Showing posts with label .adhesionsinfo. Show all posts
Showing posts with label .adhesionsinfo. Show all posts

Friday, May 06, 2011

FDA Acts to Reduce Harm from Opioid Drugs

FDA Acts to Reduce Harm from Opioid Drugs


On This Page:

•FDA Opioid Strategy

•Widespread Problem

The White House on Tuesday unveiled a multi-agency plan aimed at reducing the “epidemic” of prescription drug abuse in the U.S.—including an FDA-backed education program that zeros-in on reducing the misuse and misprescribing of opioids.



Gil Kerlikowske, director of the White House Office of National Drug Control Policy, says the plan—a collaborative effort involving agencies of the departments of Justice, Health and Human Services, Veterans Affairs, Defense, and others—provides a national framework for reducing prescription drug abuse and the diversion of prescription drugs for recreational use.



“The toll our nation’s prescription drug abuse epidemic has taken in communities nationwide is devastating,” says Kerlikowske. “We share a responsibility to protect our communities from the damage done by prescription drug abuse.”



Key elements of the plan—called Epidemic: Responding to America’s Prescription Drug Abuse Crisis—include:



•expansion of state-based prescription drug monitoring programs

•recommending convenient and environmentally responsible ways to remove unused medications from homes

•supporting education for patients and health care providers

•reducing the number of “pill mills” and doctor-shopping through law enforcement

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FDA Opioid Strategy

In concert with the White House plan, the Food and Drug Administration (FDA) is announcing a new risk reduction program—called a Risk Evaluation and Mitigation Strategy—for all extended-release and long-acting opioid medications.



Opioids are synthetic versions of opium that are used to treat moderate and severe pain.



FDA experts say extended-release and long-acting opioids—including OxyContin, Avinza, Dolophine, Duragesic, and eight other brand names—are extensively misprescribed, misused, and abused, leading to overdoses, addiction, and even deaths across the United States. FDA says a 2007 survey revealed that more than half of opioid abusers got the drug from a friend or relative.



Opioids—such as morphine and oxycodone—are used to treat moderate and severe pain. Over the past few decades, drug makers have developed extended-release opioid formulas to treat people in pain over a long period.



The new REMS plan focuses primarily on: educating doctors about proper pain management, patient selection, and other requirements and improving patient awareness about how to use these drugs safely. As part of the plan, FDA wants companies to give patients education materials, including a medication guide that uses consumer friendly language to explain safe use and disposal.



FDA wants drug makers to work together to develop a single system for implementing the REMS strategies. Toward that goal, FDA is now notifying opioid makers that they must propose a REMS plan within 120 days.



Janet Woodcock, director of FDA’s Center for Drug Evaluation and Research, says this risk management strategy is designed to improve pain management, while preserving patient access to these needed medications.



“This will be an important step toward addressing what has become a critical public health problem,” she says.



Doctor training, patient counseling, and other risk reduction measures developed by opioid makers as part of the REMS are expected to become effective by early 2012. They will be required for various brand name products known under the generic names:



•hydromorphone

•oxycodone

•morphine

•oxymorphone

•methadone

•transdermal fentanyl

•transdermal buprenorphine

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Widespread Problem

FDA estimates that more than 33 million Americans age 12 and older misused extended-release and long-acting opioids during 2007—up from 29 million just five years earlier. And in 2006, nearly 50,000 emergency room visits were related to opioids.



"Opioid drugs have benefit when used properly and are a necessary component of pain management for certain patients, but we know that they pose serious risks when used improperly—with serious negative consequences for individuals, families, and communities," says FDA Commissioner Margaret A. Hamburg, M.D. “The prescriber education component of this Opioid REMS balances the need for continued access to these medications with stronger measures to reduce their risks."



Although doctor training is not mandatory under the REMS plan, other federal agencies are working to get Congress to link mandatory physician training to the already required Drug Enforcement Administration registration number that doctors must have to prescribe controlled substances.



FDA will also require the risk management plan to include a way to determine if the education programs are helping to reduce problems associated with long-acting and extended-release opioids, as well as allowing patients who need opioids to get them.



FDA has had the power to request companies to develop REMS since 2007. The plans may also include medication guides and patient package inserts.



This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.



April 19, 2011
http://www.drugs.com/fda-consumer/fda-acts-to-reduce-harm-from-opioid-drugs-178.html

Thursday, April 28, 2011

Portrayal of caesarean section in Brazilian women’s magazines: 20 year review

Maria Regina Torloni, medical doctor12, Silvia Daher, medical doctor2, Ana Pilar Betrán, medical officer3, Mariana Widmer, technical officer3, Pilar Montilla, technical officer4, Joao Paulo Souza, medical officer3, Mario Merialdi, unit coordinator3


+ Author Affiliations

1Brazilian Cochrane Centre, Rua Pedro de Toledo 598, São Paulo, Brazil, CEP 04039-001

2Department of Obstetrics, São Paulo Federal University, Rua Napoleão de Barros 875, São Paulo, CEP 040024-002

3Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

4Osservatorio Nazionale sulla salute della Donna (O.N.Da), Milan, Italy

Correspondence to: M Torloni ginecologia@terra.com.br

Accepted 29 October 2010


Abstract

Objective To assess the quality and comprehensiveness of the information on caesarean section provided in Brazilian women’s magazines.



Design Review of articles published during 1988-2008 in top selling women’s magazines.



Setting Brazil, one of the countries with the highest caesarean section rates in the world.



Data sources Women’s magazines with the largest distribution during the study period, identified through the official national media indexing organisations.



Selection criteria Articles with objective scientific information or advice, comments, opinions, or the experience of ordinary women or celebrities on delivery by caesarean section.



Main outcome measures Sources of information mentioned by the author of the article, the accuracy and completeness of data presented on caesarean section, and alleged reasons why women would prefer to deliver though caesarean section.



