Surgery
Degenerative cervical spine disease may not progress over time
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Follow-up data on patients with degenerative disease of the upper (cervical) spinal vertebrae show little or no evidence of worsening degeneration over time, according to a study in the February 15 issue of Spine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.
For many patients with “unstable” cervical degenerative spondylolisthesis, observation may be a better choice than surgery, according to the new research by Dr Moon Soo Park and colleagues of Medical College of Hallym University, Republic of Korea. They write, “Our results suggest that the majority of these patients may be stable and do not develop progression of disease or catastrophic neurologic deficits.”
Is Unstable Spondylolisthesis Really Unstable?
The researchers analyzed the “natural history” of cervical degenerative spondylolisthesis in 27 patients. Degenerative spondylolisthesis refers to “slipped” vertebrae caused by bone degeneration. Because spondylolisthesis is commonly thought to result in instability of the cervical spine, spinal fusion surgery (arthrodesis) is sometimes considered the appropriate treatment.
Surgical procedure appears to improve outcomes after bleeding stroke
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A minimally invasive procedure to remove blood clots in brain tissue after hemorrhagic stroke appears safe and may also reduce long-term disability, according to late-breaking research presented at the American Stroke Association’s International Stroke Conference 2013.
Of the hundreds of thousands of Americans who have intracerebral hemorrhages (ICH) each year, most are severely debilitated, said Daniel Hanley, M.D., lead author and professor of neurology at Johns Hopkins School of Medicine in Baltimore, Md.
ICH is the most common type of bleeding stroke. It occurs when a weakened blood vessel inside the brain ruptures and leaks blood into surrounding brain tissue, causing neurological damage. There is not a specific evidence-based targeted treatment recommended for ICH and there is no long-term randomized data on surgical treatment.
In one-year results of the Phase II study, MISTIE (Minimally Invasive Surgery plus rtPA for Intracerebral Hemorrhage Evacuation), researchers found that patients treated with surgery and a clot- busting drug had less disability, spent less time in the hospital and were less likely to be in a long-term care facility than other ICH patients.
Heart surgery safe in Jehovah’s Witnesses
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Jehovah’s Witnesses, whose religious beliefs don’t allow for blood transfusions, seem to do as well or better than other patients after heart surgery, new research suggests.
Doctors sometimes give heart patients a transfusion of red blood cells if tests show they have low levels of hemoglobin or hematocrit after the procedure to prevent severe anemia, despite some transfusion-related risks. Because Jehovah’s Witnesses don’t have that option, surgeons typically take extra pre-procedure precautions - such as giving patients B vitamins and iron - to ensure their red blood cell counts don’t get too low during surgery. And those precautions seem to be working, according to the new study.
“The current management strategy… does not appear to place patients at increased risk, and actually some of the complications are fewer,” said Dr. Colleen Koch, who worked on the study at the Cleveland Clinic. That could have implications for managing people who are okay with getting blood transfusions - but might be better off if they could avoid one, Koch said.
Gastric bypass for weight loss increases alcohol use, study says
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A major new study confirms previous sporadic reports that weight-loss surgery increases the risk of alcohol abuse, researchers reported Monday. In the second year after having a gastric bypass, technically known as Roux-en-Y surgery, patients were 30% more likely to have problems controlling their alcohol use, a team reported online in the Journal of the American Medical Assn. and at the annual meeting of the American Society for Metabolic and Bariatric Surgery.
Previous reports have suggested that alcohol abuse could be a problem following bariatric surgery, but the studies have been small and generally involved collecting data at some point after the procedure. In the new study, a team led by epidemiologist Wendy C. King of the University of Pittsburgh School of Medicine began studying 2,458 adults before they underwent bariatric surgery at one of 10 hospitals. Of those, 1,945 could be monitored for one to two years after the procedure.
The team found that 7.6% of the patients suffered from alcohol-abuse disorders (abuse and dependence) in the year before the surgery. At the end of one year after the procedure, the percentage was about the same, 7.3%. But by the end of the second year, the prevalence of such disorders had climbed to 9.6%, a 30% increase. Virtually all of the increase occurred in patients who had undergone gastric bypass, with no increase among the roughly 30% of patients who had a banding procedure.
Robotic Surgery Proves Successful, Less Invasive Way to Treat HPV-Related Oral Cancer
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Over the past few decades, doctors have noted a surprising trend in cancer of the tonsils and base of the tongue. Though oral cancer previously appeared predominantly in elderly patients with a history of tobacco and alcohol use, it’s increasing in younger patients: 30- to 50-year-old nonsmokers with the human papillomavirus (HPV). Fortunately, the newer form of cancer tends to be less aggressive, and the latest approach to treating the tumors can avoid the debilitating consequences of open neck surgery or extensive radiation. Robotic surgery conducted through patients’ mouths provides excellent results in removing squamous cell carcinoma at the back of the throat, especially in patients with HPV, a Mayo Clinic study published in the March issue of Mayo Clinic Proceedings found.
