Some women with abnormal breast lesions may avoid surgery

Main Category: Breast Cancer
Article Date: 01 Aug 2013 - 1:00 PDT
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Some women with abnormal breast lesions may avoid surgery

Surgery is not always necessary for women with a type of breast tissue abnormality associated with a higher risk of cancer, according to a new study published online in the journal Radiology. Researchers said that periodic imaging and clinical exam are effective in these patients when radiology and pathology findings are benign and concordant, or in agreement.

Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) are abnormal breast lesions that occasionally appear as incidental findings in breast biopsies. Women with ALH or LCIS have a four to 10 times higher risk of developing breast cancer, according to Michael A. Cohen, M.D., FACR, professor of radiology at the Emory University School of Medicine in Atlanta. As a result, it is often recommended that ALH and LCIS diagnosed on image-guided core biopsy be removed surgically.

"Because of the possibility of upgrade to cancer, the bulk of the published literature says that the prudent thing to do is excise ALH and LCIS," Dr. Cohen said.

But new research from Dr. Cohen, Kristen Atkins, M.D., and colleagues may alter that thinking.

Dr. Atkins is a pathologist and associate professor at the University of Virginia in Charlottesville, Va. At one time, Drs. Cohen and Atkins were colleagues there and had many discussions about balancing the risk of cancer in ALH and LCIS patients with the costs and potential complications of surgery.

"From a pathology perspective, ALH and LCIS are often very tiny lesions, so we wondered why they were getting excised," Dr. Atkins said. "These surgeries may involve general anesthesia and possible disfigurement."

The researchers studied 10 years of pathology and radiology data to look for a correlation between the number of ALH and LCIS cases that were upgraded to cancer after surgery or follow up and the concordance between the radiologist and pathologist.

The research yielded 50 cases from 49 women aged 40 to 73 years. Radiologist and pathologist findings were concordant in 43 of the 50 cases. None of the benign concordant cases were subsequently upgraded to cancer, strongly suggesting that observation in these patients would have been a viable alternative to surgery. Of the seven discordant cases, two were upgraded to ductal carcinoma in situ, or DCIS, an early-stage, noninvasive form of breast cancer.

Dr. Cohen repeated the study after moving to Emory and found the same results.

"When there's no discordance between the radiologist and pathologist after thorough radiology-pathology correlation, there's no upgrade from ALH or LCIS to cancer in our study," Dr. Cohen said. "These findings show that some women can avoid surgery, and that yearly mammograms along with MRI or ultrasound as second-line screening tools may suffice."

The researchers suggested that their findings will help physicians and patients make informed decisions about ALH and LCIS.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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"Atypical Lobular Hyperplasia and Lobular Carcinoma in Situ at Core Breast Biopsy: Use of Careful Radiologic-Pathologic Correlation to Recommend Excision or Observation." Collaborating with Drs. Cohen and Atkins were Brandi Nicholson, M.D., and Sandra Rao, M.D.

For patient-friendly information on mammography, MRI and ultrasound, visit RadiologyInfo.org.

Radiological Society of North America

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Study suggests average of 3 years of apparent age saved after facial plastic surgery, no consistent improvement in attractiveness

Main Category: Cosmetic Medicine / Plastic Surgery
Article Date: 01 Aug 2013 - 13:00 PDT Current ratings for:
Study suggests average of 3 years of apparent age saved after facial plastic surgery, no consistent improvement in attractiveness

A study suggests that after aesthetic facial plastic surgery the average number of apparent"years saved" (true age minus guessed age) was 3.1 years but there was only an insignificant increase in attractiveness scores, according to a report published by JAMA Facial Plastic Surgery, a JAMA Network publication.

Patients seek out aesthetic facial surgery to look younger and more attractive but there is minimal literature about the effect of the surgery on perceived age and attractiveness, according to the study background.

A. Joshua Zimm, M.D., of the Lenox Hill Hospital and Manhattan Eye, Ear & Throat Institute of North Shore-LIJ Health System, New York, and colleagues quantitatively evaluated the degree of perceived age change and improvement in attractiveness following surgical procedures.

Independent raters examined preoperative and postoperative photographs of 49 patients who underwent aesthetic facial plastic surgery between July 2006 and July 2010 at a private practice in Toronto, Canada. The photographs were shown to 50 blind raters. Patients in the study ranged in age from 42 to 73 years at the time of surgery with an average age of 57 years.

