Study Supports Broader Access to Lap-Band Weight-Loss Surgery

THURSDAY, May 2 (HealthDay News) -- The Lap-Band weight-loss procedure should not be restricted only to patients who are very severely obese, a new study suggests.

Still, some experts disagreed, saying further research will be needed before the procedure is used in a wider range of patients.

The Lap-Band is a strategy in which an adjustable band is placed around the upper part of the stomach in order to create a pouch. The newly-created pouch restricts how much food a patient can eat at one time and helps reduce appetite.

In 2001, the U.S. Food and Drug Administration approved the Lap-Band for use in patients who are very severely obese (a body-mass index of 40 or higher) and for patients who are severely obese (BMI of 35 to 39.9) with an obesity-related condition such as high blood pressure or diabetes.

BMI is a measurement of body fat based on a ratio of weight to height. Obesity is typically defined as a BMI of 30 or above.

Since the 2001 approval of the device, the FDA has expanded the Lap-Band's approval for use in obese patients with a BMI of 30 to 39.9 who have at least one obesity-related condition (for example, diabetes or high cholesterol levels).

Allergan, the device's maker, funded the new study. In the study, researchers performed the Lap-Band procedure on 149 patients who had a BMI of 35 to 39.9 and did not have an obesity-related condition or who had a BMI of 30 to 34.9 (moderately obese) with at least one obesity-related condition.

One year after undergoing the procedure, nearly 85 percent of the patients had lost at least 30 percent of their excess body weight, with an average excess weight loss of 65 percent. About 66 percent of the patients were no longer obese.

Obesity-related conditions improved for many of the patients, including 64 percent of those with high cholesterol, 59 percent of those with high blood pressure and 85 percent of those with diabetes. Most side effects of the procedure were mild to moderate and resolved within a month.

The patients' results a year after the procedure were maintained or improved at two years, according to the study, which was published online May 2 in the journal Obesity.

"Patients in our study had been obese for an average of 17 years," study author Dr. Robert Michaelson, of Northwest Weight Loss Surgery in Everett, Wash., said in a journal news release. "They tried numerous other weight-loss methods and finally reached out for surgical treatment when they were wary of the repetitive failures at maintaining weight loss."

"The results of this study convinced the FDA that early intervention in the continuum of obesity is the right thing to do: Treat before people go on to develop serious conditions [related to] obesity," Michaelson said.

In addition, the American Society for Metabolic and Bariatric Surgery issued a position statement endorsing weight-loss surgery for patients with moderate obesity who have not had success with non-surgical methods of weight loss.

"The next step is to get the private insurers and Medicare, who continue to rely on guidelines established in 1991, to review the incontrovertible literature, take down the barriers to the necessary treatment for this disease, and offer the hope of a cure to 27 million Americans," Michaelson said.

In an editorial accompanying the study, however, experts said the long-term benefits and risks of this procedure in people with a BMI lower than 40 still need to be determined. They also noted that studies have shown that very severely obese people who have had the Lap-Band procedure often begin to regain weight about two years after the surgery.

There are also concerns that serious side effects are common, including reports of device removal rates as high as 50 percent, said Dr. David Arterburn, of the Group Health Research Institute in Seattle, and Dr. Melinda Maggard, of the University of California, Los Angeles.

The two experts added that, "the study was funded by the device company, who had input into the study design, and all the authors were paid for their work, again raising the concern of bias in collecting and interpreting the results."

Until longer-term data on the benefits and harms of the procedure are available, the use of the Lap-Band procedure in patients with a BMI of 30 to 35 should be limited to clinical trials, they said.

But another expert supported the use of the Lap-Band in people other than the very obese.

"In my clinical experience it is in this subgroup [of less obese patients] that I find the band most effective," said Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City.

"Many larger patients do not respond to the band making them eat slower, and only have effect when the band is overly tightened," Roslin said. "This leads to issues that ultimately can result in removal. For patients that are smaller, the results, in my opinion, will be better. For those with severe morbid obesity, I find the [stomach] stapling procedures superior."

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCES: Mitchell Roslin, M.D., chief of obesity surgery, Lenox Hill Hospital, New York City; Obesity, news release, May 2, 2013

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New Procedure May Shrink Enlarged Prostate Without Surgery

By Serena Gordon
HealthDay Reporter

MONDAY, April 15 (HealthDay News) -- Men who need treatment for an enlarged prostate may soon have a new nonsurgical option, a small, early study suggests.

Called prostatic artery embolization (PAE), the technique uses a catheter threaded into an artery in the leg. The catheter is guided to the artery that supplies blood to the prostate. Then, tiny beads are injected into the artery, which temporarily block the blood supply to the prostate.

The temporary loss of blood supply causes the prostate to shrink, relieving symptoms, according to study lead author Dr. Sandeep Bagla. What's more, the new treatment doesn't appear to have the same risk of serious complications, such as incontinence and impotence, that often accompany enlarged prostate treatment.

"This is fantastic news for the average man with benign prostatic hyperplasia. Many men decline current treatments because of the risks. But, for the average man, PAE is a no-brainer," said Bagla, an interventional radiologist at Inova Alexandria Hospital, in Virginia.

