Face Transplant Patient Can Smell, Taste, Breathe Normally
By cialis viagra levitra | February 6, 2010
The woman who underwent the first facial transplant in the United States can now smell, taste what she eats and breathe through her nose, according to a report from her surgeons.
Nearly a year after the surgery, blood vessels from the transplanted tissue have integrated with existing tissue, she has had no significant complications and her sensory and motor abilities, including the ability to speak, continue to improve, they say in the November/December issue of the Archives of Facial Plastic Surgery.
“This really does open up new frontiers both for transplanting more of the face and for offering it to individuals with previous reconstructive failures,” said Dr. Wayne Larrabee, Jr., a clinical professor of head and neck surgery at the University of Washington in Seattle and editor of the journal.
Connie Culp, a mother and grandmother from Unionport, Ohio, was shot by her husband in a failed murder-suicide attempt in 2004. The shotgun blast destroyed the middle part of her face, including her nose and nasal passage, upper jaw and cheeks, and she lost her sight.
Though there were three face transplants performed worldwide before Culp’s — and a total of about seven to date — Culp’s “near-total” face transplant was among the most extensive ever performed. The surgery replaced much of the soft tissue of her face, the bony structure of the palate (roof of the mouth) and her upper jaw.
Making the surgery even more challenging, the transplant was a “salvage operation,” done after Culp had endured 23 failed attempts at reconstructive surgery. The earlier operations caused extensive scarring and destroyed blood vessels, further complicating an already difficult task.
“This patient had undergone multiple previous procedures for reconstruction which had failed,” Larrabee said. “This made the surgery much more difficult but the ethical decision very clear.”
Last Dec. 9, eight surgeons from the Cleveland Clinic replaced 80 percent of Culp’s face and jaw during a 22-hour operation. The donor was a woman who had been pronounced brain dead and was a match for Culp’s age, race and skin complexion. The new face included the nose, upper lip, lower eyelids, upper jaw, incisor teeth, palate and various glands, as well as bones and ligaments. Culp, then 46, was given immunosuppressant drugs to prevent rejection.
Before operating, surgeons weren’t sure if all of the donor tissue could be supplied with blood through the facial arteries, but bleeding from the tissue during the surgery told them the facial arterial system would be enough, according to the report.
“It demonstrates not only a masterpiece of surgical technique but the importance of modern medical teamwork to accomplish this patient’s goals,” Larrabee said. “Technically, the ability to use just the facial blood vessels and not the deeper ones opens new possibilities. Eventually this operation could become standard for severe facial injuries.”
Dr. Laurie Casas, a clinical associate professor of surgery at the University of Chicago Pritzker School of Medicine, said much more needs to be learned before facial transplants become anything more than experimental. Some of the key questions that need to be answered are the long-term impact on patients, including to what extent they are able to return to normal activities, such as work and socializing.
“We are all so excited about the fact that it can be done. The question is, ‘On whom should it be done? And when should it be done’?” Casas said. “The world, including the United States, is just beginning to understand how face transplants will really fit into our reconstructive efforts.”
Culp will likely have another surgery later this year to remove extra glandular tissue around her lower jaw. If surgeons get their wish, the final outcome will look remarkably like a normal face.
“If the promising initial results continue, the operation may become standard of care for extensive facial injuries,” according to the report.
In related news from the same journal, researchers from the University of Texas Medical School found that rib cartilage from human donors is an alternative to the patient’s own rib cartilage in nasal plastic surgery.
Though the patient’s own rib cartilage is the preferred choice, it’s not always suitable, researchers write. A review of medical records of 357 patients who underwent nasal plastic surgery using irradiated donor cartilage found a complication rate of 3.25 percent, no greater than the complication rate when the patient’s own cartilage was used. Irradiation decreases the chances of rejection, according to the study.
During an average follow-up of nearly eight years, about 94 percent of patients reported being satisfied with their appearance, ability to breathe and quality of life.
