Surgery
Cell-Enriched Fat Grafts Improve Long-Term Graft Retention in Breast Reconstructive Surgery
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In a study published in the journal Annals of Plastic Surgery, researchers examine the science behind cell-enriched autologous fat grafting and its application to cosmetic and reconstructive surgery. The results demonstrate a doubling in graft retention in cell-enriched grafts and provide insight into the mechanisms behind this improvement. The results reinforce both commercial observations and interim data from the RESTORE 2 clinical study that was presented at the San Antonio Breast Cancer Symposium in December 2009.
The preclinical results described in the paper support the potential clinical utility for cell-enriched fat grafts in cosmetic and reconstructive surgery. The key results include:
Long term retention of cell-enriched autologous fat grafts was increased two-fold over controls.
Sepsis campaign improving treatment of major killer
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A reduction in hospital mortality from severe sepsis and septic shock was associated with participation in the Surviving Sepsis Campaign performance improvement initiative, according to an article published simultaneously in the February issues of Critical Care Medicine and Intensive Care Medicine and posted ahead of print at http://www.ccmjournal.com.
“A multifaceted performance improvement initiative was successful in changing treatment behavior as evidenced by a significant increase in compliance with sepsis performance measures,” says lead author Mitchell M. Levy, M.D. “These results should encourage similar efforts with other evidence-based guidelines as a means of improving patient care and outcomes.”
“Application of two time-related bundles of care based on the Surviving Sepsis Campaign guidelines in a performance improvement program results in measurable behavior change in the care of patients with severe sepsis and septic shock,” adds Dr. Levy, a professor of medicine at Brown University School of Medicine in Providence, R.I. A “bundle” is a group of therapeutic actions, which applied together and measured for compliance, improve outcomes as compared to being applied individually.
Pain often persists years after breast surgery
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In a study of Danish women who had surgery for breast cancer, nearly half still reported pain 2 to 3 years later, according to a report in this week’s Journal of the American Medical Association.
“Our study supports previous smaller studies that chronic pain after breast cancer surgery and treatment is common and needs to receive more focus in the future,” senior investigator Dr. Henrik Kehlet from the University of Copenhagen, Denmark, told Reuters Health.
The findings stem from 3253 women who had surgery for breast cancer between 2005 and 2006 and who responded to a survey in 2009.
Is Surgery the Best Answer for Children with Sleep Apnea?
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For children with obstructive sleep apnea, standard care often includes a tonsillectomy and adenoidectomy. But researchers at Saint Louis University say further research is needed to determine if surgery is the best option for these patients.
“We know surgery is associated with improvements in children with sleep apnea, but this research will be the first to allow us to investigate whether or not the surgery causes those improvements,” says Ron Mitchell, M.D., professor of otolaryngology at Saint Louis University and the research study’s principal investigator.
“In the future, the information we gather from this study may help us know when to recommend surgery immediately and when it is most appropriate to wait and see whether the child will grow out of the problem. This will allow us to use healthcare resources more effectively.”
More MRI machines may mean more back surgeries
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A new study suggests that the increasing availability of MRI scanners may be feeding an increase in surgery for lower back pain—despite doubts about the effectiveness of surgery for most people.
Looking at MRI availability in 318 U.S. metropolitan areas, researchers found that Medicare patients with low back pain were more likely to get a scan when they lived in an area with more MRI machines.
Greater MRI availability was also linked to higher odds of getting lower back surgery, the investigators report in the journal Health Affairs.
Air pollution may trigger appendicitis
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A new study http://www.cmaj.ca/press/cmaj082068.pdf in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca suggests that air pollution may trigger appendicitis in adults.
The study, conducted by researchers at the University of Calgary, University of Toronto and Health Canada, looked at 5191 adults admitted to hospital in Calgary, Alberta, Canada. Fifty-two per cent of admissions occurred between April and September, the warmest months of the year in Canada during which people are more likely to be outside.
