Adhesions Medical Headlines ARDvark Blog

First Oral Once-Daily Mesalamine For Ulcerative Colitis: LIALDA Available Now

Massachusetts Health Insurance Connector Board Votes To Require Prescription Drug Coverage As Part Of Draft Minimum Coverage Requirements

IOF World Congress On Osteoporosis To Be Held For First Time In Asia

Potential Non-Surgical Repair Technology To Replace Spinal Fusion As The Standard Surgical Treatment For Chronic Lower Back Pain

Report Details Options For Covering Uninsured Through Tax Credits, Medicaid; Primers Outline Medicare, Medicaid Basic Information

Epigenetic Studies Will Provide A Better Understanding Of Disease

Lawmakers Call On HHS To Garnish Portion Of Medicare Payments For Health Care Providers Who Owe Back Taxes

Researchers Examine Protein Vital To Reproduction, Regulation May Increase Chances Of Pregnancy

IPP-SHR - Parking Costs Disadvantaging Hospital PATIENTS

Diamics Receives FDA Clearance For Revolutionary New Cervical Sample Collection System

Obesity Drives US Surgical Procedure Volumes Higher

Colon Cancer Survival Linked To Number Of Lymph Nodes Examined

Met reliever Sanchez in, then out

PORT ST. LUCIE, Fla. -- Duaner Sanchez had gone through all of the warm-up steps, throwing on flat ground, long-tossing and then throwing from behind the mound. But when he climbed onto the mound Thursday for the first time this spring, it took just four minutes and 11 pitches for it all to go wrong.
Sanchez hurled the pitch, then bent over, hands on knees, as pitching coach Rick Peterson and assistant trainer Mike Herbst rushed to his side. Feeling a pop in his surgically repaired right shoulder, Sanchez was sent to the clubhouse to be examined by a doctor.
While the Mets and Sanchez downplayed the damage, the sight of Sanchez hunched over in pain threw one more question mark into the status of the Mets' bullpen.
He did not undergo any X-rays or MRI exams Thursday, being examined by one of the team doctors, Dr. Dan Tomlinson. The initial assessment was that it was scar tissue and adhesions from the surgery -- which included adding a piece of his hamstring over the shoulder -- tearing. But general manager Omar Minaya said that while that appears to be the problem, if it does not respond well in the coming days that the team will then send him for an MRI.
"I just felt a tingle all the way down to my hand," Sanchez said. "Nothing major. It's not a ligament, not a tendon, nothing like that.
"I set myself back [Thursday] because I don't want to risk everything that I've been doing for another two weeks. I set myself back and [will] relax and see what happens [today]."
"Basically what we heard is possibly some scar tissue," Minaya said. "We're going to rest him for the day and go from there. The doctors are not alarmed by it, but we'll see how he is [this] morning. They said it's part of the rehab process. Right now, it seems to be a scar tissue. We'll see where it is [today]."
After a sensational first half of the season last year, Sanchez has endured one troublesome episode after another. A cab he was riding in on July 31 was involved in a crash, separating his shoulder and costing him the rest of the season. While rehabbing, he was thrown out of camp for two days until enduring a tearful meeting with manager Willie Randolph and Minaya for his tardiness and his lack of conditioning, coming to camp overweight.
He had worked his way back to this point, the day that he would finally get on the mound. This trouble, he admitted, frightened him.
"It did," he said. "Anything can scare you if you're not expecting it. I've never been hurt in my life so I'm not expecting anything. When it happens, it scares you a little bit. [But you] step back and don't want to do anything major to it."
"Hopefully, it's some adhesions popping loose," said Randolph, who was on the way to Orlando and did not witness the bullpen session. "We'll see what happens [today]. I'm not concerned if that's what you're going to ask me. We'll just see how he feels.
"It could be something as simple as post-op stuff. Every once in awhile when you're trying to stretch out you might get some of that pulling in there, so hopefully that's all it is. I wasn't counting on him. It's not like it's a setback as far as the season. I didn't think he was going to be ready anyway."
For now, the Mets have Billy Wagner at the back end of the bullpen -- although he endured a four-hit, five-run inning in the Mets' 7-1 loss to the Braves on Thursday -- and then questions. Without Sanchez at the start of the year or Guillermo Mota, who is suspended for the first 50 games of the season for violating the league's drug policy, they are relying on Aaron Heilman (who has had bouts of elbow tendinitis this spring after undergoing off-season surgery) and Scott Schoeneweis as set-up men.
Source

Adhesions Headlines ARDvark Blog

Drug-Resistant Bacteria Defeatede By Trojan Horse Strategy

Kaiser Daily Health Policy Report Features Medical Malpractice News From Three States

Studies Examine Ovarian Cancer, Uterine Fibroids, Cardiovascular Disease

In New Study, Duloxetine Reduced Non-specific Pain And Emotional Symptoms Associated With Depression

Neuropathic Pain: Symptoms, Models, And Mechanisms

Companies' Health Care Costs Increased By About Twice Inflation Rate In 2006, Study Finds

Postnatal Health And Sexual Problems Persist At 12 Months, But Races Experience Different Levels

Ultrasound Could Help Couples Undergoing IVF

USA Today Examines Working Families Without Health Insurance

Belly Fat May Drive Inflammatory Processes Associated With Disease

Where Should I Have My Outpatient Surgery? Risk Factors Should Be Carefully Considered Before Undergoing Outpatient Surgery

Do Anti-Inflammatories Play A Role In Bleeding During Endoscopy?

Are Journal Rankings Distorting Science?

For Best Survival Benefits In Colorectal Cancer Patients, Follow-Up Endoscopic Surveillance Essential

Potential New Painkiller Drug Developed By Scientists At Leicester And In Italy

Passing gas - Even closer to spring ~ Blog excerpt

Blog excerpt
http://manixter.livejournal.com/1496.html

..........But on friday, I was up until quarter to 6. Just enough time to get a nap in before checking in with the incomming call person and driving home. Nothing specific-- a few general surgery cases with a slow surgeon topped off with a three-peat bowel obstruction. Which is to say, a patient who was on surgery #3 for obstructed bowel-- which means-- adhesions.Then, on sunday, I had the privilage of doing a small bowel transplant on a patient with even more adhesions than I had ever thought possible. For most patients, no matter how specific you get, there are usually 10 other patients that match the description. This is depressing, but it avoids violating HIPPA too too much. Small bowels are rare enough (unfortunately not rare enough for me), that I will try to be as general as possible. Suffice to say, the trifecta of a patient with other medical issues, a family situation that is... less than stable, and the standard bad-things that happen to small bowel transplants means I will see this patient again and again, eventually for her retransplant/ enterectomy. So I am NOT thrilled that I was up all night doing this surgery. Not to mention it wasn't as smooth as pediatric bowel transplants in a patient of that age typically are.

DNA layer reduces risk of reserve parts being rejected

http://www.physorg.com/news93624377.html
Dutch researchers Jeroen van den Beucken and John Jansen have given body implants a DNA layer. This layer ensures a better attachment, more rapid recovery of the surrounding tissue and less immune responses. The older we get the more 'reserve-parts' we need. Up until now placing such parts yielded advantages, but also disadvantages such as inflammations and immune responses. Van den Beucken's invention makes it easier and more reliable to use implants and has already been patented.