Results 118 articles were included. The main cited sources of information were health professionals (78% (n=92) of the articles). 71% (n=84) of the articles reported at least one benefit of caesarean section, and 82% (n=97) reported at least one short term maternal risk of caesarean section. The benefits most often attributed to delivery by caesarean section were reduction of pain and convenience for family or health professionals. The most frequently reported short term maternal risks of caesarean section were increased time to recover and that it is a less natural way of giving birth. Only one third of the articles mentioned any long term maternal risks or perinatal complications associated with caesarean section. Fear of pain was the main reported reason why women would prefer to deliver by caesarean section.



Conclusions Most of the articles published in Brazilian women’s magazines do not use optimal sources of information. The portrayal of caesarean section is mostly balanced, not explicitly in favour of one or another route of delivery, but incomplete and may be leading women to underestimate the maternal/perinatal risks associated with this route of delivery.



Previous SectionNext Section

Introduction

A caesarean section is a surgical procedure that was developed to prevent or treat life threatening maternal or fetal complications. The proportion of births using caesarean delivery has been steadily increasing in most high income and middle income countries, despite the lack of sound scientific evidence indicating any substantial maternal or perinatal benefits from increasing rates of caesarean section and consistent reports of increased risks for the mother and baby.1 2 3 4 5 In many developed nations and in Latin America, approximately a third of all deliveries occur by caesarean section.6 In the past few decades, Brazil has been one of the countries with highest proportion of deliveries by caesarean section in the world.2 6 According to data from a national health survey, the overall caesarean section rate in Brazil in 2006 was 43.6%,7 but in the private sector it can be more than 80%.8 More than 850 000 unnecessary caesarean sections are being done each year in Latin America, and almost half of them occur in Brazil.2



Despite worldwide concern, debate, and research on this subject, the modifiable causes of rising caesarean section rates remain unclear. Without a better understanding of the possible causes and contributing factors for this tendency, developing and implementing effective strategies to help curb this upward trend and reduce the number of unnecessary caesarean sections will be difficult. This is important, as high rates of non-medically indicated caesarean section have financial implications and unnecessarily expose mothers and children to risks and consequences that are not yet fully understood.



Contemporary women are exposed to and have access to a wide range of information on health topics, including their options for childbirth. This exposure can influence their opinions and affect the decision making process.9 10 11 Additionally, women’s views and preferences on type of delivery are, for different reasons, being increasingly respected by practising obstetricians.12 13 Women’s magazines are one of the most ubiquitous sources of information and can play a critical role in shaping women’s opinions and influencing the decisions they make.9 However, to the best of our knowledge, the accuracy and comprehensiveness of the information on caesarean section compared with vaginal delivery presented in these magazines has not been evaluated.



In this context, we set out to review the top selling women’s magazines published in the past 20 years in Brazil, one of the countries with the highest rates of caesarean section in the world, to analyse the content of the articles that presented information or expressed views related to caesarean section. This is part of a larger worldwide multi-country investigation covering women’s magazines from countries in Europe, Latin America, and North America, where caesarean section rates are increasing in an unprecedented manner. Our hypothesis was that the information transmitted to women through this media was incomplete, biased in favour of caesarean section (possibly presenting it as a more beneficial route of delivery), or both.



The specific objectives of the review were to assess the sources of information that the magazine authors reported to have consulted for writing their articles; the accuracy and comprehensiveness of the information presented on caesarean section versus vaginal delivery; and the views, opinions, or preferences of ordinary women and celebrities about route of delivery and the alleged reasons or motives why they would prefer a caesarean section to a vaginal delivery.

Click here to read the rest

BMJ 2011; 342:d276 doi: 10.1136/bmj.d276 (Published 25 January 2011)


Cite this as: BMJ 2011; 342:d276




Thursday, April 07, 2011

AlloDerm® Regenerative Tissue Matrix ~ Mesh alternative for hernia repair

LifeCell Tissue Matrices: new alternatives for soft-tissue repair




There are many reasons patients may need an operation to repair weak or damaged tissue. Hernia surgery, breast reconstruction after mastectomy, revision procedures after breast augmentation surgery, and other diseases and degenerative conditions can all require tissue repair.



To help reduce the risk of potential problems in repairing or replacing weak or damaged tissue, your surgeon may choose to use an alternative: AlloDerm® Regenerative Tissue Matrix or Strattice™ Reconstructive Tissue Matrix from LifeCell. AlloDerm® Tissue Matrix and Strattice™ Tissue Matrix support regeneration (growth of new tissue) and they actually become part of your own body.


Every patient is different and results may vary. Only a physician can determine the best treatment for you. Please ask your doctor to explain the benefits and risks to see if LifeCell products are right for you.
From the manufacturer:

AlloDerm® Regenerative Tissue Matrix provides a strong, intact repair for challenging hernia repair and breast reconstruction postmastectomy procedures. Unlike other acellular human dermis products, AlloDerm® Tissue Matrix is produced through a unique non-damaging process that allows the body to mount its own tissue regeneration process.


Donated human skin tissue supplied by US AATB-compliant tissue banks is aseptically processed using LifeCell’s proprietary technique to remove the epidermis and cells that can lead to tissue rejection and graft failure. The result is an intact acellular matrix of natural biological components that promotes rapid revascularization, white cell migration and cell repopulation.



AlloDerm® Tissue Matrix provides excellent handling properties, exhibits a remarkable versatility to convert into functional tissues that provide structural support (e.g., gingiva and fascia), and is screened and tested according to FDA regulations, AATB standards and appropriate state regulations.



Used in challenging hernia and abdominal wall repair and breast reconstruction postmastectomy procedures, AlloDerm® Tissue Matrix transforms into host tissue for a natural repair and a safe and clinically optimal outcome. Its benefits include:

Abdominal wall reconstruction

Breast reconstruction postmastectomy

LifeCell Corporation Instructions for use:
http://www.lifecell.com/downloads/LC_Alloderm114_IFU_B_T4.pdf

Please review all information with your doctor to see if this is an option for you.

