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April 2008 Briefing - Surgery

Here are what the editors at HealthDay consider to be the most important developments in Surgery for April 2008. This roundup includes the latest research news from journal articles, as well as the FDA approvals and regulatory changes that are the most likely to affect clinical practice.

Exercise Key to Maintaining Weight Loss in Obesity

WEDNESDAY, April 30 (HealthDay News) -- While caloric restriction leads to short-term weight loss, increases in physical activity may be necessary to overcome the body's tendency to re-establish the original body weight and prevent weight regain, according to an article in the May 1 issue of the New England Journal of Medicine.

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Blood Substitutes May Raise Risk of Heart Attack, Death

TUESDAY, April 29 (HealthDay News) -- Using hemoglobin-based blood substitutes increases the risk of death by 30 percent and the risk of myocardial infarction by 2.7 times, according to a report published online April 28 in the Journal of the American Medical Association.

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Physicians Lack Feedback on Accuracy of Diagnoses

TUESDAY, April 29 (HealthDay News) -- Clinical diagnosis is a largely open-loop system in which there is no systematic way for clinicians to obtain feedback on the outcome of their diagnoses, according to an article published in a supplement to the May issue of The American Journal of Medicine.

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Endocannabinoid Pathway Activated by Nerve Agents

TUESDAY, April 29 (HealthDay News) -- Organophosphorus nerve agents augment the endocannabinoid pathway in the brain, resulting in clinical effects such as that caused by the exogenous cannabinoid, marijuana. Selective activation of this pathway could be used to obtain desirable therapeutic effects such as analgesia, while avoiding unwanted side effects such as hypomotility and cognitive dysfunction, according to research findings published online April 27 in Nature Chemical Biology.

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Palliative Care Can Improve Patient Care Most, Poll Finds

MONDAY, April 28 (HealthDay News) -- In an international poll conducted by BMJ to determine which area of health care would enable doctors to make the greatest difference to patients, palliative care for non-malignant disease received the most votes, the BMJ Group announced at the International Forum on Quality and Safety in Health Care in Paris this week.

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Biofuels Partially to Blame in Global Food Crisis

FRIDAY, April 25 (HealthDay News) -- The global food shortage, which threatens millions of people with starvation, is due to a number of factors, including the growing use of biofuels -- potential food crops that are used as fuel for car engines -- and requires that the international community address the root causes of the crisis, according to an editorial published in The Lancet in April.

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Laparoscopic Reflux Procedure Complications Drop

THURSDAY, April 24 (HealthDay News) -- During the first 10 years of laparoscopic fundoplication to treat reflux in Finland, the rate of serious complications declined, as did the rate of serious complications following open surgery, according to research published in the April issue of Archives of Surgery.

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Practice Advisory Addresses Operating Room Fires

THURSDAY, April 24(HealthDay News) -- Appropriate strategies can help prevent or manage operating room fires, which are estimated to occur in the United States 50 to 200 times each year and can result in serious injury or death, according to a practice advisory published in the May issue of Anesthesiology.

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Heparin Contaminant Activates Contact System

THURSDAY, April 24 (HealthDay News) -- The serious allergic-type reactions recently reported in patients receiving intravenous heparin appear to be due to the presence of a contaminant, oversulfated chondroitin sulfate (OSCS), which leads to activation of the contact system and release of vasoactive mediators, according to an article first published online April 23 in the New England Journal of Medicine.

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Nasal Surgery Can Improve Quality-of-Life Scores

WEDNESDAY, April 23 (HealthDay News) -- Nasal surgery can improve quality of life in adults with obstructive sleep apnea and symptoms of nasal obstruction, according to research published in the April issue of Archives of Otolaryngology -- Head and Neck Surgery.

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Cisplatin Therapy Delivers Worse Anal Cancer Outcomes

TUESDAY, April 22 (HealthDay News) -- In patients with anal canal carcinoma, induction chemotherapy with fluorouracil and cisplatin before concurrent radiation was added failed to improve disease-free survival and resulted in a worse colostomy rate than treatment with fluorouracil, mitomycin and radiation, according to research published in the April 23/30 issue of JAMA.

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Scalp and Neck Melanomas Have Lower Survival Odds

TUESDAY, April 22 (HealthDay News) -- Patients with melanomas on the scalp and neck have a worse prognosis than their counterparts with the cancer on other parts of the body, according to a study published in the April issue of the Archives of Dermatology.

