Surgery
ACL repair often unnecessary: study
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Most people who tear the main ligament responsible for stabilizing the knee do not need surgery to rebuild it, according to a study in which researchers compared surgery to physical therapy.
“Our research showed that reconstruction of the anterior cruciate ligament (ACL), which is quite common, is not a prerequisite for restoring muscle function,” Dr. Eva Ageberg of Lund University, Sweden, told Reuters Health. She and her colleagues note that about half of Swedish patients who rupture the ligament undergo reconstructive surgery, while 90 percent of US patients do.
People who injure the ACL lose stability in the knee, boosting their risk of developing osteoarthritis. But despite widespread use of ACL reconstructive surgery, there is no evidence that patients who have the operations are any less likely to develop osteoarthritis.
‘Fantastic 4’ of breast procedures leave women extremely satisfied
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Injecting fat after breast reconstruction to correct implant wrinkling or dimpling may be safe and effective to improve breast shape, according to a study to be presented at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2008 conference, Oct. 31 – Nov. 5, in Chicago. Using fat injections for cosmetic breast enhancement; however, is still controversial and will be the subject of a panel discussion.
“My reconstruction patients could not be happier with the improvement fat transfer gives to the appearance of their breasts,” said Gregory Scott, MD, ASPS Member Surgeon and study co-author. “The initial implant reconstruction sometimes leaves them with contour deformities or wrinkling, but fat injections can correct these problems and give their breasts a smoother, softer, more natural appearance.”
The study looked at 21 patients who had 42 fat transfers for contour deformities or wrinkling. The injections were performed an average of 9.9 months following reconstruction. The fat was taken from the patients’ abdomen or upper thighs. The study found that fat injection to the breast for reconstruction is safe, improves breast shape, and corrects implant wrinkling.
Air pollution may increase risk of appendicitis
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Could there be a link between high levels of air pollution and the risk of appendicitis? New research presented at the 73rd Annual Scientific Meeting of the American College of Gastroenterology in Orlando, suggests a novel connection.
“Adult onset appendicitis is a common condition whose cause is unclear and almost universally requires surgery,” explained Dr. Gilaad G. Kaplan of the University of Calgary.
Dr. Kaplan and his colleagues identified more than 5,000 adults who were hospitalized for appendicitis in Calgary between 1999 and 2006. The team used data from Environment Canada’s National Air Pollution Surveillance (NAPS) monitors that collect hourly levels of ozone, nitrogen dioxide, sulfur dioxide, carbon monoxide, and particulate matter of varying sizes. Regression analysis was used to evaluate whether short-term daily changes in air pollution levels were related to the development of appendicitis.
Diabetes linked to poor weight loss with surgery
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Obese individuals with diabetes lose less weight with gastric bypass surgery than do their peers without diabetes, researchers at the University of California, San Francisco, report.
With gastric bypass surgery, a small stomach pouch is created, which limits food intake by making the patient feel full sooner after eating than he or she otherwise would. In addition, a portion of bowel is connected to the stomach, effectively bypassing the first portion of the bowel where most food absorption occurs.
The new findings, which appear in the Archives of Surgery, also indicate that a bigger stomach pouch leads to inferior weight loss.
Say ‘goodbye’ to back fat rolls
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Even as many of us yearn to wear the sheer, body-hugging fashions available today, we are stopped by our rear reflection and the sight of dreaded back fat rolls and lumps. A study published in the October issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS), reveals a new back lift procedure that removes these unsightly bumps and bulges while hiding the scar under the bra line.
“For many patients—even the very fit ones, such as an aerobics instructor—the upper to mid-line back where the rolls and bulges form was very frustrating,” said senior author Joseph Hunstad, MD and ASPS Member Surgeon. “This redundancy of skin occurs generally from aging and cannot be exercised away. For those who desire to wear form-fitting outfits, this procedure eliminates the problem.”
The study reviewed seven female patients who had the bra-line back lift between 2001 and 2007 with an average follow-up of 22 months. Pre-operative marks were placed to outline the patient’s brassiere, as well as delineate the excess back tissue to be removed. The procedure removed the redundant skin, sometimes up to 8 or 10 inches wide, and connected the remaining tissue together. According to the study, the procedure takes about an hour from start to finish. The authors have completed the bra-line back lift on 20 patients to date.
