Awake Sedation for Brain Surgery May Shorten Hospital Stay
ScienceDaily (June 18, 2010) — The recovery time and cost of brain-tumor surgery might both be reduced if surgery is performed while patients are awake during part of the procedure, according to a new study conducted at The Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute.
The study, published online June 18 in the Journal of Neurosurgery, examined the outcomes of 39 patients treated for glioma, a type of brain tumor that affects about 20,000 Americans annually. The doctors wanted to learn if surgeries that used conscious sedation -- in which patients are initially anesthetized but restored to consciousness during surgery on the brain itself -- had outcomes different from those using more traditional general anesthesia.
"Our data suggest that patients who received conscious sedation had shorter hospital stays than those receiving general anesthesia, and that this reduced the cost of treatment," says study leader Dr. E. Antonio Chiocca, professor and chair of neurological surgery and Dardinger Family Endowed Chair in Oncological Neurosurgery.
"This finding needs to be validated with a randomized prospective clinical trial, but if it holds true, it would mean that changing our current way of delivering anesthesia for these patients could allow them to leave the hospital sooner and save resources."
Neurosurgeons usually reserve conscious sedation for patients with tumors located near the brain's speech and sensorimotor centers, Chiocca says. The method was originally conceived as early as the 1950s to avoid or minimize the accidental damaging of these centers. Since then, additional studies have indicated that conscious sedation can result in more complications than procedures using general anesthesia, while others appear to show the opposite
To investigate the question, Chiocca and his colleagues studied the outcomes of 20 cases that used conscious sedation during surgery for stage II, III or IV gliomas and compared them with 19 cases that used general anesthesia.
The investigators evaluated each patient for the number of days they remained in the hospital and for the cost of four items that directly related to the surgery: the cost of the operating room, of anesthesia, of neurosurgical intensive care and of the hospital room. Each patient was also evaluated for neurological complications.
No significant differences were found in the percentage of complications. Regarding the four costs examined by the investigators, the expense associated with the operating room and anesthesia were the same in both groups, and both groups spent a similar period in neurosurgical intensive care. Patients receiving conscious sedation, however, had shorter hospital stays after leaving intensive care than did patients receiving general anesthesia, for a total of 3.5 days and 4.6 days respectively.
The shorter hospital stay led to an average 36 percent decrease in post-intensive-care direct cost for cases receiving conscious sedation compared with those receiving general anesthesia.
"Overall," Chiocca says, "our findings suggest that glioma resection under conscious sedation is associated with shorter hospital stays and reduced inpatient expenses compared with the same surgery under general anesthesia."
http://www.sciencedaily.com/releases/20 ... 171250.htm
Awake Sedation for Brain Surgery May Shorten Hospital Stay
New Robotic Head and Neck Cancer Surgery Preserves Speech, Without Scarring, Study Shows
ScienceDaily (Sep. 7, 2010) — An incisionless robotic surgical procedure is offering patients a new option to remove certain head and neck cancer tumors without visible scarring, while preserving speech and the ability to eat.
Henry Ford Hospital in Detroit is among the first in the country to perform TransOral Robotic Surgery (TORS) using the da Vinci® Surgical System. Unlike traditional surgical approaches to head and neck cancer, TORS patients are able to return to their normal lives only a few days after surgery without significant pain and disfigurement.
"TORS offers shorter post-operative recovery than standard open surgical approaches, giving patients the opportunity to quickly and successfully return to their normal lives," says Tamer A. Ghanem, M.D., Ph.D., director of Head and Neck Oncology and Reconstructive Surgery Division in the Department of Otolaryngology-Head & Neck Surgery at Henry Ford Hospital.
"TORS allows surgeons to completely remove tumors of the head and neck while preserving speech, swallowing, and other key quality of life issues such as eating. There also is no visible scaring or disfigurement."
Led by Dr. Ghanem, Henry Ford Hospital has performed more than a dozen TORS procedures since it was approved in January by the U.S. Food and Drug Administration to remove malignant and benign tumors of the mouth, tongue, tonsils, and parts of the throat.
Prior to TORS, patients would traditionally begin treatment with radiation therapy, or a combination of chemotherapy and radiation therapy, depending on the stage of their cancer. Side effects of radiation -- dry mouth, loss of taste and difficulty swallowing -- can potentially be avoided with TORS
Traditional surgery has side effects as well. It requires a long incision be made across the lip and jaw to access the tumor. This approach can results in significant swelling, longer post-operative recovery, damage to surrounding structures, and speech and swallowing problems.
With TORS, surgeons can access tumors through the mouth using the slender operating arms of the da Vinci, thus not requiring an open skin incision.
"Surgeons operate with greater precision and control using the TORS approach," says Dr. Ghanem, "minimizing the pain, and reducing the risk of possible nerve and tissue damage associated with large incisions."
Some of TORS's other benefits include:
- Significantly less blood loss
- No visible scarring
- Possibility of avoiding a tracheotomy
- Minimization or elimination of need for chemoradiation therapy
- Fewer complications and shorter hospital stay
- Faster recovery, return to normal speech and swallowing
- Equivalent cancer control to radiation therapy
- Patients with early stage tonsil and base of tongue cancers may not need to receive radiation therapy following TORS, depending on the final tumor margins and pathological characteristics of the tumor.
In addition to TORS, Dr. Ghanem specializes in complex head and neck oncology cases, offering both cancer resection as well as reconstructive surgery using microvascular techniques (taking tissue from one part of the body and transplanting it to the head and neck areas to improve function and esthetics). In addition, he performs thyroid, parathyroid, and salivary gland surgery, reconstruction after Mohs procedures and robotic-assisted thyroidectomy, in which the incision is made in the arm pit instead of the neck to conceal it.
http://www.sciencedaily.com/releases/20 ... 113137.htm
ScienceDaily (Sep. 7, 2010) — An incisionless robotic surgical procedure is offering patients a new option to remove certain head and neck cancer tumors without visible scarring, while preserving speech and the ability to eat.
Henry Ford Hospital in Detroit is among the first in the country to perform TransOral Robotic Surgery (TORS) using the da Vinci® Surgical System. Unlike traditional surgical approaches to head and neck cancer, TORS patients are able to return to their normal lives only a few days after surgery without significant pain and disfigurement.
"TORS offers shorter post-operative recovery than standard open surgical approaches, giving patients the opportunity to quickly and successfully return to their normal lives," says Tamer A. Ghanem, M.D., Ph.D., director of Head and Neck Oncology and Reconstructive Surgery Division in the Department of Otolaryngology-Head & Neck Surgery at Henry Ford Hospital.
"TORS allows surgeons to completely remove tumors of the head and neck while preserving speech, swallowing, and other key quality of life issues such as eating. There also is no visible scaring or disfigurement."
Led by Dr. Ghanem, Henry Ford Hospital has performed more than a dozen TORS procedures since it was approved in January by the U.S. Food and Drug Administration to remove malignant and benign tumors of the mouth, tongue, tonsils, and parts of the throat.
Prior to TORS, patients would traditionally begin treatment with radiation therapy, or a combination of chemotherapy and radiation therapy, depending on the stage of their cancer. Side effects of radiation -- dry mouth, loss of taste and difficulty swallowing -- can potentially be avoided with TORS
Traditional surgery has side effects as well. It requires a long incision be made across the lip and jaw to access the tumor. This approach can results in significant swelling, longer post-operative recovery, damage to surrounding structures, and speech and swallowing problems.
With TORS, surgeons can access tumors through the mouth using the slender operating arms of the da Vinci, thus not requiring an open skin incision.
"Surgeons operate with greater precision and control using the TORS approach," says Dr. Ghanem, "minimizing the pain, and reducing the risk of possible nerve and tissue damage associated with large incisions."
Some of TORS's other benefits include:
- Significantly less blood loss
- No visible scarring
- Possibility of avoiding a tracheotomy
- Minimization or elimination of need for chemoradiation therapy
- Fewer complications and shorter hospital stay
- Faster recovery, return to normal speech and swallowing
- Equivalent cancer control to radiation therapy
- Patients with early stage tonsil and base of tongue cancers may not need to receive radiation therapy following TORS, depending on the final tumor margins and pathological characteristics of the tumor.
