Entries in surgery (83)


Ohio Boy's Leg Reattached Backward After Cancer Surgery

Dustin Smith(FOSTORIA, Ohio) -- Watching Dugan Smith pitch, it is easy to imagine he is like any other 13-year-old on the baseball field.  He's one of the best players on his team, and it's only a limp that causes him to favor his right side that hints that something might be wrong with his leg.

Look closer, and it becomes apparent that Dugan's right leg is on backward, with his ankle is where his knee would ordinarily be -- the result of a rare surgery that allowed him to survive cancer, and play ball with his teammates.

Dugan, from Fostoria, Ohio, was 10 years old when he limped for a different reason.  He chalked it up to some knee pain from baseball practice, but after a battery of tests and doctor visits, Dugan received a sobering diagnosis: He had osteosarcoma, a cancerous bone tumor that usually develops during adolescence.

After 10 weeks of chemotherapy while wearing a full cast on his right leg, doctors gave several options for surgeries and treatments.  But Dugan, now 13, could think of only one thing: baseball.

So Dugan decided on a rare surgery called Van Nes rotationplasty in which the infected part of the leg is removed, and the remaining limb below the cancerous portion is rotated 180 degrees and reattached, with the ankle acting as the knee.  His other options included full amputation or a surgery that would replace his femur, or thighbone, with a cadaver or metal bone.

Doctors told the family that an amputation above the knee would require Dugan to use about 75 percent more energy to walk or run than with a normal leg.  With the rotationplasty, it would take only about 30 percent more energy.

Dr. Joel Mayerson, an associate professor of orthopedic surgery and director of the musculoskeletal oncology at the James Cancer Hospital at Ohio State University College of Medicine, performed the surgery on Dugan.

The procedure took 21 hours.  Doctors fused the bones together and sewed together muscles and blood vessels.  Dugan's toes could then slide into the prosthetic, which acts as the lower half of his right leg.

Only about a dozen rotationplasties are performed in the United States each year.

Copyright 2011 ABC News Radio


Major Surgery May Be Unnecessary for Cancer Diagnosis, Study Finds

Duncan Smith/Thinkstock(PARIS) -- A new study says there is an easier way of diagnosing the extent of illness for uterine cancer patients.

Patients with early-stage breast cancer no longer need to have a large number of lymph nodes removed to test for the spread of their cancer.

Now a study in the journal Lancet Oncology finds the same may be true for women with early uterine cancer.

The ongoing research was carried out on 133 women in France.

It concludes that a biopsy on a smaller number of what are called sentinel lymph nodes can diagnose with high accuracy whether the cancer has metastasized. That means women with early uterine cancer don't need to have all their pelvic lymph nodes removed -- greatly reducing the risk of complications such as painful swelling.

In a comment accompanying the study, the journal's editors say the new method could be a "win-win scenario: a more conservative procedure and a more sensitive means" to identify women at high risk and select them for proper therapy.

Copyright 2011 ABC News Radio


Study: Teens Lose Bone Mass After Gastric Bypass Surgery

Jupiterimages/Thinkstock(CINCINNATTI) -- Many adults who have gastric bypass surgery suffer bone loss in the years after their operation, and a new study shows the same thing happens to adolescents.

Researchers led by Dr. Anne-Marie Kaulfers, then a clinical fellow in endocrinology at Cincinnati Children's Hospital Medical Center, looked at 61 adolescents who had Roux-en-Y gastric bypasses.  A Roux-en-Y bypass involves making a small pouch from stomach tissue and attaching it directly to the small intestine, bypassing most of the stomach and the first part of the small intestine, called the duodenum.

They found teens suffered 5.2 percent bone loss a year after surgery, which increased to 7.4 percent after two years.  However, obese teens already have an above-average amount of mineral mass in their bones, so even though they lost more than seven percent of that mass, it decreased to the same amount that normal-weight teenagers have.

