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July 2008 Briefing - Surgery

Here are what the editors at HealthDay consider to be the most important developments in Surgery for July 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.

Joint Replacement Linked to Cardiac Complications

THURSDAY, July 31 (HealthDay News) -- Among total joint replacement surgery patients, two new risk factors -- revision surgery and bilateral joint replacement -- as well as traditional risk factors increase odds of cardiac complications, according to an article published in the July issue of Arthritis & Rheumatism.

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Device May Decrease Musculoskeletal Procedure Pain

THURSDAY, July 31 (HealthDay News) -- A reciprocating procedure device decreases patient's pain during musculoskeletal procedures, improves outcomes and may decrease needlestick injuries to health care workers, according to an article published in the July issue of Arthritis & Rheumatism.

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PAND Doesn't Add to Survival With Gastric Cancer

WEDNESDAY, July 30 (HealthDay News) -- In patients undergoing gastrectomy for curable gastric cancer, the addition of para-aortic nodal dissection (PAND) to D2 lymphadenectomy isn't advisable, according to research in the July 31 New England Journal of Medicine.

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Use of Antibiotic Prophylaxis for Endocarditis Discouraged

TUESDAY, July 29 (HealthDay News) -- Antibiotic prophylaxis should no longer routinely be given to prevent infective endocarditis in patients undergoing dental and other medical procedures, according to updated guidelines published online July 28 in the Journal of the American College of Cardiology. The guidelines were jointly developed by the American College of Cardiology and the American Heart Association.

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Infections Rare After Mohs Micrographic Surgery

MONDAY, July 28 (HealthDay News) -- Surgical site infections are extremely uncommon in patients undergoing Mohs micrographic surgery for non-melanoma skin cancer or modified Mohs micrographic surgery for lentigo maligna melanoma in situ, suggesting that the routine administration of antibiotics may be unnecessary, according to a study published in the August issue of the Journal of the American Academy of Dermatology.

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Medical Errors Have Impact After Hospital Discharge

MONDAY, July 28 (HealthDay News) -- Medical errors affect patients in the months after hospital discharge as well as during their hospital stays, leading to excess costs, deaths and hospital readmissions, according to a study published online July 25 in Health Services Research.

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Subtotal Discectomy Decreases Reoperation Rates

FRIDAY, July 25 (HealthDay News) -- Subtotal discectomy decreases reherniation after lumbar discectomy and is more effective than fragment excision alone, according to an article published in the July issue of the Journal of Spinal Disorders & Techniques.

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Teledermatology Improves Skin Cancer Outcomes

FRIDAY, July 25 (HealthDay News) -- In the management of skin cancer, teledermatology referral leads to clinical outcomes that equal or even surpass those of conventional referral, according to a report published in the August issue of the Journal of the American Academy of Dermatology.

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Vacuum-Assisted Wound Closure Improves Healing

FRIDAY, July 25 (HealthDay News) -- Vacuum-assisted wound closure (VAC) may assist wound healing in spinal procedures complicated by wound infections, according to a report the July issue of the Journal of Spinal Disorders & Techniques.

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New Laser Technique May Reduce Acne Scars

THURSDAY, July 24 (HealthDay News) -- In patients with acne scars, ablative fractional resurfacing with a novel 30-watt laser that combines carbon dioxide ablation with a fractional photothermolysis system may significantly improve facial appearance with minimal side effects, according to study findings published in the August issue of Lasers in Surgery and Medicine.

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Timing of Lymph Node Dissection Studied in Breast Cancer

THURSDAY, July 24 (HealthDay News) -- The timing of axillary lymph node dissection does not affect the number of lymph nodes recovered or long-term complications in patients with breast cancer that has metastasized to the sentinel lymph nodes, according to a report in the July 20 issue of the Journal of Clinical Oncology.