The dominant theory of the cause of appendicitis has been obstruction of the appendix opening, but this theory does not explain the trends of appendicitis in developed and developing countries. Appendicitis cases increased dramatically in industrialized countries in the 19th and early 20th centuries, then decreased in the middle and late 20th century, coinciding with legislation to improve air quality. The incidence of appendicitis has been growing in developing countries as they become more industrialized.
U.S. facing severe shortage of heart surgeons
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The U.S. is likely to face a severe shortage of heart surgeons in the next 10 years, say representatives from medical schools and thoracic surgeons’ groups.
Writing in the journal Circulation, Dr. Atul Grover of the Association of American Medical Colleges in Washington, DC and colleagues point out that the number of active cardiothoracic surgeons in the U.S. “has fallen for the first time in 20 years.”
More than half of today’s cardiothoracic surgeons are older than 50 years, and more than 15 percent are between the ages of 65 and 74 years, the researchers note.
Gastric bypass provides long-term diabetes control
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In more than half of obese patients with type 2 diabetes, their metabolic condition resolves after gastric bypass and they remain free from diabetes up to 16 years later, according to study findings presented last week at the 26th Annual Meeting of the American Society for Metabolic and Bariatric Surgery in Dallas.
In a study of 177 patients with diabetes who underwent gastric bypass for obesity, also referred to as bariatric surgery, between 1993 and 2003, the severity of diabetes before surgery was a key predictor of whether diabetes resolved in the long term. Moreover, long-term diabetes resolution correlated with the maintenance of weight loss.
“The most significant finding is that long-term resolution of diabetes seems to be linked to how severe the diabetes was at the time of surgery,” senior author Dr. James W. Maher, from Virginia Commonwealth University, Richmond, told Reuters Health. “Patients with diet-controlled diabetes had a 75 percent likelihood of being diabetes-free at long-term followup, while the figure was 65 percent diabetes-free in patients who were originally controlled with oral medications and only 28 percent of insulin-dependent diabetics had long-term resolution.”
Can Hormone Treatment Ease Post-Surgery Behavior Changes in Children?
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A scary unknown for many children, the prospect of surgery can cause intense preoperative anxiety. While some amount of stress is normal, what many parents do not know is that extreme anxiety before surgery can contribute to the occurrence of emergence delirium, a distressing incidence of acute behavioral changes experienced when “waking up” from anesthesia.
Now in the July issue of Anesthesiology, physicians focused on reducing anxiety in children and their families report that oral treatment with melatonin before surgery can significantly reduce the occurrence of emergence delirium in children.
Affecting up to 20 percent of children who undergo surgery, emergence delirium in the post-anesthesia care unit (PACU) consists of acute behavior changes including crying, thrashing and need for restraint. According to researchers, this can also lead to the development of behavioral changes outside the recovery suite with the onset of nightmares, bed wetting and separation anxiety.
ACL surgery an option for active older adults
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Active older adults no longer have to settle for a wobbly knee after injuring their anterior cruciate ligament (ACL), according to a new article in the Mayo Clinic Health Letter.
The ACL is the key ligament stabilizing the knee, and is especially important for holding the joint steady during jumping, pivoting and twisting. When a person ruptures the ACL—an injury typically accompanied by a loud popping sound and severe pain—it can be repaired using a piece of tendon from the leg or from a cadaver.
However, until fairly recently, ACL repair hadn’t been considered an option for people over 50, or even in some cases people in their 40s, according to the Health Letter article. Instead, these individuals would undergo physical therapy to restore strength and balance. Non-surgical treatment can improve knee function, but it doesn’t completely restore knee stability, so older patients had to curtail their activity levels.
Orthopaedic Surgeon Shortage Predicted Due to Soaring Joint Replacement Procedures
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In the near future, there may not be enough orthopaedic surgeons to provide joint replacements to all who need them. According to two new studies presented at the 2009 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS), the number of patients requiring hip or knee replacement surgery is likely to soon outpace the number of surgeons who can perform the procedure.