The procedure has only been available as part of Bagla's trial until recently, but he said some interventional radiologists have started doing prostatic artery embolization, and he expects the procedure will become more widely available by the end of the year.

Benign prostatic hyperplasia is the medical term for an enlarged prostate. An enlarged prostate is very common as men get older. As many as half of all men in their 60s will have an enlarged prostate, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). By the time men are in their 70s and 80s, up to 90 percent have benign prostatic hyperplasia, according to the NIDDK.

Some men experience no symptoms, while others may feel the need to urinate frequently, but they have a weak urinary stream, the NIDDK says. There are a number of treatments available for benign prostatic hyperplasia, including medications and surgery.

Bagla said that interventional radiologists in Europe and South America have been using prostatic artery embolization, and that the current study is the first in the United States to test the procedure.

He and his colleagues hope to treat a total of 30 patients, but they're reporting on the results from the first 18 patients on Monday at the annual meeting of Society of Interventional Radiology, in New Orleans. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

For the study, the average age of the patients who underwent prostatic artery embolization was 67 years. None of the men had to be admitted to the hospital after the procedure.

Ninety-four percent of the men (17 of 18) had a significant decrease in their symptoms one month after surgery. And, none reported any major complications following the surgery.

Bagla said the exact cost of the new procedure is difficult to estimate right now, but prostatic artery embolization will be cheaper than most of the currently used procedures, he said, because there's no need for an operating room and overnight hospital stays. In addition, he said, because the new procedure doesn't appear to cause complications, that will save health care dollars as well.

"This may become part of the armamentarium of treatments that can be offered for [benign prostatic hyperplasia]," said Dr. Art Rastinehad, director of interventional urologic oncology at North Shore-LIJ Health System in New Hyde Park, N.Y. He was not involved with the new study.

"This was a small series and a limited study to draw significant conclusions from. But, it's very exciting to see it evaluated and moving forward," he said.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Sandeep Bagla, M.D., interventional radiologist, Inova Alexandria Hospital, Alexandria, Va.; Art Rastinehad, D.O., director of interventional urologic oncology, North Shore-LIJ Health System, New Hyde Park, N.Y.; April 15, 2013, presentation, Society of Interventional Radiology annual meeting, New Orleans

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New Procedure May Shrink Enlarged Prostate Without Surgery

'Prostatic artery embolization' didn't cause troublesome side effects in study

By Serena Gordon

HealthDay Reporter

MONDAY, April 15 (HealthDay News) -- Men who need treatment for an enlarged prostate may soon have a new nonsurgical option, a small, early study suggests.

Called prostatic artery embolization (PAE), the technique uses a catheter threaded into an artery in the leg. The catheter is guided to the artery that supplies blood to the prostate. Then, tiny beads are injected into the artery, which temporarily block the blood supply to the prostate.

The temporary loss of blood supply causes the prostate to shrink, relieving symptoms, according to study lead author Dr. Sandeep Bagla. What's more, the new treatment doesn't appear to have the same risk of serious complications, such as incontinence and impotence, that often accompany enlarged prostate treatment.

"This is fantastic news for the average man with benign prostatic hyperplasia. Many men decline current treatments because of the risks. But, for the average man, PAE is a no-brainer," said Bagla, an interventional radiologist at Inova Alexandria Hospital, in Virginia.

The procedure has only been available as part of Bagla's trial until recently, but he said some interventional radiologists have started doing prostatic artery embolization, and he expects the procedure will become more widely available by the end of the year.

Benign prostatic hyperplasia is the medical term for an enlarged prostate. An enlarged prostate is very common as men get older. As many as half of all men in their 60s will have an enlarged prostate, according to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). By the time men are in their 70s and 80s, up to 90 percent have benign prostatic hyperplasia, according to the NIDDK.

Some men experience no symptoms, while others may feel the need to urinate frequently, but they have a weak urinary stream, the NIDDK says. There are a number of treatments available for benign prostatic hyperplasia, including medications and surgery.

Bagla said that interventional radiologists in Europe and South America have been using prostatic artery embolization, and that the current study is the first in the United States to test the procedure.

He and his colleagues hope to treat a total of 30 patients, but they're reporting on the results from the first 18 patients on Monday at the annual meeting of Society of Interventional Radiology, in New Orleans. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

For the study, the average age of the patients who underwent prostatic artery embolization was 67 years. None of the men had to be admitted to the hospital after the procedure.

Ninety-four percent of the men (17 of 18) had a significant decrease in their symptoms one month after surgery. And, none reported any major complications following the surgery.

Bagla said the exact cost of the new procedure is difficult to estimate right now, but prostatic artery embolization will be cheaper than most of the currently used procedures, he said, because there's no need for an operating room and overnight hospital stays. In addition, he said, because the new procedure doesn't appear to cause complications, that will save health care dollars as well.

"This may become part of the armamentarium of treatments that can be offered for [benign prostatic hyperplasia]," said Dr. Art Rastinehad, director of interventional urologic oncology at North Shore-LIJ Health System in New Hyde Park, N.Y. He was not involved with the new study.