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Heart Bypass Surgery Getting Safer Despite Drop in Cases

MONDAY, April 21 (HealthDay News) -- The number of coronary artery bypass grafting (CABG) surgeries being performed is declining, but mortality rates from the procedure continue to improve, particularly in hospitals with lower procedural volume, according to an article published in Archives of Surgery in April.

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Number of Surgeons Decreases 26 Percent in 25 Years

MONDAY, April 21 (HealthDay News) -- From 1981 to 2005 there was a 25.91 percent drop in the number of surgeons in the United States, according to a study published in the April issue of the Archives of Surgery.

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Laser Lithotripsy Fragments Salivary Stones In Vitro

MONDAY, April 21 (HealthDay News) -- Laser lithotripsy can effectively fragment salivary stones in an in vitro model, suggesting that lasers may be useful for the management of salivary stones in humans, according to research published online April 15 in Lasers in Surgery and Medicine.

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Merits of Abdominal Aortic Aneurysm Screening Debated

FRIDAY, April 18 (HealthDay News) -- The recent decision by the United Kingdom's Department of Health to establish programs to screen all men aged 65 for abdominal aortic aneurysm within 10 years is based on data showing that screening reduces mortality, but some feel that screening may cause more harm than good. This controversy is covered in a Head to Head article published in the April 19 issue of BMJ.

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Better Outcomes Using 'Box' Lesion for Atrial Fibrillation

FRIDAY, April 18 (HealthDay News) -- Connecting the pulmonary veins by two lesions (the "box" lesion) rather than one to isolate the posterior left atrium in patients undergoing the Cox maze procedure for atrial fibrillation is associated with less early atrial tachyarrhythmias, less recurrence of atrial fibrillation and lower use of anti-arrhythmic drugs, according to a report in the April issue of the Journal of Thoracic and Cardiovascular Surgery.

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Upsurge in U.S. Patients with Hip, Knee Replacements

FRIDAY, April 18 (HealthDay News) -- The number of primary knee and hip replacements performed in the United States is increasing at a steep rate, requiring that the health care community take steps to prepare for this demand and manage its economic burden, according to a report in the April 15 issue of Arthritis Care & Research.

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Anemia Predicts Cardiac Events After Vascular Surgery

THURSDAY, April 17 (HealthDay News) -- In patients who undergo elective vascular surgery, preoperative anemia is a significant predictor of perioperative and long-term cardiac events, researchers report in the April 15 issue of the American Journal of Cardiology.

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Nail Fixation Rate Soaring for Hip Fractures

THURSDAY, April 17 (HealthDay News) -- Since 1999, there has been a dramatic increase in the rate of young surgeons performing intramedullary nail fixation for intertrochanteric hip fractures despite a lack of evidence demonstrating its superiority over plate fixation and other evidence suggesting it may be associated with more complications, according to a review article published in the April issue of the Journal of Bone & Joint Surgery.

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Method Detects Extracolonic Lesions Over Colonoscopy

MONDAY, April 14 (HealthDay News) -- Abdominal computed tomography with colonography (CTC) is more effective and less costly than optical colonoscopy (OC) for the detection of extracolonic findings such as abdominal aortic aneurysms and extracolonic cancers, according to an article in the April 14 issue of the Archives of Internal Medicine.

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Radiation from Kyphoplasty Hazardous to Surgeon

MONDAY, April 14 (HealthDay News) -- Surgeons who perform kyphoplasty frequently may be exposed to radiation doses in unprotected areas, such as the hands and eyes, that exceed occupational safety limits, according to an article published in the Journal of Spinal Disorders & Techniques in April.

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Risk of Lumbar Degeneration After Spinal Fusion Varies

MONDAY, April 14 (HealthDay News) -- In patients undergoing low lumbar spinal fusions, floating L4/5 fusions are more likely to result in degenerative changes in adjacent segments than L4/S1 or L5/S1 fusions, according to an article published in Journal of Spinal Disorders & Techniques in April.

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New Guidelines Issued for Lumbar Spinal Stenosis

MONDAY, April 14 (HealthDay News) -- New clinical guidelines for the diagnosis and treatment of degenerative lumbar spinal stenosis issued by the North American Spine Society (NASS) provide clinicians with the latest evidence-based recommendations for delivering optimal care to patients with the spinal disorder. The guidelines are published in the March/April issue of the Spine Journal.