Maude Adverse Event Data on AlloDerm:
MAUDE Adverse Event Report


Results for 'AlloDerm® Regenerative Tissue Matrix' in All of FDA


... LIFECELL CORPORATION ALLODERM REGENERATIVE TISSUE MATRIX MESH, Back to Search Results.

Event Date 04/04/2008. ... Brand Name, ALLODERM REGENERATIVE TISSUE MATRIX. ...

www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=1045000 - 23k - Cached



Enforcement Report for April 16, 2008



... Recall # B-0911-08; d) AlloDerm, Oral Plastic ... B-0912-08; e) Graftjacket Regenerative

Tissue Matrix 5x5cm, .89 ... B-0913-08; f) Repliform Tissue Regeneration Matrix ...

www.fda.gov/Safety/Recalls/EnforcementReports/2008/ucm120502.htm - 67k - Cached



MedSun Reports



... Manufacturer response for Regenerative Tissue Matrix, AlloDerm

===== LifeCell was notified and will reveiw. ...

www.accessdata.fda.gov/scripts/cdrh/cfdocs/medsun/medsun_details.cfm?id=%25%22-_%3E%25_%3C%20%0A - 16k - Cached





TPLC - Total Product Life Cycle



... Injury, 1. MDR Distribution by Brand. STRATTICE, 15. ALLODERM, 1. ALLODERM REGENERATIVE

TISSUE MATRIX, 1. ALLODERM TISSUE, 1. LTM, 1. Device Problems. Device emits ...

www.accessdata.fda.gov/.../cfdocs/cftplc/tplc.cfm?id=FTL&min_report_year=2007&long_name=LIFECELL%20CORP. - 20k - Cached



MedSun Reports



... Device brand name: Straight Plate Self Drilling Screws AlloDerm Regenerative

Tissue Matrix. Device manufacturer's name: Medtronic ...

www.accessdata.fda.gov/scripts/cdrh/cfdocs/medsun/medsun_details.cfm?id=%25%22-_%3C%26_%5C%20%0A - 16k - Cached



MedSun Reports



... Device brand name: Straight Plate Self Drilling Screws AlloDerm Regenerative

Tissue Matrix. Device manufacturer's name: Medtronic ...

www.accessdata.fda.gov/scripts/cdrh/cfdocs/medsun/medsun_details.cfm?ID=%25%22-_%3C%26_%5C%20%0A - 16k - Cached



Medsun: Newsletter #36, May 2009



... LifeCell Corporation, AlloDerm Regenerative Tissue Matrix Other: 402025, Patient

underwent resection of pilocytic astrocytoma in the posterior fossa. ...

www.accessdata.fda.gov/scripts/cdrh/cfdocs/medsun/news/printer.cfm?id=994 - 19k - Cached



MedSun: Newsletter #36, May 2009



... LifeCell Corporation, AlloDerm Regenerative Tissue Matrix Other: 402025, Patient

underwent resection of pilocytic astrocytoma in the posterior fossa. ...

www.accessdata.fda.gov/scripts/cdrh/cfdocs/medsun/news/newsletter.cfm?news=36 - 91k - Cached



Enforcement Report for June 18, 2008



... PRODUCT Human Cornea Tissues, Recall # B ... Tissue Matrix, 2x4 cm, .33-76 mm; AlloDerm

GBR; 2x2 cm, .46-86 mm; Graft Jacket, Regenerative Tissue Matrix Ulcer Repair ...

www.fda.gov/Safety/Recalls/EnforcementReports/2008/ucm120511.htm - 193k - 2009-05-28 - Cached

Sunday, April 03, 2011

Asherman syndrome
Uterine synechiae
Last reviewed: September 12, 2010.

Asherman syndrome is the formation of intrauterine adhesions (scar tissue), which typically develop after uterine surgery.

Causes, incidence, and risk factors
Asherman syndrome is a rare condition. In most cases, it occurs in women who have had several dilatation and curettage (D&C) procedures.

A severe pelvic infection unrelated to surgery may also lead to Asherman syndrome.

Intrauterine adhesions can also form after infection with tuberculosis or schistosomiasis. These infections are rare in the United States, and uterine complications such as Asherman syndrome related to these infections are even less common.

Symptoms
The adhesions may cause amenorrhea (lack of menstrual periods), repeated miscarriages, and infertility.

However, such symptoms could be related to several conditions. They are more likely to indicate Asherman syndrome if they occur suddenly after a D&C or other uterine surgery.

Signs and tests
A pelvic exam is usually normal.

Tests may include:

•Blood tests to detect tuberculosis or schistosomiasis

•Hysteroscopy

•Hysterosonogram

•Infertility evaluation

•Transvaginal ultrasound examination

Treatment
Treatment involves surgery to cut and remove the adhesions or scar tissue. This can usually be done with hysteroscopy, which uses small instruments and a camera placed into the uterus through the cervix.

After scar tissue is removed, the uterine cavity must be kept open while it heals to prevent adhesions from returning. Your health care provider may place a small balloon inside the uterus for several days and prescribe estrogen therapy while the uterine lining heals.

Antibiotic treatment may be necessary if there is an infection.

Support Groups
The stress of illness can often be helped by joining a support group where members share common experiences and problems. See www.ashermans.org for information about an online Asherman syndrome support group.

Expectations (prognosis)
Asherman syndrome can be cured in most women with surgery, although sometimes more than one procedure will be necessary.

Women who are infertile because of Asherman syndrome may have a successful pregnancy after treatment Successful pregnancy depends on the severity of Asherman syndrome and the difficulty of the treatment, as well as other factors that affect fertility and pregnancy.

Complications
Complications of hysteroscopic surgery are uncommon and include bleeding, perforation of the uterus, and pelvic infection.

In some cases, treatment of Asherman syndrome will not cure infertility.

Calling your health care provider
Call your health care provider if your menstrual periods do not resume after a gynecologic or obstetrical procedure. An evaluation for infertility is also warranted if you are unable to achieve a pregnancy after 6 to 12 months of trying.

Prevention
Most cases of Asherman syndrome cannot be predicted or prevented.

