Loyola University Health System has established new guidelines to protect burn victims at risk for hypothermia during surgery.The skin regulates body temperature and when a large portion of skin is burned, the body loses heat. Loyola nurses recognized this threat and established a warming process for burn victims at risk for dangerously low body temperatures.”Burn victims are in an extreme amount of pain and are at risk for severe complications from their injuries,” said Sharon L. Valtman, RN, BSN, CNOR, the Loyola nurse who initiated the warming process for patients. “It is our job as nurses to listen to our patients and identify ways to ease their discomfort and prevent further health issues.”The warming process Valtman established involves using Bair Hugger technology to elevate the patients’ body temperature. The device carries warm air through a hose to a blanket that is draped over the patient. Nurses initiate this process in a patient’s hospital room one hour before surgery and continue it during the procedure. Studies have shown that keeping a patient warm during surgery results in less bleeding and faster recovery.The success of this program led Loyola’s Burn Center and operating room doctors, nurses and staff to adopt this process as hospital protocol for burn patients.Story Source:The above story is based on materials provided by Loyola University Health System. Note: Materials may be edited for content and length.Read more
New statistics released today by the American Society of Plastic Surgeons (ASPS) show that breast lift procedures are growing at twice the rate of breast implant surgeries. Since 2000, breast lifts have grown by 70 percent, outpacing implants two-to-one. Breast implants are still by far the most performed cosmetic surgery in women, but lifts are steadily gaining. In 2013, more than 90,000 breast lift procedures were performed by ASPS member surgeons.”Many women are looking for a youthful breast by using the tissue they already have,” said ASPS President Robert X. Murphy, Jr., MD.According to the new statistics, women between the ages of 30-54 made up nearly 70 percent of the breast lift procedures performed in 2013. “The breast lift procedure is way up in my practice,” said Anne Taylor, MD, an ASPS-member plastic surgeon in Columbus, Ohio. “More women are coming to us who’ve had children, whose breast volume has decreased and who are experiencing considerable sagging,” she said. “For many of them, we are able to get rid of excess skin and lift the breasts back up where they’re supposed to be.”Kim Beckman of Casstown, Ohio is one of the women who went to Dr. Taylor. “Childbirth, breastfeeding and aging takes a toll on the body,” she said. …Read more
As more people look for ways to turn back the clock or improve their appearance, dermatologists are pioneering many of the newest aesthetic laser technologies — from tattoo removal to erasing fine lines and wrinkles to reducing fat or cellulite. Before considering any cosmetic procedure, dermatologists recommend that consumers do their homework to better understand the best technologies available for their specific needs.Information was provided by board-certified dermatologist M. Christine Lee, MD, FAAD, assistant clinical professor of dermatologic surgery at the University of California, San Francisco and director of a private practice in Walnut Creek, Calif.Treatments for Cellulite, Excess Fat Now Produce Long-Lasting ResultsCellulite and excess fat are two of the biggest hurdles that many women face in their quest to improve their appearance. While diet and exercise can help reduce body fat, cellulite is resistant to these types of lifestyle changes. Unique to women, Dr. Lee estimates that cellulite affects 80 percent of women regardless of their body weight. Until now, no cellulite treatment could dramatically change the appearance of cellulite, and any results were temporary.1440 Nanometer Laser• First minimally invasive laser treatment to treat cellulite approved by the Food and Drug Administration (FDA) in 2012 and provides long-lasting, dramatic results.• Surgical procedure involves inserting a tiny fiber optic beneath the skin to break the fiber bands responsible for cellulite in women. The laser releases the skin and allows the depressions (or dimpling that gives cellulite its appearance) to rise to the surface of the skin. Once the laser beam severs the fiber bands, the blood supply to this area is cut off so the bands do not regrow, and collagen production is stimulated.• Multiple areas can be treated with only one session, and the most common treatment areas are the buttocks, hips and thighs.• Some downtime is required after the procedure, due to bruising and swelling that can take one to two weeks to resolve.Cryolipolysis• Non-invasive procedure approved by the FDA to remove localized areas of fat in the lower abdomen and along the sides of the body.