"This was a small series and a limited study to draw significant conclusions from. But, it's very exciting to see it evaluated and moving forward," he said.

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Weight-Loss Surgery May Affect Fat-Related Genes

Swedish researchers found better body-fat control in people who had procedure

By Robert Preidt

HealthDay Reporter

THURSDAY, April 11 (HealthDay News) -- Weight-loss surgery changes the levels of genes involved in burning and storing fat, a new study says.

The findings may help lead to the development of new drugs that mimic this weight-loss-associated control of gene regulation, said the authors of the study published online April 11 in the journal Cell Reports.

"We provide evidence that in severely obese people, the levels of specific genes that control how fat is burned and stored in the body are changed to reflect poor metabolic health," senior author Juleen Zierath, a professor with the Karolinska Institute in Sweden, said in a journal news release.

"After [weight-loss] surgery, the levels of these genes are restored to a healthy state, which mirrors weight loss and coincides with overall improvement in metabolism," Zierath explained.

Weight-loss surgery -- also called bariatric surgery -- can help obese people lose large amounts of weight in a short time. The surgery also leads to early remission of type 2 diabetes in many patients.

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Radiation Therapy May Raise Future Death Risk From Heart Surgery

THURSDAY, April 11 (HealthDay News) -- Cancer survivors who had chest radiation therapy have a nearly twofold increased risk of dying in the years after having major heart surgery, a new study finds.

Researchers looked at 173 people who had chest radiation treatment for cancer an average of 18 years before they required heart surgery. These patients were compared to 305 people who underwent similar heart surgeries but had no history of radiation therapy.

The death risk in the first 30 days after heart surgery was about the same for both groups. But during an average follow-up of nearly eight years, 55 percent of the patients in the radiation group died, compared with 28 percent of those in the nonradiation group, the investigators found.

The study was published April 8 in the journal Circulation.

"These findings tell us that if you had radiation, your likelihood of dying after major cardiac surgery is high," study author Dr. Milind Desai, an associate professor of medicine at the Cleveland Clinic, said in a journal news release.

"That's despite going into the surgery with a relatively low risk score. In patients who have had prior [chest] radiation, we need to develop better strategies of identifying appropriate patients that would benefit from surgical intervention. Alternatively, some patients might be better suited for [nonsurgical] procedures," Desai said.

"While radiation treatments done on children and adults in the late 1960s, '70s and '80s played an important role in cancer survival, the treatment often takes a toll on the heart," Desai explained.

"Survivors are at greater risk than people who do not have radiation to develop progressive coronary artery disease, aggressive valvular disease, as well as pericardial diseases, which affect the heart's surrounding structures," he said. "These conditions often require major cardiac surgery."

While the study found an association between chest radiation therapy for cancer and future risk of death after heart surgery, it did not establish a cause-and-effect relationship.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Circulation, news release, April 8, 2013

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Weight-Loss Surgery May Affect Fat-Related Genes

THURSDAY, April 11 (HealthDay News) -- Weight-loss surgery changes the levels of genes involved in burning and storing fat, a new study says.

The findings may help lead to the development of new drugs that mimic this weight-loss-associated control of gene regulation, said the authors of the study published online April 11 in the journal Cell Reports.

"We provide evidence that in severely obese people, the levels of specific genes that control how fat is burned and stored in the body are changed to reflect poor metabolic health," senior author Juleen Zierath, a professor with the Karolinska Institute in Sweden, said in a journal news release.

"After [weight-loss] surgery, the levels of these genes are restored to a healthy state, which mirrors weight loss and coincides with overall improvement in metabolism," Zierath explained.

Weight-loss surgery -- also called bariatric surgery -- can help obese people lose large amounts of weight in a short time. The surgery also leads to early remission of type 2 diabetes in many patients.

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCE: Cell Reports, news release, April 11, 2013

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Complications From Kidney Stone Surgery Rising, Study Finds

Title: Complications From Kidney Stone Surgery Rising, Study Finds
Category: Health News
Created: 3/29/2013 12:35:00 PM
Last Editorial Review: 4/1/2013 12:00:00 AM

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When Breast Cancer Spreads to Lungs, Surgery May Increase Survival

Title: When Breast Cancer Spreads to Lungs, Surgery May Increase Survival
Category: Health News
Created: 4/1/2013 10:35:00 AM
Last Editorial Review: 4/1/2013 12:00:00 AM

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Weight-Loss Surgery May Help Moderately Obese, Too

It reduces symptoms of type 2 diabetes, studies found, but surgical risks exist

By Serena Gordon

HealthDay Reporter

TUESDAY, June 4 (HealthDay News) -- For the extremely obese, the benefits of weight-loss surgery generally outweigh the risks of the procedure. Now, new research suggests that the same might be true for less-obese people as well.

For those who are mildly or moderately obese, weight-loss surgery can improve type 2 diabetes, high blood pressure and high cholesterol more effectively than conventional diabetes management and lifestyle changes, new research suggests.

"We're seeing a pattern in these studies. There's a definite impact on the diabetes after surgery. Some people don't respond so well, but most do," said Dr. Bruce Wolfe, a professor of surgery and co-director of bariatric surgery at Oregon Health & Science University, in Portland.