References
1.Lobo RA. Primary and secondary amenorrhea and precocious puberty: etiology, diagnostic evaluation, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 38.
2.Simpson JL, Jauniaux ERM. Pregnancy loss. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 24.
Review Date: 9/12/2010.

Reviewed by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Wednesday, March 30, 2011

Drug Used For Neuropathic Pain Relieves Discomfort From Abdominal Adhesions: Henry Ford Study

Pregabalin, FDA-approved for neuropathic pain (pain caused by shingles and peripheral neuropathy), effectively reduced abdominal pain and improved sleep in women with adhesions, according to a Henry Ford study.


Adhesion pain, a common complication after abdominal or pelvic surgery, currently lacks effective therapy. Adhesions can also form after infections in the bowel such as diverticulitis.

"Many patients in the study went from debilitating pain to complete resolution of pain on pregabalin," says Ann Silverman, M.D., senior staff gastroenterologist at Henry Ford Hospital and lead author of the study.


Study results were presented at the American College of Gastroenterology's Annual Scientific Meeting in San Diego.


"Aside from the use of analgesics, additional surgery is the only treatment option for abdominal pain from adhesions but repeat surgery can lead to more adhesions," says Dr. Silverman.


The estimates of abdominal adhesion formation following surgery have been found to be as high as 100 percent in certain studies. Surgery is only recommended for bowel obstruction.


The randomized Henry Ford study looked at 18 women who received the drug or a look-alike placebo. All patients had previous abdominal surgery and were similar in age. The first eight weeks was a randomized placebo controlled trial of pregabalin followed by a four-week open label study in which all patients received the active study drug.


Click the link to read the rest.
http://www.medicalnewstoday.com/articles/168888.php

Pregabalin Side Effects


Brand Names: Lyrica



Please note - some side effects for Pregabalin may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).



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Side Effects of Pregabalin - for the Consumer

Pregabalin

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Pregabalin:



Blurred vision; changes in sexual function; constipation; dizziness; drowsiness; dry mouth; gas; headache; increased appetite; lightheadedness; stomach pain; trouble concentrating; weight gain.



Seek medical attention right away if any of these SEVERE side effects occur when using Pregabalin:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue, unusual hoarseness); burning, numbness, or tingling of the hands, feet, or skin; chest pain; confusion; fast or irregular heartbeat; fever, chills, or persistent sore throat; inability to control urination; loss of coordination; memory loss; muscle aches, pain, tenderness, or weakness (especially if this occurs with a fever or general feeling or discomfort); new or unusual skin sores; new or worsening mental or mood changes (eg, anxiety, depression, restlessness, irritability, panic attacks, feeling "high," behavior changes, suicidal thoughts or attempts); new or worsening seizures; reddened, blistered, swollen, or peeling skin; shortness of breath or wheezing; speaking problems; sudden, unexplained weight gain; swelling of the hands, feet, or ankles; tremor; trouble sleeping; trouble walking; unusual bruising or bleeding; unusual tiredness or weakness; vision changes.



This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.



Top

Side Effects by Body System - for Healthcare Professionals

Nervous system

Nervous system side effects including dizziness (up to 38%), somnolence (up to 28%), ataxia (up to 20%), tremor (up to 11%), neuropathy (up to 9%), abnormal thinking (up to 9%), abnormal gait (up to 5%), confusion (up to 7%), speech disorder (up to 7%), amnesia (up to 6%), incoordination (up to 6%), twitching (up to 5%), vertigo (up to 4%), myoclonus (up to 4%), euphoria (up to 3%), and nervousness (up to 1%) have been reported. Anxiety, depersonalization, hypertonia, hypesthesia, decreased libido, nystagmus, paresthesia, stupor, and twitching have been reported frequently. Abnormal dreams, agitation, apathy, aphasia, circumoral paresthesia, dysarthria, hallucinations, hostility, hyperalgesia, hyperesthesia, hyperkinesia, hypokinesia, hypotonia, increased libido, myoclonus, and neuralgia have been reported infrequently. Addiction, cerebellar syndrome, cogwheel rigidity, coma, delirium, delusions, dysautonomia, dyskinesia, dystonia, encephalopathy, extrapyramidal syndrome, Guillain-Barre syndrome, hypoalgesia, intracranial hypertension, manic reaction, paranoid reaction, peripheral neuritis, psychotic depression, schizophrenic reaction, torticollis, and trismus have been reported rarely.



Metabolic

Metabolic side effects including peripheral edema (up to 16%), weight gain (up to 16%), edema (up to 6%), and hypoglycemia (up to 3%) have been reported. Decreased glucose tolerance and urate crystalluria have been reported rarely.



Gastrointestinal

Gastrointestinal side effects including dry mouth (up to 15%), constipation (up to 7%), increased appetite (up to 6%), vomiting (up to 3%), flatulence (up to 3%), nausea and diarrhea have been reported. Gastroenteritis has been reported frequently. Cholecystitis, cholelithiasis, colitis, dysphagia, esophagitis, gastritis, gastrointestinal hemorrhage, melena, mouth ulceration, pancreatitis, rectal hemorrhage, and tongue edema have been reported infrequently. Aphthous stomatitis and esophageal ulcer have been reported rarely.



General

General side effects including infection (up to 14%), accidental injury (up to 11%), headache (up to 9%), asthenia (up to 7%), pain (up to 5%), chest pain (up to 4%), facial edema (up to 3%), flu syndrome (up to 2%), and back pain (up to 2%) have been reported. Abdominal pain and fever have been reported frequently. Abscess, cellulitis, chills, malaise, neck rigidity, overdose, pelvic pain, photosensitivity reaction, and suicide attempt have been reported infrequently. Ascites, granuloma, hangover effect, intentional injury, retroperitoneal fibrosis, shock, and suicide have been reported rarely.