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Self-Assessment Detects Alcohol Abuse in Pre-Op Patients

THURSDAY, July 24 (HealthDay News) -- A computer-based self-assessment is much better than anesthesiologists at detecting alcohol abuse among preoperative patients, according to a report in the August issue of Anesthesiology.

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'Tier 4' Drugs Raise Questions About Affordability

WEDNESDAY, July 23 (HealthDay News) -- The emergence of a fourth tier of copayment for expensive drugs calls into question how Americans are going to handle the rising costs of health care, according to a perspective article in the July 24 issue of the New England Journal of Medicine.

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Consequences of Genetic Non-Discrimination Act Examined

WEDNESDAY, July 23 (HealthDay News) -- The Genetic Information Non-discrimination Act (GINA), recently signed into U.S. law, creates a troublesome distinction between those at genetic risk for a disease and those with other characteristics that predispose them to a condition, according to a perspective article published in the July 24 issue of the New England Journal of Medicine.

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Adjuvant Treatment Improves Pancreatic Cancer Survival

WEDNESDAY, July 23 (HealthDay News) -- Four new studies show that the addition of chemotherapy and radiation before or after surgery for pancreatic cancer can improve survival, according to an editorial in the July 20 issue of the Journal of Clinical Oncology.

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New Standard of Care Proposed for Metastatic Kidney Cancer

WEDNESDAY, July 23 (HealthDay News) -- Everolimus improves progression-free survival compared to placebo in patients with progressive, metastatic renal cell carcinoma that failed other targeted therapies, according to research published online July 23 in The Lancet.

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Physicians to Get Bonus for Electronic Prescribing

WEDNESDAY, July 23 (HealthDay News) -- Doctors using an electronic prescriptions system will be eligible for a bonus from Medicare from 2009 onwards for four years, according to U.S. health officials.

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Treatment for Infertile Men Looks Promising

TUESDAY, July 22 (HealthDay News) -- For infertile men with varicoceles, embolization improves sperm count and motility and may aid in pregnancy, researchers report in the August issue of Radiology.

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Carbon Dioxide Laser Effective for Reducing Wrinkles

TUESDAY, July 22 (HealthDay News) -- The use of carbon dioxide laser resurfacing for treating facial wrinkles is safe and effective, though hypopigmentation can be a common consequence, according to research published in the July/August issue of the Archives of Facial Plastic Surgery.

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Application Data Hints at Surgical Residency Completion

TUESDAY, July 22 (HealthDay News) -- The likelihood that surgical residents will fall by the wayside can be predicted from factors on their residency applications, with non-academic factors the most important, according to a paper published in the July issue of the Archives of Surgery.

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Using Older Liver Donors May Help Reduce Waiting Lists

TUESDAY, July 22 (HealthDay News) -- Using livers donated by marginal donors may reduce the waiting time for liver transplant patients without having a negative impact on outcomes, even for patients with hepatitis C virus, according to research published in the July issue of the Archives of Surgery.

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Lymph Node Evaluation Varies by Hospital Type and Volume

MONDAY, July 21 (HealthDay News) -- In patients with gastric or pancreatic cancer, lymph node evaluation is significantly more comprehensive at National Comprehensive Cancer Network (NCCN), National Cancer Institute (NCI)-designated institutions and at high-volume hospitals, according to a report published in the July issue of the Archives of Surgery.

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Anesthetic Accidents More Common in Afternoon

MONDAY, July 21 (HealthDay News) -- Anesthetic adverse events are more common in surgeries performed after 4 p.m., and are exacerbated by the shortage of anesthesia care providers, which has increased working hours and therefore fatigue, according to an article published in the July issue of the AORN Journal.

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New Technique Decreases Radiation Exposure

MONDAY, July 21 (HealthDay News) -- The use of navigation-assisted fluoroscopy for minimally invasive spine surgery is both possible and safe, according to an article published in the July issue of The Spine Journal.