• Works by freezing the lipids in fat cells, which then slowly dissolve without injuring surrounding tissues.• Typically, three treatments are needed to dissolve an inch of fat.• Results are not immediate, as it takes three to four months to see a noticeable improvement.Ultrasound• Non-invasive procedure approved by the FDA uses high-intensity, focused ultrasound energy to destroy or melt targeted fat without harming surrounding skin.• Used to reduce fat bulges in the abdomen, with the average reduction of about an inch per treatment session. Can also be used on the thighs or other large areas of fat.• Results are not immediate, requiring two to three months.• An added benefit is noticeable improvement in the appearance of cellulite in the months following the procedure.These newer treatments provide alternatives to liposuction, which has been used to remove pockets of fat for decades but is more invasive and requires more downtime. …Read more
Patient Advocate Insider | New Mesothelioma Treatment, The Hipec Procedure Kaylen Jackson, the Director of Medical Outreach at The MesotheliomaRead more
Oct. 17, 2013 — Skin-related laser procedures such as hair removal remain one of the most popular elective types of laser surgery performed in the United States today. To meet demand, more non-physicians are performing these procedures than ever before.A study published online Oct. 16 in JAMA Dermatology found that lawsuits related to procedures when non-physicians are operating the laser are increasing, particularly outside of a traditional medical setting.”Procedures performed by untrained individuals, particularly in non-medical settings, are more likely to result in litigation,” said Dr. H. Ray Jalian, clinical instructor of medicine, division of dermatology, David Geffen School of Medicine at UCLA. “Consumers should be aware that laser treatments are medical procedures and should verify the training, certification, and experience of the person performing the procedure.Researchers identified the frequency of medical professional liability claims stemming from skin laser surgery performed by non-physicians by using an online national database of public legal documents.In 175 cases related to injury from skin laser surgery from 1999 to 2012, researchers found 75 (42.9 percent) cases involving a non-physician. The percentage of cases involving non-physicians increased from 36.3 percent in 2008 to 77.8 percent in 2011.Laser hair removal was the most commonly performed procedure. While one-third of laser hair removal procedures were performed by non-physicians, 75.5 percent of hair removal lawsuits from 2004 to 2012 involved non-physicians, and 85.7 percent involved non-physicians between 2008 and 2012.Non-physicians performing skin laser surgery in the study included a diversity of operators, including nurse practitioners, registered nurses, medical assistants, electrologists and aestheticians, among others.To meet the demand for these procedures, physician delegation of laser surgery has grown significantly in the past decade and non-supervised laser surgery is performed legally in many states at nonmedical facilities such as medical spas that offer aesthetic and cosmetic procedures.According to Jalian, physician and other laser operators should know their state laws regarding physician supervision of non-physicians operating the lasers. He notes that in the correct setting with close on-site supervision and appropriate training, the use of non-physician operators can prove to be a productive and safe environment for patients.Read more
Mesothelioma Diagnosis-How Do You Diagnose Mesothelioma?By Bello KamorudeenMesothelioma is a serious cancer that advances quickly and aggressively. However the diagnosis of this type of cancer is not usually made until it has reached an advanced stage. This is mainly due to two reasons:1-Mesothelioma has a very long latency period. In a typical case, between 20 to 50 years elapse between asbestos exposure and the onset of the first symptoms of the disease show up.2-Most of the early and warning symptoms are not specific to mesothelioma; they often resemble symptoms of other conditions that are much less serious. For example, the early symptoms of pleural mesothelioma may look like those for influenza or pneumonia, and this can result in misdiagnosis.The First Stages of DiagnosisMesothelioma patients …Read more
