Sutureless Blood Vessel Repair

Updated 3/2017-- photos and all links removed (except to my own posts) removed as many no longer active. 

If this works in humans as it has in rats, then it will be a huge advance in microvascular repair.  The full article is referenced below (I did not read in it’s entirety due to pay wall).   (photo credit)

We have developed a new method of sutureless and atraumatic vascular anastomosis that uses US Food and Drug Administration (FDA)-approved thermoreversible tri-block polymers to temporarily maintain an open lumen for precise approximation with commercially available glues. We performed end-to-end anastomoses five times more rapidly than we performed hand-sewn controls, and vessels that were too small (<1.0 mm) to sew were successfully reconstructed with this sutureless approach. Imaging of reconstructed rat aorta confirmed equivalent patency, flow and burst strength, and histological analysis demonstrated decreased inflammation and fibrosis at up to 2 years after the procedure. This new technology has potential for improving efficiency and outcomes in the surgical treatment of cardiovascular disease.

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Currently, vascular microanastomosis (photo credit) is done by suturing.  Arteries 1 mm in diameter usually require 5 to 8 stitches, and veins require 7 to 10 stitches.  There is a risk of thrombosis even with the most meticulous repair -- total thrombosis rate 8%, with  no significant patency difference noted between the continuous suture technique and the interrupted suture technique in any vessel category.

REFERENCE

1.  Vascular anastomosis using controlled phase transitions in poloxamer gels; Edward I Chang, Michael G Galvez, Jason P Glotzbach, Cynthia D Hamou, Samyra El-ftesi, C Travis Rappleye, Kristin-Maria Sommer, Jayakumar Rajadas, Oscar J Abilez, Gerald G Fuller, Michael T Longaker, Geoffrey C Gurtner;  Nature Medicine, 2011; DOI: 10.1038/nm.2424

2.  Sutureless Method for Joining Blood Vessels Invented; ScienceDaily (Aug. 28, 2011)

3.  Technique for Microanastomosis; Wheeless Textbook of Orthopaedics, June 28, 2011

4.  Vascular Skills Lab Two (pdf)

Shout Outs

 Updated 3/2017--photos and all links removed (except to my own posts) removed as many no longer active.

Health 3.0 Blog  is the host for this week’s Grand Rounds. You can read this week’s edition here.

Welcome to this week’s edition of Grand Rounds. You can find the medical blogosphere’s best next week at Covert Rationing.

We’ve taken a different approach this week to organizing Grand Rounds. You can find all the submissions below in this post. But, we’ve also selected quotes from each blog and highlighted those on the main page. Consistent with our themes, we’ve also tagged all the posts related to health, happiness, design or innovation. You can search for these tags to see how each theme plays out. We’ve also added bits of commentary to some of the individual quotes and summaries - especially when we’ve read something recently that relates to the general topic or idea………

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I was aware of this new children’s book "Maggie Goes on a Diet" (I haven’t gotten to read it, but title makes me feel focus is wrong. Should be focused on eating healthy diet.), but @LindaP_MD’s tweet alerted me to a nice interview @drclaire did with @BridgetBlythe on @NECN about the book:  Talking to kids about weight, obesity

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Did you see the interview Albert Schweitzer (@SchweitzerASF) did with @docgurley?  --“The Addictive Power of Spending One’s Days Doing Something Worthwhile”: Five Questions for a Fellow with Jan Gurley, MD

Since 1979, ASF’s Lambaréné Schweitzer Fellows Program has selected senior U.S. medical students to serve clinical rotations as junior physicians at the iconic Schweitzer Hospital in Lambaréné, Gabon, Africa—the region’s primary source of health care since Dr. Albert Schweitzer founded it in 1913.

Jan Gurley, MD is one of those Fellows. ……….

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Check out the interview of @drkt at OnSurg.com:  Featured Surgeon, late summer 2011

First-year surgery resident Dr Katie has been sharing her educational experience online since undergraduate school. OnSurg is grateful for her participation in our Q & A:

What’s your story?

I first knew I wanted to be a doctor my senior year of high school (was going to go into Forensics from 7th-12th), and was told I’d never make it and that I’d change my mind. I knew what I wanted and wanted to prove people wrong at the same time. It wasn’t until the summer after my junior year that I actually had the chance to be in the hospital. When that time came, I knew that medicine was right for me.  ………….

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H/T to @DrSnit tweeting this:  “Monsters in the Dark by @chemo_babe bit.ly/reZDOi Parenting through cancer. "I don’t want to be the little boy whose mommy died.”   I hope you will go read the entire post.

…………….He grew earnest.
“But your heart will stop beating when you die. You can’t have love without a heart.”
“Love doesn’t just live in my heart. My love for you will continue on in your heart.”
Then he burst into tears and threw his arms around my neck.
“Mommy, I don’t want to be the little boy whose mommy died.”
I embraced him, stunned into silence. I looked for words of comfort. …………….

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H/T to @sandnsurf for finding and posting these “highly inappropriate adverts”:  High quality adverts (photo credit) 

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H/T to @BiteTheDust  for the link to this news article:   13 yr old designs breakthrough solar array based on Fibonacci sequence.

Plenty of us head into the woods to find inspiration. Aidan Dwyer, 13, went to the woods and had a eureka moment that could be a major breakthrough in solar panel design. ………

You can read Aidan’s award-winning essay here, which walks you through his experiment design and his results. But the short story is that his tree design generated much more electricity — especially during the winter solstice, when the sun is at its lowest point in the sky. At that point, the tree design generated 50 percent more power, without any adjustments to its declination angle. …………..

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The International Quilt Festival Summer 2011 Newsletter has a very nice tutorial for making a Patchwork/Purse Tote (pdf).  (photo credit)

Record Transfer Requests

Requests for transfer of records are coming in response to the closing practice letters.

These bring dueling emotions: pleasure in the knowledge the individual is planning for continued care AND the sting of rejection.

Intellectually, I know the second makes no sense. I am the one who is leaving them and the practice.

Still....

Razorback Blanket with Quilted Border

My nephew is headed to my old alma mater, University of Arkansas, this fall.  He is starting law school.  His birthday is in early September.   These two facts and then finding the fleece fabric in the “remnants bind” at Hobby Lobby inspired me to make this.

The fleece piece was not large enough for a guy my nephew’s size (well over 6 ft tall), but I had some left over Arkansas Razorback cotton I had used for a surgeon’s cap.

The border is reversible.  I machine pieced the 4-patches of red and white to the larger black patches.  The end borders (front and back) were sewn to the fleece first.  The fusible batting (good use for leftovers) was carefully placed in-between.  Then the two longer side borders (front and back) were done in the same fashion.

I then machine quilted the border.

Rather than make a label, I used the letter/number feature on my machine to sew one.

Pressure Treatment of Auricular Keloids

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active.

I have written of keloid treatment (general, not site specific) previously.  I have always tried to include pressure treatment as part of the plan when treating keloids of the ear lobe.   This pressure treatment came in the form of pressure earrings  -- clip-on, disc-shaped. 

The recent article (full reference below) in the Archives of Facial Plastic Surgery journal introduces a new pressure device which looks like it will work better than what has been available (photo credit) 

and as can be seen in this photo the upper ear can be treated with pressure which has not been possible with the clip earrings. (photo credit)

These devices were custom made which makes them more expensive than off-the-shelve pressure earrings and may make them difficult to get if no one is available in your area to make them.

