Rosemont, IL – Risk factors for venous thromboembolism after total hip replacement (THR) surgery were identified in a new study published in the September 2010 issue of The Journal of Bone and Joint Surgery (JBJS). While the rate of thromboembolism has been significantly reduced through medication, understanding the risk factors could further reduce the likelihood of patients developing this potentially fatal complication.
Two of the most common manifestations of a thromboembolism include:
* Deep vein thrombosis (DVT), in which the blood clot forms in a deep vein, commonly in the thigh or calf; and
* Pulmonary embolism (PE), in which the blood clot breaks free and travels through the veins.
Any surgery often carries the risk of a thromboembolism, especially orthopaedic surgery involving the lower extremities, like the hip or knee. Because of this risk, THR patients are usually treated with medications designed to prevent it from occurring. Despite that, this study found that approximately 1 percent of patients who took the medication still suffered a DVT or PE within 90 days of surgery. Read the rest of this entry »
Botulinum Toxin May Offer Temporary Drooling Relief in Children With Neurological Disorders
Chicago — Botulinum toxin treatment appears to offer a temporary, short-term solution to relieve drooling in children diagnosed with certain neurological disorders, according to a report in the September issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
“Recent estimates suggest a prevalence of [drooling in] nearly 60 percent in children in special care school, of which 33 percent could be classified as severe,” the authors write as background in the article. “Depending on the associated neurological disorder, cognitive abilities and oral motor function, affected children may experience anything from stigmatization and social neglect to numerous daily clothing changes, perioral dermatitis [skin irritation around the mouth], aspiration pneumonia or even dehydration.”
Arthur R. T. Scheffer, M.D., of Radboud University Medical Center, Nijmegen, the Netherlands, and colleagues studied 131 children diagnosed as having cerebral palsy or other non-progressive neurological disorder, and who also had moderate to severe drooling, to test the efficacy of botulinum toxin when used as a treatment for drooling in children with neurological disorders. For the injection of the toxin, children were under general anesthesia and the injections were limited to the submandibular glands, which are responsible for 70 percent of resting saliva production. The sublingual glands and parotid glands were not treated.
Of the 131 children participating in the study, 77 were boys and 54 girls with an average age of 10.9 (age range was 3 to 27 years). About 90 percent of the patients were diagnosed as having cerebral palsy. The researchers developed a drooling quotient to assess the severity of drooling, and this measurement served as the primary measure for both efficacy and duration of botulinum toxin treatment. At the two-month follow-up, the average drooling quotient had decreased from 28.8 (on a scale of zero to 100) at the start of the study (baseline) to 15.5 and 61 patients experienced a 50 percent reduction in the drooling quotient from baseline. At the eight-month follow up, the drooling quotient increased slightly to 18.7, but the authors noted there was still a significant difference compared to baseline assessment.
Additionally, patients benefited from the botulinum toxin injection for an average of 22 weeks and 25 percent of initial responders (11.3 percent of entire population) still showed a clinically significant response to the treatment after 33 weeks, with a handful of patients experiencing continued relief from drooling after one year. “Secondary beneficial effects following injection included improved oral hygiene (reduced perioral dermatitis or reduction in halitosis) in four patients (3.1 percent) and improved speech in another four patients. These effects generally disappeared after eight months.”
The authors conclude that their findings “indicate that most patients who initially respond well to injection can expect an effect to last between 19 and 33 weeks. Although the 46.6 percent success rate might appear low, its safety and efficacy make botulinum toxin a useful first-line invasive treatment if conservative measures have failed.”
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Louisville, CO – Sound Surgical Technologies, a leading manufacturer and distributor of ultrasonic body contouring technologies, announced the launch of VASER Shape MC1, a non-invasive ultrasound and massage system. Most well-known for the VASER Lipo® System, Sound Surgical Technologies has expanded its product line to include both minimally invasive devices for aesthetic body contouring and non-invasive systems to smooth and shape the body by temporarily reducing the appearance of cellulite and increasing local blood circulation.
“The VASER Lipo System has revolutionized the way surgeons approach fat removal, and we’re excited to add an effective non-invasive tool to the VASER product line,” said Daniel S. Goldberger, CEO of Sound Surgical Technologies.
VASER Shape MC1 received FDA clearance in May 2010 for relief of minor muscle aches, pain and muscle spasms, temporary improvement in local blood circulation, and temporary reduction in the appearance of cellulite. VASER Shape can be used alone or in combination with surgical body contouring procedures to minimize postoperative pain and swelling. The VASER Shape MC1 device is derived from a technology known as MedContour™ outside of the US, which has been used by hundreds of physicians to achieve excellent results.
“This new technology is the perfect complement for existing body contouring and liposuction procedures,” said Dr. Paul Zieg, Board Certified Plastic Surgeon at Zieg Plastic Surgery Center in Henderson, KY. “The VASER Shape MC1 System allows physicians to target specific problem areas for maximum results, while leaving the surrounding tissues unaffected.”
The VASER Shape MC1 technology was designed to allow physicians to tailor each treatment to the needs of the patient. Multiple handpieces provide a combination of ultrasonic diathermy (the application of high-frequency sound waves for local heat therapy) and zonal lymphatic massage. Physicians can also choose between multiple program settings that allow for a gentle postoperative session or more aggressive therapy for non-surgical results.