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Common Knee Pain May Improve With Therapy
By cialis viagra levitra | January 29, 2010
Supervised physical therapy is better than regular “wait-and-see” care for patients with a certain type of severe knee pain, according to research that suggests it reduces pain and improves function more effectively.
The findings, which are published in the Oct. 21 online edition of BMJ, examine patellofemoral pain syndrome, a common condition that causes pain in the front of the knee during and after exercise.
Women are more likely to develop the condition than men, and people usually start having symptoms when they’re teenagers, the study authors noted.
Doctors often advise patients to rest when they experience pain and avoid doing things that trigger pain. This is referred to as a wait-and-see approach.
In the new study, Dutch researchers sought to confirm previous findings that suggested conflicting results about the link between physical therapy and improvement in function, and only limited evidence that therapy would reduce pain.
The researchers looked at 131 patients aged 14 to 40, all of whom had been diagnosed with patellofemoral pain syndrome.
Of the subjects, 65 were assigned to a supervised physical therapy program and 66 took the wait-and-see approach. Both groups were given instructions about exercises to do at home, and both groups were told to avoid doing things that are painful, the study authors noted.
The researchers found that more patients who underwent physical therapy felt that they had recovered after three and 12 months, but the difference between the two groups wasn’t statistically significant.
However, the physical therapy group did do significantly better when it came to pain, both at rest and during activity, the authors reported. And that group also did better after three months, but not after 12.
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Cocoa in Chocolate May Be Good for the Heart
By cialis viagra levitra | January 22, 2010
If you’re tempted to raid your child’s Halloween candy stash at the end of this month, here’s one reason you might not have to restrain yourself.
Spanish researchers put 42 men and women on a diet that included 40 grams of unsweetened cocoa powder (about 1.4 ounces) mixed with skim milk daily, or plain skim milk. After one month, those who drank the cocoa-flavored milk had lower levels of inflammatory markers associated with heart disease than those drinking the milk alone.
That result was critical because the participants, whose average age was about 70, were at high risk of cardiovascular disease because they had diabetes and three or more risk factors for heart disease, including smoking, high blood pressure, high levels of LDL “bad” cholesterol (more than 160 milligrams per deciliter), low levels of HDL “good” cholesterol (below 35 milligrams per deciliter), obesity or a family history of early coronary heart disease.
The inflammatory markers, called adhesion molecules, are proteins that cause white blood cells to stick to the walls of the arteries, which can lead to the formation of atherosclerotic plaques, explained Shelley McGuire, an associate professor of food science and nutrition at Washington State University and a spokeswoman for the American Society for Nutrition.
“One of the major strengths of the study was they were measuring adhesion molecules, which we have recently learned are very important in the formation of atherosclerosis,” McGuire said. “Another strength is that the study was randomized and controlled. Because of this, we can pretty confidently say there was something in the cocoa powder that had an effect.”
The researchers also found that the cocoa powder group had an increase in HDL cholesterol, which can help reduce levels of LDL cholesterol and has been shown to have anti-inflammatory, antioxidant properties.
The study is published in the November issue of the American Journal of Clinical Nutrition.
During the study, participants didn’t take additional vitamins or supplements, and the only cocoa-containing products they consumed were those provided by researchers.
Previous research has suggested chocolate may be beneficial for heart health because it contains anti-inflammatory chemicals called polyphenols. Polyphenols are also found in wine, coffee and tea, along with fruits and vegetables such as apples, broccoli, onions, blueberries, blackberries, cherries, strawberries, plums and red grapes, said Connie Diekman, director of university nutrition at Washington University in St. Louis.
“One of the best ways to get plenty of polyphenols is to consume lots of fruits and vegetables,” Diekman said.
The researchers noted the anti-inflammatory effects derived from cocoa were modest compared to those observed for other foods rich in polyphenols, such as wine.