From the article:

Pressure therapy was popularized in the 1970s after clinicians noticed that pressure stockings used over lower extremity burns caused scars to mature faster with decreased erythema and thickness.  Pressure causes localized hypoxia, resulting in fibroblast degeneration and disintegration owing to decreased intercollagenous cohesion and increased collagenase activity.

Furthermore, pressure has been shown to shorten scar formation time, reorient collagen fibers within the scar to become parallel to skin surface, increase hyaluronic acid levels, and decrease chondroitin sulfate levels, all of which help to flatten the initially elevated scar tissue and reduce recurrence rates.

According to various reviews and guidelines, pressure therapy is a long-standing therapeutic option for keloids, producing thinning and pliability. Although the precise biomolecular mechanism of compression is not understood, success rates of at least a partial reduction of derailed scars, from 60% to 85%, have been reported from a monotherapeutic regimen of pressure therapy. The combination of surgery with postoperative pressure treatment showed good response rates of about 90% to 100%, especially after excision of auricular keloids. ………

Overnight use of the new pressure device seems to be an effective extension of established auricular keloid therapy, with additional potential for prophylaxis of recurrence. Preliminary work was presented and intended to produce a demonstration of an optimized treatment modality. Analysis of this therapeutic regimen based on a larger sample size, and long-term follow-up will be the substance of a future report.

REFERENCE

Auricular Keloids: Combined Therapy With a New Pressure Device; Gregor M. Bran, Jörn Brom, Karl Hörmann, Boris A. Stuck; Arch Facial Plast Surg. 2011;Published online August 15, 2011. doi:10.1001/archfacial.2011.57

Frontline's Football High

Updated 3/2017-- video and all links removed as many no longer active. 

With high school football season upon us, Frontline reran their show “Football High.”  It features two Arkansas football players who suffered heat stroke last year (one survived, one did not).  There is also a good discussion of other injuries, particularly concussions, among high school football athletes.  Here is a preview but it can be watched in it’s entirety here. 

There is more info here on Frontline’s website.

Grand Rounds Volume 7 Number 48

 Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active.

Thank you for coming to Grand Rounds 7:48, the weekly collection of the some of the best in online medical writing from all (doctors, nurses, patients, healthcare professionals).  Next week’s will be hosted by Health 3.0 Blog.

Along with the excellent posts, I’ve included pictures of the changes cameras have gone through over the years – from the pin-hole camera to digital phone cameras.  Enjoy!

Dr. Charles hasn’t had much time lately, but I was able to scribble down this pediatric poem:  A Beating.  As one commenter figured out, Dr. Charles is a new father.  Congratulations! and thanks for the poem.     (camera obscura – photo credit)

Jordan, In My Humble Opinion, writes about the covenant of being a doctor:

I mean it is kind of lonely....being your doctor. I picture it as sort of a covenant. Between you and I.

On one side you. And your family. And friends. Your house and your dogs. Your communities and lives.

On the other side me. Alone.

Skeptical Scalpel has written a post,  Do Surgeons Suffer From "Decision Fatigue"?, in response to a NY Times Magazine article.

……..Query: Has anyone seen studies linking surgical error rate to the time of day?”

The answer is, “Yes.”

But if the question had been, “Anyone seen any good studies linking surgical error rate to time of day?” the answer would have been, “No.” ………….

Dr. Schattner, MedicalLessons, talks about what she has learned from the offbeat and in some ways disturbing story of a young woman who's made a business of having had a rare form of cancer, epithe­lioid heman­gioen­dothelioma:   Notes on Crazy Sexy Cancer             (daguerreotype camera – photo credit)

Dr. Val, Better Health, asks Should Pharmacies Limit Teen Access To Protein Supplements?

A strange thing happened to me at a CVS pharmacy two days ago. I was attempting to purchase a protein drink when the girl at the counter asked me to show her my I.D. card. I assumed she meant my CVS savings card and was sincerely confused when she rejected it, saying, “No, your picture I.D.”

I dug through my purse to find my driver’s license while the girl explained,

“You have to be 18 years old to buy this product. I need to type in your date of birth into the computer.”  ……

Carolyn is a heart attack survivor who blogs at  HEART SISTERS.  In her post,    "How to be a good patient" , she shares her experiences and expertise she has gained in having a chronic illness.

Beth, Calling the Shots, discusses the controversial use of “war” terminology to describe cancer in her post:  Young Adults With Cancer: Why 'War' Analogies Work But 'Warrior' Analogies Do Not.

Many, many people don't like war analogies when it comes to cancer,  especially those of us who've been afflicted by it. We often hear that a comrade has lost or won his or her battle with cancer. Or about society declaring war on cancer. Or about someone fighting bravely against the disease.

Sure, this language of war is cliche, giving us a picture of the brave warrior fighting to the death against cancer.  ………….

Dr. Pullen

shared in his submission email his thoughts of using his own name as the name of his blog:  “I've thought a long time about why on earth I chose to use just my name as my blog name.  Thinking back it was probably not one that is going to draw much interest except from maybe the few who know me.  Maybe it was my interest in eponymous diseases.  This prompted me to have some fun with a word that is not on the tip of many tongues.”  Enjoy his post:  Eponymous Blog on Eponymous Diseases.         (Brownie   --- photo credit)

DrRich explains why direct-pay medical practices, contrary to official opinions, are not only ethical, but also may be the only remaining way for doctors to practice medicine in accordance with traditional medical ethics:  An Epiphany on Direct Pay Practices.

HealthBlawg takes a look at an unusual acquisition: a large health care system acquiring a Medicaid HMO.  What does it mean?  Check out their post:  Partners Health Care acquiring Neighborhood Health Plan: The 800-Pound Gorilla and the Fig Leaf?      (Canon F1 – photo credit)

Over at InsureBlog, Henry Stern reports on new breast cancer coverage for women only, and why that's not necessarily such a good thing:  Keeping Abreast of Cancer: Double-Standard edition

Laika,  Laika's MedLibLog, in her post -- RIP Statistician Paul Meier. Proponent not Father of the RCT – tells us  Paul Meier who recently died really had a great influence as a statistician in promoting the RCT (& he "invented" the survival curve).  Her post, however, focuses on the wrong headline in Boing Boing (the first headline she saw about the death of Paul Meijer), claiming that Paul is the father of the RCT.  In her post she tried to find out the real origin of the RCT.

Rick Pescatore, a medical student and EMT who blogs at Little White Coats  submitted a post --Help I've Fallen and I can't get up!  -- which details his experiences with senior falls as an EMT and provides a resource for seniors in his area (Philadelphia and Southern New Jersey area) to receive free medical alert devices from the PCOM Emergency Medicine Club.    (Poloraid  -- photo credit)

Amy, DiabetesMine, wants us to know about the upcoming summit on noncommunicable diseases at the UN next month:  Diabetes Battles for Obama’s / World’s Attention

Anybody heard about the first-ever upcoming United Nations (UN) High-Level Summit Meeting on Non-Communicable Diseases (NCDs), in which heads of state from around the world will meet in New York City on Sept. 19 and 20?  Um, we’re not sure President Obama has either, and that’s very bad news for diabetes, according to the International Diabetes Federation (IDF). ……….