Van den Beucken reasoned that a DNA coating should have a lot of advantages. Such a coating approximates the body's own material with the result that a less intense immune response occurs. Further DNA is rich in phosphate groups that can speed up the attachment to bone tissue and therefore the integration of bone implants in the native bone tissue. Finally, DNA can be enriched with biologically active factors that, for example, facilitate the formation of bone tissue and blood vessels. All in all, a DNA coating could be safe, reduce the immune response, facilitate bone attachment and be functionalisable. However, enzymes in the body will quickly break down a DNA coating. A method therefore had to be found to firmly attach the DNA to the implant surface. Van den Beucken used the Layer-by-Layer deposition technique (see Figure 1) to produce a multilayer coating. This coating was tested in cell cultures and animal experiments for its safety, immune response, bone attachment and functionalisation. The DNA layer was also found to speed up the deposition of calcium phosphate and could, for example, be adapted to promote bone and blood vessel formation. The good research results led to the patenting of DNA coatings for implants. A biomedical company is currently investigating whether they can take over the patent.
Following this successful result, Van den Beucken will investigate whether DNA layers can be used for the application of DNA membranes to prevent post-operative adhesions, and in biosensors such as an implanted glucose sensor for diabetic patients.
Source: NWO

Medical pot user loses again in federal court

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/03/15/MNG2EOLGPU1.DTL&type=health
A federal appeals court upheld the U.S. government's authority Wednesday to prosecute medical marijuana patients in California, but left open the possibility that a gravely ill patient could defend against criminal charges by showing that marijuana was her only shield against excruciating pain or death.
Ruling in a case that reached the Supreme Court two years ago, the Ninth U.S. Circuit Court of Appeals in San Francisco rejected an Oakland woman's last constitutional challenge to the use of federal drug laws against medical marijuana patients -- that it violates the fundamental right to preserve one's life and be free of severe pain.
With obvious reluctance, the three-judge panel said there is no right "deeply rooted in this nation's history and traditions'' to use medical marijuana to reduce pain or ward off death. California, whose voters enacted the nation's first law legalizing marijuana for medical use in 1996, has been joined by only 10 other states. The remaining states and the federal government recognize no such right, the court noted.
"For now, federal law is blind to the wisdom of a future day when the right to use medical marijuana to alleviate excruciating pain may be deemed fundamental,'' said Judge Harry Pregerson. "That day may be upon us sooner than expected,'' he added.
But in a separate portion of the ruling, the court said 2-1 that seriously ill patients like Angel Raich of Oakland could defend against a federal prosecution by showing they needed marijuana to save their lives or prevent intolerable pain, and that legal drugs were ineffective.
Raich, 41, has used marijuana since 1997, taking it every two hours to combat the pain of scoliosis, endometriosis, seizures and a life-threatening wasting syndrome. Other drugs have proven painful and ineffectual, and her doctor says she would die in agony without marijuana.
If Raich obeys federal law, which forbids marijuana possession, "she will have to endure intolerable pain,'' said Pregerson, joined by Judge Richard Paez. However, they denied Raich's request for an injunction against federal prosecution, saying they could issue such an order only after a patient was charged with a crime. Raich has never been charged with a crime for her use of medical marijuana.
Judge Arlen Beam, a visiting jurist from the Eighth U.S. Circuit Court of Appeals in St. Louis, dissented from that portion of the ruling. He said the court was premature in addressing the issue and may be in conflict with a 2002 Supreme Court ruling that rejected an Oakland cannabis dispensary's claim that it was entitled to supply marijuana to seriously ill patients.
The Supreme Court later took up Raich's case, and ruled in 2005 that the federal government has the power to enforce its marijuana laws against patients and their suppliers who obtain the drug in California or any other state with a medical marijuana law.
In the 6-3 ruling, the court said Congress' constitutional power to regulate interstate commerce extends to a ban on drugs that, though supplied locally, are often sold across state lines. The appeals court addressed the remaining issues in the case Wednesday.
At a news conference after the ruling, Raich said she was shocked but added, "I'm not done fighting.
"I don't want that coffin, but from this point on I am walking dead," she said. "I will continue to use cannabis. I will continue to smoke cannabis. ... This is real medicine and the federal government cannot tell us any differently."
Her husband and attorney, Robert Raich, said she would appeal the ruling, either to the full Ninth Circuit or to the Supreme Court.
Graham Boyd, the American Civil Liberties Union's chief lawyer on drug issues, said the ruling could help members of a Santa Cruz medical marijuana collective that was raided by federal agents, who arrested their leaders and seized their marijuana. A lawsuit by the patients and the collective is pending before a federal judge in San Jose.
The court seemed to be saying that a seriously ill person who has been arrested, or whose medical marijuana has been confiscated, could claim a legal necessity for the drug, Boyd said. "It's the one silver lining on this dark cloud,'' he said.
E-mail the writers at begelko@sfchronicle.com and jzamora@sfchronicle.com.

Operating Room Nurses Understand Unnecessary Risk of Glove Powder, Yet Many Facilities Still Use Powdered Gloves

ORLANDO, Fla., March 20 /PRNewswire/ -- Operating room nurses attending last week's Association of PeriOperative Registered Nurses (AORN) 54thCongress in Orlando, FL, report that while they understand glove powder causes unnecessary risk to healthcare workers and patients, nevertheless a majority of the healthcare facilities in which they work continue to use atleast some powdered gloves.
They also agree that a Latex-SAFE environmentis the most recommended way to address the issue of latex allergies and sensitization in healthcare facilities.
In a random sample of 822 operating room nurses at the AORN Congress,Molnlycke Health Care US, asked about glove powder and latex safety issues.
Ninety-one (91) percent of attendees responding to the survey acknowledgedthat glove powder is an unnecessary risk for healthcare workers and patients. However, when asked if their facility uses any powdered gloves,more than half (59 percent) of respondents reported that they do.
According to the survey, 83 percent of respondents believe creation of a Latex-SAFE environment is the most recommended way to address the issue of latex allergies and sensitization in healthcare facilities. Almost three- fourths (73 percent) of respondents agreed that a latex-SAFEenvironment is defined as powder-free, low protein latex gloves ornon-latex alternatives, plus having latex-safe education and policies inplace.
When asked how important it is for healthcare facilities to provide education programs on latex allergy and powder-related issues, 93 percentof respondents said "very important." However, when asked if their hospita lprovides education programs on latex allergy and powder-related issues,only two-thirds (66 percent) said that they do.
Powder-Free Powdered latex gloves should not be used for surgical procedures because it is the starch powder itself that promotes the transfer of allergenic latex proteins.(1) Delayed wound healing and many postoperative complications including adhesions and granulomas also are associated withthe use of powdered gloves. The risk of postoperative adhesions and accompanying costs of treatment can be decreased with the use ofpowder-free gloves.
(2) Hospitals adopting powder-free latex glove policies report reductionsin glove-related allergy incidence.
(3) There is a reported 1 percent annualincidence of sensitization among powdered latex-glove users, whereas usersof powder-free, low-protein, latex gloves report a 0 percent sensitizationrate.
(4) Latex-SAFE Hospitals and surgical centers should opt for latex-SAFE environmentglove choices to decrease the risk of latex allergy as well as assureexcellent barrier protection, surgeon and healthcare worker comfort, andcost- effectiveness, according to Molnlycke Health Care US, LLC,manufacturer of the Biogel(R) surgical glove line.
The Biogel product line has been responding to the ever-changing needs of healthcare professionals since 1983 and is committed to protecting people's health and well-being. "Making informed glove choices to combat latex allergy is paramount,"says G.L. Sussman, MD, FRCP, professor of immunology, University ofToronto. "What's happening now is a latex-SAFE evolution. The choice is for latex-SAFE environment, rather than non-latex. The industry is learning that it doesn't have to be all or nothing.
A latex-SAFE environment allows an individual worker or patient to be less likely to have latex allergy issues."
Additionally, the United States Army Medical Command's latex allergy prevention policy advises "focus on latex-safe rather than latex-free."
(5) A latex-SAFE environment is one in which every reasonable effort has been made to remove high-allergen and airborne latex sources from coming into direct contact with affected individuals, according to AORN's 2007 Latex Allergy Guidelines.
The Guidelines go on to state that a latex-freeenvironment (one in which all latex-containing products, not simply gloves,have been removed) is considered unattainable
.(6) Latex-SAFE Environment Glove Solutions Molnlycke recommends the use of latex, deproteinised latex andnon-latex glove styles to address both general surgery and specialty needsin a latex- SAFE environment.
"Hospitals and surgical centers need to understand their gloving choices and as informed consumers select the best protection for healthcare workers and patients," Carolyn Twomey, RN, vice president of clinical and technical affairs, says.
"For 13 years, we have been using Biogel(R) powder-free surgical glovesexclusively. With the help of Biogel, we created a latex-SAFE environment to help ensure the safety of both patients and healthcare workers at Brigham and Women's Hospital," says Peggy Doyle, director of perioperative nursing, surgical services, Brigham and Women's Hospital, Boston.
As the only major surgical glove company with an exclusivelypowder-free surgical glove line, Molnlycke's Biogel(R) surgical gloves aremade from high- tech material to which is bonded a thin inner coating ofacrylate terpolymer. The smooth inner surface allows Biogel gloves to be
easily donned with damp or dry hands without the need for a powder lubricant. This not only eliminates the risk of powder-relatedpostoperative complications, but also reduces the risk of allergicreactions to aerosolized natural rubber latex proteins.
1 Beezhold D, Beck WC, Surgical Glove Powders Bind Latex Antigens, Archives of Surgery 1992; 127: 1354-1357. 2 FDA Medical Glove Powder Report - E, September 1992. 3 Allmers H. Et al. J. Allerg. Clin. Immunol. 2004 ; 114 : 347-51. 4 G L Sussman et al, "Incidence of latex sensitization among latex glove users," Journal of Allergy and Clinical Immunology 101 (February 1998) 171-178. 5 Department of the Army, Headquarters United States Army Medical Command, MEDCOM Regulation No. 40-44, 6 June 2002, p. 3. 6 AORN 2007 Latex Guidelines, Standards, Recommended Practices, and Guidelines, pages 199-214.