VIDEO ALERT: Additional audio and video resources, including excerpts from an interview with Dr. Eric Moore are available on the Mayo Clinic News Blog. The password is robotic.
“We were surprised that the cancer cure results were even better than the traditional treatments that we have been doing, but that is probably almost as much of a matter that these cancers are HPV-mediated for the most part, and they respond much better to treatment,” says author Eric Moore, M.D., a head and neck surgeon at Mayo Clinic in Rochester. “Importantly, the treatment preserved patients’ ability to swallow and their speech performance was excellent.”
Black Elderly More Likely than Whites to Die After Intestinal Surgery
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Black senior citizens who need surgery for the intestinal disorder diverticulitis are significantly more likely to die in the hospital than their equally ill white counterparts, even when each racial group carries the same health insurance, new Johns Hopkins research suggests.
While all of the patients in the study required surgery, black patients were 26 percent more likely than white patients to undergo riskier and more expensive emergency diverticulitis surgery rather than “elective” scheduled surgery for their condition, the Hopkins researchers found. The results emerged in a study of data from Medicare, the government health insurance for senior citizens.
Black seniors also spent more time in the hospital recovering from their operations and the costs of their stays averaged nearly $30,000 more than those of comparable white patients.
Scientists take steps to making “bionic” leg
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As 20-year-old Hailey Daniswicz flexes muscles in her thigh, electrodes attached to her leg instruct a computer avatar to flex its knee and ankle—parts of Hailey’s leg that have been missing since 2005.
Daniswicz, a sophomore at Northwestern University who lost her lower leg to bone cancer, is training the computer to recognize slight movements in her thigh so she can eventually be fitted with a “bionic” leg—a robotic prosthesis she would control with her own nerves and muscles.
“We’re really integrating the machine with the person,” said Levi Hargrove, a research scientist at the Rehabilitation Institute of Chicago’s Center for Bionic Medicine who is leading the project.
New tool helps surgeons predict patients’ risk of complications after bariatric operations
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A new risk calculator can predict the risk of postoperative complications occurring for individual bariatric surgery patients, according to a study published in the March issue of the Journal of the American College of Surgeons. The risk calculator will help in surgical decision-making and will help patients better understand what they can expect during recovery in order to prepare for a bariatric operation.
The study authors developed the risk calculator based on data from the American College of Surgeons’ National Surgical Quality Improvement Program (ACS NSQIP), which collected pre-operative through 30-day follow up data on patients undergoing an operation at 183 (year 2007) and 211 (year 2008) participant academic and community hospitals. Bariatric surgical procedures have proven successful in treating obesity and particularly in addressing related co-morbidities such as diabetes, hypertension, and sleep apnea. While the epidemic of obesity continues to plague America, its highly effective surgical therapy is underutilized due to concerns for surgical risk among patients and referring physicians.
The 2007 ACS NSQIP data used to develop the risk calculator included 11,023 patients, all undergoing bariatric procedures for morbid obesity. The 2008 dataset was used for validation. Recent heart attack or angina, stroke, high blood pressure, use of blood thinners, limited ability to perform basic activities of daily living, higher weight and the type of bariatric procedure, were found to be associated with increased risk.
Hepatic vein thrombosis following liver resection
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Patients undergoing liver surgery have long been considered to be at low risk of venous thromboembolism. However, pulmonary embolism has recently emerged as an increasingly frequent and potentially fatal complication following liver resections.
A research article published on January 21, 2011 in the World Journal of Gastroenterology addresses this question. The authors shed a new light on this discrepancy by reporting two patients who developed thrombi in their hepatic veins following hepatectomy.
The report indicated that thrombosis may occur in hepatic veins after liver resection as a result of intra- or postoperative local injury. This would explain why pulmonary emboli have been observed in the absence of peripheral deep vein thrombosis. This hazard should be taken into account when performing extensive coagulation of the raw surface of the liver when a major hepatic vein is exposed.
New Research Finds Delaying Surgical Procedures Increases Infection Risk and Health Care Cost
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Delaying elective surgical procedures after a patient has been admitted to the hospital significantly increases the risk of infectious complications and raises hospital costs, according to the results of a new study in the December issue of the Journal of the American College of Surgeons.
The occurrence of infection following surgical procedures continues to be a major source of morbidity and expense despite extensive prevention efforts that have been implemented through educational programs, clinical guidelines, and hospital-based policies. The authors of the study queried a nationwide sample of 163,006 patients, 40 years of age and older, from 2003 to 2007. They evaluated patients who developed postoperative complications following one of three high-volume elective surgical procedures: 87,318 coronary artery bypass graft (CABG) procedures, 46,728 colon resections, and 28,960 lung resections.
The infectious complications evaluated included pneumonia, urinary tract infections, postoperative sepsis and surgical site infections.