The study stopped two years post-surgery, so the researchers don't know whether the decline continues beyond that point.  "However, if bone loss continues, even at a slow rate, these patients may have an increased risk of fractures later in life," the authors wrote.

While some specialists say the findings aren't new because other studies showed similar results in adults, others say the study draws attention to one of the big risks of gastric bypass surgery.

"This study is very important because we all know that there are consequences to rapid weight loss, and bone loss has been a concern in adults and now we know that it happens in adolescents," said Dr. James Geiger, surgical director of the C.S. Mott Children's Hospital Comprehensive Weight Management Program in Ann Arbor, Michigan.

Experts say it's important to learn more about bone loss in younger people who have a gastric bypass in order to determine why it happens, what the long-term consequences are and how possibly to reverse bone loss.

Copyright 2011 ABC News Radio


Transgender Woman Sues New York over Genital Surgery Law

BananaStock/Thinkstock(NEW YORK) -- Joann Prinzivalli's New York City birth certificate still reads: Paul Joseph Prinzivalli Jr., male, even though she transitioned to a woman more than a decade ago.

She attempted a transition from man to woman in the 1970s, fully prepared to have genital surgery, but her psychiatrist rejected her request.

Prinzivalli, now 57, eventually changed her name and has legal documents -- a driver's license and a Social Security card -- but her birth certificate doesn't match.

She wants to take the final step to secure her identity, but the New York City Health Department has demanded she have sex reassignment surgery -- on her genitals.  Thirty years ago, she was healthy enough, but today Prinzivalli is morbidly obese and has type 2 diabetes, high cholesterol and a blood disorder that would make surgery dangerous.

She is now one of three transgender New Yorkers who are challenging the city in a lawsuit, saying that requiring surgery amounts to discrimination.

The lawsuit was filed by the Transgender Legal Defense and Education Fund (TLDEF) in the state Supreme Court, arguing that many transgender people cannot afford the surgical procedures.  They say a doctor's verification that they have fully transitioned is enough.

The federal government allows transgender Americans to change their gender marker on their passports and Social Security accounts with a doctor's certification that the person has had appropriate clinical treatment.

"When transgender people are forced to present an ID that does not match, they are laughed at and turned away at the DMV or applying for a job," said Noah Lewis, the TLDEF lawyer who is defending the New Yorkers.  "The cost is prohibitive for some people and insurance often denies those claims.  Some people feel that surgery is not necessary or appropriate for them."

The New York City Health Department requires written proof, "satisfactory to the department that the applicant has undergone convertive surgery," which it defines as genital surgery.

"We are very sympathetic to the petitioners' concerns and recognize that this is a complex issue," wrote Gabriel Taussig, chief of the New York City Health Department's administrative law division, in a statement.  "The health department must be satisfied that an applicant has completely and permanently transitioned to the acquired gender prior to the issuance of a new birth certificate."

Copyright 2011 ABC News Radio


Lap Band Surgery Might Not Be the Solution for Super Obesity

Jupiterimages/Thinkstock(BRUSSELS, Belgium) -- Almost half of the patients who have elected to have lap band surgery for obesity eventually need to have the devices removed due to erosion or other malfunctions, researchers say.

Morbid obesity is a serious health condition that can interfere with basic physical functions such as breathing or walking.  It can also lead to reduced life expectancy.

A laparoscopic adjustable gastric band, commonly referred to as a lap band, is an inflatable device that is placed around the top portion of the stomach, via laparoscopic surgery, in order to treat obesity. 

A new study has assessed the long-term effectiveness and safety of such banding for for morbid obesity.  Dr. Jacques Himpens, of Saint Pierre University Hospital in Brussels and colleagues, evaluated 82 patients with an average age of 50 within 12 years after having the surgery. 

The researchers reported in the Archives of Surgery that although the average excess weight loss after 12 years was about 42.8 percent, a third of the patients experienced band erosion while half of them had to have the bands removed. 