Ocular

Ocular side effects including visual field changes (13%), reduced visual acuity (7%), and blurred vision (6%) have been reported. Conjunctivitis and diplopia have been reported frequently. Abnormality of accommodation, blepharitis, dry eyes, eye hemorrhage, hyperacusis, photophobia, retinal vascular disorder, and retinal edema have been reported infrequently. Anisocoria, blindness, corneal ulcer, exophthalmos, extraocular palsy, iritis, keratitis, keratoconjunctivitis, miosis, mydriasis, night blindness, ophthalmoplegia, optic atrophy, papilledema, parosmia, ptosis, and uveitis have been reported rarely.



Blurred vision resolved in the majority of cases with continued dosing. Less than 1% of patients discontinued pregabalin treatment due to vision related events (primarily blurred vision).



Patients should be informed that they should notify their physician if changes in vision occur. If visual disturbance persists, further assessment should be considered. Furthermore, more frequent assessment should be considered for patients who are already routinely monitored for ocular conditions.



Other

In a cohort study of 333 diabetic patients who received pregabalin for at least 2 years, the average weight gain was 5.2 kg. Pregabalin associated weight gain was related to dose and duration or exposure.



Other side effects including weight gain have been reported. In controlled clinical trials of up to 13 weeks, weight gain of 7% or more over baseline has been reported in 8% of pregabalin-treated patients. Otitis media and tinnitus have been reported frequently. Taste loss, and taste perversion have been reported infrequently.



Cardiovascular

Cardiovascular side effects including edema, primarily peripheral edema (6%) have been reported. Deep thrombophlebitis, heart failure, hypotension, syncope, and postural hypotension have been reported infrequently. Depressed ST and ventricular fibrillation have been reported rarely. There have been postmarketing reports of angioedema.



Specific symptoms of angioedema have included swelling of the face, mouth (tongue, lips, and gums), and neck (throat and larynx). There have also been reports of life-threatening angioedema with respiratory compromise requiring emergency treatment. Pregabalin should be discontinued immediately in patients with these symptoms. Caution is recommended if prescribing pregabalin to patients who have had a previous episode of angioedema. In addition, patients who are taking other drugs associated with angioedema (e.g., angiotensin converting enzyme inhibitors [ACE-inhibitors]) may be at increased risk of developing angioedema.



Respiratory

Respiratory side effects including dyspnea (up to 3%) and bronchitis (up to 3%) have been reported. Apnea, atelectasis, bronchiolitis, hiccup, laryngismus, lung edema, lung fibrosis, and yawn have been reported rarely.



Genitourinary

Genitourinary side effects including urinary incontinence (up to 2%) have been reported. Anorgasmia, impotence, and urinary frequency have been reported frequently. Abnormal ejaculation, albuminuria, amenorrhea, dysmenorrhea, dysuria, hematuria, kidney calculus, leukorrhea, menorrhagia, metrorrhagia, nephritis, oliguria, and urinary retention have been reported infrequently. Acute kidney failure, balanitis, bladder neoplasm, cervicitis, dyspareunia, epididymitis, female lactation, and glomerulitis have been reported rarely. Two cases of unilateral painful gynecomastia have also been reported.



Musculoskeletal

Musculoskeletal side effects including myasthenia (1%) have been reported. Arthralgia, leg cramps, myalgia, and myasthenia have been reported frequently. Arthrosis has been reported infrequently. Generalized spasm has been reported rarely.



Oncologic

Oncologic side effects including an unexpectedly high incidence of hemangiosarcoma have been reported in animal studies after pregabalin was given their diet for two years. In clinical studies comprised of 6,396 patient-years of exposure, new or worsening-preexisting tumors were reported in 57 patients. It is not known if the incidence seen in these clinical studies is or is not affected by treatment.



Hypersensitivity

Hypersensitivity side effects including allergic reactions have been reported frequently. Allergic reactions have included skin redness, blisters, hives, rash, dyspnea, and wheezing. Pregabalin should be discontinued immediately in patients with these symptoms. Anaphylactoid reactions have been reported rarely.



Hematologic

Hematologic side effects including ecchymosis have been reported frequently. Anemia, eosinophilia, hyperchromic anemia, leukocytosis, leukopenia, lymphadenopathy, and thrombocytopenia have been reported infrequently. Myelofibrosis, polycythemia, decreased prothrombin, purpura, and thrombocytopenia have been reported rarely.



Dermatologic

Dermatologic side effects including pruritus have been reported frequently. Alopecia, dry skin, eczema, hirsutism, skin ulcer, urticaria, and vesiculobullous rash have been reported infrequently. Angioedema, exfoliative dermatitis, lichenoid dermatitis, melanosis, petechial rash, purpuric rash, pustular rash, skin atrophy, skin necrosis, skin nodule, Stevens-Johnson syndrome, and subcutaneous nodule have been reported rarely.

From Drugs.com

SYNTHEMED, SNDY, SYMD, EXCS, MCGI and WRIT are the Daily Market Movers for March 29th

SNDY, SYMD, EXCS, MCGI and WRIT are the Daily Market Movers for March 29th from OTCPicks.com


OTCPicks.com Presents Today’s Daily Market Movers: Solos Endoscopy Inc. (OTC: SNDY), SyntheMed Inc. (OTCBB: SYMD), Execute Sports Inc. (OTCBB: EXCS), MedCareers Group Inc. (OTCQB: MCGI) and Writers’ Group Film Corp. (OTCQB: WRIT).