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Robotic Prostatectomy Review Points to Positive Outcomes

MONDAY, July 21 (HealthDay News) -- A review of articles comparing robotically assisted prostatectomies with open and laparoscopic procedures offers data on outcomes to help guide surgical choice. The review was published in the July issue of Urology.

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New Technique Identifies Correct Operative Spinal Level

FRIDAY, July 18 (HealthDay News) -- Computer-assisted image guidance may improve identification of the correct vertebral level prior to spinal surgery, according to an article published in the July issue of The Spine Journal.

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Report Finds U.S. Health System Lagging Further Behind

FRIDAY, July 18 (HealthDay News) -- The U.S. health system is operating poorly compared to its potential, with America falling further behind other nations that are leading on performance indicators, according to a report released by The Commonwealth Fund on July 17.

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Ovary Removal Linked to Less Depression After Hysterectomy

FRIDAY, July 18 (HealthDay News) -- Removal of both ovaries in premenopausal women undergoing hysterectomy is associated with less depression or no change in depression depending on whether they were depressed before surgery, according to a report in the July issue of the American Journal of Obstetrics & Gynecology.

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Intraoperative Radiographs Essential for Avoiding Errors

FRIDAY, July 18 (HealthDay News) -- Intraoperative radiographs and other precautions are critical for preventing incorrect-site surgery among neurosurgeons, according to three letters to the editor published in the July issue of the Journal of Neurosurgery: Spine, in response to a previous report.

Full Text (subscription or payment may be required) - Ammerman
Full Text (subscription or payment may be required) - Sahjpaul
Full Text (subscription or payment may be required) - Irace

Older Patients May Not Voice Surgery Concerns

FRIDAY, July 18 (HealthDay News) -- Older adults who are considering orthopaedic surgery may be reluctant to fully disclose their concerns to their surgeons, researchers report in the July issue of the Journal of Bone & Joint Surgery.

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Pseudoaneurysm After Spinal Device Migration Treatable

THURSDAY, July 17 (HealthDay News) -- Pseudoaneurysm of the aorta due to device migration is a rare but treatable complication following placement of an anterior spinal device, according to an article published in the July issue of The Spine Journal.

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Exception Reporting Improves Pay-for-Performance Benefits

THURSDAY, July 17 (HealthDay News) -- Pay-for-performance programs benefit from use of exclusion reporting, whereby certain patients are excluded from quality calculations, and the practice of excluding patients to disguise missed targets, known as gaming, is rare, according to study findings published in the July 17 issue of the New England Journal of Medicine.

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Medical Education Must Adapt to Changing Times

THURSDAY, July 17 (HealthDay News) -- Medical schools must adapt their admission requirements and curricula to changes in scientific theory, and are also facing a challenge to the traditional definition of who is suited to the study of medicine, according to two articles published in the July 17 issue of the New England Journal of Medicine.

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Therapy May Increase Kidney Transplant Rates

WEDNESDAY, July 16 (HealthDay News) -- Intravenous immune globulin plus rituximab is a promising desensitization combination regimen for patients awaiting kidney transplant, according to an article published in the July 17 issue of the New England Journal of Medicine.

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AMA Actions Fostered U.S. Medical Racial Divide

TUESDAY, July 15 (HealthDay News) -- From the post-Civil War years to the civil rights era a century later, the American Medical Association (AMA) made decisions that helped support a division between white and black Americans in the field of medicine in the United States, according to an article in the July 16 issue of the Journal of the American Medical Association.

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Computer-Assisted Knee Arthroplasty Costs Evaluated

MONDAY, July 14 (HealthDay News) -- The cost-effectiveness of computer-assisted surgery for total knee replacement depends on the annual hospital volume, with the technology providing less return on investment in lower-volume hospitals, according to a study published in the July issue of the Journal of Bone & Joint Surgery.

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Costs May Be Higher at Doctor-Owned Hospitals

MONDAY, July 14 (HealthDay News) -- At physician-owned specialty hospitals, financial incentives linked to ownership may significantly alter practice patterns in ways that increase patient health care expenditures, according to an article published in the July issue of Medical Care.

