Entries in surgery (83)


Protein-Free Diet May Make Surgery Less Risky

Jupiterimages/Thinkstock(CAMBRIDGE, Mass.) -- Doctors usually tell their patients not to eat or drink the night before surgery.  But there’s new evidence that food consumed weeks before an operation could affect how the body responds to the stress of surgery.

A new study found that mice fed a protein-free diet seemed to be protected from complications after surgery.  The findings, published in the journal Science Translational Medicine, could give scientists new insight into how to prevent common complications from surgery -- such as heart attacks and strokes -- in humans.

Harvard researchers studied two groups of mice, feeding one group a protein-free diet for up to two weeks before surgery, and letting the other group eat normally.  The researchers then operated on the mice, using techniques that put their kidneys and livers under added stress.

About 40 percent of the mice who ate normally died after the surgery; all of the mice on the protein-free diet survived.

Previous studies in animals have shown that restricting the diet is one way to help the body cope with stress and stay healthy.  Study author James Mitchell, an assistant professor at the Harvard School of Public Health, said he and his team were hoping to find out just which elements of the diet can help or hinder the body’s response to stress.

“Surgery, by its nature, is traumatic to the body,” Mitchell told ABC News.  “With changes to the diet, we’re getting the body ready for an acute stress like surgery.  If we can do that, the complications might be less severe or there might be fewer complications.”

Although the study tested only mice, the trauma their bodies experienced after the surgery is similar to what humans can experience, said Dr. Stavros Memtsoudis, an anesthesiologist at the Hospital for Special Surgery in New York City.

“But the human body is very complex, more complex than mice.  How one change affects all other organs is very unknown,” Memtsoudis said.  “Nevertheless, this opens up a whole new concept that should be investigated.  Nutrition is a very nuanced intervention before surgery that should be paid attention to.”

Copyright 2012 ABC News Radio


Can Giving Drugs to Breast Cancer Patients Before Surgery Save Lives?

Comstock/Jupiterimages(NEW YORK) -- Breast cancer is difficult to treat and, once treated, the potential for recurrence looms large.  So instead of just treating breast cancer after it returns, there is also great research interest in giving drugs prior to surgery.  The hope is that if they can shrink the tumor before the surgery, it will reduce the chance of recurrence and hopefully extend patients lives.

In research released Wednesday in the New England Journal, two studies suggest that Avastin, a drug recently taken off the market for use in metastatic breast cancer, might have potential to shrink breast tumors before surgery.

The studies were conducted in Europe and North America.  The European study enrolled 1,948 patients.  The results were particularly interesting for a group of patients suffering from a form of “triple negative” breast cancer, which is less common but more aggressive.  Dr. Gary Lyman of Duke University, who was a member of the Food and Drug Administration panel that voted to remove Avastin’s approval for metastatic breast cancer, says that this group of patients represents 15,000 to 20,000 of all 200,000 newly diagnosed cases of breast cancer.

According to the study, patients with this type of breast cancer that received Avastin along with standard therapy had greater rates -- about 11 percent -- of complete tumor disappearance.  However, researchers noted that Avastin resulted in a greater rate of toxic effects such as high blood pressure, skin reactions and infections.

The North American study enrolled 1,206 patients and also showed that patients receiving Avastin significantly increased the rate of complete tumor disappearance, by 6 percent.

Dr. Stefan Gluck of the University of Miami says, “We oncologists need to assess and chose very wisely. Triple negative cancers are usually very aggressive and not sensitive to chemotherapy, so the addition of Avastin can help at least temporarily.”

Dr. Lyman agrees and says, “Women in earlier stage of disease should be considered candidates, although we haven’t learned which specific patients will benefit the most.  The results of these studies do not improve overall survival but can be given to patients prior to surgery to reduce tumor burden and improve surgical outcomes.”

Most experts concur with this sentiment and recommend that further studies showing improvement in survival are necessary.

Copyright 2012 ABC News Radio


Five-Second Rule? Medics Drop Heart but Transplant Proceeds

Keith Brofsky/Thinkstock(MEXICO CITY) -- During a moment caught on tape that is sure to make a few cringe, medics in Mexico are seen bumbling, then dropping, a heart on the ground intended for a 20-year-old female heart recipient.

Medics arrived at the Mexico City hospital by helicopter dragging a blue rolling cooler. They are seen running toward a hospital entrance, as reporters stand outside, documenting the transfer. Amid the rush, one medic trips, catching the cooler with his foot. The cooler then flips, spilling its contents, including the organ (wrapped in yellow plastic) onto the ground. The medics hastily put the heart back into the cooler before running inside.