(EMAILWIRE.COM, March 29, 2011 )

SYNTHEMED INCORPORATED (OTCBB: SYMD) "Up 80.00% in morning trading"


SyntheMed, Inc., a biomaterials company, engages in the development and commercialization of medical devices for therapeutic applications. It offers surgical implants designed to prevent or reduce the formation of adhesions/scar tissue following a range of surgical procedures. The company's lead product includes REPEL-CV, a bioresorbable film designed to be placed over the surface of the heart at the conclusion of surgery to reduce the formation of post-operative adhesions. SyntheMed offers products based on the proprietary, bioresorbable polymer technology. Its products also include REPEL-AFIB, which reduces the patient risk associated with atrial fibrillation; RESOLVE that prevents or reduces post-operative surgical adhesions in gynecological and general abdominal surgery; and RELIEVE for preventing or reducing post-operative surgical adhesions in orthopedic and spinal surgery. The company, formerly known as Life Medical Sciences, Inc., was founded in 1990 and is headquartered in Iselin, New Jersey.

http://www.emailwire.com/release/60542-SNDY-SYMD-EXCS-MCGI-and-WRIT-are-the-Daily-Market-Movers-for-March-29th-from-OTCPickscom.html

Saturday, March 26, 2011

C-Section Adhesions & Scar Tissue

Unfortunately, C-Section adhesions and scar tissue are a very common side effect of having a cesarean birth.


As you heal from your c-section surgery your body will naturally produce adhesions or scar tissue which is the body’s way of replacing the damaged, cut tissues at the incision site, however these adhesions can cause complications.

To clarify, there are really two kinds of scars. There is the incision scar which is the external scar tissue that occurs at the incision site. There is also the adhesions which is the deep scar tissue that occurs in the facial layers of the body.

Both are very different in terms of the problems they can cause and how they are treated.

For example, the external c-section scar is just that, a scar. It is often red and somewhat raised but over time and with care it will disappear. There are even cesarean scar treatments that are very effective in reducing the appearance of c-section scars.


C-section adhesions, on the other hand, occur internally which can adhere or tighten and pull on the abdominal cavity affecting your muscles, organs or even your bones, nerves or arteries. When this happens it can cause things like bowel or digestion problems, back or abdomen pain, it can also become problematic for future c-sections.

Of all the common c-section complications, adhesions and scar tissue can be the most troublesome.

Adhesions begin forming almost immediately after surgery and for many women adhesions are painless, never causing any complications whatsoever, however for others they are not only painful, they can create complications to organs such as the ovaries, uterus, fallopian tubes, bladder or even cause bowel obstruction. Adhesions can also interfere with subsequent births making it harder to get pregnant again.

Click Here to read more



Wednesday, March 09, 2011

Adherencias

Adherencias Dirección de esta página: http://www.nlm.nih.gov/medlineplus/spanish/ency/article/001493.htm
.Son bandas de tejido similar al cicatricial que se forman entre dos superficies dentro del organismo y hacen que éstas se peguen.

A medida que el cuerpo se mueve, los tejidos u órganos en su interior normalmente pueden desplazarse a su alrededor entre sí, lo cual se debe a que dichos tejidos tienen superficies resbaladizas.

Causas, incidencia y factores de riesgoLa inflamación (hinchazón), una cirugía o una lesión pueden provocar que se formen adherencias casi en cualquier parte en el cuerpo, incluyendo:

•En articulaciones como el hombro
•En los ojos
•En el interior del abdomen o la pelvis
Una vez que se forman, las adherencias pueden volverse más grandes o más firmes con el tiempo. Se pueden presentar síntomas u otros problemas si las adherencias llevan a que un órgano o parte del cuerpo se retuerza, se salga de su posición o que tampoco pueda moverse.

El riesgo de formación de adherencias es alto después de cirugías intestinales o cirugías de los órganos femeninos. La cirugía en donde se usa un laparascopio tiene menor probabilidad de causar adherencias que la cirugía abierta.

Otras causas de adherencias en el abdomen o la pelvis:

•Apendicitis, con mayor frecuencia cuando el apéndice se abre (presenta ruptura)
•Cáncer
•Endometriosis
•Infecciones en el abdomen y la pelvis
•Radioterapia
Las adherencias se pueden formar alrededor de articulaciones como el hombro (ver: capsulitis adhesiva) o los tobillos, o en los ligamentos y tendones. Este problema puede suceder:

•Después de cirugía o traumatismo
•Con ciertos tipos de artritis
•Con sobrecarga de una articulación o tendón
SíntomasLas adherencias en las articulaciones, los tendones o ligamentos dificultan el movimiento de la articulación y pueden causar dolor.

Las adherencias en el vientre (abdomen) que causan un retorcijón, contorsión o tirón pueden provocar un bloqueo de los intestinos. Los síntomas abarcan:

•Distensión o hinchazón abdominal
•Estreñimiento
•Náuseas y vómitos
•Ya no poder evacuar los gases
•Dolor en el abdomen que es intenso y con cólicos
Las adherencias en la pelvis pueden causar dolor pélvico crónico o prolongado.

Signos y exámenesLa mayoría de las veces, las adherencias no se pueden ver usando radiografías o exámenes imagenológicos.

•Una histerosalpingografía puede ayudar a diagnosticar adherencias dentro del útero o las trompas de Falopio.
•Las radiografías del abdomen, los estudios de contraste con bario y las tomografías computarizadas pueden ayudar a diagnosticar un bloqueo de los intestinos causado por adherencias.
Una endoscopia (una forma de observar el interior del cuerpo usando una sonda flexible que tiene una pequeña cámara en el extremo) puede ayudar a diagnosticar adherencias:

•La histeroscopia examina el interior del útero
•La laparoscopia examina el interior del abdomen y la pelvis
TratamientoSe puede realizar una cirugía para separar las adherencias. Esto a menudo permite el movimiento normal del órgano y reduce los síntomas causados por las adherencias; sin embargo, el riesgo de presentarse más adherencias aumenta, a medida que se incrementa el número de cirugías.

Dependiendo de la localización de las adherencias, al momento de la cirugía, se puede colocar una barrera para tratar de reducir la posibilidad de que éstas reaparezcan.

Ver también: reparación de obstrucción intestinal

Expectativas (pronóstico)El pronóstico generalmente es bueno.

ComplicacionesDependiendo de los tejidos comprometidos, las adherencias pueden ocasionar diversos trastornos.