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Oral Hormone Therapy Raises Risk of Gallbladder Disease

FRIDAY, July 11 (HealthDay News) -- Postmenopausal women using hormone replacement therapy (HRT) are at higher risk of gallbladder disease if they use oral rather than transdermal drugs, according to study findings published July 10 in BMJ Online First.

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Mortality Risk High After Vertebral Fracture in Elderly

FRIDAY, July 11 (HealthDay News) -- Elderly patients of both genders and all ages and ethnicities have a high risk of mortality after a vertebral fracture, researchers report in the July issue of the Journal of Bone & Joint Surgery.

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Early Hip-Fracture Surgery Improves Patient Outcomes

FRIDAY, July 11 (HealthDay News) -- Hip-fracture patients who undergo surgery within 24 hours after hospital admission are significantly less likely to develop pressure ulcers and endure long hospital stays, and more likely to return to independent living than those who undergo later surgery, according to the results of a study published in the July issue of the Journal of Bone & Joint Surgery.

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Breast-Conserving Surgery Outcomes Affect Quality of Life

FRIDAY, July 11 (HealthDay News) -- Women with pronounced breast asymmetry after breast-conserving surgery may be at high risk of poor psychosocial functioning, according to study findings published in the July 10 issue of the Journal of Clinical Oncology.

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Health Cash Incentives for Poor People Debated

WEDNESDAY, July 9 (HealthDay News) -- Should disadvantaged people be paid to take care of their health? That's the question of a "Head to Head" debate published online July 8 in BMJ.

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Cancer Surgery Costs Lower for High-Volume Surgeons

TUESDAY, July 8 (HealthDay News) -- High-volume surgeons are associated with lower inpatient costs for cancer surgery than low-volume surgeons, while hospital volume has little effect, according to study findings published in the July issue of Medical Care.

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H-Y Effect Occurs in Kidney Transplantation

MONDAY, July 7 (HealthDay News) -- Outcomes are poorer in women who receive transplanted kidneys from male donors, suggesting that an immunological H-Y effect occurs in kidney transplantation, but outcomes are the same in patients who receive either vitespen -- an adjuvant autologous therapeutic vaccine -- or observation after nephrectomy for renal cell carcinoma, according to two studies published online July 4 in The Lancet.

Abstract - Gratwohl
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Abstract - Wood
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Survival Benefit Seen with Extracorporeal CPR

MONDAY, July 7 (HealthDay News) -- Extracorporeal cardiopulmonary resuscitation (CPR) was associated with improved survival rates at discharge, one month and one year following in-hospital cardiac arrest, according to an article published online July 7 in The Lancet.

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Research Supports Surgery for Refractory Depression

MONDAY, July 7 (HealthDay News) -- Mounting evidence suggests that depression is a network disorder instead of a condition related to perturbation of a single neurotransmitter or brain region, suggesting that surgical interventions such as deep brain stimulation may benefit selected patients with refractory depression, according to two studies published in the July issue of Neurosurgical Focus.

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Only Six New Pediatric Neurosurgeons A Year

THURSDAY, July 3 (HealthDay News) -- Although the infrastructure exists to train more than 20 pediatric neurosurgeons a year in the United States, the current system is only producing approximately six surgeons a year with American Board of Pediatric Neurological Surgery certification, raising concerns about the sufficiency of expertise in this area, according to an article published in the June issue of the Journal of Neurosurgery: Pediatrics.

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Combo Therapy Improves Survival in Hepatitis B

THURSDAY, July 3 (HealthDay News) -- Combining hepatitis B immunoglobulin (HBIG) and lamivudine significantly improves prevention of hepatitis B virus (HBV) recurrence, HBV-related death and all-cause mortality in the post-liver transplantation setting, according to an article published in the June issue of Clinical Gastroenterology and Hepatology.

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Physician's Briefing