Oct. 13, 2013 — An international research team led by scientists from Georgetown Lombardi Comprehensive Cancer Center has discovered a genetic mutation linked to low-risk bladder cancer. Their findings are reported online today in Nature Genetics.The investigators identified STAG2 as one of the most commonly mutated genes in bladder cancer, particularly in tumors that do not spread. The finding suggests that checking the status of the gene may help identify patients who might do unusually well following cancer treatment, says the study’s senior investigator, cancer geneticist Todd Waldman, MD, PhD, a professor of oncology at Georgetown Lombardi.”Most bladder cancers are superficial tumors that have not spread to other parts of the body, and can therefore be easily treated and cured. However, a small fraction of these superficial tumors will recur and metastasize even after treatment,” he says.Because clinicians have been unable to definitively identify those potentially lethal cancers, all bladder cancers patients — after surgery to remove tumors — must undergo frequent endoscopic examinations of their bladder to look for signs of recurrence, says Waldman. This procedure, called cystoscopy, can be uncomfortable and is expensive.”Our data show that STAG2 is one of the earliest initiating gene mutations in 30-40 percent of superficial or ‘papillary-type’ bladder tumors, and that these tumors are unlikely to recur,” says David Solomon, MD, PhD, a lead author on the study. Solomon is a graduate of the Georgetown MD/PhD program and is currently a pathology resident at the University of California, San Francisco.”We have developed a simple test for pathologists to easily assess the STAG2 status of these tumors, and are currently performing a larger study to determine if this test should enter routine clinical use for predicting the likelihood that a superficial bladder cancer will recur,” Solomon says.For the study, the researchers examined 2,214 human tumors from virtually all sites of the human body for STAG2 inactivation and found that STAG2 was most commonly inactivated in bladder cancer, the fifth most common human cancer. In follow up work, they found that 36 percent of low risk bladder cancers — those that never invaded the bladder muscle or progressed — had mutated STAG2. That suggests that testing the STAG2 status of the cancer could help guide clinical care, Waldman says. “A positive STAG2 mutation could mean that patient is at lower risk of recurrence.”The researchers also found that 16 percent of the bladder cancers that did spread, or metastasize, had mutated STAG2.STAG2 mutations have been found in a number of cancers, and this finding in bladder cancer adds new information, he says.Read more
Sep. 3, 2013 — When trying to unclog a drain, plumbers will insert a device from the top and guide it down to push through whatever is causing the blockage. Endovascular surgeons use the same technique when trying to open up the vessels of patients with peripheral artery disease (PAD). However, sometimes the vessels become so hardened that it’s impossible to push through. A new technique called retrograde access now gives surgeons an additional path from below.”There are three arteries that branch off into smaller arteries and supply blood to the legs and feet,” said Dr. Hosam El-Sayed, an endovascular surgeon with Houston Methodist DeBakey Heart & Vascular Center. “Over time, plaque develops in the walls of the arteries and completely blocks blood from flowing to the lower extremities. These patients can develop severe conditions such as non-healing sores or gangrene and could eventually face amputation.”Retrograde access is a delicate procedure that allows surgeons to go through arteries in the foot and work their way upward. El-Sayed says this procedure is not for everyone with PAD, only those complex patients with heavily-calcified arteries. It’s seen in many people with severe diabetes. …Read more
Sep. 1, 2013 — Aortic stenosis is the most common heart valve disease in the elderly. It is associated with congenital bicuspid aortic valve and previous rheumatic heart disease, but is also often caused by calcification of a normal valve. Calcification of a normal valve may be associated with atherosclerotic changes in the portion of the aorta closest to the valve.Dr Ranthe said: “Genetic factors may play a role in the development of aortic stenosis. A single nucleotide polymorphism in the lipoprotein(a) locus has been associated with aortic valve calcification and aortic stenosis.1 Elevated lipoprotein(a) is a risk factor for atherosclerosis, including ischaemic heart disease, which is known to aggregate in families. Our aim was to discover whether aortic stenosis also aggregates in families.”The study used information from national Danish registers and included the 4.2 million Danes born in or after 1920. The cohort was followed for more than 73 million person-years, starting in 1977 (the year the Danish Hospital Discharge Register began) and ending in 2012. Cases of aortic stenosis were recorded when they occurred at age 35 years or older.Patients with any registration of a congenital heart defect and those with cardiovascular disease diagnosed at <35 years were excluded. Family history was defined as a first degree relative registered with aortic stenosis before the cohort member.</p>During the study period 29,983 patients were registered with aortic stenosis at age >35 years. Of those, 193 had a first degree relative with aortic stenosis and the relative risk was 2.04 (95% confidence interval [CI] 1.77-2.35). …Read more