And before you start inhaling candy bars, which are high in fat and calories, researchers noted that study participants were given non-fat, sugar-free cocoa powder and skim milk. Even then, they gained a small amount of weight.
In the study, the chocolate milk contained about 136 calories. If adding cocoa to your diet, be sure to reduce calories somewhere else, or get some extra exercise.
“My recommendation, as a registered dietitian, would be for people to look at cocoa — whether in the form of cocoa or chocolate — as a part of a healthful eating plan, not a magic bullet for reducing inflammation,” Diekman said. “If including cocoa and small amounts of chocolate in an otherwise healthful eating plan helps people enjoy what they eat and stick with that plan, then these things can fit.”
In findings that should come as no surprise, researchers noted that “adherence to the dietary protocol was excellent.”
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Diabetes Drug May Boost Weight Loss in Obese Patients
By cialis viagra levitra | January 15, 2010
The diabetes drug liraglutide helps obese people without diabetes lose weight, researchers have found.
The study authors also reported that high doses of liraglutide were more effective at helping people shed pounds than the weight-loss drug orlistat.
In the study, which included 564 diabetes-free obese patients aged 18 to 65 at 19 sites in Europe, participants were randomly selected to receive one of four injected doses of liraglutide (1.2 milligrams, 1.8 milligrams, 2.4 milligrams or 3 milligrams) or a placebo once a day, or 120 milligrams of orlistat three times a day.
All of the patients also increased their levels of physical activity and followed a calorie-restricted diet, which allowed for about 500 calories less per day than they needed.
Weight loss among patients taking liraglutide doses of 1.2, 1.8, 2.4 and 3 milligrams was 4.8 kilograms (10.5 pounds); 5.5 kilograms (12 pounds); 6.3 kilograms (14 pounds), and 7.2 kilograms (15.8 pounds), respectively, compared with 4.1 kilograms (9 pounds) with orlistat and 2.8 kilograms (6 pounds)with placebo. Weight loss of more than 5 percent occurred in 76 percent of patients taking 3 milligrams of liraglutide, 44 percent of patients taking orlistat, and 30 percent of patients in the placebo group, the researchers found.
Reduced blood pressure was noted in all of the patients taking liraglutide. The groups taking 1.8 to 3 milligrams of liraglutide had an 84 percent to 96 percent reduction in the prevalence of prediabetes, which is poor blood glucose control that’s not yet bad enough to qualify as diabetes.
Nausea and vomiting was more common among patients taking liraglutide than among those in the placebo group, the study authors noted.
“The results of this study indicate the potential benefit of liraglutide, in conjunction with an energy-deficit diet, in the treatment of obesity and associated risk factors,” wrote Dr. Arne Astrup, of the department of human nutrition at the University of Copenhagen, Denmark, and colleagues.
Additional studies with a follow-up longer than 20 weeks are now needed to investigate the long-term risk/benefit profile of liraglutide, the study authors noted.
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Adding Drug Doesn’t Help Control Blood Pressure
By cialis viagra levitra | January 8, 2010
Adding an angiotensin receptor blocker (ARB) drug to help control blood pressure has no benefit for people with heart disease who already are taking an ACE inhibitor, a new study finds.
The so-called “meta-analysis” of 41 previous studies found that combination therapy seems no better than ACE inhibitor therapy alone and may be harmful.
Results of the study, funded by the U.S. Agency for Healthcare Research and Quality, were published in the Oct. 20 issue of Annals of Internal Medicine.
“The question is whether you are going to provide more benefits to patients by adding an ARB,” said Jean Slutsky, director of the AHRQ Center for Outcomes and Evidence, which commissioned the study. “From this study, it appears that it doesn’t seem to actually improve care.”
It’s a finding with financial as well as medical implications. Millions of Americans now take ACE — angiotensin converting enzyme — inhibitors to control high blood pressure. ARBs, which have become increasingly popular in recent years, tend be more expensive, since many ACE inhibitors are available as generic drugs while ARBs generally are not.