But, he added, "We need longer-term studies to identify who's the right candidate for surgery, and we need a number of years of follow-up and a fairly large study population to see if the diabetes improvements after surgery prevent the heart disease, blindness and kidney disease associated with type 2 diabetes."

Results of the two new studies, as well as an accompanying editorial written by Wolfe and colleagues, are in the June 5 issue of the Journal of the American Medical Association.

Body mass index (BMI) is a measurement calculated with height and weight that's used to estimate the amount of body fat someone has. A BMI of 18 to 24.9 is considered normal weight while 25 to 29.9 is overweight, according to the U.S. Centers for Disease Control and Prevention. Mild to moderate obesity is between 30 and 39.9, and 40 and above is morbidly (or extremely) obese.

Normally, weight-loss surgeries are done on people who have a BMI of 40 or above. The surgery is also done on people who have a BMI of 35 or more if they have heart disease risk factors, such as type 2 diabetes, high blood pressure, high cholesterol or sleep apnea, according to Wolfe.

The first study was a review of previous research on non-morbidly obese people with type 2 diabetes. The authors searched the medical literature and among other related studies, found three randomized controlled clinical trials that compared weight-loss surgery (also known as bariatric surgery) to nonsurgical treatments, such as diabetes medications and lifestyle changes.

Weight-loss surgeries -- including gastric bypass and gastric banding -- were associated with a greater weight loss than nonsurgical treatments. Weight-loss surgeries led to as much as 32 to 53 pounds more weight loss and also to greater improvements in blood sugar levels.

"I think we found some promising results for the lower BMI patients with diabetes. There were better results in terms of controlling glucose [blood sugar] and weight loss over one to two years. That we have a way to provide some sort of successful treatment is exciting. But, we don't yet know how sustainable these changes are. We need longer and larger studies," said Dr. Melinda Maggard-Gibbons, lead review author, and an associate professor with RAND Health in Santa Monica, Calif.

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Transfusions With Heart Surgery Might Raise Infection Risk

Delicate balance exists between treating anemia, avoiding side effects from infusion of red blood cells, study says

By Mary Elizabeth Dallas

HealthDay Reporter

THURSDAY, May 30 (HealthDay News) -- Patients who receive a red blood cell transfusion during or after heart surgery may be at greater risk for infection, according to a new study.

However, the use of platelets during transfusions does not appear to carry a similar risk. Limiting red blood cell use could result in fewer major postoperative infections, the researchers suggested.

The study is published in the June issue of the Annals of Thoracic Surgery.

"A common problem for many surgeons, and thereby the patient, is how to balance the risk of surgery-induced anemia with the increased risk of infection when using red blood cell transfusion to correct the anemia," study author Dr. Keith Horvath, at the U.S. National Heart, Lung, and Blood Institute, said in a journal news release.

"Through this study, we hoped to shed light on the problem and to encourage hospitals and surgeons to examine cell-salvage techniques and other alternatives to [red blood cell] transfusion during and after cardiac surgery," he explained.

The observational study, conducted by the Cardiothoracic Surgical Trials Network, involved nearly 5,200 adults who underwent heart surgery between February and September 2010.

"Our study enrolled a large population of patients from a number of different institutions who were undergoing any type of cardiac surgery," Horvath noted. "This large patient set enabled us to better examine the relationship between transfusion and infection in a very diverse population."

Of the study's participants, 48 percent received a red blood cell transfusion and 31 percent received platelets.

With red blood cell transfusions, 84 percent took place during a transplant or left ventricular assist device implantation. Meanwhile, 63 percent occurred during thoracic aortic procedures, 45 percent took place during isolated coronary artery bypass grafting surgery and 40 percent occurred during isolated valve surgery.

The study found that 65 days after surgery, 5 percent of the patients developed at least one major infection, such as pneumonia, C. difficile colitis (a bacterial infection in the colon) and bloodstream infections.

With each red blood cell unit transfused, there was a 29 percent increase in infection risk. In contrast, platelets transfused along with more than four unit of red blood cells was associated with a lower infection risk.

"Few in regulatory agencies have grasped the complex but real relationships between red cell transfusions, infection and ... readmissions," Dr. Bruce Spiess, from Virginia Commonwealth University Medical Center, wrote in a related journal commentary.

Spiess concluded that improvements in blood management among cardiac teams would enhance patient safety, reduce hospital-acquired infections and reduce critical blood shortages.

However, the researchers pointed out that since this was an observational study, the reported associations cannot be considered as a cause-and-effect relationship.

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Undereating After Wisdom Teeth Surgery?

Hi all! My names Hailey and I'm 18 years old, 5'8", and over 150lbs (Ive gotten there through consistent binging as the result from a past restrictive eating disorder). I'm looking to get down to 125-130lbs through a healthy diet and exercise.

However, I just got all four of my wisdom teeth pulled out a couple days ago and have been eating between 700-800 calories the past 2 days (which has consisted of smoothies, soups, and yogurt, so nothing heavy anyway). I know this doesn't seem healthy but I'm basically bedridden and sleeping all day. Plus, I do want to lose weight as soon as possible and I'm afraid of gaining even more if I eat too much now. How much should I be eating?