Adhesions Headlines ARDvark Blog

Woman Denied Right To Use Marijuana As Life-saving Medication
An American woman whose doctor has told her that marijuana is the only drug keeping her alive, has been denied the right to use it by a federal court. She could face prosecution on drug charges...[read article]

FDA Says Dangers Of Sleeping Pills Include Driving And Cooking While Asleep
The US Food and Drug Administration (FDA) is asking manufacturers of sedative-hypnotic sleeping pills to warn consumers and health professionals about potential risks like sleep-driving, anaphylaxis, cooking and eating food, and making phone calls while asleep...[read article]

Kroger Reiterates Company's Policy Requiring Pharmacies To Accommodate Patients If Pharmacist Refuses To Fill Prescription

Texas AG Believes Gov. Perry's Executive Order Mandating HPV Vaccination Does Not Carry Weight Of Law, Lawmaker Says

Colon Cancer Alliance Hosts Interactive Support Program At Lombardi Comprehensive Cancer Center

Kaiser Daily Health Policy Report Highlights Health Issues In State Of The State Addresses

Computer Predicts Wishes Of Incapacitated Patients Better Than Family Or Loved Ones

In Ovarian Cancer Expert Centers Prove Cost-Effective

House Speaker Pelosi Says House Budget Resolution Will Include Reserve Fund To Cover All Children Eligible For SCHIP

Cocoa 'Vitamin' Health Benefits Could Outshine Penicillin

Obesity Surgery Can Lead To Memory Loss, Other Problems

Patients Should Be Alert For Obesity Surgery Complication

Obese Patients Run Higher Risk Of Post-Operative Complications

Why Omega-3s Seem To Improve Mood

Pine Bark Significantly Reduces Endometriosis, New Study Finds

Potential For Diagnosis, Imaging, Treatment And Prognosis In Ovarian Cancer

Antibiotic Resistant Bacteria In Poultry Could Threaten Human Health

Empathy Skills Must Be Given A High Priority In Medical Education, Says Jefferson Author
Massachusetts Health Insurance Connector Board Approves Lower-Cost Health Plans For Uninsured

How To Build Strong Bones & Prevent Osteoporosis - American Council On Exercise Offers Three Moves To Care For Your Bones

Maternity Care Analysis Finds Danger Of Routine Birth Interventions

Findings from a two-year review of the science behind maternity care indicate that the common and costly use of many routine birth interventions, such as continuous electronic fetal monitoring, labor induction for low-risk women and cesarean surgery, fail to improve health outcomes for mothers and their babies and may cause harm. The review entitled, the Evidence Basis for the Ten Steps to Mother-Friendly Care, will be published in The Journal of Perinatal Education and the results will be premiered at the Coalition for Improving Maternity Services
(CIMS) Forum today. Research findings include: -- Women whose labors are induced for non-medical reasons are more likely to suffer from intrapartum fever and more likely to end up needing forceps, vacuum extraction and a cesarean surgery. -- Inductions add to the risk of poor outcomes for the health of the baby. Artificially-induced labors increase the rate of fetal distress and a serious complication of labor called shoulder dystocia (when the baby's shoulders have difficulty passing through the mother's pelvic bones). Elective induction babies are also more likely to need phototherapy to treat jaundice after birth, and are at higher risk for breathing difficulties and admission to neonatal intensive care. -- Use of electronic fetal monitors is more than 85 percent on low-risk women. They fail to reduce the number of perinatal deaths, the incidence of cerebral palsy or the number of admissions to the neonatal intensive care unit. Continuous fetal monitoring puts women at increased risk for an instrumental delivery, cesarean section and infection. -- Overall 1 in 3 U.S. women give birth by cesarean surgery. The majority of the operations are repeat procedures with no medical indication. -- When compared to women who have a vaginal birth, cesarean surgeries put women at risk for infections, hemorrhage requiring transfusion, surgical injuries, and complications from anesthesia, chronic pain, adhesions, hysterectomy, pulmonary embolism, placental problems with future pregnancies and death. Babies born by cesarean surgery are more likely to suffer from surgical lacerations, respiratory complications, and to require neonatal intensive care. There are more than 4.1 million U.S. births a year with a cesarean surgery rate more than 30 percent. The health and economic impact of high tech birth is significant. In 2004, hospital costs for deliveries were more than $30 billion. The record high cesarean surgery rate contradicts the national goals of Healthy People 2010 to reduce cesarean surgeries for first time mothers to 15 percent and to increase VBAC (Vaginal Birth After Cesarean) rates to 63 percent. The research also found that harm is caused by routine use of intravenous fluids (IVs), amniotomy (breaking the bag of waters), withholding food and water from women in labor and episiotomy. The Journal of Perinatal Education is the leading peer-reviewed journal for childbirth educators. The Journal is published quarterly by Lamaze International for readers who provide parent education in the areas of childbirth, pregnancy, breastfeeding, neonatal care, postpartum, early parenting and young family development. For more information about The Journal of Perinatal Education and Lamaze International,
visit http://www.lamaze.org.

Source

Texas Blogging judge thinks this is funny

Dallas-based U.S. District Judge Jerry Buchmeyer has been writing and collecting courtroom comedy for years.

An example comes from the deposition of an elderly plaintiff asked about her surgeries:
"Answer: I had an appendectomy, and they removed a tube. Then I had another surgery; they took out an ovary. And then I had adhesions; and the rest of them are just adhesions, exploratory.
Question: What were they searching for in these exploratory surgeries?
Answer: Money. That's the best answer I can give."