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Individualized Health Care Budgets Improve Care

FRIDAY, April 11 (HealthDay News) -- The U.K.'s National Health Service (NHS) should allow patients individual control of their health care budgets, an approach that has been shown in pilot studies to improve outcomes and patient satisfaction in a cost-effective manner, according to an analysis published April 12 in BMJ.

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Survey Examines Spine Surgery Complication in Japan

FRIDAY, April 11 (HealthDay News) -- In Japan, the incidence of vertebral artery injury during cervical spine surgery is similar to or slightly less than that reported in the literature. In many cases, this potentially catastrophic complication can be successfully managed with tamponade, according to a report published in the April issue of Spine.

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Spinal Fusion Works in Elderly Despite Osteoporotic Bone

FRIDAY, April 11 (HealthDay News) -- Using surgical rods and screws that are specially designed for osteoporotic bone allows good outcomes in elderly patients who undergo lumbar arthrodesis for severe lumbar stenosis, according to an article published in the April issue of the Journal of Spinal Disorders & Techniques.

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Subjective Measures Inform Success of Back Surgery

FRIDAY, April 11 (HealthDay News) -- While objective measures are commonly used to gauge the success of surgery for lumbar canal stenosis, several subjective measures can gauge patient satisfaction and should be used in evaluating surgical outcomes, according to an article published in the March/April issue of the Spine Journal.

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Music May Help Ease the Pain of Surgery

FRIDAY, April 11 (HealthDay News) -- Using music therapy in a perioperative setting may distract patients from their pain and reduce their levels of anxiety, according to study findings published in the April issue of the AORN Journal.

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Lumbar Decompression Doesn't Lead to Weight Loss

THURSDAY, April 10 (HealthDay News) -- After successful lumbar decompression surgery, most overweight and obese patients either maintain or gain body weight despite significant improvements in physical function and symptoms such as neurogenic claudication, according to a study published in the April issue of the Journal of Bone & Joint Surgery.

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Surgical Technique Prevents Nerve Pain After Back Surgery

THURSDAY, April 10 (HealthDay News) -- Postoperative nerve pain after posterior lumbar interbody fusion surgery (PLIF) can be prevented with careful surgical technique, according to an article published in the March/April issue of the Spine Journal.

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Consider Health Literacy Level When Writing for Patients

THURSDAY, April 10 (HealthDay News) -- Giving patients clearly written educational materials that convey key messages without resorting to jargon is an important part of engaging patient compliance with treatment and can contribute to health literacy, according to an article published in the April issue of Chest.

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Transplant Teams Should Be Aware of Donor Tuberculosis

THURSDAY, April 10 (HealthDay News) -- An estimated 0.35 percent to 6.5 percent of organ recipients in the United States and Europe will become infected with tuberculosis (TB) via the transplanted organ, according to a report published in the April 4 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

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Genetic Links to Childhood Heart Hypertrophy Uncovered

WEDNESDAY, April 9 (HealthDay News) -- Gene mutations may underlie half of all cases of sporadic childhood-onset idiopathic cardiac hypertrophy, and two-thirds of cases in which there is a positive family history, according to study findings published online April 9 in the New England Journal of Medicine.

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Corticosteroid Use Questioned in Nerve Root Infiltration

WEDNESDAY, April 9 (HealthDay News) -- In the non-surgical treatment of lumbar disc herniation with nerve root infiltration, corticosteroids show no additional benefit when combined with a local anesthetic, according to the results of an animal study published in the April issue of Spine.

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Doctors Vote on the Ways to Make Biggest Difference

WEDNESDAY, April 9 (HealthDay News) -- The BMJ has begun accepting votes on which areas of health care allow doctors to make the biggest difference to patient care, with a shortlist of six areas each being championed by eminent doctors and researchers. The winning topic will gain special coverage in the BMJ and the BMJ Group's 24 other specialist journals and online education products.

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Switch in Castration Method with Insurance Change

WEDNESDAY, April 9 (HealthDay News) -- Reductions in U.S. Medicare reimbursement for medical castration, used to treat prostate cancer by androgen deprivation, in 2003 resulted in a switch from medical to surgical castration, according to an article published online Apr. 7 in Cancer.