“VASER Shape is an excellent non-invasive option for patients who do not want a surgical procedure,” said Dr. Michael Nagy, F.A.C.S., Personal Enhancement Center in Toms River, New Jersey. “Most patients undergo a regimen of 4 to 5 total treatments, and many notice an improvement after just a single session.”
Bariatric Operations Reduce Odds of Gestational Diabetes
Obese women who undergo bariatric procedures before pregnancy are three times less likely to have gestational diabetes
Chicago – Obese women who have bariatric surgical procedures before pregnancy were three times less likely to develop gestational diabetes (GDM) than women who have bariatric operations after delivery, according to new research findings published in the August issue of the Journal of the American College of Surgeons. The retrospective study also found that delivery after bariatric procedures was associated with reduced odds of cesarean section—an outcome associated with GDM.
Gestational diabetes affects at least seven percent of all pregnancies in the United States, with rates as high as 14 percent among certain populations. Its prevalence is increasing among reproductive-age women, parallel to increasing rates of obesity and type 2 diabetes. Currently, 33 percent of women over 19 years of age meet the criteria for obesity (body mass index [BMI] > 30 kg/m2) and seven percent for extreme obesity (BMI > 40 kg/m2). Bariatric surgical procedures are the only intervention shown to produce sustained weight reduction in the vast majority of subjects.
“The major finding of our study is that women who had bariatric surgery before they delivered reduced odds of gestational diabetes when compared with women had bariatric surgery after they delivered,” said Anne E. Burke, MD, MPH, assistant professor of obstetrics and gynecology at the Johns Hopkins University School of Medicine in Baltimore, Md.
- Before and After a bariatric surgical procedure
“Despite a growing body of evidence supporting the safety and efficacy of bariatric surgery in reversing obesity-related complications, few candidates for the procedure are referred to a surgeon to discuss their options,” stated Martin Makary, MD, MPH, associate professor of surgery at Johns Hopkins University School of Medicine and senior author of the study. Read the rest of this entry »
London – The British Association of Aesthetic Plastic Surgeons, welcomes the news from the Medicine and Healthcare products Regulatory Agency (MHRA) that the gel inside controversial PIP implants shows no evidence of chemical or genotoxicity (potential for cancer). The BAAPS, the not-for-profit organisation established for the advancement of education and practice of Aesthetic Plastic Surgery for public benefit, reiterate that any ruptured implants, of any kind, will still need removing.
A study earlier this year found that the company making the low-cost PIP implants, which has since gone into administration, not only dispensed with a protective shell from 2005 but was also using an untested gel, apparently intended for use in mattresses. Further tests are still being conducted by the French Competent Authority (AFSSAPS).
According to consultant plastic surgeon and BAAPS President Nigel Mercer:
“We would like to praise the MHRA for their proactive response in conducting safety tests and are delighted with the results – that there is little risk to patients from the gel. Hopefully this will reduce the anxiety of patients whilst further studies are expected from France. Our advice remains that women with suspected rupture contact their surgeon and undergo an ultrasound and removal, as they would with any ruptured implant.”
Arthroscopic Surgery to repair torn shoulder muscles in the elderly can reduce pain
Chicago – Repairing torn shoulder muscles in elderly patients is often discouraged because of fears of complications. But a new study conducted at Rush University Medical Center has shown that minimally invasive, or arthroscopic, surgery can significantly improve pain and function.
The study has just been published online in Arthroscopy: The Journal of Arthroscopic and Related Surgery and will appear in the October issue.
“In people over the age of 70, pain is the main issue, and pain relief is a fairly reliable outcome after surgery,” said orthopedic surgeon Dr. Nikhil Verma, who led the study. “Patients do not require that their shoulder function be fully restored. They just want the pain to be gone.” Verma is assistant professor of orthopedic surgery at Rush.
With that requirement, Verma said, “age is not a contraindication” for the surgery.
Tears in the rotator cuff, the complex of four muscles that stabilize the back of the shoulder joint, occur in about 20 percent of the population over the age of 65 and typically result from chronic degenerative changes. The tears in the musculature cause considerable pain and loss of range of motion.
Surgeons impact whether a woman gets breast reconstruction
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When breast cancer surgeons regularly confer with plastic surgeons prior to surgery, their patients are more likely to have reconstruction, according to a new study led by researchers at the University of Michigan Comprehensive Cancer Center.
Where a woman goes for breast cancer treatment can vary widely – ranging from small private practices to large hospital settings. That choice can impact the type of care a woman receives when it comes to reconstruction.
“Breast reconstruction is a very complex treatment issue that requires a lot of discussion. Our results suggest that discussion can be quite different depending on where a patient gets initial treatment,” says lead study author Steven J. Katz, M.D., M.P.H., professor of internal medicine at the U-M Medical School and of health management and policy at the U-M School of Public Health.
“Patients with similar characteristics or preferences may get a different story from different surgeons – and this depends largely on whether a plastic surgeon is on the treatment decision team from the get-go. Plastic surgeons are the ones with the expertise to explain the increasingly complicated procedure options,” Katz adds.
Results of the study appear online in the journal Medical Care and will be published in the October issue.
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