Surgery for large bowel cancer

Surgery is the most common type of treatment for colorectal cancer and should be carried out by a surgeon who specialises in bowel surgery.
The operation
Before your operation
Surgery for cancer of the colon
Surgery for cancer of the rectum
Surgery for advanced colon or rectal cancer
After your operation
Diet after bowel surgery
Sex life after bowel surgery
If you need a colostomy or ileostomy
Looking after a stoma
Source

Adhesions Medical Headlines ARDvark blog

New Mexico Prepares To Pass Compulsory HPV Vaccine
New Mexico is about to pass legislation making it compulsory for girls going into the sixth grade to be vaccinated against the Human Papillomavirus (HPV)...[read article]

Studies Highlight Cocoa's Remarkable Health Properties
Two recent studies suggest compounds in natural cocoa have significant health-giving properties. One study by Prof Norman K. Hollenberg from Harvard Medical School and Brigham and Women's Hospital in Boston, US was published in the International Journal of Medical Sciences...[read article]

Ovarian Cancer May Mimic Fallopian Tube Formation

Do Doctors Understand That Morphine Kills Pain, Not Patients?

FDA Approves Elbit Software For Use With Uterine Fibroid Treatment

New Molecular Path To Fight Autoimmune Diseases Discovered By Penn Researchers

Award For Development Of (HPV) Cervical Cancer Vaccines

Washington State Lawmakers Send Children's Health Insurance Expansion Bill To Governor

California Panel Releases Recommendations To Reduce Medication Errors

Sunny Days Pose Risk Of 'Flicker Illness' For A Few Airlifted Patients

Principles Call For Changes At The Physician Practice Level To Improve Outcomes

Actions Taken On Women's Health-Related Legislation, Programs In Arizona, Maryland, Wisconsin

Gardasil Not Provided At Most New York City Health Clinics, Often Not Available At Reduced Cost, Report Says

Kaiser Daily Health Policy Report Highlights Coverage Of Military Hospital System Developments

Endogun Medical Systems Ltd. Launches Human Clinical Study For Prolapse Repair

UBC Researcher Finds New Way To Treat Devastating Fungal Infections

America's Approval Of Cosmetic Surgery At An All-Time High

Brene Brown's Offering Studies Women And Shame

EU-Directive: Potentially Dangerous Consequences For MRI

Discovery Of Morphological Subgroups That Correlate With Severity Of Symptoms In Interstitial Cystitis: A Proposed Biopsy Classification System

Older Mothers More Likely To Deliver By Caesarean

Good Health Slips Further Out Of Reach, Australia

How Anti-Depressants Create New Brain Cells

Little Is Known Of Drugs' Safety And Effectiveness In Children

Hospital Infection Control Saves Lives, Cuts Costs

Too Much Weight Spells Double Trouble For Couples Trying To Conceive

Taking The Wraps Off Drug Safety Data From Clinical Trials

New Study Cautions States On Changes To Medicaid

One Step Closer To Needle-Free Injections

16,000 Radiologists Gather For A Congress In Vienna: Innovations In Imaging Technologies Benefit Patients

Here's an odd one ~ Twist and Shout

The more senior of my two partners when I first went into practice was old school in the very best sense of the words. The most general of general surgeons, he still did the occasional orthopedic procedure, yanked out uteri (indeed, that operation is more of a “yank,” in terms of non-anatomic dissection, than most), didn’t mind drilling a burr-hole or two if called upon to do it. I’m sure he’d have been happy to deliver a baby on the proverbial kitchen table; in fact, I think he did, back a ways. Many of his patients were people for whom he provided complete care as their family doctor. Blood pressure, diabetes, pneumonia — he managed them all. And well, far as I could see. Gentle and soft-spoken, self-deprecating, Hume was welcoming to me from the start, and set an admirable example. When he assisted me, or I him, I always learned something. And, I’m happy to say, I showed him a few things as well. If it was mutual admiration, it was lop-sided in the way of a cub and a poppa bear.
He practiced mostly in the time when doctors were nothing but highly respected, and, at least in his case, it was entirely deserved. In his forty or so years of practice, he was never sued. Here’s how it was in his heyday, as he told me once: a long-time patient, on whom he’d done a colon resection several years earlier, came to see him with abdominal pain. As was standard in the days before ultrasound, Hume ordered a gallbladder Xray, which made the expected diagnosis of gallstones. “George,” he told the man, “looks like you’ll need your gallbladder out. And while we’re in there, I’m going to remove a clamp that I seem to have left in you last time.” “Sure thing, doc. Whatever you say.” (Snide-comment-avoiding explication: far as I recall, it was the stones that were the problem.)
One of my favorite tricks of patient care, for which I loved to write the order because I knew it boggled some nurses and about which I was never certain it worked but wrote it anyway because it made intuitive sense even if it seemed silly so it was fun to talk my patients into it and to imagine them doing it, having had a few people get better after doing it whether they would have or not had they not done it, and which in part I ordered because it always reminded me of Hume and made me feel like a canny old-timer who had a couple of decidedly low-tech tricks up his sleeve even when I was young but kept ordering when I was old, frequently enough that the nurses referred to it as the “Schwab shake” because it was in a different town and none of them knew Hume, was a thing he taught me. (Chew on that sentence, Strunk and White!) To see any sense in it at all, you have to be able to imagine the intestine in the midst of a small bowel obstruction.
In the virgin abdomen (but not always in the abdomen of a virgin), the small intestine is free to slip and slither pretty much anywhere it wants. (In some operations, it’s useful to “eviscerate” the patient by pulling the intestine as far as it will go outside of the abdominal cavity. Re-inserting them, those guts roll back in like a gang of slurpy slinkys over a soft stair, like the buttered spaghetti Momma dolloped onto your plate.) In an area of inflammation from an operation, or injury, or infections of one or another sort, a bit of intestine might become adherent to the abdominal wall or to other structures.Those areas are what we call “adhesions.” If other areas remain normally slippery, it’s not hard to imagine a loop or two of bowel sliding around a more fixed one, and causing a twist. And there you have it: small bowel obstruction. Typically, that means a distended abdomen as the upstream intestine fills with digestive juices, cramps as the muscular action of the gut (”peristalsis”) tries to push stuff past the blockage, cessation of bowel movement or gas passage, and, most often, vomiting. In some instances, the blockage isn’t complete, and there might be some amounts of stool. Diarrhea, even.
Surgery is usually the treatment for complete obstruction, and typically needs to be done within several hours, lest the twisted area die from lack of circulation (maybe I’ll get into some of the subtleties in the future.) Non-surgical treatment consists of “suck and drip.” Namely, a tube into the stomach to suction away the juices that are backing up, and IV fluids to replace the losses. If the patient is able, walking around is thought to be helpful, if for no other reason than to prevent secondary problems related to bed rest. But there the patient is, lying nearly continuously on her/his back, with a belly full of fat swollen intestines. If what you’re hoping for is a serendipitous untwisting, lying like that with a bunch of sausage stacked on itself seems less than propitious. Thus, Hume’s trick: get the patient out of bed, have him/her lean forward onto the bed, back as parallel to the ground as possible, and shake their hind end like kyphotic hula dancer. (I always demonstrated for my patients, which was generally found to be amusing.) Get them guts off of each other and move ‘em around. I like it. (If the idea is sound, I thought, somersaults would be ideal. In fact, one of my friends — a pediatrician, for whatever it’s worth — had a problem with recurring obstructions after splenectomy many years earlier. I suggested somersaults, which he starting doing at home at the first hint of symptoms, and he claims it helped. Eventually, however, I operated and fixed him for good.)
I never did a study; hard to imagine one ever being done. Several — not all — patients recovered without an operation after shaking it up. It’s known, of course, that some obstructions resolve without surgery, so I can’t claim to know whether the maneuver works or not. But all of my patients who could, did it. Whereas the long-term nurses on the surgical floor got used to the idea, I assume there were some — especially those on the medical floors where such patients occasionally found themselves — who thought I was nuts. Until their patients started pooping. And there’s this: I was once consulted on a patient with a bowel obstruction in whom, on bedside abdominal exam, I could easily feel a particularly fat loop of bowel. What the heck, I thought: I manipulated it upward (it was remarkably easy to do) and around in some way, immediately after which the patient excused herself rapidly from my ministrations and headed to the bathroom where she produced ample evidence that the obstruction was no longer. I think Hume would have liked it.Content from: Surgeonsblog