In addition to TORS, Dr. Ghanem specializes in complex head and neck oncology cases, offering both cancer resection as well as reconstructive surgery using microvascular techniques (taking tissue from one part of the body and transplanting it to the head and neck areas to improve function and esthetics). In addition, he performs thyroid, parathyroid, and salivary gland surgery, reconstruction after Mohs procedures and robotic-assisted thyroidectomy, in which the incision is made in the arm pit instead of the neck to conceal it.
http://www.sciencedaily.com/releases/20 ... 113137.htm
What's Causing Life-Threatening Blood Clots in Brain Surgery Patients?
ScienceDaily (Sep. 7, 2010) — One of the most severe complications of brain surgery is a life-threatening blood clot in the lungs called a pulmonary embolism.
But a Loyola University Health System study published in the Journal of Neurosurgery suggests that screening methods hospitals typically use to access the risk of pulmonary embolisms may fall short.
Hospitals typically screen for blood clots in legs, which can break free, travel to the lungs and cause pulmonary embolisms. But in the Loyola study, only seven of the 22 patients who experienced pulmonary embolisms showed evidence of leg blood clots, while nine embolism patients tested negative for leg clots. A blood clot in the vein is known as a deep venous thrombosis (DVT).
"We could not demonstrate a good correlation between lower extremity DVT and pulmonary embolism in our patient population," senior author Thomas Origitano, MD, PhD and colleagues wrote. Origitano is chair of the Department of Neurological Surgery at Loyola University Stritch School of Medicine.
One of the major risks of severe complications and deaths in brain surgery patients is venous thromboembolism, which includes DVT and pulmonary embolism. Risk factors for DVTs include tumors, spinal cord injuries, head trauma, strokes, length of surgery and decreased mobility or limb movement.
The study findings suggest there may be a subset of high-risk patients who already are prone to blood clots when they are admitted to the hospital. Or perhaps pulmonary embolisms are triggered by blood clots that break free from arms rather than from legs. Blood clots in arms can be caused by patients' immobility or the use of central lines (catheters in large veins), researchers wrote.
The study also raises questions about quality assurance measures that watchdog groups use to rate hospitals. These measures typically count a hospital's combined rate of DVTs and pulmonary embolisms. But the study's findings indicate that at least among brain surgery patients, there may not be a close correlation between DVTs and pulmonary embolisms. "Are the ratings systems measuring what we really want to measure?" Origitano said.
In the study, researchers reviewed records of all 2,638 neurosurgical patients treated at Loyola between January, 2006 and December, 2008. Among a subset of 555 high-risk patients, 85 percent of the DVTs occurred within one week of surgery. Researchers found the longer the surgery, the higher the risk of DVTs. Giving patients heparin shots either 24 or 48 hours after surgery reduced the rate of DVTs from 16 percent to 9 percent -- without bleeding complications.
This findings suggest the possibility that high-risk patients "have a predilection to developing DVT regardless of the timing of administration of [heparin]," researchers wrote. "Perhaps there is a subset of neurosurgical patients who have DVT present on admission." If so, perhaps patients should be screened for DVTs before surgery as well as after surgery, researchers wrote.
Origitano and colleagues question whether looking for DVTs in the legs following surgery is sufficient for assessing the risk of pulmonary embolisms. They propose a randomized, multicenter study of brain surgery patients that would include administration of heparin before surgery and screening for DVTs in the arms and legs before and after surgery.
http://www.sciencedaily.com/releases/20 ... 210411.htm
ScienceDaily (Sep. 7, 2010) — One of the most severe complications of brain surgery is a life-threatening blood clot in the lungs called a pulmonary embolism.
But a Loyola University Health System study published in the Journal of Neurosurgery suggests that screening methods hospitals typically use to access the risk of pulmonary embolisms may fall short.
Hospitals typically screen for blood clots in legs, which can break free, travel to the lungs and cause pulmonary embolisms. But in the Loyola study, only seven of the 22 patients who experienced pulmonary embolisms showed evidence of leg blood clots, while nine embolism patients tested negative for leg clots. A blood clot in the vein is known as a deep venous thrombosis (DVT).
"We could not demonstrate a good correlation between lower extremity DVT and pulmonary embolism in our patient population," senior author Thomas Origitano, MD, PhD and colleagues wrote. Origitano is chair of the Department of Neurological Surgery at Loyola University Stritch School of Medicine.
One of the major risks of severe complications and deaths in brain surgery patients is venous thromboembolism, which includes DVT and pulmonary embolism. Risk factors for DVTs include tumors, spinal cord injuries, head trauma, strokes, length of surgery and decreased mobility or limb movement.
The study findings suggest there may be a subset of high-risk patients who already are prone to blood clots when they are admitted to the hospital. Or perhaps pulmonary embolisms are triggered by blood clots that break free from arms rather than from legs. Blood clots in arms can be caused by patients' immobility or the use of central lines (catheters in large veins), researchers wrote.
The study also raises questions about quality assurance measures that watchdog groups use to rate hospitals. These measures typically count a hospital's combined rate of DVTs and pulmonary embolisms. But the study's findings indicate that at least among brain surgery patients, there may not be a close correlation between DVTs and pulmonary embolisms. "Are the ratings systems measuring what we really want to measure?" Origitano said.
In the study, researchers reviewed records of all 2,638 neurosurgical patients treated at Loyola between January, 2006 and December, 2008. Among a subset of 555 high-risk patients, 85 percent of the DVTs occurred within one week of surgery. Researchers found the longer the surgery, the higher the risk of DVTs. Giving patients heparin shots either 24 or 48 hours after surgery reduced the rate of DVTs from 16 percent to 9 percent -- without bleeding complications.
This findings suggest the possibility that high-risk patients "have a predilection to developing DVT regardless of the timing of administration of [heparin]," researchers wrote. "Perhaps there is a subset of neurosurgical patients who have DVT present on admission." If so, perhaps patients should be screened for DVTs before surgery as well as after surgery, researchers wrote.
Origitano and colleagues question whether looking for DVTs in the legs following surgery is sufficient for assessing the risk of pulmonary embolisms. They propose a randomized, multicenter study of brain surgery patients that would include administration of heparin before surgery and screening for DVTs in the arms and legs before and after surgery.
http://www.sciencedaily.com/releases/20 ... 210411.htm
Ultrasound Waves Aid In Rapid Treatment Of Deep Vein Thrombosis
ScienceDaily (Nov. 30, 2008) — The use of ultrasound waves for deep vein thrombosis (DVT) may help dissolve blood clots in less time than using clot-busting drugs alone, according to researchers at Emory University. The study will be presented Nov. 23, 2008 at the annual VEITHsymposium in New York City.
"These clots are a main cause of both heart attacks and stroke and the more quickly you can eliminate them the better," says Karthikeshwar Kasirajan, MD, assistant professor of surgery in the Emory University School of Medicine.
A DVT is a blood clot that forms in a vein deep in the body, most often in the lower leg or thigh. A loose clot, called an embolus, can break off and travel through the bloodstream to the lungs and block blood flow. The life-threatening condition is called pulmonary embolism. The surgeon general's campaign estimates that every year, between 350,000 and 600,000 Americans get one of these clots - and at least 100,000 of them die.
"We now know that using ultrasound, along with the traditional method of using drugs to break up or dissolve blood clots, will help restore flow, prevent valve damage and also prevent the possibility of pulmonary embolism," says Kasirajan.
Researchers treated 37 patients with the clot-dissolving drug called tPA (tissue plasminogen activator), while using ultrasound to loosen the proteins in their blood clots and send the drug into the clots faster.
Of the 37, 16 had DVT and 21 had acute in-situ arterial thrombosis. All the patients with arterial thrombosis had their clots completely dissolved, and all but six of the DVT patients had theirs completely dissolved.
Four DVT patients had their clots partially dissolved and two saw no change. Only one of the 37 had a complication (neck hematoma). Most of the 37 (83 percent) were subsequently treated with angioplasty and stent placement.
Risk factors for DVT include: being immobile for long periods of time, recent surgery, a fall or broken bone, pregnancy, a car crash, birth control pills or menopause hormones. The risk rises with age, especially over 65, and among people who smoke or are obese.
http://www.sciencedaily.com/releases/20 ... 150253.htm
ScienceDaily (Nov. 30, 2008) — The use of ultrasound waves for deep vein thrombosis (DVT) may help dissolve blood clots in less time than using clot-busting drugs alone, according to researchers at Emory University. The study will be presented Nov. 23, 2008 at the annual VEITHsymposium in New York City.
