Medicine.

Physicians often prescribe opioids, including codeine and oxycodone, after outpatient surgeries.

While these drugs are proven to be effective for temporary pain relief, they are also associated with side effects including sedation, constipation and breathing problems, as well as addiction.

Researchers analyzed data from nearly 400,000 Canadian patients ages 66 and older who received an opioid prescription within seven days of undergoing surgery for cataracts, gallbladder removal, prostate tissue removal or varicose vein stripping.

What they found was that more than 10 percent of the patients who received an opioid after a surgery were identified as long-term opioid users one year after surgery. They also found patients were 3.7 times more likely to use non-steroidal anti-inflammatory drugs on a long-term basis if they received a prescription for the drug within seven days after surgery.

"We tried to look at what some of the events are that start people on the road to acute or chronic use of opioids," said Dr. Chaim Bell, associate professor of medicine at University of Toronto and co-author of the study. "It's much easier to prevent the initiation of the medication than wean people off it later. Everyone should get pain relief, but the painkiller and the dose should be tailored to the specific patient."

The findings align with the general experience of Dr. David Maine, director of the Center for Interventional Pain Medicine. He said the decision to start and prescribe an opioid at any time is a serious one. Treatment goals should be clearly defined when a prescription is first written, to ensure safety and effectiveness of the medication -- and to minimize the risk of addiction.

"Generally with older patients, if starting an opioid, we set up a short interval follow-up to ensure tolerability of the medication as well as efficacy," said Maine. "If either of those are an issue then we make a change. Sometimes that change is discontinuing the medication entirely. Ultimately, I think the decision to stop an opioid analgesic is as important as the decision to start."

Dr. Timothy Collins of the Pain and Palliative Care Program at Duke University Medical Center said the results of the study are surprising since patients who undergo such small surgeries should be finished with their pain medications after 10 to 14 days.

"Changes in the way pain medications are prescribed such as linking the pain medication to a specific outcome would help," said Collins. "Patients would have to have better function, or significant improvement on a pain scale, in order to continue on the medication. Frequently patients just say 'I feel better' or 'it helps some' but do not have any other evidence that the medication is actually helping them function better."

One in five American adults received a painkiller prescription in 2006, totaling more than 230 million total prescription painkiller purchases.

And in 2010, the Centers for Disease Control and Prevention reported that the number of fatal opioid poisonings more than tripled from 4,000 in 1999, to 13,800 in 2006.

Lack of communication between surgeons and family physicians may contribute to excessive painkiller prescriptions, along with the potential addiction and abuse of them, Bell said. Communication barriers, such as hearing or cognition deficits in older patients, also may hinder patients' understanding of when it is appropriate to taper a pain medicine or take it only on an as needed basis, said Dr. Doris Cope, director of the Pain Medicine Program at University of Pittsburgh Medical Center.

The study emphasizes the importance of tailoring patient education on a case-by-case basis, as well as the need for careful coordination of medical care among a patient's surgeons, doctors and caregivers, said Cope. Hopefully, she added, "this can be better achieved in the offices of busy primary care physicians."

Copyright 2012 ABC News Radio

Tuesday
Feb282012

Quadruple Limb Transplant Patient Dies

Keith Brofsky/Thinkstock(LONDON) -- The Turkish man who would have been the world’s first recipient of a quadruple limb transplant died Monday after doctors had to amputate the limbs because of “metabolic imbalance,” the hospital said in a statement.

On Friday, Sevket Cavdar, 27, received two arms and two legs after a 20-hour operation at Hacettepe University Hospital in Ankara, Turkey, to replace the limbs he lost in 1998 after he was electrocuted.

On Sunday, the doctors had to remove one leg when Cavdar’s heart and vascular system failed to sustain it. On Monday, they had to remove the other three limbs.

The Turkish Red Crescent, the Muslim equivalent of the Red Cross, dispatched hundreds of blood units from around the country after Cavdar’s lead surgeon, Dr. Murat Tuncer, called for blood donations to avoid possible complications.

Dr. L. Scott Levin, president of the American Society of Reconstructive Transplantation, told ABC News that it was likely that Cavdar went into shock after the attached limbs were deprived of adequate blood supply and began releasing metabolites in his body that damaged his circulation.