http://ad4g.ttneo.com/Twist-and-Shout/

Adhesions

http://free-medical-encyclopedia.blogspot.com/2007/03/adhesions.html

What is the Definition of Adhesions?A
n adhesion is a band of scar tissue that binds together two anatomic surfaces which are normally separated from each other.Description of AdhesionsAdhesions are most commonly found in the abdomen, where they form after abdominal surgery, inflammation or injury. Adhesions are fibrous tissues within the body that join normally unconnected parts. Although sometimes present from birth, adhesions are usually scar tissue formed after inflammation. The most common site of adhesions is the abdomen, where they often form after peritonitis (inflammation of the abdominal lining) or following surgery, as part of the body?s healing process.Abdominal adhesions sometimes bind together loops of intestine and can result in intestinal obstruction. This condition is characterized by abdominal pain, nausea, vomiting, abdominal distention, and an increase in pulse rate without a rise in temperature.Nasogastric intubation and suction may relieve the blockage. If there is no relief, an operation is usually required to cut the fibrous tissue and free the intestinal loops. Although scar tissue within the abdomen can occur after any abdominal operation, they are more common after a ruptured appendix.Most adhesions cause no problems, but they can obstruct the intestine in about 2 percent of all patients. These obstructions can occur several years later. The adhesions can also block the ends of the fallopian tubes, possibly causing infertility.Adhesions also occur elsewhere and can be the cause of other disorders ? for instance, they can lead to glaucoma when located in the eyes, and when located around the heart can result in pericarditis.Adhesions can pull on nerves or organs, and depending on where they are located can cause pain in the body while stretching, exercising, or even deep breathing. Doctors can use a number of tests, including blood tests, x-rays and CT scans to determine if the problem is extensive enough to require surgery.Lysis (destruction or dissolution) of adhesions is a surgery performed to free adhesions from tissues. Laparoscopy (a camera is inserted into a small hole in the skin to view the adhesions and then they are cut) and laparotomy (a larger cut is made and the doctor sees the adhesion directly) are commonly used to treat this condition. The outcome of surgery is usually favorable, although adhesions often return because the surgery to remove them can also cause them.

What Questions to ask Your Doctor About Adhesions?
How do you know the problem is adhesions and not some other condition?
Is surgery recommended to remove the adhesions? What is the procedure?
How likely is it that the adhesions will redevelop?

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ClinicalTrials.gov ~ Search for Adhesion Trials

23 studies were found.
1.
Recruiting
DuraGen Plus® Adhesion Barrier for Use in Spinal SurgeryConditions: Spinal Injuries; Adhesions
2.
Recruiting
Pregabalin for Abdominal Pain From AdhesionsConditions: Abdominal Pain; Surgical Adhesions
3.
Recruiting
Collagenase in the Treatment of Zone II Flexor Tendon Adhesions in the HandCondition: Hand Zone II Flexor Tendon Adhesions
4.
Recruiting
Pediatric Multicenter Study of REPEL-CVCondition: Adhesions
5.
Recruiting
Use of G-CSF to Obtain Blood Cell PrecursorsConditions: Chronic Granulomatous Disease; Healthy; Immunologic Disease; Leukocyte Adhesion Deficiency Syndrome; Severe Combined Immunodeficiency
6.
Recruiting
Determination of Lymphocyte JAM-C Expression in Patients With Psoriasis VulgarisConditions: Psoriasis; Psoriasis Vulgaris
7.
Recruiting
Evaluation of Patients With Immune Function AbnormalitiesCondition: Immune System Diseases
8.
Recruiting
Effect of Exercise and Diet on Inflammation in Hypertensive IndividualsCondition: Hypertension
9.
Recruiting
Irbesartan/Hydrochlorothiazide National Taiwan University Hospital ListingCondition: Hypertension
10.
Recruiting
Combination Chemotherapy After Surgery in Treating Patients With Stage I, Stage II, or Stage III Breast CancerCondition: Breast Cancer
11.
Recruiting
Familial Mediterranean Fever and Related Disorders: Genetics and Disease CharacteristicsCondition: Periodic Disease
12.
Recruiting
Collagenase in the Treatment of Adhesive Capsulitis (Frozen Shoulder)Conditions: Adhesive Capsulitis; Frozen Shoulder
13.
Recruiting
Study of the Composition of Dental PlaqueConditions: Dental Caries; Dental Plaque; Periodontal Disease
14.
Recruiting
Genetic Factors in Age-Related Macular DegenerationCondition: Macular Degeneration
15.
Recruiting
Efalizumab to Treat UveitisConditions: Uveitis; Intraocular Inflammatory Diseases
16.
Recruiting
Raptiva to Treat Sjogren's SyndromeCondition: Sjogren's Syndrome
17.
Not yet recruiting
Value of CT-Scan and Oral Gastrografin in the Management of Post Operative Small Bowel ObstructionCondition: Small Bowel Obstruction
18.
Recruiting
A Safety Study of Two Intratumour Doses of Coxsackievirus Type A21 in Melanoma Patients.Condition: Stage IV Melanoma
19.
Not yet recruiting
Rosiglitazone and Metformin: Outcomes Trial in Nondiabetic Patients With Stable Coronary Syndromes (Romance) Pilot StudyCondition: Coronary Artery Disease
20.
Recruiting
Study on the Efficacy and Mechanism of Cardiac Rehabilitation for Stem Cell Mobilization and Heart Failure ImprovementCondition: Myocardial Infarction
21.
Recruiting
Detection and Characterization of Host Defense DefectsConditions: Immunologic Deficiency Syndrome; Infection
22.
Recruiting
Allogeneic and Matched Unrelated Donor Stem Cell Transplantation for Congenital Immunodeficiencies: Busulfan-Based Conditioning With Campath- 1H, Radiation, and SirolimusConditions: MUD Transplant; AlloPBSC; Congenital Immunodeficiencies; HLA Matched Transplant; BMT
23.
Not yet recruiting
Oxidative Stress Lowering Effect of Simvastatin and Atorvastatin.Conditions: Diabetes Mellitus; Hypertension