"These clots are a main cause of both heart attacks and stroke and the more quickly you can eliminate them the better," says Karthikeshwar Kasirajan, MD, assistant professor of surgery in the Emory University School of Medicine.
A DVT is a blood clot that forms in a vein deep in the body, most often in the lower leg or thigh. A loose clot, called an embolus, can break off and travel through the bloodstream to the lungs and block blood flow. The life-threatening condition is called pulmonary embolism. The surgeon general's campaign estimates that every year, between 350,000 and 600,000 Americans get one of these clots - and at least 100,000 of them die.
"We now know that using ultrasound, along with the traditional method of using drugs to break up or dissolve blood clots, will help restore flow, prevent valve damage and also prevent the possibility of pulmonary embolism," says Kasirajan.
Researchers treated 37 patients with the clot-dissolving drug called tPA (tissue plasminogen activator), while using ultrasound to loosen the proteins in their blood clots and send the drug into the clots faster.
Of the 37, 16 had DVT and 21 had acute in-situ arterial thrombosis. All the patients with arterial thrombosis had their clots completely dissolved, and all but six of the DVT patients had theirs completely dissolved.
Four DVT patients had their clots partially dissolved and two saw no change. Only one of the 37 had a complication (neck hematoma). Most of the 37 (83 percent) were subsequently treated with angioplasty and stent placement.
Risk factors for DVT include: being immobile for long periods of time, recent surgery, a fall or broken bone, pregnancy, a car crash, birth control pills or menopause hormones. The risk rises with age, especially over 65, and among people who smoke or are obese.
http://www.sciencedaily.com/releases/20 ... 150253.htm
Muscle Wasting in Cancer Does Not Spare the Heart
ScienceDaily (Sep. 8, 2010) — The wasting disease associated with some cancers that is typically seen affecting skeletal muscles can also cause significant damage to the heart, new research in mice suggests.
Before now, cachexia, characterized by muscle wasting and dramatic weight loss, was believed to spare the heart. But an Ohio State University study showed that the condition reduces heart function and changes the heart muscle structure in mice with colon cancer.
Previous studies have suggested that cachexia is responsible for between one-fifth and one-third of all cancer deaths. But many aspects of the condition remain misunderstood, including its cause and ways to predict who is at highest risk for the syndrome.
These new study findings could have immediate implications for treatment, said Martha Belury, lead author of the research and a professor of human nutrition at Ohio State.
"I think if we know certain types of cancer are associated with this wasting disease, it might be important to think about heart function earlier rather than once people are starting to lose weight. Clinicians could try to protect the heart while also giving patients chemotherapy for cancer and perhaps added nutrition to maintain weight," Belury said.
"The fatigue and weakness of cachexia have been attributed to skeletal muscle wasting. But our results support the idea that insufficient heart performance might also be responsible for fatigue symptoms, leading to less exercise and more severe muscle wasting. It's a vicious cycle that contributes to the complications of cancer cachexia."
The study is published in a recent issue of the International Journal of Oncology.
The researchers compared mice with and without colon cancer tumors. Colon cancer and other gastrointestinal tumors, as well as some lung cancers, are most commonly associated with development of cachexia
At day 14 of the study, when the mice with tumors were clearly losing weight, the scientists measured cardiac function in all of the mice using echocardiography, or an ultrasound of the heart. This evaluation showed that mice with tumors as a group had a heart rate of almost 21 percent fewer beats per minute on average and pumped significantly less blood than did the hearts of the healthy mice.
Three days later, the scientists observed a 23 percent difference in body weight between the mice with cancer and without tumors -- a sign that the syndrome had clearly taken hold in the mice with cancer.
Though the mice with tumors ate less as the disease developed, the study was designed to show that food consumption wasn't the sole cause of weight loss. A group of healthy mice whose food consumption matched the lower consumption of the mice with cancer also lost weight, but retained their skeletal muscle mass and showed normal heart function.
The researchers examined the heart tissue of all of the mice using electron microscopy. They found a number of signs of damage in the heart muscle tissue of mice with cachexia, including an increase in fibrous tissue and changes in mitochondria, the so-called "powerhouses" in cells that convert carbon to energy.
"The mitochondria looked pretty bad, almost as if they were breaking apart. And we also saw evidence of the precursors of scarring, or collagen formation, which you don't want to see in any type of muscle and especially not in the heart muscle," Belury said.
No similar problems were seen in the hearts of mice without tumors.
By also examining gene function in the heart tissue, the researchers found that the proteins associated with power generation in muscle had converted from their adult form to a fetal type in the hearts of mice with cachexia. This phenomenon has been linked to heart failure in previous research.
"The heart was still trying very hard to maintain function and structure, so it was inducing this kind of action to try to heal itself but it just couldn't. There was too much going on for this to work," Belury said. "We wonder if we could harness some of this knowledge into a way of reversing the heart disease."
Future research could test whether using medication or added nutrition in early stages of cachexia might prevent heart function deterioration, she said.
http://www.sciencedaily.com/releases/20 ... 121956.htm
ScienceDaily (Sep. 8, 2010) — The wasting disease associated with some cancers that is typically seen affecting skeletal muscles can also cause significant damage to the heart, new research in mice suggests.
Before now, cachexia, characterized by muscle wasting and dramatic weight loss, was believed to spare the heart. But an Ohio State University study showed that the condition reduces heart function and changes the heart muscle structure in mice with colon cancer.
Previous studies have suggested that cachexia is responsible for between one-fifth and one-third of all cancer deaths. But many aspects of the condition remain misunderstood, including its cause and ways to predict who is at highest risk for the syndrome.
These new study findings could have immediate implications for treatment, said Martha Belury, lead author of the research and a professor of human nutrition at Ohio State.
"I think if we know certain types of cancer are associated with this wasting disease, it might be important to think about heart function earlier rather than once people are starting to lose weight. Clinicians could try to protect the heart while also giving patients chemotherapy for cancer and perhaps added nutrition to maintain weight," Belury said.
"The fatigue and weakness of cachexia have been attributed to skeletal muscle wasting. But our results support the idea that insufficient heart performance might also be responsible for fatigue symptoms, leading to less exercise and more severe muscle wasting. It's a vicious cycle that contributes to the complications of cancer cachexia."
The study is published in a recent issue of the International Journal of Oncology.
The researchers compared mice with and without colon cancer tumors. Colon cancer and other gastrointestinal tumors, as well as some lung cancers, are most commonly associated with development of cachexia
At day 14 of the study, when the mice with tumors were clearly losing weight, the scientists measured cardiac function in all of the mice using echocardiography, or an ultrasound of the heart. This evaluation showed that mice with tumors as a group had a heart rate of almost 21 percent fewer beats per minute on average and pumped significantly less blood than did the hearts of the healthy mice.
Three days later, the scientists observed a 23 percent difference in body weight between the mice with cancer and without tumors -- a sign that the syndrome had clearly taken hold in the mice with cancer.
Though the mice with tumors ate less as the disease developed, the study was designed to show that food consumption wasn't the sole cause of weight loss. A group of healthy mice whose food consumption matched the lower consumption of the mice with cancer also lost weight, but retained their skeletal muscle mass and showed normal heart function.
The researchers examined the heart tissue of all of the mice using electron microscopy. They found a number of signs of damage in the heart muscle tissue of mice with cachexia, including an increase in fibrous tissue and changes in mitochondria, the so-called "powerhouses" in cells that convert carbon to energy.
"The mitochondria looked pretty bad, almost as if they were breaking apart. And we also saw evidence of the precursors of scarring, or collagen formation, which you don't want to see in any type of muscle and especially not in the heart muscle," Belury said.
No similar problems were seen in the hearts of mice without tumors.
By also examining gene function in the heart tissue, the researchers found that the proteins associated with power generation in muscle had converted from their adult form to a fetal type in the hearts of mice with cachexia. This phenomenon has been linked to heart failure in previous research.
"The heart was still trying very hard to maintain function and structure, so it was inducing this kind of action to try to heal itself but it just couldn't. There was too much going on for this to work," Belury said. "We wonder if we could harness some of this knowledge into a way of reversing the heart disease."