New surgery improves outcomes for severe flat foot deformity
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A surgery developed at Hospital for Special Surgery can improve patient outcomes in individuals with severe adult flat foot deformity, a problem that is increasingly being seen in hospitals across the country. Patients who undergo the new surgery have better long-term outcome and mobility than those who undergo traditional surgery. The paper will be presented at the annual meeting of the American Orthopaedic Foot and Ankle Society (AOFAS, abstract 348) in National Harbor, Md., on July 8.
“Before this study, we were not sure whether you could salvage patients with flat foot and ankle deformity and correct their ankle as well as their foot deformity,” said Jonathan Deland, M.D., chief of the Department of Foot and Ankle Surgery at Hospital for Special Surgery (HSS). “Now we know that with this technique you can save the ankle, and it provides a correction of the deformity even at nine years after surgery.” Dr. Deland developed the surgery and is senior author of the study.
Adult acquired flat foot deformity is basically a severe type of flat foot that develops for unknown reasons in individuals who have had flat feet all their life. It is more prevalent in women and those who are overweight, and it usually develops in individuals in their 40s and 50s. In stage I of the deformity, the tendon that runs along the inside of the ankle begins to degenerate. In stage II, the arch starts to fail, and a person develops a more severe case of flat foot. As the arch continues to collapse and the flat foot becomes more pronounced, mobility becomes difficult, and the foot becomes stiff, which is considered stage III.
New Cutting-edge Surgery Provides Relief for People with Foot Drop
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A new surgery that involves an expendable, functioning muscle from the top of the leg and a nerve below the knee can give people with foot drop a new bounce in their step.
“Foot drop is a condition where there is weakness in the muscles that raise the foot up at the ankle,” said Dr. Kevin Varner, an orthopedic surgeon with The Methodist Hospital in Houston. “People with foot drop are unable to clear their foot from the ground when swinging the foot forward. This condition is often very embarrassing and is usually caused by trauma such as a knee dislocation or penetrating injury that damages the nerve.”
People with foot drop can wear a brace that help pick their foot up, but it is often cumbersome. Another treatment is a tendon transfer, which involves moving the tendon from the back of the leg to the front and re-routing tendon function.
Obesity May be Evaded by Weight Loss Surgery
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Complication arising in pregnancy due to obesity can be evaded with weight loss surgery. If overweight women undergo weight loss surgery before they conceive, it may avert pregnancy complications.
It is known that women who are overweight have a high chance of developing complexities during pregnancy. One example of such complication is high blood pressure, or preeclampsia, which elevates the threat of premature birth and infant death.
Wendy L. Bennett, M. D., M. P. H., Assistant Professor of Medicine at the Johns Hopkins University School of Medicine and lead researcher evinces, “We have long known that women who have these blood pressure disorders are not only at an increased risk for pregnancy complications in themselves and their babies, but also for chronic diseases in the future” .
Complex spinal surgery jumps in U.S. elderly: study
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Older patients with lower back pain are increasingly getting more complex and costlier spinal fusion surgeries, resulting in higher rates of life-threatening complications and increasing costs for the healthcare system, U.S. researchers said on Tuesday.
A study of records from the federal Medicare program for the elderly and disabled between 2002 and 2007 revealed a 15-fold increase in the rate of complex surgeries to treat spinal stenosis - a common condition in the elderly in which the spinal canal narrows, causing pain in the back and legs.
And while the number of overall procedures to treat this problem dipped during the period, hospital charges for those surgeries rose by 40 percent on an inflation-adjusted basis, Dr. Richard Deyo of the Oregon Health and Science University in Portland and his colleagues reported in the Journal of the American Medical Association.
Obesity Epidemic leads to Bariatric Surgery and Post Bariatric Surgery
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The American obesity epidemic statistics are staggering. Nowhere else in the world is there a country with such a wide spread obesity problem. Approximately 11 million Americans are morbidly obese. Obesity and related problems are the leading cause of death in America. According to the American Heart Association at http://www.americanheart.org, 71% of non-Hispanic white men and 57.6% of women are overweight and of these 30.2% of men and 30.7% of women are obese. Of non-Hispanic blacks 67% of men and 79.6% of women are overweight and of these 30.8% of men and 51.1% of women are obese. Of Mexican Americans 74.6% of men and 73% of women are overweight and of these 29.1% of men and 39.4% of women are obese. Because of these staggering statistics, the prevalence of bariatric surgery is very high.
The benefits of bariatric surgery often outweigh the risks. Patients typically lose well over a hundred pounds. The health benefits are astounding, though the risks are high. With recent technological advances and changes in the way surgeries have been performed, the risks are slowly decreasing, but with old methods, serious problems exceeded 30% of those who underwent surgery. For those without complications though, bariatric surgery is a life giving procedure.
After losing over a hundred pounds, patients tend to notice the way their skin hangs in empty folds.