Aug. 26, 2013 — At first, Krista Easom figured the little red bump on her foot was nothing more than a blister. It didn’t hurt, but after a couple months, it didn’t go away either.She booked an appointment with a dermatologist to have it removed. She wasn’t worried. Easom, a 24-year-old law school student from New Jersey, was healthy, had no family history of cancer and was getting ready to enjoy some time in her newly adopted city of Chicago.That’s when she received the results from her dermatologist, who removed a part of the blister and had it tested.It turns out that little red bump was malignant melanoma, the leading cause of skin cancer death in the United States. It’s a cancer that kills one person every hour, which translates to more than 8,700 Americans each year.Further tests revealed that Easom’s melanoma had spread to her lymph nodes, which meant she needed a lymphadenectomy to have them removed. This major surgery includes a five-day stay in the hospital followed by an extensive recovery. About half of the patients who undergo this procedure suffer from wound infections because of the 12-inch incision’s hip-to-thigh location.Easom and her family looked into her options and she was referred to Northwestern Medicine® surgical oncologists Jeffery D. Wayne, MD and Karl Bilimoria, MD, two of the very few surgeons in the country using a minimally invasive procedure to remove groin lymph nodes. This laparoscopic procedure may drastically reduce the recovery rate and chance of infection for patients like Easom.”Only a handful of surgeons in the country are doing this and it makes a world of difference to the patient,” said Bilimoria, a surgical oncologist at Northwestern Memorial Hospital and an assistant professor of surgery at Northwestern University Feinberg School of Medicine. …Read more
July 26, 2013 — A new cornea transplant technique called DMEK provides significantly improved vision and faster recovery from surgery than standard cornea transplants.The cornea is the clear outer lens on the front of the eye. In a cornea transplant, also called a keratoplasty, part of the defective cornea is replaced with corneal tissue from a deceased donor.DMEK stands for Descemet Membrane Endothelial Keratoplasty. In a DMEK, only the ultra-thin, innermost corneal layer (the Descemet membrane) is replaced, rather than the entire thickness of the cornea. This reduces the chance of a patient rejecting the donor cornea tissue because there is much less foreign donor material implanted into the patient. The procedure is indicated for patients who have problems only with the back layer of the cornea.With the current standard of care for replacing the back layer of the cornea, patients are typically restored to a best-corrected vision of 20/30 or 20/40. With DMEK, patients can typically obtain a vision of 20/20 or 20/25. They also recover from surgery more quickly, said Amy Lin, MD, a Loyola University Medical Center ophthalmologist and cornea transplant specialist.Chicago-area ophthalmologists recently learned about the technique in a hands-on demonstration at Loyola. They practiced the technique on cadaver eyes donated by the Illinois Eye Bank. It was the first Chicago-area DMEK demonstration of its kind.The DMEK instruction course is an example of how ophthalmologists from Loyola and other Chicago-area centers frequently collaborate on educational, research and other projects that will improve patient care, said Charles Bouchard, MD, chair of Loyola’s Department of Ophthalmology.The demonstration was conducted in Loyola’s Advanced Procedure Education Center (APEC), a state-of-the art facility that serves the surgical-skills training needs of students, residents, fellows and practicing physicians. APEC is part of the Center for Simulation Education at Loyola University Chicago Stritch School of Medicine.The DMEK instructional course at Loyola was taught by DMEK experts Kenneth M. …Read more