Future research could test whether using medication or added nutrition in early stages of cachexia might prevent heart function deterioration, she said.
http://www.sciencedaily.com/releases/20 ... 121956.htm
Brain Stimulation Can Help Partially Paralysed Stroke Patients Regain Use of Their Muscles, Research Finds
ScienceDaily (Sep. 13, 2010) — Stroke patients who were left partially paralysed found that their condition improved after they received a simple and non-invasive method of brain stimulation, according to research in the September issue of the European Journal of Neurology.
Researchers from the Ain Shams University in Cairo, Egypt, studied 60 patients with ischaemic stroke -- where the blood supply is reduced to the brain -- who had been left with mild to moderate muscle weakness down one side of their body.
Twenty of the randomly assigned treatment group received repetitive transcranial magnetic stimulation (rTMS) applied at 5-Hz over the brain hemisphere affected by the stroke and the other 20 received 1-Hz stimulation of the unaffected hemisphere. The remaining 20 formed the control group, receiving inactive placebo doses of the treatment. All patients received the same physical therapy.
"When we compared the results between the three groups, we found that both of the treatment groups showed significant motor function recovery" says co-author Anwar El Etribi, Professor of Neurology and Psychiatry at the University. "No improvements were seen in the control group who had received the placebo treatment and the same physical therapy protocol."
The majority of the patients (95 per cent) had suffered their stroke in the last three years, having been enrolled in the study at least one month after their stroke. However, there was no difference between the level of clinical improvement and the interval since the patients' strokes.
"We believe that people develop partial paralysis down one side after they have a stroke because the hemispheres of the brain become unbalanced" explains Professor Etribi. "The hemisphere that has not been affected can become over-active, while the damaged hemisphere can become inhibited.
"Our treatment worked on the theory that increasing the activity of the hemisphere affected by the stroke and reducing the activity of the unaffected hemisphere can reduce muscle weakness and improve overall motor function."
The 60 patients who took part in the study had similar baseline characteristics, apart from a lower incident of ischaemic heart disease in the 5-Hz rTMS group, which was unlikely to have had an effect on recovery.
Patients averaged just under 54 years of age and just over two-thirds were male.
The patients were randomly assigned to one of the three groups and magnetic stimulation was administered in three different ways:
- Patients in group one received a daily 5-Hz session for 10 days over the part of the brain affected by the stroke. This equated to 750 pulses per session and 7,500 pulses over the course of the treatment.
- Patients in group two received a daily 1-Hz session for 10 days over the part of the brain not affected by the stroke. This equated to 150 pulses per session and 1,500 pulses over the course of the treatment.
- The "treatment" in the placebo group was applied in the same way as group two, but the stimulator was angled at 90 degrees to render it ineffective.
- Patients were clinically assessed at baseline and at two, four, eight and 12 weeks using a range of tools to determine motor function and cognitive status.
Further details of the scores and the treatment sessions are outlined in detail in the full paper.
"Our study shows that using rTMS can help patients who have suffered an ischaemic stroke and are experiencing partial paralysis on one side of their body to regain motor function" says Professor Etribi. "We also found that the time interval from stroke to treatment did not have an effect on how well the patient recovered.
"It appears that inhibitory and stimulatory rTMS may well prove useful tools in long-term programmes to rehabilitate stroke patients."
http://www.sciencedaily.com/releases/20 ... 080829.htm
[comment - may benefits those of us who have post surgical hemiparesis]
ScienceDaily (Sep. 13, 2010) — Stroke patients who were left partially paralysed found that their condition improved after they received a simple and non-invasive method of brain stimulation, according to research in the September issue of the European Journal of Neurology.
Researchers from the Ain Shams University in Cairo, Egypt, studied 60 patients with ischaemic stroke -- where the blood supply is reduced to the brain -- who had been left with mild to moderate muscle weakness down one side of their body.
Twenty of the randomly assigned treatment group received repetitive transcranial magnetic stimulation (rTMS) applied at 5-Hz over the brain hemisphere affected by the stroke and the other 20 received 1-Hz stimulation of the unaffected hemisphere. The remaining 20 formed the control group, receiving inactive placebo doses of the treatment. All patients received the same physical therapy.
"When we compared the results between the three groups, we found that both of the treatment groups showed significant motor function recovery" says co-author Anwar El Etribi, Professor of Neurology and Psychiatry at the University. "No improvements were seen in the control group who had received the placebo treatment and the same physical therapy protocol."
The majority of the patients (95 per cent) had suffered their stroke in the last three years, having been enrolled in the study at least one month after their stroke. However, there was no difference between the level of clinical improvement and the interval since the patients' strokes.
"We believe that people develop partial paralysis down one side after they have a stroke because the hemispheres of the brain become unbalanced" explains Professor Etribi. "The hemisphere that has not been affected can become over-active, while the damaged hemisphere can become inhibited.
"Our treatment worked on the theory that increasing the activity of the hemisphere affected by the stroke and reducing the activity of the unaffected hemisphere can reduce muscle weakness and improve overall motor function."
The 60 patients who took part in the study had similar baseline characteristics, apart from a lower incident of ischaemic heart disease in the 5-Hz rTMS group, which was unlikely to have had an effect on recovery.
Patients averaged just under 54 years of age and just over two-thirds were male.
The patients were randomly assigned to one of the three groups and magnetic stimulation was administered in three different ways:
- Patients in group one received a daily 5-Hz session for 10 days over the part of the brain affected by the stroke. This equated to 750 pulses per session and 7,500 pulses over the course of the treatment.
- Patients in group two received a daily 1-Hz session for 10 days over the part of the brain not affected by the stroke. This equated to 150 pulses per session and 1,500 pulses over the course of the treatment.
- The "treatment" in the placebo group was applied in the same way as group two, but the stimulator was angled at 90 degrees to render it ineffective.
- Patients were clinically assessed at baseline and at two, four, eight and 12 weeks using a range of tools to determine motor function and cognitive status.
Further details of the scores and the treatment sessions are outlined in detail in the full paper.
"Our study shows that using rTMS can help patients who have suffered an ischaemic stroke and are experiencing partial paralysis on one side of their body to regain motor function" says Professor Etribi. "We also found that the time interval from stroke to treatment did not have an effect on how well the patient recovered.
"It appears that inhibitory and stimulatory rTMS may well prove useful tools in long-term programmes to rehabilitate stroke patients."
http://www.sciencedaily.com/releases/20 ... 080829.htm
[comment - may benefits those of us who have post surgical hemiparesis]
Depression can be treated with electromagnets (better than drugs)
NaturalNews) A therapy known as repetitive transcranial magnetic stimulation (rTMS), which involves inducing electromagnetic fields in the brain, may ease the symptoms of depression in hard-to-treat patients better than antidepressant drugs, researchers have found.
"This study should help settle the debate about whether rTMS works for depression," said lead researcher Mark George of the Medical University of South Carolina. "We can now follow up clues suggesting ways to improve its effectiveness, and hopefully further develop a potential new class of stimulation treatments for other brain disorders."
RTMS therapy uses highly focused magnetic pulses similar in strength to those produced by an MRI to induce an electric current in the Dorsilateral Prefrontal Cortex in the front left portion of the brain. Over the course of a single, 37-minute session, the brain is exposed to a total of 3,000 such pulses.
RTMS is the only FDA-approved biological depression treatment besides antidepressant drugs and electroconvulsive therapy (ECT, also known as electroshock therapy). It functions under basically the same mechanism as ECT, but without inducing seizures.
Prior studies have demonstrated the effectiveness of rTMS, leading the FDA to approve it as a treatment for depression in 2008. Since then, more than 20,000 procedures have been performed. Yet because scientists had never been able to develop a way to test the device against a placebo -- study participants were consistently able to tell whether they were receiving the real treatment or not -- critics have questioned the validity of the therapy.
For the new study, published in the Archives of General Psychiatry, researchers developed a device that causes the same eye-twitching and skull-tapping sensation induced by an rTMS machine, but without making use of electromagnetic fields. This sham treatment device and its physical effects appeared so similar to that of the real device that even the researchers could not tell them apart.
The researchers tested either true rTMS or the sham device on 190 patients who had suffered from serious depression for between three months and five years. All study participants had previously been treated with at least one antidepressant drug but had failed to respond.
After at least three weeks of treatment, 14 percent of the patients in the rTMS group experienced remission of symptoms, compared with only 5 percent in the sham treatment group.