Both classes of drugs lower blood pressure by their effect on angiotensin II, a molecule that tightens arteries. ACE inhibitors attempt to prevent formation of angiotensin II, while ARBs block the cell receptors through which they act.
The new study was one of a series done to improve the effectiveness of health care in the United States, Slutsky said. “There was some uncertainty about the effectiveness, benefits and harms of ACE inhibitors versus ARBs in this population” (people with known but stable heart disease), she said.
The analysis of the 41 trials examined in the study found that ACE inhibitors reduced the risk of death by about 13 percent for people whose cardiac problems did not include heart failure, and the risk of heart attack by about 17 percent. Adding an ARB drug did not reduce the risk further, but did increase the rate at which drug therapy was discontinued because of side effects such as fainting.
“We showed results similar to what they [the authors of the new study] did,” said Dr. Sripal Bangalore, a fellow in interventional cardiology at Brigham and Women’s Hospital in Boston, who published a similar meta-analysis a year ago. “Our study showed that the addition of an ARB to an ACE inhibitor did not give any benefit in terms of heart endpoint, unless in patients who had heart failure.”
The lesson for doctors prescribing drugs for blood pressure control in people with stable heart disease is clear, Bangalore said: “Based on current studies, combination therapy should be avoided.”
Current guidelines by organizations such as the American Heart Association already reflect that lesson. Guidelines generally recommend ACE inhibitors as a first-line therapy for high blood pressure.
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Do Preemies Benefit From High-Tech Measures?
By cialis viagra levitra | December 29, 2009
Even though more treatments are provided for extremely preterm infants, they’re no more likely to survive than they were in the mid-1990s, a U.S. study has found.
Researchers at Johns Hopkins University School of Medicine compared 75 extremely preterm infants (born at 22 to 24 weeks’ gestation) delivered between 1993 and 1995 (early epoch) and 104 delivered between 2001 and 2003 (late epoch).
Mothers of infants in the late epoch group were twice as likely to be transported to a higher level of care, and they were more likely to be monitored by sonogram (48 percent), more likely to receive antibiotics (60 percent) and more likely to receive antenatal steroids (61 percent) than the early epoch group, the researchers noted.
In addition, infants in the late epoch group were more likely to receive life-sustaining interventions, such as high-frequency ventilation, chest tubes and administration of dopamine and steroids than those in the early epoch group.
But death rates for infants in both groups were the same, the researchers found.
“Mortality has not changed in our hospital over the past 10 years despite escalation in care at each gestational age studied. What has changed is the length of time until death,” wrote Pamela K. Donohue and colleagues at Johns Hopkins Children’s Center. “Applying all available medical technology to the perinatal care of extremely premature infants prolongs but does not prevent their death.”
The study appears in the October issue of the journal Archives of Pediatrics & Adolescent Medicine.
The researchers noted an ongoing debate about “whether scientific advances can continue to lower the border of viability (the gestational age at which an infant can survive) or whether this goal should even be attempted.”
Evidence suggests that extremely preterm infants are regularly resuscitated, even though many die within days after birth. This raises concerns that “aggressive resuscitation results in prolonging death and suffering in some” of these infants, the study authors said.
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Habits May Keep Couples Together or Tear Them Apart
By cialis viagra levitra | December 21, 2009
Marriages can be at risk when one partner is an excessive drinker and/or smoker, but the other isn’t, researchers say.
However, when their drinking and/or smoking habits are similar, both partners remain relatively satisfied with their marriage, according to the study published in a recent edition of the journal Addiction.
Researchers tracked 634 newly married couples for seven years, and at their first, second, fourth and seventh wedding anniversaries, the couples completed questionnaires about their marital satisfaction.
Overall, there were initial declines in marital satisfaction, followed by a leveling off after a few years. At each assessment, a difference in heavy drinking between spouses was more common than a difference in smoking. About 15 percent of the couples reported differences in both smoking and drinking habits, the study authors noted.
