An increasingly common surgical procedure for repairing spinal fractures might not be all it’s cracked up to be–in fact, the surgery had the same effect on patient’s pain as a placebo, two studies report in the New England Journal of Medicine.
The technique, called vertebroplasty, involves injecting medical cement into a fractured spine bone to strengthen it. More than 38,000 such procedures are done in the United States every year and the number has been [increasing] rapidly, nearly doubling from 2001 to 2005 [Reuters]. But the new studies showed that the procedure alleviated pain about the same amount as a placebo “surgery,” in which the physicians tapped on the spine and piped in the smell of cement to make groggy volunteer subjects believe they were receiving the real thing.
Researchers found that 36 volunteers who received sham surgery did just as well as 35 who got the real operation. A separate test, of 131 people at 11 medical centers, … also found that sham surgery produced a comparable degree of pain reduction and movement [Reuters].
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The first U.S. patient to receive a face transplant came forward yesterday to show off the results and to praise the doctors and the unnamed donor who made it possible. The 46-year-old Connie Culp underwent a 22-hour surgery in December to receive her new face. Her expressions are still a bit wooden, but she can talk, smile, smell and taste her food again. Her speech is at times a little tough to understand. Her face is bloated and squarish. Her skin droops in big folds that doctors plan to pare away as her circulation improves and her nerves grow, animating her new muscles. But Culp had nothing but praise for those who made her new face possible [AP].
Culp was severely disfigured by a shotgun blast to the face that left only her upper eyelids, forehead, lower lip, and chin intact. News reports prior to her surgery say she was shot by her husband in an apparent murder-suicide attempt in 2004. He also survived and is serving a seven-year prison sentence. In the years before the transplant, Ms. Culp had 30 different reconstructive surgeries, but none effectively restored the lost functionality [The Wall Street Journal]. She was unable to breathe unaided, eat solid food, smell, or smile.
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Within a few decades, a surgeon may be able to make a tiny incision in a patient’s artery and insert a miniature robot that would scoot along through the blood vessel to the area of concern. The microbot could remove blockages, scrape plaque off of artery walls, remove a few cells from an organ to test for cancer, or could even, eventually, carry a tiny camera to show doctors exactly what’s going on inside the body. In a major step towards that science fiction-tinged surgical scenario, researchers have built and demonstrated a motor about twice the width of a human hair that could power such a microbot.
Researcher James Friend says that miniature mechanics have been a long time coming. “If you pick up an electronics catalogue, you’ll find all sorts of sensors, LEDs, memory chips etc that represent the latest in technology and miniaturisation,” he says. “Take a look however at the motors, and there are few changes from the motors available in the 1950s” [BBC News].
Doctors already snake catheters through blood vessels in many procedures to reduce the impact of surgery, but some blood vessels, like the labyrinthine network in the brain, are too narrow and delicate to reach with current technology. But a microbot might be able to reach even these most sensitive areas, and could one day be used to remove clots from stroke patients’ brains in the emergency room. The researchers have tested their motor in human blood and artificial arteries and later this year it will begin experiments in pigs, whose arteries and brains are similar to humans, before proceeding to full-scale human trials [Telegraph].
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The next big break through in surgery might not be a sophisticated new tool or imaging device; instead, it may be a simple checklist that the surgical team has to run through before making the first incision. In a pilot study, researchers found that using the checklist cut the death rate following surgery by 47 percent, while the complication rate decreased by 36 percent. The procedure is simple: Surgeons and nurses run through a series of basic safety checks before each operation, similar to those made by pilots before take-off. The checks include asking: Is this the right patient? Is this the right limb? Has the patient had the right drugs? [The Independent]
The checklist is composed of 19 fairly obvious items, but lead researcher Atul Gawande says that even a small change, like having surgical team members take a moment to say who they are and what they do before scalpel touches skin, can have important consequences later on should one of them develop a concern during the operation. Earlier studies have shown that communication problems are fairly common in operating rooms, with junior members of the team sometimes hesitant to speak up. “Giving them a chance to say their names allows them to speak up later,” Dr. Gawande said [The New York Times].
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The first face transplant operation in the United States has been completed and initial results are positive, reports the medical team at the Cleveland Clinic. The patient, who had suffered severe facial disfigurement from trauma, had 80 percent of her face replaced with one taken from a cadaver, leaving only her own upper eyelids, forehead, lower lip, and chin. After the transplant, “I must tell you how happy she was when with both her hands she could go over her face and feel that she has a nose, feel that she has a jaw,” said the lead surgeon, Dr. Maria Siemionow [AP].