Based on these findings, the authors concluded that gastric banding may have poor long-term outcomes.

Gastric banding has come under scrutiny and a number of previously published studies have reported similarly poor long-term effects.

Copyright 2011 ABC News Radio 


Girl With Rare Facial Deterioration Saved by Surgery

Photo Courtesy - Getty Images(MADISON, Wis.) -- Christine Honeycutt's battle with a rare disease started about six years ago with something doctors and her mother thought was nothing more than a birthmark.

"I noticed a small line in her forehead.  It looked like she ran into a door jamb," said Vicki Honeycutt, Christine's mother.

Doctors told Honeycutt not to worry too much.  They gave her cream to put on it, instructed Christine, then only 5 years old, to stay out of the sun and said it would eventually fade away.

Over the years, despite doctors' reassurances, the line only got darker and deeper and one summer, after moving from North Carolina to southern California, Honeycutt noticed something else.

"One day, I kissed her ear and then she rolled over and her right ear was in my face. I noticed her left ear was half the size of her other ear, and also that her nostril on her left side looked like a baby's nostril," she said.

After a visit to another pediatrician, numerous tests and then a consultation with a genetic specialist the pediatrician recommended, Honeycutt had a diagnosis: Parry-Romberg Syndrome, a rare condition that progressively causes the skin and tissue of one side of the face to waste away.  The degree of atrophy varies from person to person.  No one knows what causes the disease and there is no cure.

Patients with Parry-Romberg may also have neurological symptoms, such as seizures and severe migraines.  Honeycutt said Christine had a seizure when she was seven and also suffered from severe pain in her face as well as bloody noses.

Even though the condition has no cure, that wasn't going to stop Honeycutt from trying to save Christine's face, despite the fact that numerous doctors told her there was no hope.

There have been case reports that methotrexate, a cancer drug, stopped Parry-Romberg's progression.  But it didn't work for Christine, who has since moved back to North Carolina with her family.

After the unsuccessful treatment with methotrexate, Honeycutt found Dr. John Siebert, professor of surgery at the University of Wisconsin School of Medicine in Madison.  Siebert has performed a special type of microsurgical reconstruction on about 120 people with Parry-Romberg Syndrome.

He operated on Christine on Nov. 15.  The surgery involved taking tissue from the area under her arm near where her breast would be and transplanting it into her face.  Siebert said the tissue already had working blood vessels.

Siebert said Christine's first surgery went well.  She will have to have another surgery in the spring for what he calls "fine tuning."  He'll remove some of the extra tissue that's caused some swelling. 

Copyright 2011 ABC News Radio


Gastric Bypass More Effective than Lap Band in First Year

Photo Courtesy - Getty Images(SAN FRANCISCO) -- A new study published in the Archives of Surgery suggests that gastric bypass surgery is more effective than the lap band in helping morbidly obese people lose weight.

Researchers at the University of California in San Francisco studied 200 patients, 100 of whom chose to undergo gastric bypass and 100 who opted for a lap band. The study found that after a year, those who had a gastric bypass lost an average of 64 percent of their excess weight, compared to 36 percent for those with a lap band.

Gastric bypass was also more effective in the resolution of diabetes, at 76 percent, compared to the lap band, at 50 percent.

However, experts have cautioned about the validity of the results, given that it can take up to three years to see the full effect of lap band surgery.

Copyright 2011 ABC News Radio


Spina Bifida: Babies May Do Better With Prenatal Surgery

Photo Courtesy - Getty Images(PHILADELPHIA) - A new study suggests children with spina bifida, a sometimes-debilitating birth defect in which the spine fails to close around the spinal cord during the first months of pregnancy, may do better in the long run if they have surgery before they are even born.

Researchers from nearly a dozen centers nationwide compared nearly 200 babies with spina bifida, half of whom underwent surgery in utero, while the other half underwent surgery after birth. They found that after one year, those who had surgery before birth were 30 percent less likely to need follow-up surgeries than infants who had surgery after birth.