Search Term

Adhesions, and what can be done about them

Pelvic Adhesions Pelvic adhesions cause many problems for millions of women. From obstructed tubes associated with infertility, to pelvic tenderness, and painful intercourse, to chronic pelvic pain. Curiously, adhesions can be very extensive, yet relatively silent. They may remain silent indefinitely, or long after the causative event, become symptomatic. The causes of adhesions are multiple but basically the tissue irritation that produces the adhesive process arises from an inflammatory event, or from trauma (i.e. post surgical). Examples of an inflammatory event would be a tubal infection from a sexually transmitted disease (e.g. Gonorrhea), a post surgery infection, or appendicitis. Chronic "irritation" of the pelvic tissues from a common disease process such as endometriosis, may also incite adhesions. A very significant proportion of symptomatic pelvic adhesive disease arises from previous necessary pelvic surgery ( removal of an ovarian cyst would be a good example). What are "pelvic adhesions" anyway?? In the process of trying to repair injured tissue, a series of normal healing events may cause some structures in the pelvis to become unintentionally "stuck" to another tissue or structure. In a normal healthy pelvis (or the whole abdominal cavity for that matter) this large space is lined with a tissue called peritoneum, which also covers the outside of organs located in the abdomen and pelvis. In an non-injured or irritated state, the peritoneum can be likened to slippery cellophane wrap…. the organs and structures lying immediately adjacent to each other just slip off each other and do not become bonded together. Given a tissue injury, the healing process initiates a sequence of events that can result in a certain tissue becoming "stuck" to its neighbor, and when this happens certain undesirable results occur. The ovary for example is a very sensitive structure, much like the testis. If as a consequence of an ovarian cystectomy,( the removal of the cyst from the ovary) the ovary becomes "attached' to the pelvic sidewall, or the top of the vagina, the patient may experience persistent pelvic pain and/or painful intercourse. The diagnosis is suspected by a history of ovarian surgery, and subsequent persistent pain or tenderness unrelated to her menstrual cycle. After a large abdominal incision (e.g. a hysterectomy for large fibroids) the bowel or an associated fatty structure called the omentum may become adherent to the abdominal wall. Adhesions begin to develop within hours of surgery. If by chance it is a loop of bowel, the patient may experience intermittent bouts of crampy pain, perhaps associated with some nausea, bloating, or even vomiting. The intestinal symptoms are related to some degree of bowel obstruction that inhibits the passage of the bowel contents or gas through the partially obstructed area. When the obstruction is severe then the patient will be very ill with nausea, distention and vomiting, and may not be passing any gas rectally. Xray studies may confirm the severe obstruction, and treatment may require decompression of the bowel by means of a tube passed through the stomach to the intestine, or even exploratory surgery. More often in my experience, the symptoms are troublesome and annoying, and the obstruction is not severe enough to make any of the Xray tests informative. Often the patient will be sent to the gastroenterologist , and endoscopoic evaluation of both the upper and lower bowel will be performed . Frequently, the diagnosis is "irritable bowel syndrome". It should be remembered that intra-abdominal and pelvic adhesions rarely if ever show up on Xray or ultrasound. Unfortunately, every time an abdominal incision is performed, the risk is present for recurrent adhesion problems. The good news is however that most patients will not develop serious post-operative adhesions causing further problems. Those unfortunate to do so may ultimately undergo repeated surgeries, always hoping that "this will do it!!" Does everybody develop adhesions?? No they do not, but it is not understood why one person develops very extensive adhesions, and the next individual none at all. The nature of the traumatic tissue event, the duration of the inflammatory insult, the nature of the preceding surgery, the operative technique of the surgeon, and the unknown healing characteristics of a given individual all interplay in the final outcome. What can be done to minimize pelvic adhesions from forming? Early treatment of an infectious process if identified, utilization of safe sex practices to minimize the transmission of sexually transmitted disease, meticulous surgical technique to minimize unnecessary tissue trauma, and perhaps using barrier products where appropriate. The latter may be helpful in reducing the extent or severity of the post operative adhesion development. What to do if symptomatic adhesions develop, what are the patients options? The first option in any situation is don't do anything. Pain is a relative experience, and the degree of severity will vary from individual to individual. Minor, or even moderately severe discomfort can often be lived with, or controlled by medication, acupuncture, or medical hypnosis. Not infrequently pelvic pain is not helped by conventional treatment such as hormones, pain medicine, or even surgery. In those circumstances, non-conventional treatment with acupuncture or hypnosis can sometimes be very helpful. Given significant symptomatic pelvic adhesions being suspected from the history and physical exam, a thorough workup is indicated , which may include special xray studies and ultrasound. Ultimately, laparoscopy may be utilized to allow visual inspection of the intra-abdominal organs. What to do surgically depends on the findings. If an ovary is bound down with adhesions from previous surgery, the extent of the adhesive process may indicate a simple cutting of the adhesions or if necessary, removal of the ovary. If the patient has completed her fertility requirements, and if the pelvic adhesive process is very extensive, a complete hysterectomy with removal of both tubes and ovaries may be indicated. Obviously, the patient and her gynecologist need to have had a very comprehensive and detailed discussion about what might be encountered, and what options might be exercised. What about abdominal wall adhesions resulting from prior abdominal surgery? These can usually be taken down laparoscopically, thus minimizing tissue injury, as opposed to a conventional large incision. Multiple tiny incisions may be necessary in order for the surgeon to see well, and from different angles the area of dense adhesions. Nonetheless, several tiny 1/2 inch incisions are far less uncomfortable than a conventional laparotomy incision. If the adhesions are extensive, and the patient has undergone previous adhesion surgery that failed, I have taken an unorthodox approach to such individuals. Because adhesions begin to form almost immediately, along with the healing process involving the raw anterior abdominal wall, I have in special situations recommended a repeat laparoscopy in one week. At this point, the "new" adhesions are flimsy, soft, do not contain a blood supply, and can be swept away with minimal tissue injury, compared to a conventional adhesiolysis (freeing the adhesions surgically) of old adhesions that are dense, very adherent, and bloody. This is performed in an outpatient setting, and usually takes but a few minutes, compared to the time involved dealing with extensive, dense old adhesions. It is important that patients inquire about their surgeon's experience with extensive adhesions, because what might be viewed as "not possible laparoscopically" by one gynecologist, may be very familiar territory for another. Because bowel may be intimately involved with the adhesive process the patient has to be aware that the worst case scenario may require bowel surgery, and a conventional laparotomy incision. Pelvic adhesions can be a serious detrimental quality of life issue. Some patients are total pelvic cripples because of this problem. Once formed, they do not disappear with time. If you are suffering from some of the medical complaints outlined earlier, do consider a consultation with an experienced laparoscopic gynecologist and hopefully your adhesive problems can be solved.

J. Glenn Bradley, MD OBGYN.net Correspondent for Laparoscopy and Hysteroscopy and Alternatives to Hysterectomy Advisory Board Member

Rare but often serious complications continue to plague the most common laparoscopic operation.

