The Surgeon

Scientists have for the first time discovered that people with the same cancer susceptibility genes respond differently depending on their race. Their results are published in Nature Genetics* .

The team from the University of Edinburgh has shown that a genetic marker is associated with an increased the risk of colon cancer in Europeans, but not in the Japanese population. But this genetic variant was associated with a similar risk of rectal cancer in both populations.

While dietary differences are already well known to be important, this discovery shows for the first time that genetic factors might explain some of the differences in bowel cancer risk between populations**.
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Patients with breast cancer who developed anemia during chemotherapy had nearly three times the risk of local recurrence as those who did not, according to a study published in the April 1 issue of Clinical Cancer Research¸ a journal of the American Association for Cancer Research.

“We speculate that there may be an interaction between chemotherapy/radiotherapy and anemia,” said lead researcher Peter Dubsky, MD, a senior consultant in the department of surgery at the Medical University of Vienna, Austria. “Both treatment modalities have been shown to be less effective in anemic patients. Since we do not see the effect in terms of relapse-free survival, the interaction with local adjuvant treatment may play a more important role.”
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In a new collaborative study, the BC Cancer Agency, an agency of the Provincial Health Services Authority (PHSA), is trying to determine if a test for Human Papilloma Virus (HPV) can replace the standard Pap test as the primary method of cervical cancer screening, allowing women to be screened more effectively and less frequently.

The HPV FOCAL Study – the first long term and largest study of its kind in North America is conducted in collaboration with another PHSA agency, the BC Centre for Disease Control, as well as the UBC Department of Family Medicine and the Faculty of Medicine, McGill University department of Epidemiology, and about 100 family doctors in Greater Vancouver.
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Management of ingested foreign bodies is a common clinical encounter. Complications of this pathology are dependent on a patient’s age, the nature and localization of the foreign body, the presence of a perforation, and initial management procedures.

Dr. Christian Righini from the University Medical Center of Grenoble advocates the use of the rigid endoscope which is placed just above the proximal tip of the foreign body where it dilates the esophageal lumen to the extent that the impacted foreign body is movable.
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Johns Hopkins Health Alerts has just published a review of the new GERD guidelines, for safe, effective treatment of your acid reflux.

There are four types of treatments for gastroesophageal reflux disease (GERD): lifestyle measures, medication, surgery, and endoscopic procedures.

Why it is important to treat GERD

Treating GERD is important. Untreated GERD can lead to serious complications, such as esophageal ulcers (nonhealing mucosal defects), esophageal strictures, Barrett’s esophagus (a disorder of the cells lining the esophageal mucosa, which may lead to cancer), and even esophageal cancer.
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African-Americans are far more likely to be diagnosed with and to die from colorectal cancer than whites or other minority groups. Despite this increased risk, a new study led by Vanderbilt University Medical Center researchers found that African-Americans are far less likely to undergo colonoscopy screening than whites, even when both groups have a family history of colorectal cancer. The study was published in the March 24 issue of the Archives of Internal Medicine.

Lead author Harvey Murff, M.D., M.P.H., assistant professor of Medicine, said family history is a strong predictor of colorectal cancer risk

“Individuals who have a first-degree relative with colorectal cancer have a twofold to threefold increased risk of developing the disease and they are likely to be diagnosed with the malignancy 10 years earlier than patients without this family history,” explained Murff. “We wanted to know if people who knew about their inherited risk factors would be more likely to undergo screening.”
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Colon cancer screening is a tough sell. It’s icky, uncomfortable and the thought of a colonoscopy, especially the prep, can be intimidating, to say the least.

But here’s what clinches the sale: Colon cancer can be largely prevented through proper screening.

Researchers, including those at the University of Michigan Comprehensive Cancer Center, are working to make colorectal screening a little easier, through a combination of more choices and less-invasive procedures.

Colorectal cancer is the second biggest cancer killer in both men and women, surpassed only by lung cancer. Some 148,810 Americans will be diagnosed with colorectal cancer this year, and 49,960 people will die from the disease.
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Despite domestic concerns like inflation and a looming home lending crisis, average Americans continue to spend money on plastic surgery. According to the latest procedural statistics report from the American Society of Plastic Surgeons (ASPS), almost 12 million cosmetic plastic surgery procedures were performed in 2007 – a 7 percent increase from 2006 and a 59 percent increase from 2000. Also, 5.1 million reconstructive plastic surgery procedures were performed last year.
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A LOWER total dose of radiotherapy, delivered in fewer, larger treatments has been shown to be as effective as the international standard of a higher total dose delivered over a longer time to treat women with early breast cancer – according to new research published in the Lancet and Lancet Oncology. This confirms long-held beliefs of cancer specialists in the UK who have been using shorter schedules for many years.

Nearly 4,500 women took part in the START Trials co-ordinated by the Clinical Trials and Statistics Unit at The Institute of Cancer Research and funded by Cancer Research UK, the Medical Research Council and the Department of Health. Just under half the women received the international standard radiotherapy delivering 25 treatments, treating five times per week over five weeks. The remainder received a lower total dose given in fewer, larger treatments in either three or five weeks.

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A soft pancreatic texture with a narrow pancreatic ductal size creates a high risk for the development of a pancreatic fistula after pancreaticoduodenectomy, often leading to death. Several methods have been advocated to reduce the occurrence of leakage, but the best technique is still a subject of debate.

Leakage of the pancreaticoenterostomy remains a major cause of postoperative morbidity and mortality after pancreaticoduodenectomy. Many factors have been identified that are associated with an increased incidence of this complication. Among them, a small pancreatic ductal size with a soft pancreas creates one of the technical hurdles to the completion of the anastomosis, and is known to be a risk factor for major leakage.

A team led by Dr. Kenichi Hakamada from Hirosaki University, Japan, has, however, developed a new method of pancreaticojejunostomy with a fast-absorbable suture material, irradiated polyglactin 910, and a temporary stent tube to overcome the technical difficulties of performing a pancreaticoenterostomy of a soft pancreas with a narrow pancreatic duct.

In the view of the team, the key aspect of this method is the use of an irradiated polyglactin 910 suture and a temporary stent. In this method, complete external drainage of the pancreatic juice is secured for about 2 weeks by approximating the pancreatic duct and the jejunal mucosa with this fast-absorbable suture.

It has also been suggested that the incidence of a pancreatic fistula varies according to the definition. It is, therefore, quite important to use an internationally-accepted definition of pancreatic fistula to compare the different aspects of the new surgical method with the conventional one. By applying the four well-documented definitions strictly, the preliminary results of this novel method were well described by doctors from the Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Japan. The late surgical and nutritional outcomes were also reported.

Any conclusion for the surgical method needs to await randomization or a good cohort study, but the good early and late outcomes of this simple and easy-to-perform method seem to justify the carrying out of a randomized prospective study to compare this new method with appropriate controls.

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