Ryan,  ACP Internist blog, looks at the recent trends in healthy lifestyle choices by adapting two recent studies (and adding a touch of humor):   Smoking in front of the television must be really bad

ACP Hospitalist blog  feels doctors may already have all the skills they need to make the right diagnosis:  History and physical the best way to diagnose patients   (iPhone which includes camera  -- photo credit)

Geeners, Code blog: Tales of a Nurse, gives us a view of what it’s like to be a school nurse:  Interview - School Nurse

Well, what better time to post my interview with Erin at Tales of a School Zoned Nurse than now, when everyone’s headed back to the classroom? ……

Steven J. Seay, Ph.D. presents us with a timely post as school is back in session:   School Refusal & Parental Stigma: Am I a Bad Parent?

Like any other behavior, school refusal does not have a singular cause. This is pretty self-evident, but in the heat of the moment when your child is having a tantrum, this fact is quickly forgotten. It is simply too easy to conclude that you have raised a “bad child.” Sadly, much of society might wrongly agree with you. ……..

Louise, Colorado Health Insurance Insider, discusses the PPACA and changes made over the year since it was signed into law in her post:   Seeking Certainty

…. It's been over a year since the PPACA was signed into law.  Many Americans are eagerly awaiting 2014 when their health conditions will no longer limit them to high risk pools and when their health insurance premiums will be subsidized.  Health insurance carriers have already made numerous changes to comply with the law, with many more planned for the next few years.  A lot of states are working hard to come up with health insurance exchanges that will best serve their residents' particular needs.  Many other states have mounted costly legal battles against the individual mandate.  Some states - like Colorado - have done both.  In a nutshell, an awful lot of money and time is being expended on a law that still has a very uncertain legal future……….

Pathologist Gizabeth, Metodical Madness, sends us a poem, Monarch Butterfly and well wishes. 

REFERENCES
History of Photography by Mary Bellis
The Development of the Camera over the Years by Mandi
Canon Camera Story
History of the Digital Camera by Mary Bellis

Time for New Journal Subscription Model

I like open access, but I’m realistic.  The big journals (NEJM, JAMA, society journals, etc) aren’t likely to go that route anytime soon though more of them are making select articles available in full for limited time periods.

I have been thinking of the current subscription model more and more as my print journals stack up in my office and I read the articles online.  It has really been in my thoughts as I am closing my practice and have had to decide what to do with all the journal volumes accumulated over the past years.

Currently, subscription to a journal (ie my PRS journal) gives me both a print copy and the online access.  The online access allows me to search all years of the journal, even those prior to my subscription.  I love this.  I no longer go to the print indexes to search for a topic or article.  I lose this access if I cancel the subscription.

What I propose is a subscription model that would allow the subscriber to chose online access only without receiving the print version.   I would like this subscription model to allow the subscriber long term online access to the years (ie 1990 to 2015) of active subscription.

I believe it is possible to create a database of subscribers and years of full subscription so that this would be possible.   I also think the publishers savings from the mailings and print could be put towards keeping up this database.

Note, I am not asking for continued full access to all the old and any new journal volumes.  Just the ones I would have access to if I kept all the print volumes, but with this new model I would not have a storage problem of 20 plus years of not just one journal but several.

Anyone else have any thoughts on this model? 

…..

By the way, I’ve decided to just recycle the print copies of the journals I have.  I don’t have room at home and don’t want to end up being an episode of Hoarders.  I will continue my subscriptions as a way to keep current as I will continue to need CMEs.

More Fabric Postcards

This summer I seem to have been on a fabric postcard making spree.  Here are several more I have made.

This one I call “Girl with Basket of Pinwheel.”  It is 4.5 in X 5.5 in.

This one I simply call “Flowers.”  It is 3.5 in X 5 in.
This one I can’t decide on a name.  I want to call it either “Don’t Look Back” or “Are You Coming?”   It is 5 in X 7 in.

This one I call “Home Sweet Home.”  I mailed it to a friend who recently moved cross country to a new home.  I hand embroidered flowers on the fabric scene.  It is 5 in X 7 in.
This one I call “Let’s Ride.”  It is 5 in X 7 in.
This one I call “Leap Frog.”  I mailed it to @geeners who indicated that she loved my postcards.  It is 5 in X 7 in.
Here is the back of “Leap Frog.”  Most are just a simple plain back.
This one I simply call “Friends.”  It is 5 in X 7 in.
This one I call “Make a Wish.”  I hand sewed beads/sequins onto the cupcake and flame.  It is 5 in X 7 in.
This one is a simple fabric background with a ruched rose hand sewn onto to it.  I call it “Single Rose” and mailed it as a birthday card to a teacher from high school, Mrs. Bronnie Rose.

Role Playing to Learn Communication

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. 

I was alerted to this Archives of Surgery article (full reference below) by MedPage Today:  Role Playing Boosts Surgical Residents' Bedside Manner.

I find it intriguing.  Role playing gives you a chance for a “do-over” when you make a social or communication faux pas. 

So much of medicine is communication.  Those of us who have been at it for years, deliver bad news differently (learned the hard way) now than we did previously.  You choose your words more carefully (though I still occasionally screw up).  Some words are more emotionally charged than others.  Some patients want more information than others. 

The University of Connecticut Health Center conducted a prospective study  of a pilot projected designed to  teach surgical residents patient-centered communication skills.

The study offered 44 general surgery residents the opportunity to participate in the three-part patient communication curriculum: A pre-test, training, and a post-test.  Only 30 completed all three parts.

The pre-test assessed general communication skills awareness of the resident while he/she delivered a new diagnosis of either breast or rectal cancer to a patient. The evaluation was done by a standardized patient instructor.

The training portion required residents to attend a 90-minute workshop that involved a lecture from a professor of surgery and formal instruction from the director of the center's clinical skills program, followed by a 30-minute role-playing session.

The post-test assessment re-evaluated the residents by the standardized patient in a crossover fashion (those who previously participated in a breast cancer diagnosis now participated in a rectal cancer diagnosis and vice versa).

The study authors concluded:

Residents' assessment of their patient communication skills indicates that there is an immediate need for a formal educational curriculum. Our results show that case-specific improvements seem more amenable to measurable improvement than general communications skills, at least with the limited short-term training that we used. Such skills can be assessed over a longer period, perhaps by incorporating this model and assessments from year to year.

Surgical and nonsurgical residency programs will benefit by helping residents incorporate patient needs and opinions into the care team's decision-making process. Principles such as emotional support, transition and continuity of care, provision of information and education, involvement of family and friends, and respect for patient values and preferences will form the basis of our educational series.

REFERENCE

Pretraining and Posttraining Assessment of Residents' Performance in the Fourth Accreditation Council for Graduate Medical Education Competency: Patient Communication Skills; Rajiv Y. Chandawarkar; Kimberly A. Ruscher; Aleksandra Krajewski; Manish Garg; Carol Pfeiffer; Rekha Singh; Walter E. Longo; Robert A. Kozol; Beth Lesnikoski; Prakash Nadkarni; Arch Surg. 2011;146(8):916-921.