The head of Mexico’s Institute of Social Services said the drop did not affect the organ and the procedure continued on despite the stumble.  Doctors who conducted the transplantation reportedly want to wait 72 hours before confirming that the surgery was a success.

“Because it would have been under multiple other sterile layers and seemed to be nearly at the point of the planned transplant it is very unlikely to have had any significant adverse impact beyond embarrassment,” said Dr. Stephen Bartlett, chairman in the department of surgery at the University of Maryland School of Medicine. “They were appropriately hurrying.  Bungee cords around the cooler can help keep the cooler closed during times when things are bouncing around in turbulence in the helicopter and when they are running.  No harm done but this will stay on Youtube for a while.”

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Copyright 2012 ABC News Radio


Why So Many Vocal Cord Surgeries for Award-Winning Singers?

Kevin Mazur/WireImage(LOS ANGELES) -- For some of today's most powerful young singers, vocal cord issues have them "rolling in the deep."

The health of singing sensation Adele's raspy voice, which propelled her into superstardom and has made her a favorite to sweep the Grammys next month, was threatened last year. Weeks after her Sept. 22 concert at Albert Hall in London, the singer/songwriter had surgery to repair her vocal cords and save her career. She hasn't sung publically since her surgery.

But the 23-year-old isn't the only young singer to go under the knife to help save her voice. John Mayer, 34, was operated on last year, as was 44-year-old country star Keith Urban.

Singers are suffering from polyps, nodules and even hemorrhaging in their throats, the kind of severe damage that can shut down any booming voice, according to Dr. Shawn Nasseri, an otolaryngologist in Beverly Hills who treats many of the biggest money-making singers in the music business today.

It takes the coordination of the lungs, diaphragm, neck, voice box, throat and mouth to produce a voice, but it's when the vocal cords are brought together and vibrate that a pitch and tone are produced. Nasseri said for a singer suffering from a hemorrhaging polyp on their vocal cords, similar to what Adele had, the polyp can keep the two vocal cords from meeting and give the person "absolutely no voice."

Nasseri said these kinds of injuries are not attributed to genetics, but happen because of a specific vocal technique that singers are doing wrong -- forcing or straining their voice when they should be resting it.

"It's like if you have a bruised, swollen ankle and you want to go run 10 miles, that's exactly when you're going to have trouble," he said.

Problems are easily developed when high demands are placed on popular singers by the new realities of the music business, which is now so dependent on touring, traveling and keeping an active public profile.

And it's not just the career demands that can take its toll on singers, but also lifestyle choices -- cigarettes, alcohol and even acid reflux can cause long-term voice problems.

Soul singer John Legend, 33, said he has grown mindful of the importance of looking after his voice.

"I've certainly been no stranger to having issues with my voice," he said. "My first year performing was the worst year because I didn't know how to pace myself, and once I started to understand how it worked, I started to pace myself better."

When the vocal cords are damaged, Nasseri said minimally invasive surgery, the type Adele underwent, heals wounds with minimal risk.

"But we always use surgery as a last option, because everyone knows about Julie Andrews' voice," he said.

Andrews, the star of the original "The Sound of Music" and "Mary Poppins" films, lost her singing voice after a 1997 surgery. Her story remains a cautionary tale to other musicians. Recording artist Celeste Prince is slowly making a comeback after, she said, vocal problems and subsequent surgery ruined her signature raspy sound and threatened her career. Since her recovery Prince said she was "relieved" to get her voice back.

Vocal coach Roger Love, who has worked with almost everyone in the music business from Gwen Stefani to Def Leppard, said he prefers to heal damaged vocal cords without surgery.

"Why would anyone want surgery?" Love said. "If I tell the artist that I can eliminate those calluses that are on their cords by teaching them how to sing better, who's going to take the knife? In my view the vocal cords are never better after surgery."

Love said he will lay down the law of good vocal practice with his top-tier singing clients, starting with proper vocal warm-up exercises before shows.

Copyright 2012 ABC News Radio


FDA Targets Risks from Reused Medical Devices

Keith Brofsky/Thinkstock(WASHINGTON) -- Having any medical procedure can cause anxiety for patients. But should they worry about the cleanliness of reused medical tools? Some medical instruments are used many times over in routine surgical procedures.
Devices such as clamps and forceps are reused repeatedly in surgery, as are endoscopes, which allow doctors to see inside the body during exploratory procedures such as colonoscopies. These devices get "reprocessed" or high-level cleaning, disinfection and sterilization.