•En el ojo, la adherencia del iris al cristalino puede llevar al desarrollo de un glaucoma.
•En los intestinos, las adherencias pueden producir una obstrucción intestinal completa o parcial.
•Las adherencias dentro de la cavidad uterina, llamadas síndrome de Asherman, pueden hacer que una mujer tenga ciclos menstruales irregulares y que sea incapaz de quedar en embarazo.
•Las adherencias pélvicas que involucran cicatrización de las trompas de Falopio pueden llevar a que se presente esterilidad y problemas reproductivos.
•Las adherencias pélvicas y abdominales pueden causar dolor crónico
Situaciones que requieren asistencia médicaConsulte con el médico si presenta:

•Dolor abdominal
•Incapacidad para evacuar los gases
•Náuseas y vómitos que no desaparecen
•Dolor en el vientre intenso y con cólicos
Nombres alternativosAdherencia intrauterina; Adherencia pélvica; Adherencia intraperitoneal

Actualizado: 3/30/2010Versión en inglés revisada por: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington. Clinical Teaching Faculty, Department of Obstetrics and Gynecology, Unviersity of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Traducción y localización realizada por: DrTango, Inc.

Hojee la enciclopedia
http://www.nlm.nih.gov/medlineplus/spanish/ency/article/001493.htm

Postoperative adhesions: from formation to prevention.

Semin Reprod Med. 2008 Jul;26(4):313-21.

Postoperative adhesions: from formation to prevention.
Alpay Z, Saed GM, Diamond MP.

Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Wayne State University, Detroit Medical Center, Detroit, Michigan 48201, USA.

Abstract
Postoperative intra-abdominal and pelvic adhesions are the leading cause of infertility, chronic pelvic pain, and intestinal obstruction. It is generally considered that some people are more prone to develop postoperative adhesions than are others. Unfortunately, there is no available marker to predict the occurrence or the extent and severity of adhesions preoperatively. Ischemia has been thought to be the most important insult that leads to adhesion development. Furthermore, a deficient, suppressed, or overwhelmed natural immune system has been proposed as an underlying mechanism in adhesion development. The type of surgical approach (laparoscopy or laparotomy) and closure of peritoneum in gynecologic surgeries and cesarean section have been debated as important factors that influence the development and extent of postoperative adhesions. In this article, we have reviewed the current state of adhesion development and the effects of barrier agents in prevention of postoperative adhesions.

PMID: 18756408 [PubMed - indexed for MEDLINE]

Thursday, February 24, 2011

Hyperosmolar water-soluble contrast medium in the management of adhesive small-intestine obstruction.

J Int Med Res. 2010;38(6):2126-34.

Hyperosmolar water-soluble contrast medium in the management of adhesive small-intestine obstruction.
Atahan K, Aladağli I, Cökmez A, Gür S, Tarcan E.

First Surgical Department, İzmir Atatürk Training and Research Hospital, İzmir, Turkey. kemalatahan@yahoo.com.tr

Abstract
This prospective study investigated the value of the hyperosmolar water-soluble contrast medium Urografin(®) in choosing which patients with small-intestine obstruction, caused by post-operative adhesions, to treat conservatively. Thirty-seven patients with adhesive intestinal obstruction received Urografin(®) via a nasogastric tube. Direct abdominal radiographs were taken after 2, 4 and 8 h. Twenty-four patients (64.9%) had Urografin(®) in the right colon within 8 h and were considered to have partial obstruction. These patients commenced oral feeding even though abdominal radiographs revealed gas-fluid levels. In the remaining 13 patients (35.1%), Urografin(®) was not observed in the right colon within 8 h: three of the 13 patients (23.1%) were successfully treated conservatively; 10 of the 13 patients (76.9%) developed toxic signs and underwent surgery, with obstruction resulting from adhesive bands being confirmed at operation. Conservative treatment can be recommended for patients in whom contrast medium is observed in the right colon within 8 h following administration, regardless of the presence of obstruction signs. Absence of contrast medium in the right colon within 8 h cannot, however, be considered an indication for surgery.

PMID: 21227018 [PubMed - in process]

http://www.ncbi.nlm.nih.gov/pubmed/21227018

Wednesday, February 16, 2011

Mom Dies of Adhesion Related Disorder

From KETV

OMAHA, Neb. -- Employees at a local Red Robin restaurant helped an 8-year-old boy deal with the loss of his mother.

Austin Leeling's family said his mother, Robin, died Friday from a little known condition called Adhesion-Related Disorder.

Because his mother's name was Robin, he said he decided to eat at the Red Robin restaurant on 180th Street......

Click Link to see video

Friday, February 11, 2011

FDA Mulls Health Warning on Powdered Gloves

By John Gever, Senior Editor, MedPage Today
Published: February 08, 2011


Health risks associated with powdered medical gloves -- for professionals as well as patients -- may soon be highlighted on their packages, according to the FDA.

In a draft guidance document for manufacturers, the FDA proposed that powdered surgical and patient examination gloves carry a warning that the products may cause health problems ranging from latex allergies to granulomas and adhesions in patients.

The guidance won't be formally adopted until after the agency digests comments on the proposal, which it is accepting through April. Technically, guidance documents are not enforceable, but most manufacturers follow their recommendations scrupulously.

According to the draft, the FDA is reacting to reports on adverse effects associated with powdered medical gloves.

In 1997, an FDA study found a range of allergic reactions that could be caused by these products, which include gloves made of natural rubber latex, nitrile, vinyl, and polychloroprene.

The powder particles -- usually cornstarch -- can carry latex molecules from the natural rubber gloves, triggering or exacerbating allergies in some patients and professionals, the FDA found.

Powders on nonlatex gloves have also been the subject of adverse event reports more recently, the FDA indicated, citing more than 30 studies. These include impaired wound healing, inflammation, granulomas, and adhesions in patients.

Some have shown that hospitals switching to unpowdered gloves have reduced allergy development and respiratory problems, the FDA added.

The agency also noted, however, that "this has not been a universal finding," and the studies have had significant methodological limitations.