July 25, 2013 — It is a fascinating phenomenon that homing pigeons always find their way home. A doctoral student in biology at the University of Zurich has now carried out experiments proving that pigeons have a spatial map and thus possess cognitive capabilities. In unknown territories, they recognize where they are in relation to their loft and are able to choose their targets themselves.Homing pigeons fly off from an unknown place in unfamiliar territory and still manage to find their way home. Their ability to find their way home has always been fascinating to us humans. Despite intensive research, it is not yet definitively clear where this unusual gift comes from. All we know is that homing pigeons and migratory birds determine their flight direction with the help of Earth’s magnetic field, the stars and the position of the sun. As Nicole Blaser, a doctoral student in biology at the University of Zurich demonstrates in the Journal of Experimental Biology, homing pigeons navigate using a mental map.Navigating like a robot or cognitive capabilities?Research proposes two approaches to explain how homing pigeons can find their home loft when released from an unfamiliar place. The first version assumes that pigeons compare the coordinates of their current location with those of the home loft and then systematically reduce the difference between the two until they have brought the two points together. If this version is accurate, it would mean that pigeons navigate like flying robots. The second version accords the pigeons a spatial understanding and “knowledge” of their position in space relative to their home loft. …Read more
July 15, 2013 — Newly published findings by medical researchers at the University of Alberta provide more evidence that music decreases children’s perceived sense of pain.Faculty of Medicine & Dentistry researcher Lisa Hartling led the research team that involved her colleagues from the Department of Pediatrics, as well as fellow researchers from the University of Manitoba and the United States. Their findings were published in the peer-reviewed journal JAMA Pediatrics today.The team conducted a clinical research trial of 42 children between the ages of 3 and 11 who came to the pediatric emergency department at the Stollery Children’s Hospital and needed IVs. Some of the children listened to music while getting an IV, while others did not. Researchers measured the children’s distress, perceived pain levels and heart rates, as well as satisfaction levels of parents, and satisfaction levels of health-care providers who administered the IVs. The trial took place between January 2009 and March 2010.”We did find a difference in the children’s reported pain — the children in the music group had less pain immediately after the procedure,” says Hartling. “The finding is clinically important and it’s a simple intervention that can make a big difference. Playing music for kids during painful medical procedures would be an inexpensive and easy-to-use intervention in clinical settings.”The research showed that the children who listened to music reported significantly less pain, some demonstrated significantly less distress, and the children’s parents were more satisfied with care.In the music listening group, 76 per cent of health-care providers said the IVs were very easy to administer — a markedly higher number than the non-music group where only 38 per cent of health-care providers said the procedure was very easy. Researchers also noticed that the children who had been born premature experienced more distress overall.Hartling and her team hope to continue their research in this area, to see if music or other distractions can make a big difference for kids undergoing other painful medical procedures. The pain and distress from medical procedures can have “long-lasting negative effects” for children, note the researchers.”There is growing scientific evidence showing that the brain responds to music and different types of music in very specific ways,” said Hartling. “So additional research into how and why music may be a better distraction from pain could help advance this field.”The study noted that previous research has shown that the mood of the music, whether it has lyrics, and whether it is familiar to the listener could have an impact on pain perception as well.This research trial was funded by the Women and Children’s Health Research Institute.Read more
June 17, 2013 — Understanding how gastric bypass surgery changes the properties of nerve cells that help regulate the digestive system could lead to new treatments that produce the same results without surgery, according to Penn State College of Medicine scientists, who have shown how surgery restores some properties of nerve cells that tell people their stomachs are full.The results may also better predict which patients will keep the weight off after surgery.Roux-en-Y gastric bypass surgery is the most effective way to get severe obesity under control. Doctors make the stomach smaller and bypass a section of the small intestine. Besides restricting the amount of food a person can eat at one time, the procedure also seems to alter the properties of nerve cells.”Restricting the size of the stomach has some role in the effectiveness of gastric bypass, but it’s not the full story,” said Kirsteen