The information collected from the couples revealed important clinical information, said study author Gregory G. Homish, an assistant professor of health behavior, and colleagues in the University at Buffalo’s School of Public Health and Health Professions and the university’s Research Institute on Addictions.
“For example, if one partner of a heavy-drinking couple enters treatment for his/her alcohol use, the break-up of the ‘drinking partnership’ could have unintended negative outcomes for the couple,” Homish said in a news release from the university. “Therefore, approaches such as behavior couples therapy that assess and treat both partners could have a more beneficial outcome at both the individual and family level.”
In terms of research, “the current findings suggest that an assessment of substance use should extend beyond quantity and frequency of substance use and also incorporate information about the partner’s behavior,” Homish noted.
“Most studies that investigate the impact of substance use focus solely on individual-level risk factors and do not consider the impact of social network influences such as those that exist from a partner,” Homish stated in the news release.
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Doctors May Be Able to Predict Domestic Abuse
By cialis viagra levitra | December 10, 2009
It may be possible to use a person’s electronic medical records to predict the likelihood of domestic abuse years before it actually occurs, according to U.S. researchers.
They analyzed the medical records of more than 500,000 adults that included at least four years of data on hospital admissions and visits to emergency departments. In total, the electronic records included more than 16 million diagnoses.
The researchers developed a scoring system to predict which people were likely to receive a diagnosis of domestic abuse. The system was able to predict future diagnoses of abuse an average of 10 to 30 months in advance, the researchers said.
For women, the risk for future diagnosis of abuse was highest among those treated for injuries, poisoning and alcoholism. Among men, the risk was highest among those treated for mental health conditions such as depression and psychosis.
The researchers also developed a prototype “risk-visualization environment” that offers doctors instant overviews of patients’ medical histories and related profiles.
“In conjunction with alerts for high-risk patients, this could enable clinicians to rapidly review and act on all available historical information by identifying important risk factors and long-term trends,” wrote Ben Reis, of the Informatics Program at Children’s Hospital Boston and an assistant professor at Harvard Medical School, and his research colleagues.
Their findings were published Sept. 30 online in the British Medical Journal.
Domestic abuse is the most common cause of nonfatal injuries among women in the United States, according to the researchers, and accounts for more than half the murders of women each year.
“Doctors typically do not have the time to thoroughly review a patient’s historical records during the brief clinical encounter,” Reis said in a news release from the journal. “As a result, certain conditions that could otherwise be detected are often missed. One such condition is domestic abuse, which may go unrecognized for years as it is masked by acute complaints that form the basis of clinical encounters.”
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Medications That Lower Breast Cancer Risk Carry Other Dangers
By cialis viagra levitra | December 1, 2009
Medications given to women at high risk for developing breast cancer do reduce their cancer risk, but the drugs carry other health risks, a new analysis suggests.
That was the conclusion of researchers who looked at numerous published studies, including randomized clinical trials and a head-to-head assessment of the medications used for risk reduction. Those include tamoxifen, raloxifene and tibolone. The third drug is not currently on the U.S. market but is available in other countries, and there is some research on its risk-reduction benefits.
“We found that the three drugs actually did reduce the risk for invasive breast cancer by 30 to 68 percent,” said review author Dr. Heidi D. Nelson, a research professor at Oregon Health & Science University. The report is published in the Sept. 15 issue of the Annals of Internal Medicine.
While the medications provided similar reductions in breast cancer risk, each carries its own level of side effects. “They did differ on the harm side,” Nelson said. “That’s important to know.”
The use of the drugs to reduce breast cancer risk in healthy, high-risk women is not as common, Nelson noted, as their use to prevent recurrence in women already diagnosed with and treated for breast cancer. For instance, tamoxifen has been used for years to lower the chances of recurrence among breast cancer survivors. Recently, however, other researchers found tamoxifen only lowers the risk of a more common type of breast cancer, called ER-positive, while it raises the risk of developing ER-negative breast cancer, a more aggressive disease, in breast cancer survivors.