"The effect sizes we report with rTMS are about on par with what you see with antidepressant medications," said researcher Sarah Lisanby of Columbia University and the New York State Psychiatric Institute. "The difference is that to get into our study, people had to have failed to have responded to a medication. And studies show that with previous failure to respond to an antidepressant, the rate of success for a second antidepressant is lower."
The researchers found that rTMS was more effective in patients who had previously taken only one antidepressant than in patients who had taken more than one.
"It is looking as if rTMS would be more effective earlier in the treatment course rather than later," said Matthew Rudorfer, of the National Institute of Mental Health, which funded the study.
Although the study was conducted without any industry support, all the researchers reported financial relationships with companies involved in rTMS. In addition, Columbia University holds an rTMS patent in Lisanby's name.
Participants in both the real- and sham-treatment groups suffered some side effects such as headaches and nausea. These effects were more common in participants that underwent true rTMS. Unlike antidepressants, however, rTMS does not circulate through the body and should have no systemic side effects such as dry mouth, sexual dysfunction, upset stomach or weight gain.
In contrast with ECT, no sedation is required for rTMS and patients can drive themselves to and from their appointments.
http://www.naturalnews.com/029848_depre ... gnets.html
NaturalNews) A therapy known as repetitive transcranial magnetic stimulation (rTMS), which involves inducing electromagnetic fields in the brain, may ease the symptoms of depression in hard-to-treat patients better than antidepressant drugs, researchers have found.
"This study should help settle the debate about whether rTMS works for depression," said lead researcher Mark George of the Medical University of South Carolina. "We can now follow up clues suggesting ways to improve its effectiveness, and hopefully further develop a potential new class of stimulation treatments for other brain disorders."
RTMS therapy uses highly focused magnetic pulses similar in strength to those produced by an MRI to induce an electric current in the Dorsilateral Prefrontal Cortex in the front left portion of the brain. Over the course of a single, 37-minute session, the brain is exposed to a total of 3,000 such pulses.
RTMS is the only FDA-approved biological depression treatment besides antidepressant drugs and electroconvulsive therapy (ECT, also known as electroshock therapy). It functions under basically the same mechanism as ECT, but without inducing seizures.
Prior studies have demonstrated the effectiveness of rTMS, leading the FDA to approve it as a treatment for depression in 2008. Since then, more than 20,000 procedures have been performed. Yet because scientists had never been able to develop a way to test the device against a placebo -- study participants were consistently able to tell whether they were receiving the real treatment or not -- critics have questioned the validity of the therapy.
For the new study, published in the Archives of General Psychiatry, researchers developed a device that causes the same eye-twitching and skull-tapping sensation induced by an rTMS machine, but without making use of electromagnetic fields. This sham treatment device and its physical effects appeared so similar to that of the real device that even the researchers could not tell them apart.
The researchers tested either true rTMS or the sham device on 190 patients who had suffered from serious depression for between three months and five years. All study participants had previously been treated with at least one antidepressant drug but had failed to respond.
After at least three weeks of treatment, 14 percent of the patients in the rTMS group experienced remission of symptoms, compared with only 5 percent in the sham treatment group.
"The effect sizes we report with rTMS are about on par with what you see with antidepressant medications," said researcher Sarah Lisanby of Columbia University and the New York State Psychiatric Institute. "The difference is that to get into our study, people had to have failed to have responded to a medication. And studies show that with previous failure to respond to an antidepressant, the rate of success for a second antidepressant is lower."
The researchers found that rTMS was more effective in patients who had previously taken only one antidepressant than in patients who had taken more than one.
"It is looking as if rTMS would be more effective earlier in the treatment course rather than later," said Matthew Rudorfer, of the National Institute of Mental Health, which funded the study.
Although the study was conducted without any industry support, all the researchers reported financial relationships with companies involved in rTMS. In addition, Columbia University holds an rTMS patent in Lisanby's name.
Participants in both the real- and sham-treatment groups suffered some side effects such as headaches and nausea. These effects were more common in participants that underwent true rTMS. Unlike antidepressants, however, rTMS does not circulate through the body and should have no systemic side effects such as dry mouth, sexual dysfunction, upset stomach or weight gain.
In contrast with ECT, no sedation is required for rTMS and patients can drive themselves to and from their appointments.
http://www.naturalnews.com/029848_depre ... gnets.html
Scarless Brain Surgery Is New Option for Patients
ScienceDaily (Sep. 29, 2010) — Surgeons at the University of California, San Diego, School of Medicine and University of Washington Medical Center have determined that transorbital neuroendoscopic surgery (TONES) is a safe and effective option for treating a variety of advanced brain diseases and traumatic injuries. This groundbreaking minimally invasive surgery is performed through the eye socket, thus eliminating the removal of the top of the skull to access the brain. These findings were published in the September issue of Neurosurgery.
"By performing surgery through the eye socket, we eliminate the need for a full craniotomy, gain equivalent or better access to the front of the brain, and eliminate the large ear-to-ear scar associated with major brain surgery," said Chris Bergeron, MD, assistant professor of Surgery, Division of Head and Neck Surgery, at UC San Diego Health System. "This novel technique is also critical to protecting neurovascular structures such as the optic and olfactory nerves."
To achieve access, the surgeons make a small incision behind or through the eyelid. A tiny hole is then made through the paper-thin bone of the eye socket to reach the brain. This pathway permits repairs to be made without lifting the brain. The TONES approaches also protect the optic nerves, the nerves for smell, as well as the carotid and ophthalmic arteries.
"This approach has opened a new field of brain surgery," said study investigator, Kris Moe, MD, chief of the Division of Facial Plastic and Reconstructive Surgery and professor of Otolaryngology at University of Washington Medical Center. "The advantages to this transorbital approach are many, including reduced pain and decreased recovery time for the patient."
Transnasal surgery, a technique performed through the nose, offers similar access to some areas of the brain but means a more crowded operating environment for the surgeon than TONES. Moe, who pioneered the TONES in 2005, said the novel technique builds on the nasal approach but offers increased maneuverability and visibility for the surgical teams which usually require four sets of hands.
In a traditional craniotomy, a large portion of skull bone is removed. With TONES, the area of bone removed is only two to three centimeters. The operating time is much shorter since the skull does not need to be repaired and there is no need to close a large incision.
Patients underwent the TONES procedure to repair cerebral spinal fluid leaks, optic nerve decompression, repair of cranial base fractures and removal of tumors. Given further research, the surgeons believe that TONES may serve as a means to treat pituitary tumors, meningiomas, and vascular malformations. TONES is currently performed at only two institutions in the world: UC San Diego Medical Center and the University of Washington Medical Center.
http://www.sciencedaily.com/releases/20 ... 155427.htm
ScienceDaily (Sep. 29, 2010) — Surgeons at the University of California, San Diego, School of Medicine and University of Washington Medical Center have determined that transorbital neuroendoscopic surgery (TONES) is a safe and effective option for treating a variety of advanced brain diseases and traumatic injuries. This groundbreaking minimally invasive surgery is performed through the eye socket, thus eliminating the removal of the top of the skull to access the brain. These findings were published in the September issue of Neurosurgery.
"By performing surgery through the eye socket, we eliminate the need for a full craniotomy, gain equivalent or better access to the front of the brain, and eliminate the large ear-to-ear scar associated with major brain surgery," said Chris Bergeron, MD, assistant professor of Surgery, Division of Head and Neck Surgery, at UC San Diego Health System. "This novel technique is also critical to protecting neurovascular structures such as the optic and olfactory nerves."
To achieve access, the surgeons make a small incision behind or through the eyelid. A tiny hole is then made through the paper-thin bone of the eye socket to reach the brain. This pathway permits repairs to be made without lifting the brain. The TONES approaches also protect the optic nerves, the nerves for smell, as well as the carotid and ophthalmic arteries.
"This approach has opened a new field of brain surgery," said study investigator, Kris Moe, MD, chief of the Division of Facial Plastic and Reconstructive Surgery and professor of Otolaryngology at University of Washington Medical Center. "The advantages to this transorbital approach are many, including reduced pain and decreased recovery time for the patient."
Transnasal surgery, a technique performed through the nose, offers similar access to some areas of the brain but means a more crowded operating environment for the surgeon than TONES. Moe, who pioneered the TONES in 2005, said the novel technique builds on the nasal approach but offers increased maneuverability and visibility for the surgical teams which usually require four sets of hands.