"This is a big breakthrough. For the first time we can show a clear cut benefit, treating a non-life-threatening malformation by repairing it before birth," said Dr. Scott Adzick, chief of surgery at Children's Hospital of Philadelphia and first author of the study published Wednesday in the New England Journal of Medicine.

Spina bifida is often detected five to seven months after pregnancy begins. Surgeons can go inside a pregnant woman's uterus and gently stitch up the open spinal cord of the developing fetus. This stops the leaking of spinal fluid and spares a child brain and nerve damage.

Seven out of 10,000 babies in the U.S. are born with spina bifida and often require immediate surgery after birth to avoid complications, according to the Spina Bifida Association.

Copyright 2011 ABC News Radio


'Am I Going to Wake Up?' Scientists Continue to Analyze the Effects of Anesthesia

Photo Courtesy - Getty Images(CAMBRIDGE, Mass.) -- Modern medical advancements could put patients more at ease when going under anesthesia, but scientists are only now researching the effects of the drug on the brain.

A patient’s fear of waking up while under the knife could be calmed by modern developments such as brain monitors that can gauge levels of consciousness. Such developments, however, underscore the complex science of keeping patients free from consciousness and pain without killing them.

The use of general anesthesia is a routine part of surgical operations at hospitals and medical facilities around the world, but the precise biological mechanisms of the drug's effects on the brain are only now being analyzed.

In a review article published this week in the New England Journal of Medicine, scientists have for the first time used a range of disciplines, including neuroscience and sleep medicine, to lay the groundwork for better understanding of how anesthesia actually works.

Armed with the new information, doctors can speak more frankly and knowledgeably to patients.

"The biggest concern among patients is, "Am I going to wake up?" said lead study author Dr. Emery Brown, an anesthesiologist at Massachusetts General Hospital and professor at Massachusetts Institute of Technology. "That happens extremely rarely but it's a fear everyone has. I think the way to assuage the fear is to know what we are doing. But we can't continue to comfort people if it's a black box and I assure you it's not going to go wrong."

Among the most common misconceptions given by doctors to patients regarding anesthesia is the idea that they are being put to sleep. General anesthesia, however, is a reversible coma. Brown said doctors often tell their patients they are putting them to sleep in hopes of scaring them less.

Copyright 2010 ABC News Radio


Toxic Butt-Boosting Injections: Why Is It Still Happening?

Photo Courtesy - Getty Images(NEW YORK) -- It's not the first time patients have allegedly been harmed by a risky, unapproved approach to a larger, curvier backside -- and it probably won't be the last.

So say cosmetic surgeons in response to the latest news of another untrained practitioner -- this time a 28-year-old model in New Brunswick, N.J. -- facing charges of practicing medicine without a license in offering butt-boosting injections, according to reports this week in the Star-Ledger.

Anivia Cruz-Dilworth allegedly injected six women in the buttocks with silicone bathtub caulk in March. The women reportedly showed up in hospital emergency rooms complaining of problems, several requiring surgery to treat serious bacterial infections.

Illegal butt-boosting procedures have sent other women to the hospital in recent years as well. Cosmetic surgeons said the occurrence of such procedures is evidence that much of the public remains uneducated about the difference between the risky, unapproved practice and legitimate cosmetic surgery.

"This is a real problem, especially with the slow economy," said Dr. Julius Few, commissioner of cosmetic medicine for the American Society for Aesthetic Plastic Surgery.

"More people are trying to achieve an enhancement, all over the body, the 'easy way,' and large volume silicone injections to the buttock is an example. It seems easy, you see the change right away, and it is cheap because industrial-grade material is used, not medical."

Buttock augmentation was up 37.5 percent in 2009 from the previous year and buttock lifts were up 34.6 percent, according to the American Society for Aesthetic Plastic Surgery.

Copyright 2010 ABC News Radio

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