Thanks!

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Women's Weight-Loss Surgery May Benefit Later Offspring

Study links procedure to genetic activity in children

By Randy Dotinga

HealthDay Reporter

TUESDAY, May 28 (HealthDay News) -- Weight-loss operations in women could be a genetic bonus for the health of their future children, a new study suggests.

Researchers found differences in the activity of genes in children born to women after they'd had gastric bypass surgery compared to their siblings born before surgery. The changes suggest that the kids born after surgery, to thinner mothers, will fare better in terms of heart health because of benefits gained in the womb.

"It appears that there's an effect that is transmitted to the next generation," said study co-author Marie-Claude Vohl, a professor at Laval University in Quebec City. "This may have some consequence later in life for the health of the children."

The study isn't definitive, and researchers don't know exactly how much the health of kids may be affected by being born to a thinner mother. It's also not clear if there's something unique about weight-loss surgery or if the key is to simply drop pounds.

Weight-loss surgery, which aims to limit the amount of food that patients can eat, is no simple matter. It's expensive, involves risk and is not always covered by insurance. However, severe obesity is itself a major health risk.

In the new study, researchers examined the genetic makeup of 50 children who were born to 20 mothers before or after they underwent gastric bypass surgery.

The researchers suspected that the genes of children born after surgery would act differently than those born before. They found several thousand genes that did just that, and the differences in the post-surgery children suggest they're in better shape health-wise.

As far as physical differences, children born to mothers before weight-loss surgery weighed more and had greater waist and hip girth compared to the others. Children born to mothers after weight loss-surgery had better fasting insulin levels and lower blood pressure.

"It's more evidence that the benefits of gastric bypass surgery extend beyond the original aim of weight loss," said Dr. Francesco Rubino, a metabolic and bariatric surgeon with the Catholic University of Rome, who was not involved with the study. Other research has linked weight-loss surgery, in some cases, to major improvements in diabetes.

What's going on? It's not a matter of the mothers transferring different genes to the children based on whether they'd had surgery. Instead, weight-loss surgery seems to affect the activity of the genes in the children's bodies even outside the womb, he said.

Dr. Edward Phillips, vice chair of the department of surgery at Cedars-Sinai Medical Center, in Los Angeles, said it's a mystery how that might happen.

"If you're a fetus, you're bathed in a bunch of chemicals and hormones," Phillips said. "But when you're out in the real world, why wouldn't your own genes go back to the basic set of what they were supposed to be?"

Could weight-loss surgery in fathers have a similar effect on their subsequent children? Researchers don't know. There are other questions too. Might the children born after their mothers had surgery be exposed to a different kind of environment than their older siblings, especially in regard to food? Could that affect how their genes act?

Phillips said those questions need to be answered. But, he said, this is still "an exciting early study" that opens the door toward greater understanding of genes and weight.

The study appeared online May 27 in the Proceedings of the National Academy of Sciences.

More information

For more about gastric bypass surgery, try the U.S. National Library of Medicine.

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Therapy as Good as Surgery for Some With Torn Knee Cartilage

Study looked at osteoarthritis patients in severe pain

By Robert Preidt

HealthDay Reporter

TUESDAY, March 19 (HealthDay News) -- Physical therapy is comparable to surgery in improving movement and reducing pain for some patients with knee arthritis and torn knee cartilage, new research finds.

Many middle-aged and older adults have severe knee pain due to a tear in the meniscus, a crucial support structure in the knee that is often damaged in people with knee osteoarthritis.

Each year in the United States, more than 450,000 arthroscopic surgeries are performed to treat meniscal tears, but scant data exist to help doctors determine if physical therapy or surgery is the best treatment for a patient, according to the researchers at Brigham and Women's Hospital in Boston.

Their study of 351 patients -- all over age 45 with knee pain, meniscal tear and knee osteoarthritis -- suggests that physical therapy may be equal to surgery for some patients.

Participants were randomly assigned to be treated with either arthroscopic surgery or physical therapy. When they were assessed six and 12 months later, both groups had substantial and similar improvements in movement.

The study was scheduled for presentation this week at the annual meeting of the American Academy of Orthopaedic Surgeons, in Chicago, and published online March 19 in the New England Journal of Medicine.

"Since both the patients who received physical therapy and those who received surgery had similar and considerable improvements in function and pain, our research shows that there is no single 'best' treatment," principal investigator Dr. Jeffrey Katz said in a hospital news release.

However, the release noted that some of the original physical therapy patients did eventually opt for surgery.

"Patients who wish to avoid surgery can be reassured that physical therapy is a reasonable option, although they should recognize that not everyone will improve with physical therapy alone. In this study, one-third of patients who received physical therapy ultimately chose to have surgery, often because they did not improve with [physical therapy]," added Katz, who is director of the Orthopedic and Arthritis Center for Outcomes Research at Brigham and Women's Hospital, and a professor of medicine and orthopedic surgery at Harvard Medical School.

One expert agreed with those conclusions.

"The article reinforces the standard that if a patient suffers a degenerative meniscal tear related to mild to moderate osteoarthritis then the first line of treatment is typically physical therapy," said Dr. Leon Popovitz, an orthopedic surgeon at Lenox Hill Hospital in New York City.