But the Food and Drug Administration (FDA) says there have been occasions where patients have been exposed to blood, body fluids and tissue from other people on reusable devices that were not adequately reprocessed. While instances of infections being transmitted were rare, the potential for infection is there.
Now the FDA is working with health care providers, manufacturers and other agencies to set standards for reprocessing, to make sure the maker's directions for disinfecting and sterilizing are clear and that hospital staff follow those instructions.
For now, however, the FDA says there's no need to cancel or reschedule your medical procedure.

Copyright 2011 ABC News Radio


Full Face Transplants: A Cutting Edge Closer Look

Face transplant recipient, Dallas Wiens, speaks at a press conference with Dr. Bohdan Pomahac (L) in Boston, Massachusetts in May 2011. Adam Hunger/AFP/Getty Images(BOSTON) -- Surgeons lift the face off one person and transplant it onto another person. Sounds like a scene out of a John Travolta and Nicholas Cage movie.

But when Dr. Bohdan Pomahac, director of plastic surgery and transplantation at Brigham and Women's Hospital in Boston, performed the first full face transplant in the nation, he transformed a science fiction concept into reality.

Now, he says, there's no going back.

"I think it's important for people to realize this is becoming a reproducible technique," said Pomahac.

Pomahac recalled feeling uncertain about the procedure when he received the file of his first patient in need of a full face transplant. Dallas Weins, 25, a construction worker from Dallas, Texas suffered severe burns to his face two and a half years ago when the boom lift he was operating drifted into a high voltage power line.

After 22 surgeries, Wiens was left with a face void of features, except for a lipless mouth and a goatee. Even his eye sockets were smoothed over with skin taken from other parts of his body.

Pohomac looked at the chart of the potential face transplant recipient and thought the risks were high.

"I was worried the defect was too extensive," said Pohomac. "I was worried that his nerves were damaged to the point that we wouldn't be able to reconnect them."

But Wiens was young, and his face could be repaired back to the way it was should something go wrong.

"We don't want patients to end up with worse deformity than before if the face is rejected," said Pohomac.

There was even a donor face that matched, so he became the perfect candidate for the procedure. Screening and preparation took months.

"It's the most extensive consenting I've ever done," he said.

Since 2005, 18 patients have received facial transplants, most of them designed to restore partial face defects. But Weins' case became the first procedure out of three Pomahac performed this year to replace a full face.

Pomahac called the novel technique a "unique way to simplify anatomy." Facial tissues are extracted from the donor as one block, including the skin and underlying muscles and nerves and reconnected to the recipient. In Wiens' case, the nasal bone was also transferred.

Pomahac reports on Wiens and the two other full face transplant patients in an article published Wednesday in the New England Journal of Medicine.

Within four hours, the patients recovered sensation and movement in their faces.

"All patients had postoperative infections of differing severity, and they all recovered," the authors wrote. But the procedure is not exactly science fiction come to life.

The surgeons expected the recipients wouldn't look like themselves before their injuries, and they also expected that the facial changes they would experience as their new faces molded onto their frames would keep them from looking like their donors.

"We anticipated that the underlying skeleton and facial volume would shape the final facial appearance, making resemblance to the donors unlikely," the authors wrote. "It is our subjective opinion, as well as that of two of the donor families, that the patients do not look like their donors."

With each patient, the surgeons refined their technique to cut down on the small revisions that were originally necessary after the initial surgery.

Each patient's surgery was described in separate televised press conferences that Pomahac says may have made the procedure seem like isolated cases that were difficult to reproduce. But his team is working to make the procedure accessible. Pomahac said one patient is now listed for the transplant and waiting for a suitable donor.

"We can do it now so much better than the first cases," said Pomahac. "The extent of how it will be used is undetermined, but it's here to stay."

Copyright 2011 ABC News Radio 


FDA Approves Berlin Heart for Kids

Keith Brofsky/Thinkstock(WASHINGTON) -- Friday the U.S. Food and Drug Administration approved the Berlin Heart for pediatric patients waiting for heart transplants. The ventricular assist device is similar to the one worn by former Vice President Dick Cheney but scaled down for children and babies.

"Without that device I wouldn't have my son," said Traci Shaffer, whose 9-year-old son Lane survived 16 months on the Ohio transplant waiting list because of the Berlin Heart.