In a traditional craniotomy, a large portion of skull bone is removed. With TONES, the area of bone removed is only two to three centimeters. The operating time is much shorter since the skull does not need to be repaired and there is no need to close a large incision.
Patients underwent the TONES procedure to repair cerebral spinal fluid leaks, optic nerve decompression, repair of cranial base fractures and removal of tumors. Given further research, the surgeons believe that TONES may serve as a means to treat pituitary tumors, meningiomas, and vascular malformations. TONES is currently performed at only two institutions in the world: UC San Diego Medical Center and the University of Washington Medical Center.
http://www.sciencedaily.com/releases/20 ... 155427.htm
Surgeons use florescent light to target brain cancer
SAN FRANCISCO (KGO) -- An experimental technique is giving Bay Area surgeons a way to attack brain tumors with more precision than ever before and the advantage is clearly visible.
After earlier treatments, one patent had his brain cancer come back three times, but this time director of neurosurgery at UCSF Dr. Mitchel Berger believes the odds are better.
"The overall goal here is to give a substance to a patient to illuminate a tumor, so we can take it out in a more aggressive fashion," says Berger.
The tumor itself is clearly visible on the operating room monitors, but when the lights are turned off, Berger can get any entirely different view of it.
A blue light shining down from the microscope is part of an experimental technology. Several hours before the operation, the patient was given an oral dose of an organic dye known as 5-ALA. The substance migrates into tumor cells, causing a biological reaction that turns them fluorescent, making them clearly visible under the laser light.
"This is a glowing tumor now. The dye is being excited and it's turning the tumor orange," says Berger.
Using the microscope to guide him, Berger's instruments zero in on the highlighted orange areas to remove the tumor itself.
"This is like flying a plane with radar at night," says Berger.
But he says the real advantage will come next, when he begins hunting for cancer that often remains hidden.
"Because a lot of times the tumor is very clear, but the actual infiltrating margin looks just like normal brain. So it's hard to find those cells. But now that they're orange, we can go after them selectively," says Berger.
For an hour, Berger methodically clears out the tiny spots of orange, eliminating cells that could cause the tumor to return.
"So not only have we taken out the tumor, but we've taken out any of the small cells," says Berger.
The fluorescence-guided glioma surgery is new in the U.S. and Berger's team is leading a clinical trial. But there are results from a study in Europe showing long-term benefits for patients.
In that study, published in the journal The Lancet, a German research team found that surgeons were nearly twice as successful at removing the entire tumor using the fluorescent technique and after six months, those patients were twice as likely to have no recurrence.
With all the visual evidence of cancer cleared away, the patient is ready for post operative cancer treatments, which Berger's team believes have my higher chance of success.
"Absolutely, this told us we not only took out the tumor, but we took out invading, infiltrating tumor margin, which is really going to make a huge impact for him in terms of his outcome," says Berger.
This procedure was the first ever performed in the U.S., but Berger believes the clinical trial could lead to mainstream use of the fluorescent dye technique within one to two years.
http://virtualtrials.com/news3.cfm?item=4881&showtext=y
SAN FRANCISCO (KGO) -- An experimental technique is giving Bay Area surgeons a way to attack brain tumors with more precision than ever before and the advantage is clearly visible.
After earlier treatments, one patent had his brain cancer come back three times, but this time director of neurosurgery at UCSF Dr. Mitchel Berger believes the odds are better.
"The overall goal here is to give a substance to a patient to illuminate a tumor, so we can take it out in a more aggressive fashion," says Berger.
The tumor itself is clearly visible on the operating room monitors, but when the lights are turned off, Berger can get any entirely different view of it.
A blue light shining down from the microscope is part of an experimental technology. Several hours before the operation, the patient was given an oral dose of an organic dye known as 5-ALA. The substance migrates into tumor cells, causing a biological reaction that turns them fluorescent, making them clearly visible under the laser light.
"This is a glowing tumor now. The dye is being excited and it's turning the tumor orange," says Berger.
Using the microscope to guide him, Berger's instruments zero in on the highlighted orange areas to remove the tumor itself.
"This is like flying a plane with radar at night," says Berger.
But he says the real advantage will come next, when he begins hunting for cancer that often remains hidden.
"Because a lot of times the tumor is very clear, but the actual infiltrating margin looks just like normal brain. So it's hard to find those cells. But now that they're orange, we can go after them selectively," says Berger.
For an hour, Berger methodically clears out the tiny spots of orange, eliminating cells that could cause the tumor to return.
"So not only have we taken out the tumor, but we've taken out any of the small cells," says Berger.
The fluorescence-guided glioma surgery is new in the U.S. and Berger's team is leading a clinical trial. But there are results from a study in Europe showing long-term benefits for patients.
In that study, published in the journal The Lancet, a German research team found that surgeons were nearly twice as successful at removing the entire tumor using the fluorescent technique and after six months, those patients were twice as likely to have no recurrence.
With all the visual evidence of cancer cleared away, the patient is ready for post operative cancer treatments, which Berger's team believes have my higher chance of success.
"Absolutely, this told us we not only took out the tumor, but we took out invading, infiltrating tumor margin, which is really going to make a huge impact for him in terms of his outcome," says Berger.
This procedure was the first ever performed in the U.S., but Berger believes the clinical trial could lead to mainstream use of the fluorescent dye technique within one to two years.
http://virtualtrials.com/news3.cfm?item=4881&showtext=y
Brain Tumor Removed Through Man's Nose
Doctors in the U.K. removed a man's small brain tumor through his nose, sidestepping the need for major surgery, the Daily Mail reported.
Father of two Ian Bradley had a tumor about the size of a penny lodged in the front of his brain.
Surgeons placed a tiny hook up through Bradley's nostril, extracting the cancerous mass back through his nose rather than removing it during an invasive procedure.
The operation took about six hours.
Doctors also cut out a segment of bone where the cancer had spread, according to the Mail.
"I was amazed that they were able to get rid of the tumor without cutting me at all," Bradley, 60, told the paper. "I didn't much fancy having my head cut open, so I was very grateful."
Traditional brain surgery for a tumor like Bradley's would have involved cracking and opening his skull, and rolling back his nose to get at the cancer.
He discovered he had the brain tumor after his nose began running constantly and then started to bleed.
The mass was found during a brain scan at a local hospital. Doctors also saw that it had spread to a section of bone in Bradley's head located near his smell receptors, the Mail said.
The operation left Bradley with no scarring, as is often the case with a typical brain surgery.
"By using this new technique, it meant we were able to remove the cancerous tumor without leaving an unsightly scar on Ian's face," Dr. Gary Walton, who led the procedure, told the newspaper. "This technique is better for patients as they recover quicker and we know many of them can find being scarred in such a prominent place traumatic."
The downside is that Bradley lost his sense of smell. But he isn't complaining.
"I'm quite happy to live without my sense of smell if the tumor has gone," he told the paper. "I can breathe through my nose again too, which has made a huge difference to my quality of life. Within a few days of the operation, I was back out playing golf."
http://www.aolhealth.com/2010/11/11/bra ... mans-nose/
Doctors in the U.K. removed a man's small brain tumor through his nose, sidestepping the need for major surgery, the Daily Mail reported.
Father of two Ian Bradley had a tumor about the size of a penny lodged in the front of his brain.
Surgeons placed a tiny hook up through Bradley's nostril, extracting the cancerous mass back through his nose rather than removing it during an invasive procedure.
The operation took about six hours.
Doctors also cut out a segment of bone where the cancer had spread, according to the Mail.
"I was amazed that they were able to get rid of the tumor without cutting me at all," Bradley, 60, told the paper. "I didn't much fancy having my head cut open, so I was very grateful."
Traditional brain surgery for a tumor like Bradley's would have involved cracking and opening his skull, and rolling back his nose to get at the cancer.
He discovered he had the brain tumor after his nose began running constantly and then started to bleed.
The mass was found during a brain scan at a local hospital. Doctors also saw that it had spread to a section of bone in Bradley's head located near his smell receptors, the Mail said.
The operation left Bradley with no scarring, as is often the case with a typical brain surgery.
"By using this new technique, it meant we were able to remove the cancerous tumor without leaving an unsightly scar on Ian's face," Dr. Gary Walton, who led the procedure, told the newspaper. "This technique is better for patients as they recover quicker and we know many of them can find being scarred in such a prominent place traumatic."
The downside is that Bradley lost his sense of smell. But he isn't complaining.