Hidden Risks
March 12, 2007 issue - When surgeons removed Carol Hurlburt's diseased gallbladder in 2005, they had to cut a long, gory incision in her abdomen, and she was still hurting when her husband developed his own gallbladder infection a month later. Richard Hurlburt, however, was a candidate for a less painful, minimally invasive procedure performed with the aid of cameras inserted through small holes in his abdomen—a "laparoscopic cholecystectomy" that would have him home the next day. But, Carol says, Richard's common bile duct, which links the gallbladder, liver and small intestine, was cut. Over the next eight months, Richard became sicker and died waiting for a liver transplant. What was supposed to be a simple procedure ended in tragedy. Determining what caused it all, and where it went wrong, has moved from the hands of doctors to the hands of lawyers. Last summer, Carol filed suit.
One of the most common surgical procedures in the country, performed on 750,000 patients annually, laparoscopic gallbladder removal has a record of success stretching back almost two decades. Serious complications are rare; less than 1 percent of patients die. Along with other surgeries that rely on scopes as well as scalpels—including gastric bypass, hernia repair and appendectomies—the "lap chole" has largely supplanted open operations, helping millions of patients avoid long and potentially dangerous recoveries in hospitals. "Minimally invasive surgery was a revolution," says California Pacific Medical Center's Leonard Shlain, who was one of the first to perform it.
But some doctors now say the demands of an overeager public have pushed them over the years into doing minimally invasive procedures before they had the necessary skills. In the rush, says Ram Chuttani of Beth Israel Deaconess Medical Center in Boston, "major complications occurred which might have been prevented." Shlain says some laparoscopic operations have "a dark side" of rare but serious complications, and that patients go into them falsely believing they are more or less risk-free. As doctors begin to perform new minimally invasive operations that seemed unthinkable a few years ago—including one that involves no skin incision at all—there is a danger that they, too, will overlook risks that have been there all along.
The first minimally invasive procedure to gain wide acceptance, the laparoscopic cholecystectomy arrived in the 1990s "like a thunderbolt," says Josef Fischer, chair of surgery at Beth Israel Deaconess Medical Center. Surgeons quickly adopted it as the standard of care for gallbladder infections, practicing on pigs at weekend workshops and then quickly moving on to human patients who lined up for it—even some whose problems were too mild to warrant open operations. Though popular with both docs and patients, the operation carried new risks, some more severe and more common than those of the procedure it was replacing. Most serious was the rising rate of injury to the common bile duct, at least five times higher than it was in open surgery. Most doctors, however, blamed this on the inevitable awkwardness of novices. The learning curve, they thought, would flatten out with time, and the operation would become safer.
Since then, the tools of minimally invasive surgery have improved greatly; today's equipment includes high-definition cameras and rotating scopes and lights that put the anatomy "right up in your face," says Ed Phillips of Cedars-Sinai Medical Center in Los Angeles. Surgeons have adopted preventive measures, such as X-rays that offer clear views of the common bile duct. They also now have experience with other minimally invasive procedures to treat heart failure, obesity and other ailments. Not all of them are better than their open counterparts, but overall, says Tom Russell, executive director of the American College of Surgeons, "pretty much everything in surgery is going this way."
Amid the promising changes, though, a troubling fact: the learning curve for laparoscopic cholecystectomies never flattened out. Just as in the '90s, in almost one out of every 200 cases, the surgeon cuts the common bile duct. That's nearly 4,000 patients per year. And the number may be underreported, says Shlain, because "few surgeons rush to tell people about their catastrophes." At conferences, he adds, he hears of more dire outcomes from laparoscopic gallbladder removal than the statistics suggest.
Read the rest of this Newsweek article

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Wyeth Pharmaceuticals, a division of Wyeth (NYSE: WYE) and Progenics Pharmaceuticals, Inc. (Nasdaq: PGNX), today announced that Wyeth is beginning clinical testing this month of a new formulation of oral methylnaltrexone for the treatment of opioid-induced constipation. Preliminary results from the phase 2 trial, conducted by Wyeth, showed that the initial formulation of oral methylnaltrexone was generally well tolerated but did not exhibit sufficient clinical activity to advance into phase 3 testing. Should the new formulation be successful, the companies could file a New Drug Application (NDA) for oral methylnaltrexone as early as late 2009 or early 2010.
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Surgical Menopause: Special situations: no HRT

There are a number of reasons why some women are unable to take hormones in surgical menopause. A blood clotting disorder or cancer are the most common reasons for this, but occasionally we hear of doctors recommending against hormones for other reasons such as blood pressure, smoking, or fear of the other risks they can carry. Whatever the reasoning, this is a difficult road to follow. While women in natural menopause can often get by with symptomatic relief to augment their own lingering ovarian output, a woman in surgical menopause is most likely going to have to face life in some degree of hormonal deficiency.
Of course there are also women who wish to refrain from taking HRTs or supplementing their hormones (these may not be considered the same thing by many women). We've read comments from many women who are afraid of hormones or HRTs because of some family history of cancer or because they had their hysts for cancer. But not all cancers are the same in the effects hormones may have on them, and if you don't know, for sure and in detail, that your specific cancer or family risk is specifically estrogen-mediated, you may want to discuss your own particular risk factors with an oncologist. Just because cousin Mabel thinks she recalls that Great-aunt Violet died of some sort of cancer doesn't mean that HRT may pose an unacceptable level of risk for you.
By the same token, if you cannot safely take HRTs, please understand that alternative HRTs like nutraceuticals and high-phytoestrogen foods do contain functional hormones and carry those same risks you're avoiding with prescription HRTs. And consider further that if you deem a family or personal cancer risk too high to supplement your hormones, you may want to discuss with an oncologist whether your own hormones also present that level of risk. Remember: your body doesn't stop producing hormones entirely when you lose your ovaries: you are still producing enough for the majority of your needs via body fat and adrenal conversion. If the small increment that HRT use adds is too dangerous, so too might your own production pose an unacceptable risk. An oncologist can help you explore whether you need to take drugs to block all hormone production or use in the body, and this may be every bit as important for you as not adding more to your system.
.........for Sandy
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Camilla 'recovering well' after surgery

THE Prince of Wales visited the Duchess of Cornwall yesterday as she recuperated from her hysterectomy, Clarence House said.
Charles went into King Edward VII Hospital in central London by a side door, out of sight of waiting reporters. He stayed for about half an hour.Camilla was said to be "recovering well" after the operation.The Duchess is expected to remain in hospital for the rest of the week following the operation, which was performed by Michael Dooley and Marcus Setchell.Mr Dooley is the Duchess's gynaecologist and Mr Setchell the royal gynaecologist.Camilla, 59, arrived at the private hospital in a chauffeur-driven car just before 11pm on Sunday.Once she is discharged from hospital, she will rest for a further six weeks, with planned engagements postponed.Clarence House described the operation – the removal of the womb – as routine and said it was not cancer-related, but refused to discuss Camilla's condition further.A hysterectomy can be performed for several medical conditions including fibroids ("lumps" in the uterus), cancer and endometriosis, when small pieces of the womb lining stick to other parts of the body, such as the bladder.
Fibroids or irregular bleedings can occur in women taking hormone replacement therapy.Other reasons can include painful pelvic inflammatory disease,or prolapse where the uterus or part of the vaginal wall drops down.More than 40,000 hysterectomies are carried out in the UK each year and one in five British women will have one before the age of 60.
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Coalition for Improving Maternity Services Presents Evidence Exposing Dangers of Induction and Cesareans