Lane was born with a defect that caused his heart to swell and eventually fail. With no donor heart on the horizon, Lane needed a Berlin Heart. But because it was still unapproved in the U.S., it was hard to get.

"The doctors said, 'This is experimental, it's not FDA-approved, and here's the thing: You might not even get it in time,'" said Shaffer, who lives in Philadelphia, Ohio.

Lane's doctors had to ask the FDA for emergency access to the Berlin Heart under a provision called compassionate use. Only after approval could they order the device from Germany, bringing the wait time up to seven days.

"The child has to be on death's door before you can even apply for it," said Shaffer, adding that Lane was given seven-to-10 days to live when they started the process. "We've seen kids that couldn't wait seven days. It's very scary."

Lane weighed 35 pounds when his Berlin Heart arrived at the Cleveland Clinic in May 2010 -- his ribs visible through pale skin as he lay curled up in the fetal position. But after the nine-hour procedure to implant the device, Lane started to improve.

"Immediately after the surgery I could see the color of his skin had changed," said Shaffer. "His feet were no longer white and cold; they were pink and warm. His cheeks were rosy. That was the moment when you say, 'This is working.'"

The FDA's decision to approve the Berlin Heart means hospitals can stock the device in a range of sizes -- from walnut-size pumps for babies to fist-size pumps for teens.

"I will sleep better knowing there's a Berlin Heart sitting here in the Cleveland Clinic," said Dr. Gerard Boyle, a pediatric cardiologist at the Cleveland Clinic. "In the middle of the night, if we have a device here we can support the patient immediately."

The Berlin Heart is a temporary fix, though. Like Lane, kids who receive it will ultimately need a heart transplant.

"For families with a child who needs a heart transplant -- and there are enough of those -- we can say, 'We'll try to get a heart, but while we wait we have a plan,'" said Boyle. "This device gives us confidence that the number of patients who die waiting will decline dramatically."

Lane used the Berlin Heart until December 2010, when his parents got the call that his new heart had been donated.

Now Lane weighs 75 pounds, loves sports and motorcycles and is "eating his family out of house and home," according to his mom. But he's not out of the woods yet. He'll have to take anti-rejection drugs for the rest of his life, and he might eventually need another heart transplant.

But Lane, the boy with the "biggest blue eyes and smile you have ever seen," is staying positive and living life to the fullest, Shaffer said.

"I couldn't wait to tell him about the FDA approval because it's something he's been praying for and wanted since day one," said Shaffer, describing her phone call to Lane when she heard the news. "He screamed in my ear and said, 'You're kidding me! No more kids have to die, mom!'"

Copyright 2011 ABC News Radio


At-Home Robots Monitor Kids After Surgery

Jupiterimages/Thinkstock(BOSTON) -- It sounds like a plot straight out of the futuristic sitcom The Jetsons -- robots that tend to and monitor patients recovering from surgery. But such a scenario is no longer science fiction.

Doctors at Children’s Hospital Boston have sent robots home with children after their surgeries as part of a pilot program designed to use technology to make post-surgical care easier, more efficient and less costly.

The $6,000 robot is essentially a teleconferencing system on two wheels, with cameras, audio gear and video screens that allow Children’s Hospital Boston doctors to check on their young patients once they’re home, and talk with parents or caregivers about their care.

Dr. Hiep Nguyen, director of Children’s Hospital’s Robotic Surgery Research and Training Center, said he wanted to improve post-surgical care for his young patients by marrying Star Wars-style technology with a medical custom that has gone the way of the phonograph player and the VCR: a doctor’s house call.

A high-speed 4G connection allows doctors in Boston to remotely control the 4-foot-6, 17-pound robot’s functions and maneuver it around the patient’s home.

Children’s Hospital Boston has five of these robots, made by visual communications and robotics company VGo Communications, and has sent them home with eight patients so far, as reported by the Boston Globe. But the project is the beginning of what the hospital hopes will be an expanding program that combines robotics and telemedicine to improve care.

The Boston robot program is a first in health care and the latest example of the growing use of telemedicine.

When critical care doctors are in short supply, for example, some hospitals use eICU programs in which intensive care specialists in central control centers use cameras, computers and audio equipment to keep an eye on critically ill patients in several different hospitals.

A camera system called NicView allows parents to keep an eye on their newborns in neonatal intensive care units, using $1,000 webcams attached to a baby’s crib and encrypted passwords that parents and faraway relatives can use to log on and keep track of the baby’s condition over the Internet.