"I'm quite happy to live without my sense of smell if the tumor has gone," he told the paper. "I can breathe through my nose again too, which has made a huge difference to my quality of life. Within a few days of the operation, I was back out playing golf."
http://www.aolhealth.com/2010/11/11/bra ... mans-nose/
Aggressive Surgery Is Best for Children With Brain Tumors, Study Suggests
ScienceDaily (Nov. 22, 2010) — A new Mayo Clinic study found that children with low-grade brain tumors (gliomas) who undergo aggressive surgery to completely remove the tumor have an increased chance of overall survival. If complete removal is not possible, adding radiation therapy to a less complete surgery provides patients with the same outcomes as a complete removal. This study was presented at the Society for NeuroOncology Annual Scientific Meeting and Education Day in Montreal on Nov. 21.
"This study further reinforces Mayo Clinic's practice of aggressive surgical resection," says Nadia Laack, M.D., a Mayo Clinic radiation oncologist and the study's lead author. "We found that when compared to previous studies, more children are now able to have complete removals, most likely due to the fact that we have better neurosurgical techniques and better imaging techniques that help guide the surgeons."
As part of an ongoing study, Dr. Laack and a team of Mayo Clinic researchers identified 127 consecutive pediatric patients with World Health Organization Grade I and Grade II low-grade gliomas treated at Mayo Clinic between 1990 and 2005. Of those, 90 patients had complete removal of their tumor and 20 patients had subtotal resections with added radiation therapy. Results showed that greater than 89 percent of the patients are surviving more than 10 years later.
When combined with results from a previous Mayo Clinic study, this is the largest group of patients reported and was conducted through long-term follow-up by the Mayo Clinic team.
"This is great news for families because it shows that even if a complete surgery isn't possible, adding radiation to a less than complete surgery reduces their chances of tumor progression to yield the same outcome as if there was a complete removal," says Dr. Laack.
http://www.sciencedaily.com/releases/20 ... 152049.htm
ScienceDaily (Nov. 22, 2010) — A new Mayo Clinic study found that children with low-grade brain tumors (gliomas) who undergo aggressive surgery to completely remove the tumor have an increased chance of overall survival. If complete removal is not possible, adding radiation therapy to a less complete surgery provides patients with the same outcomes as a complete removal. This study was presented at the Society for NeuroOncology Annual Scientific Meeting and Education Day in Montreal on Nov. 21.
"This study further reinforces Mayo Clinic's practice of aggressive surgical resection," says Nadia Laack, M.D., a Mayo Clinic radiation oncologist and the study's lead author. "We found that when compared to previous studies, more children are now able to have complete removals, most likely due to the fact that we have better neurosurgical techniques and better imaging techniques that help guide the surgeons."
As part of an ongoing study, Dr. Laack and a team of Mayo Clinic researchers identified 127 consecutive pediatric patients with World Health Organization Grade I and Grade II low-grade gliomas treated at Mayo Clinic between 1990 and 2005. Of those, 90 patients had complete removal of their tumor and 20 patients had subtotal resections with added radiation therapy. Results showed that greater than 89 percent of the patients are surviving more than 10 years later.
When combined with results from a previous Mayo Clinic study, this is the largest group of patients reported and was conducted through long-term follow-up by the Mayo Clinic team.
"This is great news for families because it shows that even if a complete surgery isn't possible, adding radiation to a less than complete surgery reduces their chances of tumor progression to yield the same outcome as if there was a complete removal," says Dr. Laack.
http://www.sciencedaily.com/releases/20 ... 152049.htm
Deadly superbug found in Sydney
New testing has found the first New South Wales cases of a super bug that has killed thousands of patients in European and North American hospitals.
New South Wales Health says 21 patients tested positive to a virulent strain of Clostridium difficile, not detected in Australia until earlier this year in Melbourne.
Some of the symptoms include mild to severe diarrhoea, fever and stomach pains.
Professor Lyn Gilbert, chair of the New South Wales expert advisory group on health care associated infections, says New South Wales Health are now testing regularly for the bug.
"Some cases have been identified almost by chance in northern Sydney that have occurred over the last couple of years in several different hospitals in northern Sydney," she said.
"None of them as far as we can tell have particularly severe disease, contrary to what happened in the northern hemisphere where it often was more severe than usual."
http://www.abc.net.au/news/stories/2010 ... ion=justin
New testing has found the first New South Wales cases of a super bug that has killed thousands of patients in European and North American hospitals.
New South Wales Health says 21 patients tested positive to a virulent strain of Clostridium difficile, not detected in Australia until earlier this year in Melbourne.
Some of the symptoms include mild to severe diarrhoea, fever and stomach pains.
Professor Lyn Gilbert, chair of the New South Wales expert advisory group on health care associated infections, says New South Wales Health are now testing regularly for the bug.
"Some cases have been identified almost by chance in northern Sydney that have occurred over the last couple of years in several different hospitals in northern Sydney," she said.
"None of them as far as we can tell have particularly severe disease, contrary to what happened in the northern hemisphere where it often was more severe than usual."
http://www.abc.net.au/news/stories/2010 ... ion=justin
Twenty-five percent of patients end up in worse shape after surgery than they were before
(NaturalNews) A new study published in the British Journal of Surgery has found that surgical operations are not always beneficial to patients. According to study data, roughly 14 percent of patients end up with more physical and emotional pain after their surgeries than before them, and about 25 percent experience an overall decrease in strength a year after the procedure.
For the study, more than 400 men and women took a health survey prior to their operations, and at six and 12 months after them. The survey evaluated physical strength capability, levels of pain and mental acuity at these various intervals, and compared them to one another.
A year after their surgeries, 17 percent of patients reported more pain than before, 14 percent indicated reduced functional ability and 16 percent said their mental states had declined.
"Our study showed poor recovery was relatively frequent six and 12 months after surgery and could be partly explained by various physical and psychological factors," explained Dr. Madelon Peters from the Department of Clinical Psychology Science at Maastricht University, in a report.
Though most surgery patients seem to recover fairly well during the year following the procedure, a significant number do not. One of the serious long-term side effects of surgery is chronic post-surgical pain and according to recent studies, the number of cases of this condition have increased at an alarmingly high rate over the past few years.
Consequently, some experts argue that extra caution must be taken when determining whether or not to undergo surgery. If a surgery is necessary, it is best to apply naturopathic healing techniques, such as supplementing with certain therapeutic vitamins and minerals both before and after surgery, to help ensure an optimal recovery.
http://www.naturalnews.com/030839_surgery_patients.html
[comment - the fact that I ended up disabled was unfortunate, however if 25% are worse off we have a problem (I realise that this involves all types). I didn't realise that there are 2 types of neurosurgeon - spine and brain. It is important to get a brain specialist. I believe the method of operating also can be important. If given the option, and there is a next time, I prefer endoscopy as its less invasive and recovery is generally faster]
(NaturalNews) A new study published in the British Journal of Surgery has found that surgical operations are not always beneficial to patients. According to study data, roughly 14 percent of patients end up with more physical and emotional pain after their surgeries than before them, and about 25 percent experience an overall decrease in strength a year after the procedure.
For the study, more than 400 men and women took a health survey prior to their operations, and at six and 12 months after them. The survey evaluated physical strength capability, levels of pain and mental acuity at these various intervals, and compared them to one another.
A year after their surgeries, 17 percent of patients reported more pain than before, 14 percent indicated reduced functional ability and 16 percent said their mental states had declined.
"Our study showed poor recovery was relatively frequent six and 12 months after surgery and could be partly explained by various physical and psychological factors," explained Dr. Madelon Peters from the Department of Clinical Psychology Science at Maastricht University, in a report.
Though most surgery patients seem to recover fairly well during the year following the procedure, a significant number do not. One of the serious long-term side effects of surgery is chronic post-surgical pain and according to recent studies, the number of cases of this condition have increased at an alarmingly high rate over the past few years.
Consequently, some experts argue that extra caution must be taken when determining whether or not to undergo surgery. If a surgery is necessary, it is best to apply naturopathic healing techniques, such as supplementing with certain therapeutic vitamins and minerals both before and after surgery, to help ensure an optimal recovery.
http://www.naturalnews.com/030839_surgery_patients.html
[comment - the fact that I ended up disabled was unfortunate, however if 25% are worse off we have a problem (I realise that this involves all types). I didn't realise that there are 2 types of neurosurgeon - spine and brain. It is important to get a brain specialist. I believe the method of operating also can be important. If given the option, and there is a next time, I prefer endoscopy as its less invasive and recovery is generally faster]
Hip surgery ruins lives
JACQUELINE GRAY enjoyed dancing, had a passion for surf lifesaving and did her own shopping.