Care Supporting Normal Birth Best for Mothers and Babies
Ponte Vedra Beach, FL (PRWeb) March 1, 2007 -- Findings from a two-year review of the science behind maternity care indicate that the common and costly use of many routine birth interventions, such as continuous electronic fetal monitoring, labor induction for low-risk women, and cesarean surgery, fail to improve health outcomes for mothers and their babies and may cause harm.
The Coalition for Improving Maternity Services (CIMS) Expert Work Group study entitled, Evidence Basis for the Ten Steps to Mother-Friendly Care, reviewed the evidence in support of each of the Ten Steps of the Mother-Friendly Childbirth Initiative for Mother-Friendly Hospitals, Birth Centers, and Home Birth Services.
Research findings include:
• Women whose labors are induced for non-medical reasons are more likely to suffer from intrapartum fever and more likely to end up needing forceps, vacuum extraction and a cesarean surgery. • Inductions add to the risk of poor outcomes for the health of the baby. Artificially induced labors increase the rate of fetal distress and a serious complication of labor called shoulder dystocia (when the baby's shoulders have difficulty passing through the mother's pelvic bones). Elective induction babies are also more likely to need phototherapy to treat jaundice after birth, and are at higher risk for breathing difficulties and admission to neonatal intensive care.
• Use of electronic fetal monitors is over 85% on low-risk women. They fail to reduce the number of perinatal deaths, the incidence of cerebral palsy or the number of admissions to the neonatal intensive care unit. Continuous fetal monitoring puts women at increased risk for an instrumental delivery, cesarean section and infection.
• Overall 1 in 3 US women give birth by cesarean surgery. The majority of the operations are repeat procedures with no medical indication. • When compared to women who have a vaginal birth, cesareans put women at risk for infections, hemorrhage requiring transfusion, surgical injuries, and complications from anesthesia, chronic pain, adhesions, hysterectomy, pulmonary embolism, placental problems with future pregnancies, and death. Babies born by cesarean are more likely to suffer from surgical lacerations, respiratory complications, and to require neonatal intensive care.
• There are more than 4.1 million US births a year with a cesarean rate over 30%.
The health and economic impact of high tech birth is significant. In 2004, hospital costs for deliveries totaled over $30 billion dollars. The record high cesarean rate contradicts the national goals of Healthy People 2010 to reduce cesareans for first time mothers to 15% and increase VBAC (Vaginal Birth After Cesarean) rates to 63%. The CIMS study found that harm is also caused by routine use of intravenous fluids (IVs), amniotomy (breaking the bag of waters), withholding food and water from women in labor, and episiotomy. CIMS recommends supporting normal birth for birthing women and limited use of many common and costly birth interventions.
The CIMS Evidence Basis for the Ten Steps to Mother-Friendly Care will be published as a supplement to the Winter Issue of The Journal of Perinatal Education. The results will be premiered at the CIMS Forum on March 8th at the DoubleTree Atlanta-Buckhead in Atlanta, Georgia.
Members of the CIMS Expert Work Group include: Henci Goer, BA, Project Director; Judith Lothian, RN, PhD, LCCE, FACCE, Project Coordinator; Mayri Sagady Leslie, CNM, MSN; Amy Romano, MSN, CNM; Katherine Shealey, MPH, IBCLC, RLC Sharon Storton, MA, CCHT, LMFT; Karen Salt, CEE, MA; Deborah Woolley, CNM, PhD, FACCE
The Coalition for Improving Maternity Services (CIMS), a United Nations recognized NGO, is a collaborative effort of numerous individuals, leading researchers, and more than 50 organizations representing over 90,000 members. Promoting a wellness model of maternity care that will improve birth outcomes and substantially reduce costs, CIMS developed the Mother-Friendly Childbirth Initiative in 1996. A consensus document that has been recognized as an important model for improving the healthcare and well being of children beginning at birth, the Mother-Friendly Childbirth Initiative has been translated into several languages and is gaining support around the world. For more information about CIMS and the Mother-Friendly Childbirth Initiative, visit
www.MotherFriendly.org

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Camilla to have hysterectomy today

Camilla to have hysterectomy today
Press AssociationMonday March 5, 2007
Guardian Unlimited
The Duchess of Cornwall was expected to undergo a hysterectomy operation at a private hospital in London today.
Camilla, 59, arrived at the exclusive King Edward VII hospital last night.
The duchess returned to the UK a few days ago after a 10-day tour of the Gulf with the Prince of Wales and a further day in Banjaluka, Bosnia, with the 1st Battalion Welsh Guards to mark St David's Day.
In Qatar, on the fifth day of the tour, there were some doubts whether Camilla would attend an evening engagement, visiting a traditional Arab market.
But later that day a Clarence House spokesman said the duchess would join the prince for the event. "She's had a good rest and is coming along," he said.
The duchess arrived at the private hospital in central London in a chauffeur-driven car just before 11pm last night.
The medical centre is the first port of call for royals and is where the Queen had her knee operation.
The duchess will spend several days in hospital and rest for six weeks afterwards, with planned engagements postponed.
Clarence House described the operation - the removal of the womb - as routine and said it was not cancer-related, but refused to discuss Camilla's condition further.
About one in five women in the UK is given a hysterectomy before the age of 60.
The operation can be performed for several medical conditions including fibroids ("lumps" in the uterus), cancer, and endometriosis, when small pieces of the womb lining stick to other parts of the body, such as the bladder.
Fibroids or irregular bleedings can occur in women taking hormone replacement therapy.
Other reasons can include painful pelvic inflammatory disease, caused by infection or prolapse, where the uterus or part of the vaginal wall drops down as a result of weak tissues.
The royal couple visited five countries in total during the demanding trip to the Arabian peninsula and on one occasion it appeared the engagements were taking their toll on the 59-year-old.
Source

Advocate Lutheran General Hospital Doctors Use Robotics for Gynecological Surgery

http://www.emaxhealth.com/4/9983.html
Mary Lockhart of Batavia underwent a robotic hysterectomy performed by Karen Fish, M.D., and Dan Pesch, M.D., using the da Vinci Surgical System on December 29 at Advocate Lutheran General Hospital. The 38-year-old was released from the hospital the next day, went grocery shopping the day after that and five days later drove herself to work!
"I feel great," Lockhart said. "I had just four tiny incisions—the largest was 1/2-inch—and I was back to my 45-minute aerobic workout just two weeks after surgery."
Hysterectomy is the most common female surgery, with roughly 650,000 performed each year in the United States, mostly through an abdominal incision. For many patients, the use of the da Vinci Surgical System—robotic technology designed to facilitate minimally invasive surgery—offers the potential for less blood loss, fewer complications, a shorter hospital stay, less scarring and faster recovery. Additional benefits include less pain and faster return to normal activities.
The first robotic hysterectomy in Chicagoland was performed by Dr. Charles Miller, director of minimally invasive surgery and vice president of the AAGL, the world’s largest organization of minimally invasive gynecologic surgeons. "Not only have we performed robotic hysterectomies, but we have also removed fibroids, tubes, ovaries and adhesions with the robot," said Dr. Miller. "Soon I will be performing a laparoscopic tubal ligation reversal to help a couple achieve pregnancy."
Dr. Pesch, medical director of obstetrics and gynecology and director of ambulatory education at Lutheran General Hospital worked on Lockhart's procedure with Dr. Fish, M.D., a fellow trained in minimally invasive surgery. "The surgeon has greater control with the robotic system compared to conventional laparoscopy," said Dr. Pesch.
Direct, precise instrument movement through the robotic surgical system provides physicians with increased dexterity, 3-D visualization and allows for more precise suturing. “It allows surgeons to perform more complex, advanced procedures in the operating room that would otherwise require an open incision or laparoscopy," said Dr. Fish.

Video: Hysteroscopic Polypectomy.

Keith Isaacson, MD will discuss the current utilization of diagnostic and operative hysteroscopy in an office setting as well as operative office hysteroscopy in treatment various intrauterine pathology such as myoma, polyp and Asherman's syndrome. Please also view the accompanying video: Hysteroscopic Polypectomy.

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Researchers seek 90 people for study - people suffering from chronic abdominal pain because of surgical scar tissue - Lyrica

Researchers seek 90 people for study
Researchers at Henry Ford Hospital are trying to find 90 people suffering from chronic abdominal pain because of surgical scar tissue for a study on the effectiveness of a pain-relieving drug.
The drug, pregabalin, is an approved medication for people suffering from pain associated with shingles and diabetic nerve pain. It is marketed by Pfizer under the name Lyrica.
The study is a pilot program to see if larger studies prove that the drug can provide relief for those who suffer from chronic pelvic and abdominal pain caused by scar tissue, according to Ann Silverman, a gastroenterologist and lead researcher of the study. The problem is more prevalent in women because they have more abdominal surgeries, such as hysterectomies and C-sections, and develop scar tissue known as adhesions. "We hope it will help people who have abdominal pain," said Silverman. "Right now there is no treatment available."
Rhonda Kaschalk started having pain from adhesions she developed two years ago after undergoing treatment for endometriosis. She was among the first participants in the study. Soon after taking the drug, she felt relief. She has been pain-free for more than a year.
"My whole attitude has changed," said Kaschalk, an Eastpointe resident. "I am doing more for myself. I am working out now. I feel a lot better."
Participants must agree to take part in a 12-week study. To enroll, call (248) 661-7928.
You can reach Kim Kozlowski at (313) 222-2024 or kkozlowski@detnews.com.
Source

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