Changes

Due to many things, I will be closing my practice over the next few months and going to work for the Arkansas Disability Determination Services (DDS).  I only recently made the final interview and signed the contract.  My first day there will be October 3rd.  I don’t want to discuss the reasons, but I want you to know how difficult a decision this has been for me.

I have not hinted to patients that I might leave until recently.  I didn’t want them to leave me prematurely, so I now worry that I may not have given them enough heads up.  Such a blurry line between taking care of yourself/family and abandoning patients. 

I don’t think I have abandoned any of them, but I wonder if they might feel that way.  I have managed to “leave the door open” to see current patients on Fridays and Saturdays (if need be) over the next few months. 

Yesterday, I got the letters to patients, organizations (ie AMA, Arkansas State Medical Board, AMS, PCMS, etc), and hospitals in the mail. 

There are many things left to do, but I am fortunate to have a young colleague who is willing to allow me to transfer the charts to him.

I have begun making the phone calls regarding cancelling malpractice insurance, office overhead insurance, etc.   I will have to figure out a new voicemail message and when to change it.

I have been caught mid-contract with several leases (ie Pitney Bowes, credit card processor, and the actual office), but so it goes.  I have yet to talk with the building management.  I am hoping they will be able to sublease it for me.

I hope to continue to blog.  I have to maintain my medical license and do CMEs and blogging has become a way of learning for me.  Not sure what to do with the title as I will no longer be “suturing” for a living, but for now it will stay the same.  I will update the header at some point.

Suture for a Living to Host Grand Rounds

I’ll be your host next Tuesday, August 23rd, for Grand Rounds Volume 7 Number 48.   It will be my fifth time as host of this the weekly compilation of the best of the medical bloggers.  I have no specific theme in mind, but if you need a “spark of a suggestion” think of  changes:  schools are back in session, football season will soon begin, and there is just a hint of fall with no more triple digit weather here in the south.   Now apply that to medicine/surgery.

Submissions should be recent.  Please, only submit one (your best) post per blog.  Submissions are welcome until noon (CST) Monday August 22. 

Send an email to me ---  rlbatesmd(at)gmail(dot)com  ---   with Grand Rounds in the subject line.  Please help me out by including your site name, site url, your post  title, post url, your name and a sentence or two about why you think your submission is great. 

 

In the meantime check out my previous four editions:

Grand Rounds 4:33 (May 6, 2008)

Grand Rounds Vol. 5 No. 52 (September 15, 2009)

Grand Rounds Vol 6, No 26 (March 23, 2010)

Grand Rounds Vol 7 No 20 (February 8, 2011)

Shout Outs

Dr. Pullen  is the host for this week’s Grand Rounds. You can read this week’s edition here (photo credit).

I think I learned my lesson this time.  The first two times I hosted Grand Rounds many of the posts seemed to come from happy bloggers.  I think the lesson this time is don’t be a host when all the news is bad.  Maybe it’s the drought and heat wave in much of the U.S.  Or maybe using the words of Bill Clinton “It’s the economy, Stupid.”  For whatever the reason this week’s Grand Rounds is dominated by rants and whines from bloggers around the globe.  ………  To try to have some fun with emotions I decided to try to draw a sketch to give you an idea of the mood of the writer:

Dr Bates gets first position since she is hosting Grand Rounds next week.  She breaks the trend too in not being upset or angry.  She writes at Suture for a Living wondering How old is too old for cosmetic surgery?  Her answer?    ……….

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Interesting ethical question posed by the MedPage Today article by Mikaela Conley:  Harvesting Dead Girl's Eggs Raises Ethical Issues

An Israeli court has granted permission for family members to extract and freeze the eggs of its 17-year-old daughter, who died earlier this month in a car accident, according to the Israeli English-language website Haaretz.  ……..

"Ethically, the important issue is not whether the woman would have wanted children," said Rosamond Rhodes, director of bioethics education at Mount Sinai School of Medicine in New York. …..

Instead, Rhodes said the critical issue is whether Chen would have wanted her biological children to come to life after she was dead.  ……….

The comments are interesting, also.  Personally (remember I don’t have any children, unable to get pregnant), I don’t think it would be a good idea.  I lost my father when I was 8.  I can’t imagine being a mother-less child.

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H/T to @Skepticscalpel for the tweet  which linked to this NY Times Health article -- “Beautifully written by a patient’  --  Opinion: I Won’t Have the Stomach for This

I AM a ravenous, ungraceful eater. I have been compared to a dog and a wolf, and have not infrequently been reminded to chew. I am always the first to finish what’s on my plate, and ever since I was a child at my mother’s table, have perfected the art of stealthily helping myself to seconds before anyone else has even touched fork to frog leg. My husband and I have been known to spend our rent money on the tasting menu at Jean Georges, our savings on caviar or wagyu tartare. We plan our vacations around food — the province of China known for its chicken feet, the village in Turkey that grows the sweetest figs, the town in northwest France with the very best raclette.

So it was a jarring experience when, a few months ago, at 36 years old, I learned I had stomach cancer.   ……….

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H/T to @EvidenceMatters for the link to another article on food and a human’s relationship to it (as EM put it: Read it: it probably isn't what you think.)  by @fatnutritionist:  If only poor people understood nutrition.

It seems like some people are constantly wringing their hands about how poor people eat (to wit: badly.) And the most popularly proposed solution is to teach them (“them”) more about nutrition! Or educate them in general.……….

Here comes the part where I bust up that nice, warm bubble bath. ……..

Because getting enough to eat is always our first priority.  …………….

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A nice post from @DrJenGunter: What is a menstrual cup and why should I use one? (photo credit)

A menstrual cup is exactly what you think it is: a cup to catch menstrual fluid. The concept has been around since the 1930’s, but has recently become more popular. Some cups are made of rubber, but allergies to latex and other components of rubber are increasingly more common so the best option is a cup made of medical grade silicone, which is hypoallergenic………….

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An informative post from @drfiala, PSB - the Orlando plastic surgery blog:   New side-effects from Propecia? (photo credit)

For those users of Propecia - used for hair loss in men, and Proscar - used for the treatment of benign prostatic hypertrophy (BPH) in men, here is a new concern raised by Health Canada, which is the Canadian version of the FDA.

Apparently, prescription drugs Propecia and Proscar seemed to be linked to rare cases of male breast cancer. ……….

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Isn’t this just an absolutely beautiful quilt?!!!  I don’t know much about it.  It was shared with me on Google+ by Alex Veronelli

 

Management of Latex Allergic Surgical Patient

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. 

A couple of nice articles recently on latex allergy have crossed my path – one in a journal I subscribe to (Aesthetic Surgery Journal) and the other via twitter and @Allergy  (Ves Dimov, M.D., blogs at Allergy Notes).  I’ve put both full references below.

Latex allergy became widely recognized in the late 1980s and early 1990s.  The increase in latex allergies cases is felt to be associated with the increase use of latex gloves and implementation of universal precautions (now known as standard precautions) in the 1980s.

Management of possible or confirmed latex allergic patients begin with history and suspicion:

All patients who present for surgical procedures or exams which require latex gloves (pelvic exam, dental exams, etc) should be questioned about possible latex allergy.

