Minimally Invasive Stents Show Advantage Over Bypass Surgery

by Bidita Debnath on? August 07, 2013 at 11:05 PM Research News People who undergo minimally invasive placement of stents to open clogged leg arteries are significantly less likely than those who have conventional bypass surgery to need a second treatment for the condition within two years.
This research was suggested by Johns Hopkins. For now, bypass surgery remains the gold standard for treating symptoms of peripheral artery disease (PAD), but the Johns Hopkins researchers are hopeful that further study will confirm the advantage their study shows for the stents.

The researchers, reporting online in the Journal of Vascular Surgery, also found that both treatments were equally successful in restoring healthy blood circulation to the legs. But threading a stent through an artery through access in the groin and into the blocked leg vessel to create a wider path for blood requires no general anesthesia and is typically associated with shorter hospital stays and recovery times than open bypass, they add.

"We are constantly looking for the best way to improve quality of life for the 10 percent of the population who suffer from peripheral artery disease," says study leader Mahmoud B. Malas, M.D., M.H.S., an associate professor of surgery at the Johns Hopkins University School of Medicine, director of endovascular surgery and director of The Vascular and Endovascular Clinical Research Center at Johns Hopkins Bayview Medical Center. "Our study suggests the minimally invasive approach shows real promise, and we are embarking on a large, randomized study of the two procedures to develop guidelines that can be used for determining when a stent is likely to be best and when a bypass cannot be avoided."

PAD is a common circulatory problem in which narrowed arteries reduce blood flow to the limbs, a likely sign of a widespread accumulation of fatty deposits in the coronary and cerebral vessels, where blockages may lead to heart attacks and stroke, respectively. Without enough oxygen-rich blood flow to keep up with demand, people experience PAD's most notable symptom ? leg pain when walking. As the disease progresses, patients may develop gangrene or open sores that threaten the limb.

Once the pain is serious and chronic, even without walking, doctors consider manually bypassing the blockages. In contrast to minimally invasive stenting, a so-called femoral-popliteal bypass requires a large incision to open the leg, and the surgical attachment of a piece of vein or a synthetic tube above and below the blockage to reroute blood flow.

The small study, just published, was conducted by analyzing records from 104 patients with PAD who either got a stent or a bypass operation at Johns Hopkins Bayview Medical Center between September 2005 and September 2010. The average age of patients in the study was 68 years.

Patients who received stents had a 31 percent risk of needing another procedure to restore blood flow within 24 months, while those who received a bypass had a 54 percent chance of needing another intervention. The researchers found that women were twice as likely as men to need a second operation.

Malas cautions that patients in the stent group may have had better outcomes because 77 percent of them had what were considered smaller blockages, while 73 percent of those who had bypass surgery had larger ones. Physicians use a somewhat subjective measure to choice a treatment, confounding efforts to tease out clear guidelines about when to use stents or bypass.

It is most difficult to determine which course of action to take with medium-sized blockages, Malas says, noting that in his study, patients with longer blockages were more likely to have had a stent in the past that failed, so their diseases may have progressed further along.

Malas says he tells his patients how important it is to adopt healthy habits ? exercising, eating properly, taking aspirin and medications to control elevated cholesterol and not smoking ? to try to reduce the effects of PAD, which is a "cousin" of coronary artery disease. By the time they need surgical intervention, he says, their disease could not only be threatening their limbs, but their lives.

"We try to improve their quality of life, but stents and bypass won't cure the patient of PAD at this stage," he says. "We're improving circulation, but the disease is still there and it will continue to progress, so modifying other risk factors is a must."

Source-Eurekalert

var xmlHttpvar imgpath,imagefunction RefreshImage(ImageId){image=document.getElementById(ImageId);//alert(ImageId);xmlHttp=GetXmlHttpObject();if (xmlHttp==null) { alert ("Your browser does not support AJAX!"); return; } var url="http://www.medindia.net/captcha/captcha.asp";url=url+"?x="+Math.random();imgpath=url;xmlHttp.onreadystatechange=stateChangedReg;xmlHttp.open("GET",url,true);xmlHttp.send(null);} function stateChangedReg(){if (xmlHttp.readyState==4){image.src = imgpath;}}function RequestCode(){xmlHttp=GetXmlHttpObject();if (xmlHttp==null) { alert ("Your browser does not support AJAX!"); return; } var url="http://www.medindia.net/captcha/reqimgvalue.asp";url=url+"?x="+Math.random();xmlHttp.onreadystatechange=stateChangedReq;xmlHttp.open("GET",url,true);xmlHttp.send(null);} function stateChangedReq(){if (xmlHttp.readyState==4){var seccode=xmlHttp.responseText;if(seccode==document.getElementById("scode").value){//alert(seccode + "same value");}else{document.getElementById("scode").value=xmlHttp.responseText;}}}function GetXmlHttpObject(){var xmlHttpNew=null;try { // Firefox, Opera 8.0+, Safari xmlHttpNew=new XMLHttpRequest(); }catch (e) { // Internet Explorer try { xmlHttpNew=new ActiveXObject("Msxml2.XMLHTTP"); } catch (e) { xmlHttpNew=new ActiveXObject("Microsoft.XMLHTTP"); } }return xmlHttpNew;}function GetXmlHttpObject(){var xmlHttp=null;try { // Firefox, Opera 8.0+, Safari xmlHttp=new XMLHttpRequest(); }catch (e) { // Internet Explorer try { xmlHttp=new ActiveXObject("Msxml2.XMLHTTP"); } catch (e) { xmlHttp=new ActiveXObject("Microsoft.XMLHTTP"); } }return xmlHttp;} function fnsearch(){day1 = document.search.SelDay.value;month1 = document.search.SelMonth.value;year1 = document.search.SelYear.value;tmpdate=month1+"/"+day1+"/"+year1 fromdate=new Date(year1,month1-1,day1)if (!((fromdate.getDate()==day1)&&(fromdate.getMonth()+1==month1)&&(fromdate.getFullYear()==year1))){alert("Please Select a valid Date")document.search.SelDay.focus();return false;}tmpcatid=document.search.ncategoryid.value;tmpkeyword=document.search.keyword.value;document.search.action="http://www.medindia.net/news/newsday_list.asp?ddate="+tmpdate+"&ncategoryid=" +tmpcatid +"&keyword=" +tmpkeywordreturn true;}News Categories:?? Latest Health News Popular News AIDS/HIV News Alcohol & Drug Abuse News Alternative Medicine News Anti-Aging News Bird Flu News Cancer News Celebrity Health News Chikungunya News Child Health News Cholesterol News Clinical Trials News Corporate News Dengue News Dental News Diabetes News Diet & Nutrition News Drug News Education News Environmental Health General News Genetics & Stem Cells News Health Insurance News Heart Disease News Hospital News Hypertension News Indian Health News Lifestyle News Medical Gadgets Medical PDA News Medico Legal News Men?s Health News Mental Health News News on IT in Healthcare Nursing Profession News Obesity News Organ Donation News Research News Respiratory Disease News Senior Health News Sexual Health News Tropical Disease News Weight Loss Women Health News