Now the 53-year-old, who lives near the beach on the NSW mid-north coast, has lost her hair, is unable to walk without help and lives in excruciating pain.
Mrs Gray's life changed five years ago when she underwent a hip replacement operation at Port Macquarie Base Hospital.
Advertisement: Story continues below She was one of thousands of Australians fitted with a DePuy ASR hip implant, now the subject of global litigation over its high failure rate.
DePuy, a unit of Johnson & Johnson, voluntarily withdrew the metal implant last year. Cobalt and chromium, released as the implant wears away, have been leaching into patients' blood, causing inflammation and benign tumours.
Mrs Gray, who has joined the class action, is unable to get around without help despite numerous surgical procedures. She takes painkillers daily and has lost her hair due to the level of chromium in her body.
''It's changed my life completely,'' she said. ''I used to be heavily involved in surf lifesaving, I was a level one coach, I used to train the kids, I used to love doing it but I can't even get down on the beach now. It's just gutted me,'' she said.
Mrs Gray has spent months in a wheelchair, had four operations to rectify problems caused by the original implant and has chromium levels five times higher than normal.
She has a large blood clot in her affected leg, which has swollen to four times its original size, and has been told she will need to wear pressure stockings for the rest of her life.
Her husband, Warren, has to assist her with basic tasks. ''To put it mildly, it's stuffed up our lives,'' he said.
''She is only 53 now, so this could go on for another 30 or 40 years. With the stuff in her body, no one can tell us what's going to happen in the future.''
More than 30,000 Australians undergo hip replacement surgery each year, the majority with no complications.
According to the National Joint Replacement Registry, about 5000 Australians were fitted with the DePuy ASR Resurfacing Device or the ASR Conventional Hip Device between 2003 and 2009.
The devices have been found to have a 12 to 13 per cent failure rate within five years, meaning about 650 Australians are potentially affected.
About 230 Australian patients have joined a class action by Shine Lawyers against the manufacturer in the US.
Solicitor Rebecca Jancauskas of Shine Lawyers said: ''There is such a huge number of people globally who have been affected.
''This surgery is so traumatic and having another hip replacement takes such a big toll, so for those reasons this is one of the largest and most severe medical stuff-ups we have seen.''
The action, to be brought in the US, will seek punitive damages as well as compensation.
A spokeswoman for Johnson & Johnson declined to comment on the action but said DePuy is offering support and information to those affected. "DePuy Orthopaedics Inc understands that the ASR recall is concerning for patients, their family members and surgeons,'' she said.
''DePuy intends to cover reasonable and customary costs of testing and treatment for patients who need services, including revision surgery if it is necessary, associated with the ASR recall.''
http://www.smh.com.au/nsw/hip-surgery-r ... 1bs0q.html
JACQUELINE GRAY enjoyed dancing, had a passion for surf lifesaving and did her own shopping.
Now the 53-year-old, who lives near the beach on the NSW mid-north coast, has lost her hair, is unable to walk without help and lives in excruciating pain.
Mrs Gray's life changed five years ago when she underwent a hip replacement operation at Port Macquarie Base Hospital.
Advertisement: Story continues below She was one of thousands of Australians fitted with a DePuy ASR hip implant, now the subject of global litigation over its high failure rate.
DePuy, a unit of Johnson & Johnson, voluntarily withdrew the metal implant last year. Cobalt and chromium, released as the implant wears away, have been leaching into patients' blood, causing inflammation and benign tumours.
Mrs Gray, who has joined the class action, is unable to get around without help despite numerous surgical procedures. She takes painkillers daily and has lost her hair due to the level of chromium in her body.
''It's changed my life completely,'' she said. ''I used to be heavily involved in surf lifesaving, I was a level one coach, I used to train the kids, I used to love doing it but I can't even get down on the beach now. It's just gutted me,'' she said.
Mrs Gray has spent months in a wheelchair, had four operations to rectify problems caused by the original implant and has chromium levels five times higher than normal.
She has a large blood clot in her affected leg, which has swollen to four times its original size, and has been told she will need to wear pressure stockings for the rest of her life.
Her husband, Warren, has to assist her with basic tasks. ''To put it mildly, it's stuffed up our lives,'' he said.
''She is only 53 now, so this could go on for another 30 or 40 years. With the stuff in her body, no one can tell us what's going to happen in the future.''
More than 30,000 Australians undergo hip replacement surgery each year, the majority with no complications.
According to the National Joint Replacement Registry, about 5000 Australians were fitted with the DePuy ASR Resurfacing Device or the ASR Conventional Hip Device between 2003 and 2009.
The devices have been found to have a 12 to 13 per cent failure rate within five years, meaning about 650 Australians are potentially affected.
About 230 Australian patients have joined a class action by Shine Lawyers against the manufacturer in the US.
Solicitor Rebecca Jancauskas of Shine Lawyers said: ''There is such a huge number of people globally who have been affected.
''This surgery is so traumatic and having another hip replacement takes such a big toll, so for those reasons this is one of the largest and most severe medical stuff-ups we have seen.''
The action, to be brought in the US, will seek punitive damages as well as compensation.
A spokeswoman for Johnson & Johnson declined to comment on the action but said DePuy is offering support and information to those affected. "DePuy Orthopaedics Inc understands that the ASR recall is concerning for patients, their family members and surgeons,'' she said.
''DePuy intends to cover reasonable and customary costs of testing and treatment for patients who need services, including revision surgery if it is necessary, associated with the ASR recall.''
http://www.smh.com.au/nsw/hip-surgery-r ... 1bs0q.html
Weekend the deadliest time in intensive care
PATIENTS admitted to hospital intensive care units on weekends have an increased risk of dying, new research shows.
An eight-year study of 245,000 admissions to 41 intensive care units throughout Australia, published in The Medical Journal of Australia, showed the pattern persisted even after accounting for severity of illness.
The study showed that patients admitted to intensive care units between 6pm and 6am on weekdays had a 17 per cent mortality rate, compared with 14 per cent for those admitted during the day.
Advertisement: Story continues below On weekends 20 per cent of patients died, compared with 14 per cent on weekdays.
Lead author Dr Deepak Bhonagiri, a specialist at Sydney's Liverpool Hospital, said intensive care units handled more difficult cases after hours, when people suffered more serious injuries.
But, he said emergency cases did not account for the increased mortality, which was instead seen in planned admissions to intensive care units following elective surgery.
Dr Bhonagiri said one of the possible explanations was that complications had arisen during elective surgery during the day, leading to delayed admission to intensive care.
''Alternatively, these admissions may be of patients whose elective surgical procedures were started at times when a lack of normal facilities, resources and staff have put the patients at increased risk of death,'' he said.
http://www.theage.com.au/national/weeke ... 1c296.html
[comment - I guess that we have limited control over when an emergency, but forewarned may be forearmed]
PATIENTS admitted to hospital intensive care units on weekends have an increased risk of dying, new research shows.
An eight-year study of 245,000 admissions to 41 intensive care units throughout Australia, published in The Medical Journal of Australia, showed the pattern persisted even after accounting for severity of illness.
The study showed that patients admitted to intensive care units between 6pm and 6am on weekdays had a 17 per cent mortality rate, compared with 14 per cent for those admitted during the day.
Advertisement: Story continues below On weekends 20 per cent of patients died, compared with 14 per cent on weekdays.
Lead author Dr Deepak Bhonagiri, a specialist at Sydney's Liverpool Hospital, said intensive care units handled more difficult cases after hours, when people suffered more serious injuries.
But, he said emergency cases did not account for the increased mortality, which was instead seen in planned admissions to intensive care units following elective surgery.
Dr Bhonagiri said one of the possible explanations was that complications had arisen during elective surgery during the day, leading to delayed admission to intensive care.
''Alternatively, these admissions may be of patients whose elective surgical procedures were started at times when a lack of normal facilities, resources and staff have put the patients at increased risk of death,'' he said.
http://www.theage.com.au/national/weeke ... 1c296.html
[comment - I guess that we have limited control over when an emergency, but forewarned may be forearmed]