Patients at highest risk include those who have a history of multiple surgeries (especially for urogenital abnormalities which may require frequent urinary catheterizations), allergic disease, or spina bifida, or who are employed in occupations with inherent latex use (ie, healthcare workers).

If an individual patient notes a history of food allergies (atopy), pay special attention if those foods include banana, kiwi, avocado, or stone fruits like cherries or peaches which are associated with latex allergy.

Regardless of the cause, the presence of hand dermatitis is a risk factor for developing latex allergy among healthcare workers

Confirmation of latex allergy is achieved through laboratory testing.  Dr. Dimov has a nice post which explains this:  Latex Allergy - ACAAI Video

Confirmation should be done if there is time.  If not, then proceed as if the patient is latex allergic.

Here’s my check list:

1.  When I schedule the procedure, I inform the facility so they can prepare using their own check list (ie special cleaning of room and anesthesia equipment, pulling of latex free supplies, labeling room as latex-free, etc).

2.  I schedule latex-sensitive/allergic patients as the first case of the day.  This assumes it is an elective case and not an emergency.

3.  If I need girdles or other postoperative garments, I make sure they are latex-free when I order them.

……

The second article (the one from Dr. Dimov) takes a look at hospital policies which ban the use of natural rubber latex (NRL) devices and whether they may be an overreaction.

Their conclusions (bold emphasis is mine):

With the reduced incidence of allergic reactions, the availability of specific and sensitive testing for the selection of low-allergen gloves, competitive costs and lower environmental impact, NRL remains an excellent choice of material for medical gloves and should continue to be used.

In recent years, a number of high profile institutions have moved to a totally NRL-free environment, including gloves. However, the evidence within Europe demonstrates that the many benefits of NRL can be retained by purchasing low-allergen, low-protein and powder-free gloves, thereby reducing the risk of type I and type IV sensitization as well as allergic reactions.

NRL gloves are characterized by a high level of barrier performance for staff and patients, good comfort allowing staff to perform safely and efficiently, and competitive pricing in a period of economic difficulty. NRL is an environmentally sustainable material, which is also naturally biodegradable, enabling hospitals to meet their ‘green’ purchasing requirements.

Finally, compared with various synthetic materials, NRL is generally better accepted by the clinicians. There will, of course, be a continuing requirement for synthetic gloves for known latex-allergic patients and staff, and for these purposes several options are currently available. In conclusion, we believe that a sensible balance requires a mix of latex and synthetic gloves.

 

REFERENCES
Recognition and Management of the Latex-Allergic Patient in the Ambulatory Plastic Surgical Suite;  Deborah Accetta and Kevin J. Kelly; Aesthetic Surgery Journal July 2011 31: 560-565, first published on June 1, 2011 doi:10.1177/1090820X11411580
Latex Medical Gloves: Time for a Reappraisal; Palosuo T, Antoniadou I, Gottrup F, Phillips P; Int Arch Allergy Immunol 2011;156:234-246 (DOI: 10.1159/000323892)

Ohio Star Color Wheel

A few weeks ago I posted the color wheel kit I purchased years ago and finally got around to making.  This was made from some of the left over fabric and uses all the colors of the wheel.  It is an Ohio Star block within an Ohio Star block framed with a dark blue fabric.  I machine pieced and quilted it.  The wall hanging measures 24.5 in square.

Here is a close view of the center to show the quilting done with a light to medium blue thread.
Here is the back (the fabric is actually the dark blue used for the quilt border on the front of the quilt.  It looks washed out here.

Herr – Designer of His Own Limbs

 Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active.

Yesterday, I was able to catch the interview on NPR’s Fresh Air of Hugh Herr by Terry Gross:  The Double-Amputee Who Designs Better Limbs  (photo credit)

It’s worth reading or listening to.  Here’s the beginning:

Hugh Herr's legs were amputated below his knees in 1982 after a climbing accident. From his knees down to the floor, he's completely artificial.

"I'm titanium, carbon, silicon, a bunch of nuts and bolts," he tells Fresh Air's Terry Gross. "My limbs that I wear have 12 computers, five sensors and muscle-like actuator systems that able me to move throughout my day."

But Herr doesn't just wear artificial legs. He designs them, too. As the director of the Biomechatronics Group at the MIT Media Lab, Herr and his team are responsible for creating prosthetic devices that feel and act like biological limbs. They are also one of the subjects in Frank Moss' new book, The Sorcerers and Their Apprentices: How the Digital Magicians of the MIT Media Lab are Creating the Innovative Technologies That Will Change Our Lives.

Moss, the former head of the MIT Media Lab, profiles several of the researchers who are working on inventions that could change the way we move, socialize and interact with computers.  ……….

Related posts:

Amputations, Prosthetics, and War (February 13, 2008)

Facial Prosthetics Restores Face (August 5, 2010)

Rejection  (December 1, 2010)

Facing Monday  (January 24, 2011)

Rebuilding the Face Injured by War (March 2, 2011)

Ageism and Plastic Surgery

 Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active.

I admit that over the years my idea of “how old is too old” has changed.  Part of that is my increasing age, but a bigger part has come from the patients themselves – the 72 year old woman with a deflated NS implant who wanted it replaced rather than removed, etc.

Never Too Old for Plastic Surgery  (photo credit) By Tara Parker-Pope

If you think you’re too old for a few nips and tucks, consider the story of 83-year-old Marie Kolstad. ……….

To learn more, read Abby Ellin’s article “The Golden Years, Polished With a Nip and a Tuck,” …….

Don’t forget to read the comments of Parker-Pope’s article.

Still I have mixed feelings about what I see as not “aging gracefully” and tend to agree more with bioethicist Carl Elliott who is mentioned in Gary Schwitzer’s post:  Some reactions to NY Times' "Never Too Old for Plastic Surgery"

Minnesota bioethicist Carl Elliott wrote a book, "Better Than Well: American Medicine Meets the American Dream." In it, he wrote:

"We need to understand the complex relationship between enhancement technologies, the way we live now, and the kinds of people we have become."

I asked for his comment on the NY Times story, and he wrote:

"Everyone agrees that one root of the problem is toxic social pressures. The problem is that giving in to these pressures just reinforces them. The more cosmetic surgery older people get, the more social pressure that other older people feel to get the surgery themselves. (And articles like this just make the problem worse.)

Also, does anyone really think that cosmetic surgery actually makes these people look younger? What it really does is make them look as if they've had work done. And having work done is not so much a marker of youth as it is of money."

When is someone too old for plastic surgery?  There’s not an easy answer.  I think it comes down to an individual.  To their health.  To their reasons.  To their expectations. 

Related posts:
Suitability  (January 3, 2008)
“Suitable” for Plastic Surgery? (January 14, 2010)
Psychological Considerations of the Bariatric Surgery Patient Undergoing Body Contouring Surgery--An Article Review (September 22, 2008)

Shout Outs

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. 

Dr. Deb Serani is the host for this week’s Grand Rounds. You can read this week’s edition here (photo credit).

Grand Rounds is a weekly round up of the best health blog posts on the Internet. Each week a different blogger takes turns hosting - me this time around - and summarizes the submissions of the week.

As a music lover, I thought I'd give Grand Rounds a vintage vinyl feel. So please make sure your phonographs are ready to go. Thanks to Dr. Val Jones and Dr. Nick Genes for the invite.   ……….