Nevertheless, the agency is proposing that manufacturers include the following warning on glove boxes:

"Powdered gloves may lead to foreign body reactions and the formation of granulomas in patients. In addition, the powder used on gloves may contribute to the development of irritant dermatitis and Type IV allergy, and on latex gloves may serve as a carrier for airborne natural latex leading to sensitization of glove users."

If the guidance is adopted, manufacturers are urged to place the warning on product labeling within six months.

Thursday, February 10, 2011

Peterson's Hernia after Gastric Bypass

A terrifying account of emergency adhesiolysis 10 years after a gastric bypass.






This was tricky. A middle aged lady ten years status post laparoscopic gastric bypass surgery (Roux en Y configuration) presented with crampy abdominal pain and nausea. Her plain films showed multiple dilated loops of small bowel. So I got a CT scan to better delineate the anatomy.

Bowel obstructions in Roux-n-Y gastric bypass patients always make me a little nervous. As opposed to garden variety, adhesion-mediated obstructions in people with normal anatomy, conservative treatment often fails in these patients. For one thing, you cannot adequately decompress them with nasogastric suction. Furthermore, the incidence of internal hernias is much higher, owing to the altered anatomy of the procedure (roux limbs and split mesenteries etc). So going into these cases, your threshold for surgery has to be exponentially higher than normal.

The scan above shows a subtle spiralling of some small bowel mesenteric vessels in the area where one would normally find the jejunojejunal anastomosis. Single views don't do the pathology justice; you really have to be able to scroll up and down through the loops of bowel on the scan. The patient looked uncomfortable, was tender, and I just didn't feel like dicking around for much longer. So I explored her in the OR.

She'd had two previous surgeries, prior to her gastric bypass even, for bowel obstructions secondary to an old hysterectomy, so things were pretty confusing, anatomically speaking, when I first entered her peritoneal cavity. The jejunojejunostomy appeared to be corkscrewed. That was clear enough from the beginning. Then I identified a decompressed limb of bowel going up to the gastric pouch (roux limb, a ha!). And then it looked like a bunch of small bowel had slipped through a space between the roux limb and the transverse mesocolon---classic Petersen's defect. Unfortunately, however, the bowel didn't want to slide back out of the space right away. It was stuck somewhere else further downstream. So I basically had to perform a full adhesiolysis of bowel, starting from terminal ileum and working back. To keep things organized, I literally had to place identifying stitches in the serosa of the proximal bowel as I flipped things back and forth. A couple of times it got a little hairy as the bowel started to turn bluish and I had to reverse my maneuvers, untwist things the correct way. Finally I freed everything up and the bulk of the small bowel was liberated, came rushing out from behind the defect. Looking down, the J-J anastomosis was normal again, the corkscrew configuration gone. I closed the defect, put in some voodoo-ish anti-adhesive Seprafilm and got the hell out.
Click on link to see imaging and read comments:
http://ohiosurgery.blogspot.com/2009/12/petersons-defect.html

Monday, February 07, 2011

A Device Preemption Quickie -- Heisner v. Genzyme

In Heisner v. Genzyme, No. 08-C-593, 2009 U.S. Dist. LEXIS 37322 (N.D. Ill. Apr. 30, 2009), Heisner allegedly died as a result of an allergic reaction to Seprafilm, an anti-adhesive surgical barrier implanted in her body during a surgery. Seprafilm is a Class III medical device approved by the FDA through the premarket approval process.

Heisner's surviving spouse and estate filed the usual product liability claims against Genzyme, which manufactured Seprafilm. The trial court granted Genzyme's motion to dismiss on the ground of federal preemption.

Two items merit quick note: First, plaintiff asserted that his claims were "parallel" to, rather than "different from or in addition to" the federal requirements applicable to Seprafilm, because Genzyme had allegedly failed to report to the FDA (1) the death of plaintiff's decedent, and (2) a clinical trial protocol and related warnings finalized after Heisner's death. The trial court didn't have to address the "parallel requirements" issue, because events that took place after Heisner's death could not possibly have proximately caused Heisner's injury. Id. at *5.

Second, plaintiff's express warranty claims were based on statements made by Genzyme in (1) the package inserts for Seprafilm, and (2) the PMA protocol for certain Seprafilm clinical trials -- both of which had been approved by the FDA. Because the alleged warranties were based on statements that had been approved by the FDA, the court found those allegations of breach of warranty to be preempted. Id. at *8.

We'll include this one in the ever-expanding (New) Medical Device Preemption Scorecard.
Posted by Beck/Herrmann at 8:00 AM Labels: Medical Device, Preemption

Monday, January 31, 2011

Adhesion Awareness: A National Survey of Surgeons.

Schreinemacher MH, ten Broek RP, et al: World J Surg; 2010;34 (December): 2805-2812


Objective: To report on a survey of Dutch surgeons, hypothesizing that lack of knowledge about adhesions and their consequences is related to surgeon practice and adhesion-related complications.

Design: Survey.

Participants: 1455 surgeons and trainees.

Methods: Initial survey questions were developed by a group of surgeons with a particular interest in adhesions. Questions were then edited by researchers with expertise in survey design and construction of multiple choice questions. Resultant survey was pilot-tested with 5 practicing surgeons and 3 surgical trainees. Final survey contained 55 multiple-choice questions, 4 open-ended questions, and 4 optional questions. Survey was sent to all members of the Dutch Association for Surgery, as well as to all registered surgical trainees. A reminder was sent electronically 1 week after the initial email if no response was obtained. Data from surveys with <80% p ="0.032).">Conclusions: The magnitude of the problem of postoperative adhesions is underestimated.
Reviewer's Comments: None of the agents that have been proposed as the magic bullet to prevent adhesions has lived up to expectations (or hopes), although certain products are effective in certain high-risk operations and populations. Even if adhesions are viewed as an inevitable result, it does make sense to include this in the preoperative discussion with patients, particularly those in high-risk groups. It appears that hopes and expectations will continue to rest on a future magic bullet.(Reviewer–Karen J. Brasel, MD, MPH).
© 2010, Oakstone Medical Publishing
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