Although the woman’s identity and the nature of her trauma has not been revealed, doctors say her injuries were so severe that she lacked a nose and palate, and could not eat or breathe on her own without a special opening into her windpipe [AP]. The 22-hour-long surgery took place sometime in the last two weeks and is the most radical facial transplant ever attempted. Along with about 500 square centimeters of skin, the transplant also included bones, muscles, blood vessels, nerves, a nose, sinuses, the upper jaw, and even some teeth. The doctors hoped the operation would allow her to regain her sense of smell and ability to smile [AFP].
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Two years after receiving a dramatic face transplant, a Chinese man who was mauled by bear can eat, drink, and talk normally, doctors reported. Another patient, a Frenchman who suffered from a rare genetic disease that deforms the face, received a similar transplant one year ago and can now smile and blink, proving that the brain is restoring facial nerve connections.
Despite recurrent episodes of tissue rejection in the first year after their transplants, neither man had psychological problems accepting their new faces and have been able to rejoin society [Reuters]. Doctors say that the successes with these two men, who are only the second and third people to ever receive the operation, suggest that the procedure is safe and could one day become routine. “There is no reason to think these face transplants would not be as common as kidney or liver transplants one day,” said Dr. Laurent Lantieri, one of the French doctors [AP].
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Under a new law, California hospitals are supposed to report all serious medical errors to the state, and the first batch includes stories that will scare anyone with a looming hospital admission date. [D]uring a 10-month period ending in May, doctors performed the wrong surgical procedure, operated on the wrong body part or on the wrong patient 41 times, records show. During the same period, hospitals reported that foreign objects were left in surgical patients 145 times [AP].
Officially called “adverse events,” those accidents are also known as “never events” because they are considered preventable, and many safety experts say they should never happen [Los Angeles Times]. The new disclosures listed 1,002 cases that caused serious medical harm; under the new law, the public health department must begin to post all these cautionary tales on the Internet by 2015.
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It seems counterintuitive, because anesthetics are supposed to knock out patients and make them numb to all the jolts, jabs, and twinges of surgery. But a new study shows that many anesthetic drugs actually stimulate parts of the nervous system that sense pain, and can lead to increased discomfort after surgery.
Surgeons already knew that some knock-out drugs cause a burning sensation at the site of injection or in the lungs if the drug is inhaled, but the new research illuminates the mechanism of that response, and helps explain postoperative pain that was thought to be a result of the surgery exclusively. “Probably what is most significant for people to know is that this activation of a pain channel actually adds to post-surgery inflammation, so what we didn’t know before was that you could exacerbate swelling of surgery-damaged tissue with general anesthetics,” says Georgetown neuroscientist Gerard Ahern, who oversaw the new study [Science News].
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Gastric bypass surgery may seem a drastic option for someone battling obesity, but good results keep coming in: It works, and it appears to bring a host of health benefits. Last August, two studies showed that patients who tried the surgery had a reduced risk of dying from cancer; now a more specific study has demonstrated that the surgery cuts the risk of breast and colon cancer, the two most common forms.
Bariatric surgery is the only effective treatment for morbid obesity, according to the World Health Organization, and is usually performed using one of two different techniques. One focuses on reducing the size of the patient’s stomach alone, leading to decreased food intake. The second also reroutes food through the intestines, allowing fewer calories to be absorbed [Globe and Mail]. The surgery has already been shown to reduce risks of heart disease and diabetes, and the U.S. Medicare program is currently considering paying for the expensive surgery as a diabetes treatment.
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A week after the announcement that he has brain cancer, Senator Ted Kennedy will undergo surgery this morning in an attempt to remove the malignant tumor.
There had been speculation that Kennedy might avoid surgery since the tumor is in a sensitive part of the brain that controls language, a crucial chunk of gray matter for a politician and orator. Bolstering that impression, early releases from Kennedy’s doctors discussed a treatment plan of radiation and chemotherapy, but didn’t mention surgery.
But after a weekend meeting with cancer experts from the National Institutes of Health and the National Cancer Institute, Kennedy apparently decided to take his chances with the scalpel. Now, as the nation waits for news, attention has shifted to the surgery’s risks and possible outcomes.
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