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I had already read this MiM post by Cutter (surgery resident), Not just us anymore, before @MotherinMed tweeted

Perfect companion reading to last MiM post: Bringing Out the Mother in All of Us. (by @paulinechen) http://nyti.ms/rdrxia

She is so right. I don’t think it matters which order you read them in, but I go read both of them.

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H/T to @MotherinMed for tweeting the link to this NY Times op-ed piece written by Dr. Ezekiel Emanu: Shortchanging Cancer Patients

RIGHT now cancer care is being rationed in the United States.
Probably to their great disappointment, President Obama’s critics cannot blame this rationing on death panels or health care reform. Rather, it is caused by a severe shortage of important cancer drugs.
Of the 34 generic cancer drugs on the market, as of this month, 14 were in short supply. ……….

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H/T to @krupali and @paulinechen for the link to the Slate article by Meghan O'Rourke and Leeat Granek: How To Help Friends in Mourning -- Condolence notes? Casseroles? What our grief survey revealed. (bold emphasis is mind)

……….The most surprising aspect of the results is how basic the expressed needs were, and yet how profoundly unmet many of these needs went. Asked what would have helped them with their grief, the survey-takers talked again and again about acknowledgement of their grief. They wanted recognition of their loss and its uniqueness; they wanted help with practical matters; they wanted active emotional support. What they didn't want was to be offered false comfort in the form of empty platitudes. Acknowledgement, love, a receptive ear, help with the cooking, company—these were the basic supports that mourning rituals once provided …….

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Medgadget’s post, Animated Anatomies Exhibition of Historical Anatomy Flap Books, prompted me to ask @UAMSlibrary (my medical school) if they had any of them. They replied they would check and get back to me. And they did (photo credit):

Historical Anatomy Flap Books at UAMS http://on.fb.me/plDXqw (cc: @rlbates)

I think I may have to find the time to go look at the ones here locally.

……………………………….

H/T to @DrVes for the link to the article on Computer Vision Syndrome [INFOGRAPHIC]. From the piece comes this good advice – remember the 20-20-20 rule. Every 20 minutes take a 20 sec break to look away from the screen at something 20 feet away.

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CNN reporter Matt Sloane is following Diana Nyad’s swim from Cuba to Florida -- Nyad: Today's swim shows 60s 'not too late' for goals (August 8, 2011)

Editor's note: CNN alone will be in the support boats with Diana Nyad on her attempt to swim from Cuba to Florida. @MattCNN will be Tweeting live. CNN.com and The Chart will have a position tracker.

(CNN) -- Diana Nyad's personal test has begun. At 7:45 p.m. ET she jumped into the water and began her 103-mile swim between Cuba and Florida. ……….

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Why Quilts Matter: History, Art & Politics is a nine-part documentary series which will be available to PBS stations nationwide this fall.  I sure hope my local station carries it.

"Why Quilts Matter: History, Art & Politics" - Independent Production from The Kentucky Quilt Project, Inc. from The Kentucky Quilt Project, Inc. on Vimeo.

Review of NSAIDs Effects & Side Effects for Arthritis Pain

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. 

Recently I gave in and went to see a rheumatologist after more than 3 months of intense morning stiffness and swelling of my hands (especially around the PIPs and MCPs) and wrists which improved during the day but never went away.  It had gotten to the point where I could no longer open small lid jars (decreased strength), do my push-ups or pull ups (pain and limited wrist motion), and OTC products (Tylenol, Advil, etc) weren’t working.  I can’t take Aleve due to the severe esophagitis it induces.  I didn’t want to write a prescription for my self-diagnosed (without) lab arthritis.

BTW, all the lab work came back negative with the exception of a slightly elevated sed rate and very weakly positive ANA.  The rheumatologist was impressed with the swelling, pain, and stiffness and was as surprised as I by the normal lab work.  He thinks (and I agree) that I am in the early presentation of rheumatoid arthritis.  He wrote a prescription for Celebrex and told me to continue with the Zantac I was already taking (thanks to the Aleve).  The Celebrex is helping.

So I was happy to see this article (full reference below) come across by twitter feed.  H/T to @marcuspainmd: Useful review of NSAIDs effects & side effects for arthritis pain http://cot.ag/oHxQDX

A major disadvantage of NSAID use is the gastrointestinal side effects. These range from abdominal pain, nausea, diarrhea, and dyspepsia to more serious events, such as gastric or duodenal ulcers, anemia, and bleeding, or perforated ulcer. These side effects are due to the simultaneous inhibition of COX-1 and COX-2.

As many as 25% of chronic NSAID users will develop ulcer disease
2%–4% will bleed or perforate, especially those who have been designated as being in a high-risk category
The overall risk for these complications in patients taking NSAIDs was approximately 2.4.

High-risk patients are those with a history of complicated peptic ulcer disease or multiple (at least two) risk factors; moderate-risk patents are those with one to two risk factors, ie, age 65 years, high-dose NSAID therapy, previous history of an uncomplicated ulcer, concurrent use of aspirin (including low-dose), corticosteroids, or anticoagulants; and low-risk patients are those with no risk factors.

The two methods employed to prevent the development of peptic ulceration and mucosal injury in patients taking NSAIDs:

(1) prophylaxis with a proton pump inhibitor or a prostaglandin analog (such as misoprostol) or high-dose histamine 2-receptor antagonist (H2RA)
(2) with substitution of a traditional NSAID by a COX-2 inhibitor
The article on ulcer formation in COX-2 (Celebrex) vs NSAIDS:

Goldstein et al14 determined gastroduodenal damage
from endoscopy after 4, 8, and 12 weeks of treatment with celecoxib 200 mg twice daily or naproxen 500 mg twice daily in 537 patients with osteoarthritis or rheumatoid arthritis.

The cumulative incidence of gastric and duodenal ulceration for celecoxib was 9% and for naproxen was 41%. In the group that received celecoxib, the occurrence of ulcers was significantly associated with a number of factors, including H. pylori positivity, concurrent aspirin usage, and a history of ulcers.

It’s a really nice review article and is open source.



REFERENCES
Combination therapy versus celecoxib, a single selective COX-2 agent, to reduce gastrointestinal toxicity in arthritic patients: patient and cost-effectiveness considerations;  Marina Scolnik, Gurkirpal Singh; Open Access Rheumatology: Research and Reviews 2011:3 53–62

Scrappy Kite Quilt

I love to use up scraps of fabric in quilts.  This one turned into a kite.  I used a wide velour rick-rack for the tail of the kite.  The quilt is machine pieced and quilted.  It measures 34 in X 46 in.

Here you can see some of the fabrics in closer detail.  Find the dogs, the steer, the hippo, and the girl with the pinwheel.
Here is the bottom of the kite.  You can better appreciate the tail with its bows.  See the football player and the pink rabbit?
The back of the quilt to show the quilting.

Timing of Radiotherapy in Implant-Based Breast Reconstruction

 Updated 3/2017-- all links (except to my own posts) removed as many no longer active.

As Jackie Fox, Dispatch From Second Base, writes the choices after getting diagnosed with breast cancer can be overwhelming.  These choices (dependent on type and stage of breast cancer, desire for reconstruction, treatment needed, etc) can make the timing tricky when it comes to radiotherapy and reconstruction choices. 