Chest Surgeons Propose Measures for Indicating Quality of Lung Surgery
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Even though 30,000 patients in the United States undergo lung surgery each year, no standard criteria exist to measure the quality of their care. In the current issue of The Annals of Thoracic Surgery, Mayo Clinic surgeons have proposed a system of lung surgery quality indicators for surgeons and the public as a method to demonstrate best practices for obtaining positive patient outcomes.
Death rates following surgery are frequently reported. However, because they aren’t adjusted for factors such as patient age and disease severity, they don’t tell the whole story. To overcome this lack of risk adjustment in death rate data, the Mayo Clinic team proposed patient-centered processes that should occur prior to, during and after surgery to assure the likelihood of best surgical outcomes.
“There are certain processes that we can measure and report that clearly indicate whether patients have received high-quality care around the time of their lung operation,” explains Stephen Cassivi, M.D., Mayo Clinic thoracic surgeon and lead study author.
How gastric bypass rapidly reverses diabetes symptoms
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A report in the September Cell Metabolism, a publication of Cell Press, offers new evidence to explain why those who undergo gastric bypass surgery often show greater control of their diabetes symptoms within days. It also helps to explain why lap-band surgery doesn’t offer the same instant gratification. By studying mice that have undergone both procedures, the researchers show that changes in the intestine are the key.
In addition to removing about two-thirds of the stomach, gastric bypass in effect produces a “double intestine,” said Gilles Mithieux of Institut National de la Sante et de la Recherche Medicale in France. The portion closest to the stomach is taken out of the loop so that it receives no nutrients. The segment normally farther down is then attached directly to the stomach, where it receives all the nutrients coming in.
In both cases, those positional changes ramp up production of blood sugar by the small intestine, Mithieux said. He noted that fasting normally induces blood sugar production by the upper small intestine. By placing the lower small intestine, which doesn’t normally produce much glucose, in close proximity to the stomach, it starts to act more like the upper portion.
Surgery May Be Considered for Extreme Face Pain
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A new guideline developed by the American Academy of Neurology finds surgery may be considered for people who suffer from extreme, electric shock-like pain in their face and do not respond well to drugs. The guideline on treating trigeminal neuralgia is published in the August 20, 2008, online issue of Neurology®, the medical journal of the American Academy of Neurology.
“There are very few drugs with strong evidence of effectiveness in treating trigeminal neuralgia,” said guideline author Gary Gronseth, MD, with the University of Kansas in Kansas City and Fellow of the American Academy of Neurology. “If people fail to respond to these drugs, physicians should not be reluctant to consider referring the patient for surgery. Often surgery is considered a last resort and patients suffer while the well-intentioned physician tries other medications with limited effectiveness.”
Trigeminal neuralgia is a chronic pain condition that causes extreme, stabbing pain throughout the face. The pain normally doesn’t last more than a few seconds or a minute per episode, but the episodes can last for days, weeks, or months and then disappear for months or years. The intense pain can be triggered by shaving, applying makeup, brushing teeth, eating, drinking, talking, or being exposed to the wind. It is more common in women than in men.
Rhinoplasty technique preserves ethnic identity
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African Americans who underwent a nose job, also referred to as rhinoplasty, reported a high degree of satisfaction with the results.
Rhinoplasty was conducted using a three-tiered approach that included an adjustment in nasal height and angle with a reshaping of the tip and a reduction in the width of the nose.
Dr. Oleh Slupchynskyj and Marzena Gieniusz analyzed questionnaires completed by 75 African American patients who underwent the procedure at their private practice, the Aesthetic Facial Surgery Center of New York and New Jersey in New York City.
Laparoscopic gastric bypass provides better results
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Performing gastric bypass surgery to reduce the weight of morbidly obese patients using a laparoscopic method, rather than the conventional more invasive “open” abdominal method, reduces postoperative complications, the need for a second operation, and shortens hospital stays, new research shows. Nevertheless, laparoscopic gastric bypass is more expensive.