"If patients do not improve, then arthroscopy is a viable option to improve their symptoms," he added.

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Therapy as Good as Surgery for Some With Torn Knee Cartilage

Title: Therapy as Good as Surgery for Some With Torn Knee Cartilage
Category: Health News
Created: 3/19/2013 10:35:00 AM
Last Editorial Review: 3/19/2013 12:00:00 AM

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Study Examines Combo Chin, Nose Plastic Surgery

Profile proportions important to overall appearance, doctors say

By Steven Reinberg

HealthDay Reporter

FRIDAY, March 15 (HealthDay News) -- For patients considering plastic surgery to correct their facial profile, changing the nose and chin simultaneously may provide the most satisfying results, Italian researchers say.

Moreover, success of the combination rhinoplasty (nose) and genioplasty (chin) appears to continue long term with minimal change, or instability, in the shape of the patient's chin, according to the new study.

"We can for sure improve facial profile with stable results with rhinoplasty alone, but the association with genioplasty is fundamental and necessary to achieve the best aesthetic result," said lead researcher Dr. Dario Bertossi, an associate professor in the department of surgery at the University of Verona.

The nose-chin-neck relationship strongly determines an "aesthetically proportionate" face, the authors explained in the study. This is why someone having a successful "nose job" can still end up with a face that lacks pleasing proportions.

The combination surgery, which is done regularly, is often the better solution, especially for people enlarging a small chin (microgenia), the authors added.

"Genioplasty, if performed with bone remodeling, is a stable operation which guarantees long-term results," Bertossi said.

Doing both procedures at the same time makes sense, said Dr. Jeffrey Salomon, an assistant clinical professor of plastic surgery at Yale University School of Medicine in New Haven, Conn. It reduces overall patient costs and avoids a second procedure and recovery period, according to Salomon, who was not involved with the study.

Because these are usually cosmetic procedures, they are not covered by insurance and can run from $7,000 to 12,000, Salomon noted. "You can double that for New York City or Miami. It's cosmetic, so whatever the market will bear," he said.

For the study, published online March 14 in JAMA Facial Plastic Surgery, Bertossi's group followed 90 people who had their noses and chins reshaped simultaneously between January 2002 and January 2004.

Over three years of follow-up, the researchers found that almost half (45.6 percent) of those who had their chin reduced had no subsequent changes in the new chin.

For those who had chin extensions, 52 percent had a "stable" profile three years later, meaning no more than a millimeter of change, the researchers noted.

Salomon pointed out that each of these surgeries does carry some element of risk.

Nose surgery may be more problematic than chin surgery. "It is decidedly harder to get good rhinoplasty results compared with genioplasty," Salomon said. Also, all nose jobs subtly change over the first 12 to 24 months, he added.

"Complications of rhinoplasties are not uncommon," Salomon said. "There are some surgeons known to be the 'go-to surgeons' for secondary or tertiary nose-job revisions, and those surgeons get their referrals from other surgeons who had bad results."

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Can stapedectomy surgery reverse my hearing loss?

Posted May 25, 2013, 2:00 am

I’ve been gradually losing my hearing. My doctor says he can restore my hearing with a procedure called stapedectomy. Can you tell me about it?

To answer your question, I need to explain how you hear. It is an amazing process. Sound travels in waves through the air into your ear canal. Inside the ear canal, the sound waves are amplified. The waves strike your eardrum. The eardrum is a thin membrane, similar to the wall of a balloon.

Right behind the eardrum is a group of tiny bones called ossicles. When the sound waves cause the eardrum to vibrate, the vibration is transmitted to the tiny bones. These bones then transmit the vibrations through fluid in a part of your inner ear called the cochlea. Inside the cochlea are tiny hairs. Vibrations in the fluid are transmitted to the hairs. When the hairs vibrate, signals are sent up the main nerve for hearing. Those signals then land in a part of the brain where the signal is received and interpreted.

Why is the way we hear so complicated? Don’t ask me, I didn’t design it. But I count myself lucky every day that I can hear.

Not surprisingly with such a complex process, many things can go wrong. For example, hearing loss can occur when something blocks sound waves from passing through the outer or middle ear. The source of the obstruction can be any number of things: earwax, fluid, inflammation, a cyst or other abnormal growth, or something accidentally lodged in the ear. Not unexpectedly, this happens more often in infants than in adults. But I once saw a man in his 50s who was having trouble hearing in his left ear. It turned out he had the cotton from the end of a Q-tip stuck inside his ear canal.

The obstruction can also be caused by otosclerosis, which is most likely the cause of your hearing loss. Otosclerosis is the abnormal growth of the tiny ossicle bones. It usually occurs on the stapes, the smallest ossicle in the middle ear. Hearing loss occurs because the stiffened stapes can no longer vibrate and pass sound waves from the ear canal to the inner ear.

Stapedectomy can correct otosclerosis. Working through the ear canal, the surgeon removes all or part of the stapes. He or she replaces it with an artificial stapes that can vibrate. (I’ve put an illustration of this procedure below.)