On average, raters estimated their patients' ages to be about 2.1 years younger than their chronological age before surgery and 5.2 years younger than their chronological age after surgery. The average overall years saved following surgery was 3.1 years, according to the results. There also was a small and insignificant increase in attractiveness scores in postprocedural photographs, the results indicate.

"In conclusion, the subjective nature of facial rejuvenation surgery presents a challenge in the assessment of successful results," the study concludes. "Given the limitations of the attractiveness component of this study as described herein, further investigation is warranted to verify these findings."

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JAMA Facial Plast Surg. Published online August 1, 2013. doi:10.1001/jamafacial.2013.268.

JAMA

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Physician bonuses help drive increases in laparoscopic colon cancer surgery with minimal benefits for patients, says McMaster study

Main Category: Colorectal Cancer
Article Date: 24 Jul 2013 - 2:00 PDT Current ratings for:
Physician bonuses help drive increases in laparoscopic colon cancer surgery with minimal benefits for patients, says McMaster study

Financial incentives for Ontario surgeons are likely a key factor driving greater use of laparoscopic colon cancer surgery, says a study led by a McMaster University surgeon.

The research, published online by the Annals of Surgical Oncology, found that between 2002 and 2009 there was an increase in laparoscopic versus traditional open techniques for colon and rectal cancer surgery. These increases were associated with only minimal decreases in how long patients stayed in hospital after surgery and no changes in the survival of patients.

The authors point out that in October 2005, the Ontario physician billing schedule was altered, providing surgeons with a 25% premium if laparoscopic rather than open techniques were used for colon cancer. Most of the incentives went to surgeons already enthusiastic about laparoscopic approaches.

"Our paper highlights two important issues," said principal investigator Dr. Marko Simunovic, an associate professor of surgery of McMaster's Michael G. DeGroote School of Medicine.

"First, in our publicly funded health care system we need to critically review the advantages and disadvantages of new expensive technologies or treatments before they're widely introduced into the province. Second, Ontario physicians provide high quality care to the best of their abilities - one should question the logic of financial incentives."

Simunovic added: "A 25% bonus for laparoscopic surgery sends a strong signal to surgeons that they should provide this service, even though the available evidence to date does not demonstrate superiority for laparoscopic versus open techniques."

The more expensive laparoscopic surgery usually results in a smaller visible scar and a slightly shorter hospital length of stay.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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The research was funded by Canadian Institutes for Health Research.

Annals of Surgical Oncology

DOI: 10.1245/s10434-013-3123-2

McMaster University

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University, M. (2013, July 24). "Physician bonuses help drive increases in laparoscopic colon cancer surgery with minimal benefits for patients, says McMaster study." Medical News Today. Retrieved from
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'Physician bonuses help drive increases in laparoscopic colon cancer surgery with minimal benefits for patients, says McMaster study'

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Preventing nerve injury during thyroid surgery by routine exposure of recurrent laryngeal nerve

Main Category: Ear, Nose and Throat
Also Included In: Endocrinology;  Neurology / Neuroscience
Article Date: 25 Jul 2013 - 1:00 PDT Current ratings for:
Preventing nerve injury during thyroid surgery by routine exposure of recurrent laryngeal nerve

Recurrent laryngeal nerve injury is the most common serious complication of thyroid surgery. Therefore, preventing recurrent laryngeal nerve injury is an important goal in thyroid surgery.

A retrospective clinical controlled study from Xinhua Hospital, Shanghai Jiao Tong University School of Medicine demonstrates that dissecting the recurrent laryngeal nerve during thyroid surgery is clinically significant for preventing nerve injury.

To determine the value of dissecting the recurrent laryngeal nerve during thyroid surgery with respect to preventing recurrent laryngeal nerve injury, this study retrospectively analyzed clinical data from 5 344 patients undergoing thyroidectomy. Among these cases, 548 underwent dissection of the recurrent laryngeal nerve, while 4 796 did not. There were 12 cases of recurrent laryngeal nerve injury following recurrent laryngeal nerve dissection (injury rate of 2.2%) and 512 cases of recurrent laryngeal nerve injury in those not undergoing nerve dissection (injury rate of 10.7%). This difference remained statistically significant between the two groups in terms of type of thyroid disease, type of surgery, and number of surgeries.