Browning, assistant professor of neural and behavioral sciences. “It is not fully understood why the surgery works.” The researchers published their findings in the Journal of Physiology.Complications from diseases such as diabetes can resolve before weight is lost, and sometimes before the person even leaves the hospital after gastric bypass surgery.”This suggests an altering of the neural signals from the gut to the brain and back,” Browning said.These nerve cells send signals to tell the body’s digestive system how to respond properly and regulate normal functions of digestion. In obese people, the nerve cells are less excitable, meaning they respond less tonormal stimulation. For example, there are neurons that help tell a person that their stomach is full, called satiation.”These signals tell you to stop eating,” said study co-author Andrew Hajnal, professor of neural and behavioral sciences. “Obviously these signals are strong enough to be overcome by all of us and we can eat more even after we are told we are full. However, as obesity develops, it appears these signals are less strong and easier to overcome.”Penn State Hershey researchers used a high-fat diet in rats to replicate long-term exposure to a Western diet. They then observed the effects of gastric bypass on the rats and have shown for the first time that the effects of diet on nerve cells seem to be restored to normal function after the surgery. This would help in restoring satiation signals so that they can be recognized more easily.”We know gastric bypass improves the health of nerve cells and reverses the effects on the signals,” Browning said. …Read more
June 12, 2013 — The consequences of high blood pressure are one of the most common causes of death worldwide. Despite this, according to the World Health Organization WHO, fewer than one in two of those affected measures their blood pressure regularly. The main reason for this is that regular measurements are costly or inconvenient. An innovative wrist sensor should now change that.Measuring and monitoring blood pressure is a tedious business for patients. It usually involves a cuff which is activated every 15 minutes over several hours and compresses the upper arm, a cumbersome measuring device on the body, or in some cases even invasive monitoring, in which a catheter is inserted into the artery. It is no wonder that those affected avoid this procedure if at all possible.A new sensor hardly bigger than a wristwatch should soon offer a more pleasant method for measuring blood pressure. The company STBL Medical Research AG (STBL) has developed a device that can be worn comfortably on the wrist and records the blood pressure continuously — with no pressure cuff or invasive procedure. The measurement is carried out by several sensors which simultaneously measure the contact pressure, pulse and blood flow on the surface of the skin in the vicinity of the wrist. Michael Tschudin, co-founder of STBL, sees great potential for the device: “This measuring device can be used for medical purposes, for example as a precaution for high-risk patients or for treating high blood pressure, but also as a blood pressure and heart rate monitor for leisure activities and sports as well as for monitoring fitness in high-level sports.”Empa sensor greatly increases measuring accuracyEngineers had one particular obstacle to overcome in this new technology: the pressure of the device on the skin changes constantly, meaning that highly sensitive correctional measurements are necessary. Empa’s Laboratory for High Performance Ceramics sought a suitable solution to this problem within the scope of a CTI project. …Read more
June 1, 2013 — Any breast cancer surgeon who regularly performs lumpectomies confronts the question “Did I get it all?” Thirty to 60 percent of the time in the U.S., the answer is “no,” requiring the patient to undergo a second surgery to remove the remaining tumor.Surgeons at UC Irvine Medical Center are the first in the country to use a device that reduces by half the need to reoperate and cut out breast cancer cells missed during an initial lumpectomy. The MarginProbe System lets the surgeon immediately assess whether cancer cells remain on the margins of excised tissue. Currently, patients have to wait days for a pathologist to determine this.”All of my patients know someone who has had to go back into surgery because their doctor didn’t get the entire tumor out,” said UC Irvine Health surgical oncologist Dr. Alice Police. “The ability to check tissue in the operating room is a game changer in surgery for early-stage breast cancer.”The goal in a lumpectomy is to completely remove the cancer while preserving as much normal breast tissue as possible. If a pathologist finds cancer cells on the edges of the tissue taken out, surgeons must assume the lumpectomy