A similar story appears to be unfolding when the drugs are used for risk reduction in women who are cancer-free but at high risk of breast cancer. The women may be termed high risk due to genetic mutations such as BRCA1 and BRCA2, a strong family history, both, or other factors. Some choose to take the drugs to reduce risk. “It’s important to call this [strategy] risk reduction, not prevention,” Nelson said.
When Nelson’s team evaluated the results from the studies, they found that tamoxifen and raloxifene boosted blood clots by 60 percent to 90 percent. Raloxifene caused fewer blood clots than tamoxifen.
Tamoxifen was also more likely than a placebo to lead to endometrial cancer and more likely to cause cataracts than was raloxifene.
In women over age 70, tibolone was associated with strokes.
Much of the information about this particular risk-and-benefit picture is already known, said Dr. Scott Maul, a medical oncologist at Oncology Alliance in Milwaukee. “They wanted to bring together all these studies under one publication, and try to quantify the benefit of these three different medications and their risk.”
The decision to use the medications to reduce risk is not a simple one, Maul said. He urged women to talk it over with their doctors first. Nelson encourages women to get genetic testing and to use that genetic information — including any findings about genetic mutations that boost breast cancer risk — to get a more accurate picture of risk than other models may provide.
“The discussion on whether to use these drugs is a very detailed one with women,” Maul said. While the decision is extremely individual, he did offer this advice: “Women should only take these [to reduce first-time breast cancer risk] if they are truly at higher risk for breast cancer.” Even then, they may decide not to take them, he said, for good reasons. “If someone has risk factors for heart attack or stroke, these medications may not be a good idea.”
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Early postoperative viagra appeared to have beneficial effects and definitely warrants more clinical drawing.
By cialis viagra levitra | June 2, 2008
Compared with direct insertion, 0.2% to 23% of verapamil was detected in the excised cloak tissues, thereby substantiating the welfare of the direct solution skillfulness over other topical methods for drug conveyance of title to Peyronie’s plaques.
In the surgical kingdom, a 2-year follow-up using Tutoplast (Tutogen; Clifton, New Jersey)-processed pericardium for reproval of severe penile differential coefficient was also described by Levine and colleagues. They reported generally good results, but added bedtime viagra (25 mg) on postoperative day 10 and continued until coitus was reinitiated after operating theater.
Surgical Vista of Andrology Medicament areas of hospital room are exposure required in sexual penalization in constituent to the system of measurement procedures for prosthetic work and Peyronie’s disease.
Gholami and associates reported on the event of penile aneurysms after different forms of psychological condition.
Rather than resecting the attenuated tunica albuginea and reapproximating the edges with articulatio, the authors plicated the deficient tunica and covered it with a supportive stratum of Tutoplast .
Postoperatively, all patients reported straight person erections, good possibleness, and no complications or worsening over time.
A long-term follow-up (mean, 5.6 years) in 61 men who had undergone penile revascularization procedures (anastomosis of the graphic symbol epigastric thoroughfare to either the dorsal vein or arteria, according to the preoperative arteriographic findings) was given by Vardi and colleagues. Work-clothes, results were encouraging, with younger men who were nonsmokers demonstrating the best winner.
The beingness of venous leak or the type of surgery did not determiner the results.
Trombetta and coworkers presented long-term results on 42 male transsexuals who underwent male-to-female sexual reassignment surgeries.
The authors detailed important techniques, including inverted penile skin vaginoplasty, a scrotal skin chemical change skillfulness, and the fixing of an inflatable vaginal tutor for 3 months nightly postoperatively.
Results were judged to be excellent, with 95% of patients claiming orgasm.
The authors maintain that because of the information with this anatomical area, urologists should be involved in this ever-growing area of reconstructive surgical procedure.
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