UMass Memorial Medical Center is one of a few hospitals that use NicView, and Maureen Guzzi, nurse manager of the UMass neonatal ICU, said the technology helps parents feel connected to their newborns, who may be in the hospital for three weeks or more.

Charlie Kemp, director of the Healthcare Robotics Lab at the Georgia Institute of Technology, said patients can expect these technologies to start popping up throughout the health care system as technology becomes less expensive and more refined, and telecommunications infrastructure more reliable.

As the robot program at Children’s Hospital Boston progresses, Nguyen’s goal is for the robots to become even more involved in patient care -- taking blood samples for diabetics or testing lung function in children with asthma. Doing so could mean that patients leave the hospital earlier, saving doctors and patients time and money, he said.

Copyright 2011 ABC News Radio


Smoking Could Cause You to Lose Your Nipples

Zoonar/Thinkstock(DETROIT) -- One plastic surgeon has given his patients yet another reason to give up cigarettes: Smoking could make their nipples fall off during cosmetic breast surgery.

When Dr. Anthony Youn, who practices in Detroit, warned his patients of this possible surgical outcome, he wasn’t just trying to scare them.

“I’ve actually seen it happen,” he told ABC News.

In his memoir, In Stitches, Youn described a smoker whose nipples began to turn dark purple during breast lift surgery, indicating that the tiny veins in her breasts were failing to keep blood flowing properly.

Cosmetic surgeries like breast lifts and breast reductions alter the blood flow to these body parts as it is. But Youn said the nicotine and carbon monoxide from cigarettes could strangle blood flow even more. Body parts that don’t receive blood flow turn from purple to black -- to dead, he said.

“Among plastic surgeons, this is a very well-known complication,” Youn said. “If patients don’t stop smoking for three to four weeks before and after the surgery, they put themselves at risk for major problems.”

The risk is not only for breast surgeries. The American Society of Plastic Surgeons recommends that patients stop smoking well in advance of any cosmetic procedure. In 2009, a report to the American College of Surgeons noted that smoking could complicate the management of anesthetic during any surgery and also hinder a patient’s recovery.

Youn said patients who didn’t kick their smoking habits while undergoing nips and tucks were at a high risk for wounds straight out of a horror movie.

Smoking can, for example, damage or kill the skin of the face after a face-lift, leaving exposed tissue. Smokers getting a tummy tuck could see the skin and fat of their abdomens die off, “leaving a big crater,” Youn said.

Even secondhand smoke could lead to these complications, which can result in months of recovery and a couple thousand dollars in extra medical expenses.

Youn said he found that the most effective way to get his patients to kick their smoking habit was to tell them the truth about these very real risks.

“Smokers are addicted, and unfortunately, in order to get them to stop smoking, sometimes you have to shock them,” Youn said. “And many of my patients say, ‘Thank you so much for telling me this because now I really am going to quit.’”

Copyright 2011 ABC News Radio


Fire Erupts on Florida Woman’s Face During Routine Surgery

Keith Brofsky/Thinkstock(CRESTVIEW, Fla.) -- A Florida woman was rushed by helicopter to an Alabama burn center after her face caught fire during routine surgery.

Kim Grice, a 29-year-old mother of three, was having cysts removed from her head at an outpatient surgery center in Crestview, Fla., when the flash fire erupted.

“A flash fire is basically a fire that flashes up and then goes out,” Crestview Fire Department Chief Joseph Traylor told ABC News.  “The fire was already out when our staff arrived.”

Grice was treated at the North Okaloosa Medical Center before being flown 90 miles to the University of South Alabama in Mobile, Ala., with burns to her face and neck.

The cause of the fire is still under investigation, but surgical fires are usually sparked by heat -- often from tools like lasers -- and then fueled by alcohol, surgical drapes and oxygen.  Grice was wearing a non-rebreathable oxygen mask, according to Traylor.

In October, the U.S. Food and Drug Administration launched an initiative to curb surgical fires through increasing awareness and promoting risk reduction practices.

“There are between 550 and 650 surgical fires a year,” said Mark Bruley, vice president for accident and forensic investigation for the ECRI Institute, adding that fewer than 30 of them result in patient injuries.

The frequency of fires is on par with other surgical mishaps, like wrong-site surgery or retained instruments, according to the ECRI Institute.

Grice was in stable condition and talking to her family when she was transferred to the Alabama burn center, according to Rachel Neighbors, a spokeswoman for the North Okaloosa Medical Center.

Copyright 2011 ABC News Radio

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