didn’t get the entire tumor.The Food & Drug Administration approved MarginProbe in December 2012, and UC Irvine Medical Center is the first hospital in the U.S. to employ the system, according to manufacturer Dune Medical Devices.Police, assistant professor of surgery at UC Irvine and medical director of Pacific Breast Care in Costa Mesa, and Dr. Karen Lane, associate professor of surgery and clinical director of the UC Irvine Health Breast Health Center in Orange, began operating with MarginProbe in early March.They had participated in an FDA trial that included more than 660 women across the U.S. In the prospective, multicenter, randomized, double-arm study, surgeons applied the device to breast tissue removed during in-progress initial lumpectomies and, if indicated, shaved additional tissue on the spot. This was found to reduce by 56 percent the need for repeat surgeries.”It will save you a lot of anxiety,” said Jane Madigan, a Costa Mesa resident who underwent the procedure with Police as part of the MarginProbe trial. …Read more
Feb. 3, 2011 — Surgery to “deactivate” migraine headaches produces lasting good results, with nearly 90 percent of patients having at least partial relief at five years’ follow-up, reports a study in the February issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
In about 30 percent of patients, migraine headaches were completely eliminated after surgery, according to the new study, led by Dr. Bahman Guyuron, chairman of Plastic and Reconstructive Surgery at University Hospitals Case Medical Center and Case Western Reserve University School of Medicine in Cleveland, Ohio.
‘Trigger Site’ Surgery Reduces or Eliminates Migraine Headaches
Dr. Guyuron, a plastic surgeon, developed the migraine surgery techniques after noticing that some migraine patients had reduced headache activity after undergoing cosmetic forehead-lift procedures. The techniques consist of “surgical deactivation” of “trigger sites” in the muscles or nerves that produce pain.
For example, for patients with frontal migraine headaches starting in the forehead, the muscles in that area were removed, as in forehead-lift surgery. This procedure may reduce headache attacks by relieving pressure on key nerve in the frontal area. Other approaches target other migraine trigger sites.
Before surgery, each patient was tested with botulinum toxin A (Botox) to confirm the correct trigger sites. For most patients, surgery targeted at least two trigger sites. The five-year results — including standard measures of migraine-related pain, disability, and quality of life — were evaluated in 69 patients.
Eighty-eight percent of these patients had a positive long-term response to surgery. Headaches were significantly decreased in 59 percent of patients, and completely eliminated in 29 percent. The remaining patients had no change in headache activity.
Migraine attacks were less frequent after surgery; average migraine frequency decreased from about eleven to four per month. When attacks occurred, they didn’t last as long — average duration decreased from 34 to eight hours. Migraine surgery also led to significant improvements in quality of life, with few serious adverse effects.
Migraine is a very common problem that interferes with many aspects of daily life for millions of Americans. About one-third of patients are not helped by current treatments. The new surgical techniques have the potential to reduce or eliminate migraine attacks for many patients who do not respond to other treatments. A previous study found good results at one-year follow-up evaluation.
The new report shows that these good outcomes are maintained through five years’ follow-up. The findings “provide strong evidence that surgical deactivation of one or more trigger sites can successfully eliminate or reduce the frequency, duration, and intensity of migraine headache, and the results are enduring,” Dr. Guyuron and colleagues write. More research will be needed to refine the surgical techniques — as well as to clarify the reasons for the effectiveness of surgical deactivation of trigger sites in relieving migraine headaches.Read more
June 7, 2011 — A plastic surgery procedure in which the patient’s own fat is transplanted to the breasts — used along with treatment to expand the breast tissue before surgery — can achieve up to a twofold increase in breast size, according to a study in the June issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons.
The procedure builds on previous fat transfer techniques to provide excellent outcomes of breast enhancement surgery. “Pre-expansion to the breast allows for mega-volume (over 300 cc) grafting with reproducible, long lasting results that can be achieved in less than two hours,” according to Drs. Daniel Alexander Del Vecchio and Louis Paul Bucky, authors of the new report.