Even a single limb transplant is extremely taxing for patients, and Levin said the effort to give Cavdar four new limbs was particularly bold.

“In these transplants, there may be a threshold that we cross in terms of how much of a burden we put on a patient when we try to do more than one limb at a time. Perhaps the limit is two extremities and perhaps not more,” he said.

Copyright 2012 ABC News Radio

Wednesday
Feb222012

Surgeon Gave Teen Daughter Breast Implants

iStockphoto/Thinkstock(NEWPORT BEACH, Calif.) -- A California plastic surgeon is keeping it in the family by performing multiple cosmetic procedures on his own young daughters.

Dr. Michael Niccole, founder of the CosmetiCare Plastic Surgery Center in Newport Beach, Calif., gave his daughter Brittani, now 22, breast implants when she was 18. Brittani also had a rhinoplasty. Niccole performed surgery on his daughter Charm, now also 22, when she was 10 to turn her “outtie” belly button into an “innie.”

Dr. Niccole said he has performed surgery on other family members as well and felt comfortable operating on his daughters, both of whom are adopted.

“Who would give them the time -- that extra little look during surgery more than I would?” the surgeon said.

Brittani told 20/20 she wanted breast augmentation surgery to “build my self-esteem.”

“I didn’t have large breasts when I was younger, and all my friends did…I felt very self-conscious about it,” she said.

Both Brittani and Charm also receive regular injections of Botox to prevent wrinkles and undergo other cosmetic procedures.

Though critics say women Brittani and Charm's age have no business undergoing cosmetic procedures, Dr. Niccole defends his work on his daughters as “maintenance.”

“I’m not changing their looks in any means. They want maintenance,” he said. "They don’t want to get old. They want to stay young.”

Copyright 2012 ABC News Radio

Tuesday
Feb212012

Doctor Live-Tweeting Coronary Bypass Surgery

Keith Brofsky/Thinkstock(HOUSTON) -- Doctors tweeting throughout surgery and providing pictures and video is not new, but tweeting during open-heart surgery? That’s happening for the first time Tuesday.

Surgeons at Memorial Hermann Northwest Hospital in Houston are live tweeting a coronary bypass, complete with almost instantaneous YouTube videos and pictures of a beating heart.

Some of the pictures and video are already rolling into the hospital’s Twitter feed, @houstonhospital, but before clicking over, remember that the content is graphic, and includes images of the heart itself.

Dr. Michael Macis is conducting the two-hour bypass, wearing a helmet cam that snaps the photos and video, and sends them to a computer. Another camera in the operating room is also capturing images.

The patient’s name has not been released, but according to the Houston Chronicle, he is a 57-year-old male.

The surgery coincides with Heart Month. Memorial Hermann has arranged for a doctor on its staff to answer questions from the public through CoverItLive, which is embedded here.

Copyright 2012 ABC News Radio

Friday
Feb102012

Celebrity Voices Saved by Surgery

Kevin Mazur/WireImage(NEW YORK) -- Singer-songwriter Adele will take the stage at the Grammys on Sunday, giving her first performance since she had surgery in November for a vocal cord hemorrhage. Though operations have saved several famous voices in recent years, doctors say going under the knife is often a last resort when it comes to repairing vocal cords.

A vocal cord hemorrhage like Adele’s happens when tiny blood vessels feeding the vocal cords rupture and leak. Surgery can seal the blood vessels to prevent them from filling the vocal cords with blood, which make it difficult for them to vibrate.

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Recovering from the surgery is no small matter, especially for a performer who needs a booming voice to sing for millions of people. Dr. Kristine Tanner, clinical director of the University of Utah Voice Disorders Center, said Adele has likely had full use of her voice since early January. Usually after surgery for a vocal hemorrhage, patients completely rest their voices for one week, begin speaking lightly after two or three weeks and can gradually begin singing three to six weeks after surgery.

“Then you have to work back up to your previous endurance level, like going back to the gym after being out for six weeks,” Tanner said.

Vocal cord problems are an occupational hazard for many professional singers, recently plaguing the likes of John Mayer and Keith Urban, both of whom went under the knife to save their voices.