Among the 548 cases undergoing recurrent laryngeal nerve dissection, 128 developed anatomical variations of the recurrent laryngeal nerve (incidence rate of 23.4%), but no recurrent laryngeal nerve injury was found. In addition, the incidence of recurrent laryngeal nerve injury was significantly lower in patients with the inferior parathyroid gland and middle thyroid veins used as landmarks for locating the recurrent laryngeal nerve compared with those with the entry of the recurrent laryngeal nerve into the larynx as a landmark.

Among the 548 cases, seven of the 442 cases (1.6%) with the inferior parathyroid gland as a landmark for locating recurrent laryngeal nerves showed recurrent laryngeal nerve injury; two of the 79 cases (2.5%) with the middle thyroid vein as a landmark were injured; and three of the 27 cases (11.1%) with the recurrent laryngeal nerve into the larynx as the landmark showed recurrent laryngeal nerve injury.

These findings were published in Neural Regeneration Research (Vol. 8, No. 17, 2013).

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Article: " Routine exposure of recurrent laryngeal nerve in thyroid surgery can prevent nerve injury " by Chenling Shen, Mingliang Xiang, Hao Wu, Yan Ma, Li Chen, Lan Cheng (Department of Otolaryngology & Head and Neck Surgery, Ear Institute, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China)

Shen CL, Xiang ML, Wu H, Ma Y, Chen L, Cheng L. Routine exposure of recurrent laryngeal nerve in thyroid surgery can prevent nerve injury. Neural Regen Res. 2013;8(17):1568-1575.

Full text: http://www.sjzsyj.org:8080/Jweb_sjzs/CN/article/downloadArticleFile.do?attachType=PDF&id=625

Neural Regeneration Research

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Surgeons Save Teen's Sight Using Pioneering Laser Surgery

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Main Category: Eye Health / Blindness
Article Date: 14 Jul 2013 - 0:00 PDT Current ratings for:
Surgeons Save Teen's Sight Using Pioneering Laser Surgery

UK eye surgeons have saved the sight of a 16-year-old boy using laser treatment inspired by "tongue and groove" floor boards.

James Bowden was facing blindness after suffering from an eye condition called Keratoconus, which occurs when the cornea of the eye becomes cone-shaped as a result of thinning layers near the center of the eye.

The condition is progressive and usually begins at puberty, causing blurred sight, double vision and even blindness.

The seriousness of Bowden's condition was extremely rare at his age. He was unable to watch television or socialize unaided, and he was on the verge of giving up sports for good.

But surgeons at the UK's Centre for Sight hospital in East Grinstead decided to perform a laser-assisted corneal graft, called a Femtosecond laser Deep Anterior lamellar keratoplasty (DLEK), on one of James' eyes, resulting in a full return of his sight on that eye. This makes him the youngest patient in the UK to undergo this procedure.

The surgery was carried out using lasers as opposed to metal blades, which the surgeons say vastly improves the fit of the graft, the strength of the wound and the patients visual recovery. The graft was inspired by "tongue and groove" floor boards - where the boards fit together like a jigsaw - increasing accuracy in the graft.

Sheraz Daya, medical director and consultant eye surgeon at the Centre for Sight, explains:

"The Femtosecond laser Deep Anterior lamellar keratoplasty is a way to perform the procedure using laser and forming geometric tongue and groove type incisions. These incisions allow the graft to slot into the host cornea perfectly and with good mechanical strength."

Because the operation had increased accuracy and the laser's speed was faster compared to the blades, the operation could be performed under local anesthetic, so Bowden was discharged the same day. He is waiting for a full recovery before surgery goes ahead on the second eye.

Daya adds: "The use of this type of laser during surgery meant that we were able to dramatically improve James' experience during the procedure and reduce his recovery time. We were delighted with how James' operation went and his recovery time, thanks to this method, has been reduced from around a year, to just three months."

The boy's mother, Stephanie Bowden, says: "The most difficult part of James' loss of sight was his loss of independence. It was heart-breaking for me to see him unable to do the same as his friends. He is particularly sporty and having to face the possibility that he might have to give up rugby and cricket was devastating for him.

"We now have so much to look forward to as a family. We are soon emigrating to America where James will continue further education. He's recovering brilliantly and his sight in one eye is almost completely restored."

The first DLEK surgery was carried out in the US in 2000 on two patients suffering from pseudophakia with Fuchs' endothelical dystrophy, a corneal cell disease.

Written by Honor Whiteman

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'Pioneering Treatment Saves Life of 16-Year-Old Boy', press release, July 11, 2013

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