Obesity surgery, also called bariatric surgery, is growing in popularity and more and more of these operations are being done using a laparoscope, note co-authors Dr. Wendy E. Weller, from the University at Albany in New York, and Dr. Carl Rosati, from Albany Medical Center.
This is done by placing one or more small incisions in the abdomen, through which a hollow tube is inserted. This allows very small instruments to be inserted to perform the gastric bypass. The entire procedure is visualized on a screen. In contrast, the more invasive “open” procedure involves making an incision to open the abdomen so the procedure can be performed.
Pioneering heart surgeon DeBakey dies at age 99
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Surgeon Michael DeBakey, whose ground-breaking heart transplants and coronary bypass operations made him one of the giants of 20th century medicine, has died at age 99.
The Baylor College of Medicine and Methodist Hospital said DeBakey died on Friday of natural causes. Methodist Hospital in Houston was his primary surgical hospital for many years.
In a career that spanned more than seven decades, DeBakey developed a number of new surgical procedures that now are standard in treating heart ailments and led many to consider him the father of modern cardiovascular surgery.
Neurologic Complications of Heart Surgery Detailed in Comprehensive Review Article
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Possible neurologic complications of heart surgery, ranging from headaches to strokes, are detailed in a new report in the online journal MedLink Neurology.
The review article, which compiled results of previously published studies, was written by Dr. Betsy Love and Dr. Jose Biller of Loyola University Chicago’s Stritch School of Medicine and Dr. James Fleck of Indiana University School of Medicine.
In the most comprehensive and up-to-date review of its kind, researchers list possible nervous system complications of bypass surgeries, cardiac catheterizations, valve replacements, heart transplants and surgeries for congenital heart disease.
Minimally Invasive Weight-Loss Surgery Improves Health of Morbidly Obese Teens
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Teenagers’ obesity-related medical complications improve just six months after laparoscopic gastric banding surgery, according to outcomes data presented this week. The preliminary results by physician-scientists from Morgan Stanley Children’s Hospital of NewYork-Presbyterian and Columbia University Medical Center were presented on June 17 at The Endocrine Society’s 90th Annual Meeting in San Francisco.
The study reports that the small group of extremely obese teenagers who received the minimally invasive surgery, also called the Lap-Band procedure, as part of a clinical trial lost an average of 20 pounds after six months and had significant improvements in abdominal fat, triglyceride measurements (levels of fat in the blood) and blood sugar levels as measured by hemoglobin A1c—all risk factors for diabetes and heart disease. The patients’ liver function and a measure of immune response also improved, according to the abstract.
“Extremely obese teenagers have obesity-related health problems, particularly diabetes and increased cardiovascular risk. Laparoscopic gastric banding, which has been shown to be a safe and effective way to lose weight, now offers the possibility of reducing obesity’s medical complications,” says lead author Dr. Ilene Fennoy, a pediatric endocrinologist at Morgan Stanley Children’s Hospital of NewYork-Presbyterian and clinical professor of pediatrics at the Columbia University College of Physicians and Surgeons.
Cosmetic surgery booming in Britain, study finds
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Britons might be feeling the pinch of the global credit crunch, but they’re still ready to pay thousands of pounds for cosmetic surgery, a report suggested on Monday.
Britain’s largest cosmetic surgery provider the Harley Medical Group said demand for procedures had grown by 35 percent over the past 10 months.
Abdomnoplasty or “tummy tuck” operations, a procedure costing nearly 5,000 pounds ($9,700), were up 59 percent, while breast augmentation surgery swelled 40 percent, it said.
Heart surgery deaths often preventable
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New research indicates that roughly one third of deaths that occur in the hospital after heart bypass surgery are preventable.
The findings also suggest that while overall death rates are convenient measures of hospital quality, they do not correlate with preventable deaths.
In light of these findings, Dr. Veena Guru, from the Institute for Clinical Evaluative Sciences in Toronto, and colleagues conclude that healthcare “providers should conduct detailed adverse event audits to drive meaningful improvements in quality.”