Performers who belt out songs to sold-out arenas, record tracks for new albums and use their voice for day-to-day speaking can develop polyps and nodules on their cords, keeping them from vibrating correctly when air passes over them. Doctors can detect these problems using imaging technology and scopes with cameras attached, and fix them with minimally invasive procedures, such as phonomicrosurgery.

But voice experts say surgery is often a last resort for a performer’s vocal troubles. Dr. Michael Benninger, chairman of the Head and Neck Institute at the Cleveland Clinic, has treated dozens of celebrity singers and public speakers. He said most doctors recommend other types of treatments to correct patients’ vocal troubles.

“We rarely have to do surgery on these patients,” Benninger said. “It is surprising how many high-profile performers that we see that behavioral modification is what they need.”

Formal vocal training, speech therapy, larynx massages and even changes in diet, alcohol use and other lifestyle habits can do a lot to alleviate exhausted, injured vocal cords, which can take as much of a beating as the muscles and bones of athletes. Often, these fixes are a better solution than surgery, Tanner said.

“It’s like a runner. You can operate on their ankle, but it would be preferred to change their form so they don’t continue to re-injure themselves,” Tanner said.

Copyright 2012 ABC News Radio

Friday
Feb102012

Knee Replacements Double in 10 Years, Study Says

Jupiterimages/Thinkstock(WASHINGTON) -- More Americans are getting total knee replacements than ever before, according to the first national estimate of the procedure’s frequency. In 2009 alone, the number of surgeries topped 600,000, twice the number of procedures of the past decade.

The numbers, presented Friday at a meeting of the American Academy of Orthopaedic Surgeons, are higher than expected – 4.5 million Americans currently live with total knee replacement in at least one knee, which is nearly 5 percent of the population age 50 and older. More than 5 percent of women older than 50 have had the procedure, compared with 4 percent of older men.

Knee replacements become more common with age, when the pain and discomfort of arthritis become more disabling for many people. According to the study, nearly 10 percent of Americans age 80 and older have had at least one knee replaced. Still, Dr. Elena Losina, the study’s senior author, said the rising numbers of knee replacement surgeries are coming from people in their 50s and 60s.

“The demographics of this procedure are changing. More and more younger people are undergoing the procedure,” Losina said.

As baby boomers age combined with the epidemic of obesity, the number of knees that wear out have grown. But Losina said those factors account for only about a quarter of the number of knee replacement surgeries. Instead, a growing number of knee injuries in middle-aged adults can lead to the early development of arthritis.

“It’s likely happening to people who are active and don’t want to be bothered by knee pain,” she said.

Advances in technology and improvements in surgical techniques have made the surgery more successful in recent years, although patients run the risk of infections and scar tissue development after the surgery. The procedure requires several days in the hospital, weeks of rehabilitation and costs about $40,000.

Currently, artificial knees, made out of metal and plastic, can last up to 20 years. But patients who get knees replaced at younger ages will probably need a revision surgery as they age and their new joint wears out.

“On average, we take 1 [million] to 2 million steps per year. That’s a lot of back and forth on that hinge. And patients who are younger and active can put significant force on that,” said Dr. Jason Koh, vice chairman of orthopedic surgery at the North Shore University Health System in Chicago. “But in terms of the value that you get from the surgery in terms of improvement in quality of life, this is one of the best ways we can use our health care dollars.”

According to the AAOS, 90 percent of people who have a total knee replacement will experience a dramatic reduction in pain and discomfort.

Losina said it’s likely that people who have a knee replacement at age 50 will need another one when they reach age 70 or 75.

“But the improvement in quality of life that we see with these procedures may way outweigh the potential for the need for another surgery down the road,” she said.

Losina said scientists need to do more research on the long-term outcomes of the procedures.

Copyright 2012 ABC News Radio

Thursday
Feb022012

Study Finds Possible Link Between Anesthesia and ADHD

Jupiterimages/Thinkstock(ROCHESTER, Minn.) -- Young children who undergo multiple procedures requiring anesthesia could be at higher risk for developing attention-deficit hyperactivity disorder (ADHD) later on, according to a new study published in the current issue of the journal Mayo Clinic Proceedings.