An abnormal bone growth, as shown in the top figure (A), sometimes prevents the stapes from vibrating and passing sound waves to the inner ear. To correct this condition, the surgeon removes the stapes bone and replaces it with a prosthesis (B). After surgery, sound waves pass through the eardrum, vibrating it. The vibrations pass to the malleus and then the incus, which is connected to the prosthesis. These vibrations cause the prosthesis to move, and the sound waves pass into the inner ear.

A major risk of stapedectomy is hearing loss, which can be total. Some doctors will not operate until the hearing loss is great enough to justify the risks of surgery.

With newer techniques and materials, the risks of this operation are not as great as they used to be. Still, it’s important to discuss the risks and benefits with your doctor. If you decide to go ahead with it, choose a surgeon who performs this operation frequently.

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Can surgery help my spinal stenosis?

Posted May 08, 2013, 2:00 am

I’m a man in my 70s with spinal stenosis. What are my surgical options?

Your spine is made up of a column of bones called vertebrae. The vertebrae are separated by tough little shock-absorbing disks that keep the bone of the vertebra on top from rubbing against the bone of the vertebra beneath it. The vertebrae and disks have a circular space in the center, called the spinal canal, through which your spinal cord (the long nerve that extends from your brain down your back) passes. For much of your life, your spinal canal is wide enough that it doesn’t touch or push on your spinal cord.

However, as the bones and disks grow older, in some people they begin to break down. The disks may bulge out and push on the spinal cord, or pinch a nerve root coming out of the spinal cord. Ligaments, which connect your vertebrae to one another and allow them to move flexibly, may thicken, or small bony growths may develop and protrude into the spinal canal.

Spinal stenosis is a narrowing of the spinal canal caused by the problems with aging disks, ligaments or bones that I just mentioned. (I’ve included an illustration depicting spinal stenosis below.) It causes low back pain and discomfort in the thighs or lower legs when you stand up straight, bend backward or walk even short distances. You’re probably more comfortable sitting or leaning forward.

Spinal stenosis, a narrowing of the spinal canal, usually results from degeneration of the disks, the ligaments, or the facet joints on the posterior (rear) part of the spine. Age-related changes can cause the disks to shrink, which reduces the space between the vertebrae and the facet joints. Stress on these joints can lead to arthritic changes, which can cause one vertebra to slip forward, a condition called spondylolisthesis. In this example, the fifth lumbar vertebra (L5) has slipped forward a few millimeters with respect to the first sacral vertebra (S1).

For some people, symptoms improve substantially over time without treatment. If your stenosis is fairly recent, give yourself some time to see if your symptoms improve on their own.

If you are overweight, weight loss can help. The heavier you are, the more pressure one vertebral bone puts on the bone below it.

Exercises and physical therapy are the most widely used treatments. My impression, and that of most of my colleagues, is that they are effective. However, there aren’t many large, rigorous scientific studies to confirm that opinion.

Exercises that are less likely to cause the vertebral bones to pound on each other are preferred. So rather than jogging, try swimming, bicycling or using equipment such as an elliptical cross-trainer.

If your symptoms don’t improve, surgery to remove the structures that are pressing on your spinal cord is often successful. People who have this surgery can usually be physically active, with few or no restrictions, for a long time. However, up to one in four patients need a second surgery within 10 years of their initial surgery.

Sometimes the changes that cause spinal stenosis cause a vertebra to slip forward. If that’s true in your case, you might consider spinal fusion surgery. This fixes the position of the vertebrae permanently, preventing future displacement. By reducing motion in the affected area of the spine, spinal fusion relieves the pain caused by abnormal movement.

So even though you asked about surgery, you should know that most people with spinal stenosis never need it. Fortunately, simpler approaches work for most people.

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Gov. Christie’s weight-loss surgery: a good idea for health

Posted May 08, 2013, 4:49 pm

New Jersey Governor Chris Christie’s revelation yesterday that he had secretly undergone weight-loss surgery back in February shouldn’t come as a big surprise. He has been publicly (and privately) struggling with his weight for years and fits the profile of a good candidate for this kind of operation.

Although weight-loss surgery, also known as bariatric surgery, should be considered a last resort when diet and exercise don’t work, it can do some amazing things. Among people who are severely overweight, it can yield a 25% to 35% weight loss within two years. In many people who undergo the surgery, type 2 diabetes, high blood pressure, high cholesterol, and the disruptive and potentially harmful snoring pattern known as sleep apnea disappear. It can also improve a number of other health problems, ranging from arthritis and heartburn to infertility and incontinence.

In general, weight-loss surgery is appropriate for people with a body mass index (BMI) of 40 or higher, as well as for those with a BMI of 35 to 39.9 and a severe, treatment-resistant medical condition such as diabetes, heart disease, and sleep apnea.

Much of the speculation about Christie’s surgery was whether he did it for political reasons or concerns about his future health. But there shouldn’t be any speculation about whether he was a good candidate for it. While the Governor never made public his exact weight, the estimate is over 300 pounds. At just under 6 feet tall, that gives him a body mass index of at least 41. Christie also acknowledged trying to lose weight many times, using different weight loss programs. He had some initial success. But like most obese people, he regained all the lost pounds and more.