“Pre-Expansion” Maximizes Results of Breast Fat Transfer
The technique is an adaptation of the increasingly popular autologous fat transplantation technique. In these procedures, fat obtained by liposuction from one part of the body — for example, the thighs — is transferred for use in breast enlargement and reshaping.
In the procedure used by Drs. Del Vecchio and Bucky, the patient first undergoes several weeks of “pre-expansion” treatment. This is done with a bra-like device that uses gentle negative pressure to gradually expand the breast. The pre-expansion procedure provides extra room in the breast, which is “backfilled” using the liposuctioned fat.
The authors report their experience using pre-expansion and autologous fat transfer in 46 breasts of 25 women. Some of the patients wanted to increase their breast size or to replace implants; others were seeking treatment for certain types of breast deformities. On average, about 300cc of fat was transplanted per treated breast.
When evaluated after six months, the women had significant improvements in breast size and shape. On average, the treated breasts approximately doubled in size, with a “soft and natural…appearance and feel,” the researchers write. Follow-up magnetic resonance imaging scans showed no cysts, masses or other abnormalities.
As they gained experience, the surgeons were able to perform the breast fat transfer procedure within less than two hours. There were no significant complications.
While the idea of breast fat transfer is not new, it has seen a resurgence in recent years, with several plastic surgery groups reporting good results. Drs. Del Vecchio and Bucky believe pre-transplant breast expansion is an important technical advance, providing increased space to be occupied by the patient’s own fat. Patients also used the vacuum device for a few weeks after the procedure, which may act as a “splint” to help promote healing.
Further research will be needed to assess the results of the pre-expansion and fat transplantation technique — including not only the long-term outcomes, but also important safety issues. As reported in recent issues of Plastic and Reconstructive Surgery, there is some question as to whether breast fat transfer procedures interfere with mammographic screening for breast cancer.
In the meantime, Drs. Del Vecchio and Bucky believe their results — a two-fold increase in breast size, achieved in two hours or less — are a significant step forward in the use of autologous fat transplantation for breast enhancement. They conclude, “These results serve as a standard to objectively compare other techniques of fat grafting to the breast in the future.”Read more
July 1, 2011 — Surgery and all its implications can be scary, especially so for pediatric patients and their parents who dread sometimes disfiguring scars.
Now a UT Southwestern Medical Center urologist has developed a new “hidden” minimally invasive procedure that makes scarring virtually invisible yet is just as effective as more common surgical methods.
“Currently used incisions, even with minimally invasive surgery, leave the child with up to three scars that are visible any time the abdomen is exposed. The new technique of hidden incision endoscopic surgery (HIdES) eliminates visible scarring,” said Dr. Patricio Gargollo, assistant professor of urology at UT Southwestern and author of a study in a recent issue of the Journal of Urology.
He reports using the procedure for a dozen kidney surgery cases between April and July 2010 with no complications, but believes it has broader applications.
“I envision that this could be used for any upper abdominal procedure that needs to be done laparoscopically, and I currently perform all upper abdominal and some pelvic surgery with this technique,” said Dr. Gargollo, who is also director of pediatric urology minimally invasive and robotic surgery at Children’s Medical Center of Dallas.
HIdES was named the Best New Technique Award at the International Robotic Urology Symposium in 2010.
Minimally invasive techniques such as laparoscopy are often used in kidney surgeries. They leave much less scarring than open surgery, which requires a large incision across the patient’s abdomen. But laparoscopic surgery, in which a tiny camera inserted through a small incision acts as the surgeon’s “eyes,” still leaves noticeable scars, Dr. Gargollo said.
In addition to its cosmetic benefits, the HIdES technique offers surgeons greater technical flexibility than laparoscopic surgery because it uses multiple surgical ports for robotic-assisted surgical equipment and a camera. These ports are hidden below the bikini line, making them invisible if the patient is wearing a bathing suit.
Patients old enough to answer a survey, including older teenagers, and parents of younger children showed greater satisfaction with the HIdES incision scars than those generated by laparoscopic and open surgery, the study reported.Read more