The current issue of Plastic and Reconstructive Surgery Journal (first reference below) seeks to shed some light on the question of timing in implant-based breast reconstruction.

The authors looked at three populations  who received implant-based reconstruction from October of 2003 to October of 2007, a total of 257 patients (mean age, 49 years) were prospectively involved in this study.  All patients underwent a two-stage immediate breast reconstruction with subpectoral temporary expanders (ST 133; Allergan, Inc., Irvine, Calif.) and permanent implants (ST 410-510; Allergan).  Median followed up was 50 months.

• The first population (group 1, n = 109 patients) was made up of women affected by early-stage breast cancer with extensive nodal involvement that required postmastectomy radiotherapy and adjuvant chemotherapy.  This group received radiation on permanent implants (radiotherapy plus permanent implants).
• The second population (group 2, n = 50 patients) was made up of patients with locally advanced breast cancer who preoperatively were candidates for radiotherapy and who received chemotherapy before surgery.  This group  received radiation during the expansion phase of STE (radiotherapy plus tissue expanders).
• A third population (n = 98 patients) who did not receive radiotherapy was included as a control group.

The estimate of the totally failed reconstruction rate was the principal endpoint of this study. Capsular contracture rates and patients' and surgeons' subjective evaluations were the secondary endpoints.

Highlights of the study:

The totally failed reconstruction rate was significantly higher in group 2, with 40% (20/50) of unsuccessful reconstructions, compared with 6.4% (7/109) in group 1 and 2.3% (2/98)  in the control group (p < 0.0001).

Half (10/20) the failed reconstructions in group 2 involved those stopped at the first stage with removal of temporary expander for extrusion (5 cases) or infection (5 cases).

The other half of the failed reconstructions in group 2 occurred during the second stage and were converted to flap surgery --  2 due to extrusion, 3 due to infection, and 5 due to poor results (e.g., asymmetry, Baker grade IV capsular contracture).

The 7 failures in group 1 were due to severe capsular contracture (5), wound dehiscence (1), and an infection that required implant removal (1).

The incidence of Baker grade IV capsular contracture rate was significantly higher for group 1 (10.1%) and group 2 (13.3%) compared with the control group which did not receive any radiation (0%),  p = 0.0001).

The shape assessment performed by the surgeons demonstrated a higher incidence of good results in group 1, although the highest value was still reported in the control group (group 1, 58.7 %; group 2, 30.8 %; control group, 74.2 %; p = 0.0009).

The estimate of patients' opinions demonstrated a higher prevalence of good results in group 1 in comparison with group 2, although as with the surgeons assessment it was highest in the control group (good opinion: group 1, 52.2%; group 2, 46.2%; and control group, 68.1%; p = 0.04)

The study authors conclusions:

This study demonstrated that a higher total failure rate affects breast reconstructions that undergo irradiation during tissue expansion. For this reason, we suggest that if tissue expansion can be performed during postoperative chemotherapy, chest wall irradiation should be delivered on permanent implants. The second surgical step can be scheduled 3 weeks after the end of chemotherapy, and the irradiation should not begin more than 3 weeks later. Patients whose need for radiotherapy is not known preoperatively can, in this way, improve their surgical outcome.

REFERENCES

Outcome of Different Timings of Radiotherapy in Implant-Based Breast Reconstructions; Nava, Maurizio B.; Pennati, Angela E.; Lozza, Laura; Spano, Andrea; Zambetti, Milvia; Catanuto, Giuseppe; Plastic & Reconstructive Surgery. 128(2):353-359, August 2011; doi: 10.1097/PRS.0b013e31821e6c10

BreastCancer.org:  When Is Radiation Appropriate?, last updated August 6, 2008

New Composite Material

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active.

Yesterday, I came across this press release from John Hopkins regarding a new composite material which may someday be used to restore damaged soft tissue.  (photo credit)

The liquid material is a composite of biological and synthetic molecules which is injected under the skin.  Transdermal light is then used to "set" the material into a more solid structure.

The results of the early experiments in rats and humans has been reported in the July 27 issue of Science Translational Medicine (full reference below).

It is hoped that the new liquid material is a biosynthetic soft tissue replacement composed of poly(ethylene glycol) (PEG) and hyaluronic acid (HA).

From the press release

"Implanted biological materials can mimic the texture of soft tissue, but are usually broken down by the body too fast, while synthetic materials tend to be more permanent but can be rejected by the immune system and typically don't meld well with surrounding natural tissue," says Jennifer Elisseeff, Ph.D., Jules Stein Professor of Ophthalmology and director of the Translational Tissue Engineering Center at the Johns Hopkins University School of Medicine. "Our composite material has the best of both worlds, with the biological component enhancing compatibility with the body and the synthetic component contributing to durability."

The researchers created their composite material from hyaluronic acid (HA), a natural component in skin of young people that confers elasticity, and polyethylene glycol (PEG), a synthetic molecule used successfully as surgical glue in operations and known not to cause severe immune reactions. The PEG can be "cross-linked"—or made to form sturdy chemical bonds between many individual molecules—using energy from light, which traps the HA molecules with it. Such cross-linking makes the implant hold its shape and not ooze away from the injection site, Elisseeff says.

To develop the best PEG-HA composite with the highest long-term stability, the researchers injected different concentrations of PEG and HA under the skin and into the back muscle of rats, shone a green LED light on them to "gel" the material, and used magnetic resonance imaging (MRI) to monitor the persistence of the implant over time. The implants were examined at 47 and 110 days with MRIs and removed. Direct measurements and MRIs of the implants showed that the ones created from HA and the highest tested concentration of PEG with HA stayed put and were the same size over time compared to injections of only HA, which shrank over time.

The researchers evaluated the safety and persistence of the PEG-HA implants with a 12-week experiment in three volunteers already undergoing abdominoplasty, or "tummy tucks." Technicians injected about five drops of PEG-HA or HA alone under the belly skin. None of the participants experienced hospitalization, disability or death directly related to the implant, which was about 8 mm long—or about as wide as a pinky fingernail. However, the participants said they sensed heat and pain during the gel setting process. Twelve-weeks after implantation, MRI revealed no loss of implant size in patients. Removal of the implants and inspection of the surrounding tissue revealed mild to moderate inflammation due to the presence of certain types of white blood cells. The researchers said the same inflammatory response was seen in rats, although the types of white blood cells responding to implant differed between the rodents and humans, a difference the researchers attribute to the back muscles— the target tissue in the rats—being different than human belly fat.

It will be interesting to watch how this develops.




REFERENCE
New Composite Material May Restore Damaged Soft Tissue; John Hopkins Medicine, August 1, 2011

Photoactivated Composite Biomaterial for Soft Tissue Restoration in Rodents and in Humans; Hillel AT, Unterman S, Nahas Z, Reid B, Coburn JM,  Axelman J, Chae JJ, Guo Q, Trow R, Thomas A, Hou Z, Lichtsteiner S, Sutton D, Matheson C, Walker P, David N, Mori S, Taube JM, and Elisseeff JH; Sci Transl Med 27 July 2011: Vol. 3, Issue 93, p. 93ra67; DOI: 10.1126/scitranslmed.3002331

Shout Outs

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. 