Researchers from the Mayo Clinic in Rochester, Minn., and Children's Hospital in Boston analyzed the medical records of more than 5,300 children previously enrolled in other studies.  They found that children younger than two years old who underwent more than one procedure that called for anesthesia were more likely to develop ADHD.

But Dr. David Warner, a co-author and professor of anesthesiology at the Mayo Clinic, stressed that the study only found an association between the procedures performed on the children in the study and ADHD.

"We need to do more work to confirm whether this is really a problem in children or not," he said.  "We can't exclude there is a problem, but we also haven't determined there is a problem."

The potential effects on the developing brain also remain unknown, he said.  Previous studies on young rodents found a link between anesthesia exposure and problems with learning and memory.  But while researchers are able to separate out the effects of anesthesia on animals by exposing them only to anesthesia, they cannot do the same in children, making it difficult to determine whether ADHD is related to the anesthetic drugs, to the specific procedures, or to other medical conditions.

"It's not normal for a one-year-old to have two surgeries before the age of two, so maybe there are some underlying conditions that leads them to have surgery," said Dr. Rod Eckenhoff, vice chair of research in the Department of Anesthesia and Critical Care at the University of Pennsylvania in Philadelphia.  Eckenhoff was not involved with the Mayo Clinic research.

Prior research on children has also linked surgical procedures to learning disabilities, autism spectrum disorders in children and the risk of deteriorating brain function in the elderly.

Copyright 2012 ABC News Radio

Tuesday
Jan312012

Re-Operation Rates Vary Among Breast Cancer Surgery Patients

iStockphoto/Thinkstock(CHICAGO) -- Women who undergo certain types of breast cancer surgery may be more likely to face subsequent surgeries, according to a new study published in the Journal of the American Medical Association.

Researchers found that nearly one in four women who undergo lumpectomies for breast cancer treatment end up having follow-up surgery to remove additional tissues. This procedure is known as a re-excision. But that rate of second surgeries varies greatly among surgeons and hospitals, researchers found.

Breast conservation surgery is one of the most common cancer surgeries performed in the United States. It is intended to remove cancerous and pre-cancerous tumor tissues while keeping the maximum aesthetic appearance of the breast.

Because of today's advances in chemotherapy, hormone treatment and radiation, many women do not need the entire breast removed. Instead, doctors are able to remove only the tumor and surrounding tissue, while preserving the breast itself.

But surgeons cannot know if the entire tumor has been removed until it is put under a microscope. Once the tumor is removed, a pathologist examines the rim of the tissue, known as a surgical margin, to be sure that it is free of cancer cells. A margin free of cancer cells is known as a "clear margin."

While effective, this process leaves the door open to the possibility that patients will have to go under the knife a second time to remove the rest of the cancerous tissue.

Researchers from Michigan State University analyzed data obtained from patient and medical records of more than 2,200 women who underwent a partial mastectomy. They found that more than 20 percent of the patients had to return for follow-up surgery to remove more tissue from the affected breast.

The second operation rates varied greatly among surgeons (from 0 percent to 70 percent) and institution (1.7 percent to 20.9 percent).

Authors suggest that there should be clearer literature that allows for comprehensive criteria on what is a "clear margin" of breast tissue.

"It appears there is a wide variation in how surgeons go about performing second operations following a partial mastectomy," said senior study author Dr. Laurence E. McCahill of the Richard J. Lacks Cancer Center in Grand Rapids, Mich. "About two-thirds of breast cancer patients will undergo a lumpectomy and about one-quarter will undergo a second operation."

Dr. Jay Harris, professor and chair of the department of radiation oncology at Harvard Medical School in Boston, said there is large variability in how much of a margin is needed.

Nevertheless, "the evidence is quite clear that for invasive cancer you only need two millimeters of clear margin, but many [surgeons] places aim for greater margins," Harris said.

Newer approaches to cancer treatments take several years to filter into general clinical practice -- and this could be one of the reasons for the varying statistics, said Dr. Daniel Kopans, professor of radiology at Harvard Medical School.

"There is a great deal of art involved in breast surgery and there is also a great deal of variation between cancers," Kopans said.

There are several questions that are left unanswered from the study, including the size of the cancers, what kind of imaging was used to guide the surgery, and how the cancers were found, he said.

Copyright 2012 ABC News Radio







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