According to a study co-authored by Thomas K. Fehring, M.D., if the number of orthopaedic surgeons able to perform total joint replacements continues at its current rate:
• In 2016, 46 percent of needed hip replacements and 72 percent of needed knee replacements will not be able to be completed.
“I was somewhat shocked at the shortfall that we predicted,” says Dr. Fehring, an orthopaedic surgeon at OrthoCarolina Hip and Knee Center in Charlotte. “This is life-changing surgery, offering patients the chance to be mobile, and a very high percentage of patients may not be able to receive it.”
Gender affects outcome of heart valve surgery
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Men and women have different long-term outcomes after surgery to replace a defective heart valve, according to a report by Canadian researchers.
Valves play a critical role in making sure that blood flows only one way through the heart. Of the four valves present in the heart, the mitral and aortic valves are, by far, the ones most commonly replaced.
The mitral valve prevents blood that has come into the left ventricle, the main pumping chamber of the heart, from backing up into the blood vessels of the lungs, whereas the aortic valve stops blood that has just been pumped out of the heart from flowing back in.
Growth hormone treatment after weight loss surgery prevents loss of muscle mass
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Growth hormone treatment for six months after weight loss surgery reduces patients’ losses in lean body mass and skeletal muscle mass, according to a new study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM).
Weight loss surgery techniques, such as gastric banding, have been shown to be effective in reducing body weight and obesity-related diseases, such as diabetes. Although the results of these procedures are widely beneficial, there are some complications. Following surgery, patients are at risk of losing needed lean body mass and skeletal muscle mass due to the serious complications associated with rapid and sustained weight loss. This new study investigated whether growth hormone treatment could prevent or reduce these losses.
“Besides its more commonly known effect on linear growth during childhood, growth hormone benefits body composition throughout life by increasing muscle mass and reducing fat mass,” said Dr. Silvia Savastano, M.D., Ph.D., researcher at University Federico II of Naples in Italy and lead author of the study. “The results of our study show that the use of short-term treatment with growth hormone during a standardized program of low calorie diet and physical exercise is effective in reducing the loss of muscle mass and increasing the loss of fat mass after bariatric surgery.”
Delayed surgery may affect fracture recovery
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An elderly person who has fractured their femur - the large thigh bone that connects the leg to the hip - may want to have surgery sooner rather than later, according to a study linking longer times to surgery to a somewhat increased risk of post-surgery complications.
Dr. Rudiger Smektala from Ruhr University Bochum in Bochum, Germany, and colleagues used data from a study on hip fractures at 286 hospitals to determine whether elderly patients benefit from early surgical treatment for these common fractures.
Just over a quarter of patients had surgery within 12 hours of the fracture, 41 percent had surgery within 12 to 36 hours, and roughly 32 percent more than 36 hours after the fracture.
Botulinum Toxin Provides New Treatment Option
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For patients with an uncommon condition causing a swollen appearance of the lower face, treatment with botulinum toxin type A (Botox) provides an effective alternative to plastic surgery, according to a study in the November Journal of Craniofacial Surgery. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, pharmacy and the pharmaceutical industry.
Dr. Gianpaolo Tartaro and colleagues of Seconda Università degli Studi di Napoli, Italy, report on the use of botulinum toxin type A to treat patients with masseteric muscle hypertrophy (MMH). Patients with MMH have painless enlargement of the masseter (cheek) muscles, causing a swollen or “square-faced” appearance. The cause of MMH is unknown. In the past, the only treatment option was plastic surgery to remove part of the masseter muscle and/or jawbone.
Botulinum Toxin Provides New Treatment Option
Dr. Tartaro and colleagues used botulinum toxin type A to treat MMH in five patients—three women and two men, aged 46 to 56 years. Known by the brand name Botox, botulinum toxin is commonly used for cosmetic plastic surgery, including treatment of forehead wrinkles. Injected into muscles, the toxin blocks nerve transmission, causing those muscles to relax.