James Logan, MD is the host for this week’s Grand Rounds. You can read this week’s virtual tour edition here.

Remember the days when one accessed the internet by using a telephone line to dial up an isp? For that matter, remember when one made telephone calls using an actual telephone line? Well, for this blogger, that day has returned. I very foolishly agreed to host grand rounds during the week after a move to a new apartment (still no agreement on a new dining room table, by the way) not realizing that our high speed internet would not yet be set up during the time I would be preparing this post. No matter. I temporarily have free dial-up access! Hence, this grand rounds is going to be a tribute to Web 1.0 and the various deprecated tags of HTML 4. Comments, of course, are still enabled. ……….

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Elaine Schattner, M.D, Medical Lessons, discusses the recent news regarding mammograms in her recent post:  Mammography Update

This week I’ve come across a few articles and varied blog posts on screening mam­mog­raphy. The impetus for rehashing the topic is a new set of guide­lines issued by the American College of Obste­tri­cians and Gyne­col­o­gists. That group of women’s health providers now advises that most women get annual mam­mo­grams starting at age 40.

Why every year? I have no idea. To the best of my knowledge, there are no data to support that annual mam­mo­grams are cost-​​effective or life-​​saving for women in any age bracket at normal risk for BC. ….

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Really loved this story reported on ABC Evening News this past week:  Dog Raises Over $17,000 After Running Marathon for Cancer Research (photo credit)

In 2008, when his new family adopted him, Dozer the Goldendoodle was the only pup left in the litter.

"He was the last of the bunch," said Rosana Dorsett, Dozer's owner. "He was the dog no one wanted ... but he's got a great heart."

It made Dozer kind of an underdog. But fast forward three years to the day of the Maryland Half Marathon -- a 13-mile race for cancer research -- and this pup found his way to the front of the pack. ……

The article includes a great video.  Go watch it!

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H/T to @KentBottles  for the link to this Salon article by Mandy Van Deven:  The neuroscience of disgust

We all have things that disgust us irrationally, whether it be cockroaches or chitterlings or cotton balls. For me, it's fruit soda. It started when I was 3; my mom offered me a can of Sunkist after inner ear surgery. Still woozy from the anesthesia, I gulped it down, and by the time we made it to the cashier, all of it managed to come back up. Although it is nearly 30 years later, just the smell of this "fun, sun and the beach" drink is enough to turn my stomach.

But what, exactly, happens when we feel disgust?
………….

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Check out LITFL weekly review of the “webbed world of emergency medicine and critical care”  -- LITFL Review 029

……… Broome Docs:  Top spot this week heads up north to Casey Parker with his brilliant take off of the hit song “If you are happy and you know it.” If you’ve just come of a weekend of dealing with drunks, punks and personality disorders your bound to be singing this all the way to your next shift. Maybe we could even use the song as a preventative health measure and play it in the waiting room? 

“If you are angry and you know it, punch a pillow.

If you are angry and you know it, punch a pillow.

Don’t punch your wife, or the fridge or a window -

If you are angry and you know it punch a pillow!

If you are sad and you know it, call a friend. ….”

……….…….

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Check out DinoDoc’s post: Overkill

I saw a lady with a boil. It began as a small red bump which got bigger and harder, then drained white stuff, and was now getting better.

The reason she was worried about it was its location: it was on her breast. This was why the chief complaint officially read, “Breast lump” despite the fact that it was technically no such thing.

I examined her carefully, determining that the pathologic process was indeed confined to the skin and clinically did not involve the actual breast tissue in any way. However because she was of an age for screening mammography, I did take the opportunity to urge her to have it; which she did. The problem arrived with the radiology report:    …………..

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Tomorrow, Wednesday Aug 10th, Dr. Tony Youn will be doing a live online reading from In Stitches via Livestream at 5:30pm ET at www.livestream.com/dryoun.    There will also be a live Q&A where viewers can ask questions and get them answered by Dr. Youn in real time.  Dr. Yong blogs at Celebrity Cosmetic Surgery and can be followed on twitter:  @TonyYounMD.  (photo credit)

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I recently discovered another sewing blog:  the Dreamstress.  This post is for the sewer and the shoe lover:  Greek key shoes – swoon  (photo credit)

As we all know, I’m really into Greek keys.
My current Greek key  obsession is these evening boots:

……….I like the idea of the shoes, but really, I couldn’t handle them in person.  It’s just too much shoe for me

Is Prophylactic Mastectomy Worth It?

Updated 3/2017--  all links (except to my own posts) removed as many no longer active. 

There is a recent article which asks this question (full reference below).  I think it is a question which must be answered on an individual basis.  

For someone like me, the answer would be no.  I have no family history or personal history of breast cancer.  I have small, more dense than fatty breast, but have always had normal mammograms.  I have never had any lesions which needed biopsy.

For an individual woman with a strong family history of breast cancer (especially genetically proven, BRCA1 and BRCA2) and a person history of breast cancer (ie right mastectomy for lobular carcinoma), then it is easy to say “Yes, a prophylactic left mastectomy would be worth it for you.”

In between these two examples is the gray area, and this article doesn’t necessarily make the gray area any clearer.

There is plenty of evidence that prophylactic mastectomy lowers the risk of breast cancer in the high–risk population in at least 95%.

The authors of the June 2011 Aesthetic Plastic Surgery Journal article performed a retrospective study by reviewing the records of all their patients (n=52) who underwent prophylactic mastectomy within a 25-year period to look at the aesthetic and long-term oncologic outcomes, complications, and patient satisfaction.

Of the 52 patients, 40 had the surgery on one side only (contralateral prophylactic mastectomy) and 12 had bilateral (bilateral prophylactic mastectomy), giving a total of 64 prophylactic mastectomies.

Of the 52 patients/ 64 mastectomies, there was 1 (1.56%) case of unexpected breast cancer in the mastectomy specimens.

Two thirds (42/64) were subcutaneous prophylactic mastectomies and the other third (22/64) were simple total prophylactic mastectomies.

Most of their patients chose to have reconstruction with implants (58/64 = 90.62%) while the other 6 (9.37)  chose to use autologous tissue --  5 (7.81%) received latissimus dorsi flaps with implants and 1 (1.56%) had a TRAM flap.

The complications included 4 (6.25%) breasts that developed capsular contracture, 2 (3.12%) cases of hematoma, and 1 (1.56%) infection.

More than 90% of the patients reported being either highly (39/52) or partially satisfied  (10/52).  Only 3/52 reported being unsatisfied. The authors report an overall aesthetic index of 8.8.

There were no deaths among their patients, nor any new development of breast cancer during the time period.

Related posts
Women Don’t Regret Prophylactic Mastectomy (May 5, 2011)

Prophylactic Mastectomy (January 28, 2009)

Advances in Nipple-Sparing Mastectomy – an article review (April 27, 2011)

Are Patients Making Good Decisions About Breast Reconstruction? (February 28, 2011)

REFERENCE

Prophylactic Mastectomy: Is It Worth It?; Jose Abel de la Peña-Salcedo, Miguel Angel Soto-Miranda, Jose Fernando Lopez-Salguero; Aesthetic Plastic Surgery, Volume 35 (3), June 2011;  DOI: 10.1007/s00266-011-9769-x

American Cancer Society:  What are the risk factors for breast cancer?