Even if Christie’s claims of otherwise being in good health are correct, he was at high risk of developing problems directly related to his weight. I believe his choice was a good one for his health.

Christie underwent laparoscopic gastric banding, also known as lap banding. There are also two other types of weight-loss surgery.

Gastric banding is done laparoscopically, meaning through small holes made in the abdomen. The surgeon wraps an adjustable silicone band about two inches in diameter around the upper part of the stomach. This creates a small pouch with a narrow opening that empties into the rest of the stomach. The small size of the upper stomach make a person feel full much sooner than before. Depending on the person’s rate of desired weight loss and how he or she feels, the band can be easily tightened or loosened as needed by injecting or withdrawing sterile salt water saline through a port implanted just under the skin. Compared with gastric bypass, the surgery is simpler and has a lower risk of complications immediately following the operation.

Gastric bypass, also known as the Roux-en-Y procedure, shrinks the size of the stomach by more than 90%. This makes a person feel full after eating very small amounts of food. In addition, the body absorbs fewer calories because food bypasses most of the stomach and upper small intestine. The operation is done through an incision made in the abdomen or laparoscopically. The surgeon converts the upper part of the stomach into a small pouch about the size of an egg. The small intestine is then cut. One end is connected to the stomach pouch and the other is reattached to the small intestine, creating a Y shape. This allows food to bypass most of the stomach and the upper part of the small intestine, although both continue to produce the gastric juices, enzymes, and other secretions needed for digestion. These drain into the intestine and mix with food at the crook of the Y. Gastric bypass surgery is not reversible.

The gastric sleeve technique transforms the stomach into a small, narrow tube by removing the curved side of the organ creates a small pouch using the side of the stomach rather than the bottom. One advantage is that no rearrangement of the intestines is needed. The vertical pouch the sleeve procedure creates is less prone to stretching compared to the pouch left by a gastric bypass. Like gastric bypass, the gastric sleeve technique is not reversible.

For the first few months after surgery, appetite is usually turned down. Eating too quickly or too much overfills the stomach pouch. That can cause vomiting or pain in the chest and upper abdomen. After a high-carbohydrate meal, a person who has had gastric bypass surgery may suffer from “dumping syndrome,” a reaction that causes flushing, sweating, severe fatigue, nausea, vomiting, diarrhea, and intestinal gas. To prevent nutritional deficits, it’s also a good idea to take vitamins (especially vitamins B12 and D) and minerals (especially calcium and iron).

If you are considering weight loss surgery, realize that you must commit to a life-long change in the way you eat. Surgery without lifestyle change will either make you miserable or not result in successful weight reduction. Likely both.

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Weight-Loss Surgery Won't Cut Obesity-Related Medical Costs: Study

Title: Weight-Loss Surgery Won't Cut Obesity-Related Medical Costs: Study
Category: Health News
Created: 2/20/2013 4:35:00 PM
Last Editorial Review: 2/21/2013 12:00:00 AM

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Thousands of Mistakes Made in Surgery Every Year

Dec. 26, 2012 -- More than 4,000 preventable mistakes occur in surgery every year at a cost of more than $1.3 billion in medical malpractice payouts, according a new study.

How preventable? Well, researchers call them "never events" because they are the kind of surgical mistakes that should never happen, like performing the wrong procedure or leaving a sponge inside a patient's body after surgery.

But researchers found that paid malpractice settlements and judgments for these types of never events occurred about 10,000 times in the U.S. between 1990 and 2010. Their analysis estimates that each week surgeons:

Leave a foreign object like a sponge or towel inside a patient's body after an operation 39 timesPerform the wrong procedure on a patient 20 timesOperate on the wrong body site 20 times

"I continue to find the frequency of these events alarming and disturbing," says Donald Fry, MD, executive vice president at Michael Pine and Associates, a health care think tank in Chicago. "I think it's a difficult thing for clinicians to talk about, but it is something that must be improved."

In the study, researchers looked at malpractice claim information for surgical never events from the National Practitioner Data Bank from 1990 to 2010. The results are published in Surgery.

Malpractice settlements and judgments relating to leaving a sponge or other object inside a patient, performing the wrong operation, operating on the wrong site or on the wrong person were included in their analysis.

The results showed a total of 9,744 paid malpractice judgments and claims for these types of never events were reported over the 20-year period, totaling $1.3 billion.

Based on these results, researchers estimate that 4,044 surgical never events occur each year in the U.S.

Researchers say the actual number of these surgical mistakes is likely even higher.

"What we report is the low end of the range because many never events go unreported," says researcher Marty Makary, MD, MPH, associate professor of surgery at Johns Hopkins University School of Medicine.

Makary says by law, hospitals are required to report never events that result in a settlement or judgment.

But not all items left behind after surgery are discovered. They are typically only reported when a patient experiences a complication after surgery, and doctors try to find out why.

"We believe the events we describe are real," says Makary. "I cannot imagine a hospital paying out a settlement for a false claim of a retained sponge."

The consequences of surgical mistakes ranged from temporary injury in 59% of the cases to death in 6.6% of the cases and permanent injury in 33% of people affected.

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