View the original article here

Man With Ten-Stone Testicles Undergoes Surgery

Wesley Warren Jr accidentally squashed his testicles five years ago when he was getting out of his bed. Doctors tried to bring down the swelling through antibiotics but without any success.

Wesley was diagnosed to have scrotal lymphoedema, a severe build-up of fluid, which is an extremely rare condition found more commonly in Africa and south east Asia where it is caused by parasites. He tried to raise funds for surgery through donations but was stopped by social services before Californian consultant Dr Joel Gelman offered to perform the surgery free of cost provided Nevada's Medicaid system was willing to pay using a hospital theatre.

Stating that he now feels a great sense of comfort following the surgery, Wesley said, "I do feel a great sense of comfort that the weight is no longer between my legs. It got to the point that it was a danger to my health. But when I look down at what's here now it's not the same as what it was. It's totally different. My natural look prior to the growth is not what came out of surgery. What came out of surgery is a nub an inch long and it doesn't get any larger."

Source-Medindia

View the original article here

Herbal Supplement Use Popular in Cosmetic Surgery Patients

"It is extremely important to investigate the use of herbal medicines, as many of these supplements can put the surgical patient at risk," writes ASPS Member Surgeon Dr. Bahman Guyuron and colleagues of Case Western Reserve University, Cleveland. They advise patients to stop taking supplements at least two weeks before cosmetic plastic surgery.

Many Cosmetic Surgery Patients Use Herbal Supplements The researchers analyzed 200 patients undergoing cosmetic facial surgery (such as facelift surgery or rhinoplasty). The patients' preoperative medication lists were reviewed to determine how many patients were taking herbal supplements and what types they were using. More than 80 percent of patients were women; the average age was 45 years.

Forty-nine percent of patients were using at least one type of supplement. Vitamin and mineral supplements only?most commonly multivitamins, vitamin D, calcium and vitamin B?were used by 25% of patients. Twenty-two percent were taking animal- and plant-based supplements?most commonly fish oil?in addition to vitamins and minerals.

Only 2.5 percent of patients were taking animal and plant-based supplements only. Older patients and women were more likely to report supplement use.

Overall, patients reported taking 53 different types of supplements. The average number of supplements was 2.8 per patient, although one patient was taking 28 different supplements.

Many Linked to Bleeding or Other Risks Thirty-five patients were taking supplements that have been linked to an increased risk of bleeding, such as bilberry, bromelain, fish oil, flaxseed oil, garlic, methylsulfonylmethane (MSM), selenium and vitamin E. In Dr. Guyuron's practice, patients were advised to stop taking supplements two to three weeks before surgery. The researchers write, "Therefore, 17.5 percent of all patients?would have been at risk of bleeding" if they had not discontinued supplement use.

Dietary supplements are widely used in the United States. Since supplements are not regulated, there is a "severe lack" of data on their safety and effectiveness, according to Dr. Guyuron and colleagues. Because patients regard supplements as safe, "natural" products, they may not tell doctors about supplements when asked what medications they are taking.

However, many of these products have side effects that could lead to problems in surgical patients. In addition to the supplements potentially related to bleeding risk mentioned above, other popular supplements with potential adverse effects include echinacea, ephedra (ma huang), ginkgo, ginseng, kava, St John's wort, valerian, feverfew and ginger.

"These high risk supplements...are quite commonly used and the surgeon must elicit a complete history in order to avoid the known adverse consequences of supplement use on surgical outcome," Dr. Guyuron and coauthors write. They emphasize their policy of advising patients to stop taking supplements is consistent with current recommendations for preoperative patient evaluation.

Source-Eurekalert

View the original article here