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Omega-3 Fatty Acids Don't Prevent Crohn's Relapse

TUESDAY, April 8 (HealthDay News) -- Omega-3 free fatty acids are not effective in maintaining remission in patients with Crohn's disease, according to study findings published in the April 9 issue of the Journal of the American Medical Association.

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Combined Therapy Promising in Unresectable Liver Cancer

TUESDAY, April 8 (HealthDay News) -- In patients with large unresectable hepatocellular carcinoma tumors, treatment with transarterial chemoembolization followed by radiofrequency ablation leads to improved survival compared to treatment with either of the two modalities alone, according to research published in the April 9 issue of the Journal of the American Medical Association.

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Drug Reduces Clotting Risk After Hip Replacement

MONDAY, April 7 (HealthDay News) -- A synthetic oligosaccharide with anti-factor Xa and IIa activities reduces the rate of venous thromboembolism after hip replacement surgery, researchers report in the April 15 issue of the Journal of the American College of Cardiology.

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Allopurinol Does Not Halt Procedure-Related Pancreatitis

FRIDAY, April 4 (HealthDay News) -- Pre-procedure treatment with allopurinol does not appear to reduce the risk of pancreatitis caused by endoscopic retrograde cholangiopancreatography (ERCP) but may be of benefit in patients at highest risk of the complication, according to research published in Clinical Gastroenterology and Hepatology in April.

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Provider Input Affects Post-Mastectomy Reconstruction

FRIDAY, April 4 (HealthDay News) -- Disparities in rates of breast reconstruction following mastectomy for breast cancer may in part depend on whether physicians discussed breast reconstruction with their patients, according to an article published in the April issue of the Journal of the American College of Surgeons.

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Benefit of Lung Transplant for Cystic Fibrosis Affirmed

THURSDAY, April 3 (HealthDay News) -- Lung transplantation should continue to be offered as a treatment option for children with cystic fibrosis, the authors of an article published in the March issue of Pediatric Transplantation maintain, directly challenging another recent study that questions the benefit of lung transplantation in this population.

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Controversy Highlights Need for Funding Disclosure

THURSDAY, April 3 (HealthDay News) -- An editorial published April 2 in the New England Journal of Medicine disclosed that a previously published study reporting a favorable prognosis among individuals with stage I lung cancers detected by screening had received a large amount of funding from a foundation with links to the cigarette industry, highlighting the necessity of full disclosure of funding sources of biomedical research.

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Men Less Willing Than Women to Question Doctors

THURSDAY, April 3 (HealthDay News) -- Surgical patients are more likely to ask doctors and nurses factual questions, and if they do ask challenging questions they are more likely to direct them at nurses than doctors, according to an article published in the April issue of Quality & Safety in Health Care.

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Obese Teens Improve Cardiac Function After Weight Loss

WEDNESDAY, April 2 (HealthDay News) -- Obese adolescents who lose large amounts of weight due to bariatric surgery have better cardiac function and geometry, researchers report in the April 8 issue of the Journal of the American College of Cardiology.

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Adverse Effects of Shock Waves for Kidney Stones Studied

WEDNESDAY, April 2 (HealthDay News) -- Shock wave lithotripsy treatment of renal or ureteral stones does not appear to increase the rate of new-onset hypertension or diabetes mellitus, according to research published in the April issue of Urology.

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Chemotherapy Anemia Linked to Breast Cancer Relapse

WEDNESDAY, April 2 (HealthDay News) -- Premenopausal patients with early-stage primary breast cancer who develop anemia after receiving adjuvant cyclophosphamide/methotrexate/5-fluorouracil chemotherapy have a significantly increased risk of local relapse, according to research published in the April 1 issue of Clinical Cancer Research.

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Pediatric Liver Transplantation Affects Patients and Families

WEDNESDAY, April 2 (HealthDay News) -- After pediatric liver transplantation, children aged 5 and over have compromised physical function and their parents have higher levels of stress. Although transplant families do not generally appear to have a higher level of family dysfunction, this may not be true for all demographic groups, according to a report published in the April issue of Liver Transplantation.

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Phototherapy Seems to Help in Bile-Duct Cancer Survival

WEDNESDAY, April 2 (HealthDay News) -- In patients with unresectable cholangiocarcinoma, photodynamic therapy used with endoscopic retrograde cholangiopancreatography (ERCP) may improve survival compared with just ERCP, according to research published in the March issue of Clinical Gastroenterology and Hepatology.

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Physician's Briefing