After his first weight-loss surgery three years ago, Paul Martin considered getting a tattoo designed around the four small surgical scars on his side—say, a golf green.

After a second weight-loss surgery in December, Martin didn’t have any new scars to add to the design. “I woke up with just a slight sore throat,” he says about the procedure, which took about two hours. “There wasn’t any pain because there weren’t any incisions.”

Martin, 53 years old, is among the first patients at Stanford Hospital & Clinics to be treated using what is called natural orifice surgery. In his case, the entire surgery was performed through his throat.

“We went down his throat with a device that looks like a regular endoscope, with a ‘duckbill’ on the end,” the surgeon, John Morton, MD, said. “In the duckbill is a tiny instrument like a sewing machine, with a needle that has plastic sutures.”

Morton, who is also associate professor of surgery, stitched pleats in the stoma, the opening between the patient’s intestine and the small pouch that had been created in the earlier surgery. He then tightened the pleats around the endoscope, reducing the stoma from 20 millimeters to 14, helping to control the amount of food Martin could digest.

Morton described the procedure he performed as part of a continuum of evolving practices. “They’re innovations in what I call ‘minimal access’ surgery,” he said. “We’re moving away from small, multiple incisions, to just one scar or, in some cases, no scar. It’s something we can offer that hopefully will decrease pain and allow for quicker recovery.”

As Morton and other surgeons at Stanford continue to refine no-scar and single-incision procedures, he predicted that more flexible instruments, which will help surgeons work in smaller areas and around corners, will be developed. “That’s a prime direction for the hospital’s Surgical Innovations Program, that we look for new tools and new technologies to help us perform these procedures,” he said.

Other bodily openings that surgeons nationwide have used for natural orifice surgery include the mouth, vagina, rectum and penis. Instead of taking out gall bladders through painful incisions in the abdominal wall, for example, surgeons have removed the organs through these so-called natural orifices, reducing patients’ pain and recovery times.

For another patient who wanted weight-loss surgery, Morton, a specialist in bariatric surgery, chose a different approach. David Pierson, a 32-year-old construction supervisor who had struggled with obesity since he was 12, was a good candidate for lap-band gastric bypass surgery. The twist? The entire procedure was performed through one small incision in the patient’s belly button—the first such surgery in Northern California.

Morton inserted the laparoscopic instruments and camera required for the lap-band procedure through Pierson’s belly button, which he calls an ideal entry point. “The instruments went in one direction—up. The only challenging part was tying knots on the inside. But it was pretty smooth, and looks great,” he said. “We know that one incision is less painful than four or five, and the lower the incision, the less the pain.” By going through the belly button, he avoided making a larger incision closer to the rib cage, which would have caused pain because of the muscles pulling on it.

Pierson said he woke up from the two-hour surgery feeling like his stomach “had been worked on—like I’d been trying to do crunches.” He spent one night in the hospital and returned to work the following week. “I couldn’t see the incision for two days,” because of a bandage, Pierson recalled. “But when it came off, it just looked like little stitches.”

In the operation on Martin—a stomach plication procedure called Stomaphyx—no trace was visible after Morton inserted the instruments down the patient’s throat. Indeed, Martin called it a “tune up” to correct a slight weight gain he experienced after his 2006 gastric bypass surgery. Before that first operation, Martin said, he “huffed and puffed” and had to use an electric cart to get around the construction sites he manages. Now he walks those sites and climbs stairs. Since December, he has lost 17 pounds.

After the operation three years ago, Martin had initially lost more than 150 pounds, before regaining some weight. Such weight regain is rare, noted Morton. Of the 1,200 procedures he has performed, he said, only 20 patients have regained more than five percent of the weight they lost. “But obesity is a chronic disease, and there can be relapses,” he added. “So you find options for patients.”

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Studies prove that mammography saves lives. The screening tool can detect breast cancer early when it’s still curable. But for the thousands of women with dense breast tissue, mammography is not enough. These women may need additional screening tests such as MRI’s. Now, researchers at Mayo Clinic have developed new technology that can spot breast tumors in dense tissue at a fraction of the cost of MRI’s.

Research proves that screening for breast cancer with mammograms saves lives. But mammograms are not perfect. They can miss tumors, especially in women with dense breast tissue. That’s why Doctors at Mayo Clinic also use MRI’s to screen for breast cancer in high risk women. The technology can detect some tumors that mammograms cannot.

Watch an animation of a virtual colonoscopy showing a 9-mm polyp protruding into the colonic lumen. Animation courtesy of the Radiological Society of America.

A new study shows that an imaging technology developed by Mayo Clinic researchers can identify liver fibrosis with high accuracy and help eliminate the need for liver biopsies. Liver fibrosis is a common condition that can lead to incurable cirrhosis if not treated in time.

The technology, called magnetic resonance elastography (MRE), produces color-coded images known as elastograms that indicate how internal organs, muscles and tissues would feel to the touch. Red is the stiffest; purple, the softest. Other imaging techniques do not provide this information.

“Knowing the liver’s elasticity or stiffness is invaluable in diagnosing liver disease,” says Jayant Talwalkar, M.D., M.P.H., a Mayo Clinic hepatologist and co-investigator on the study. “A healthy liver is very soft, while a liver with early disease begins to stiffen. A liver with cirrhosis, advanced liver disease, can be rock hard.”

The study, which included 113 patients, will be presented Nov. 3 at The Liver Meeting, an annual gathering of the American Association for the Study of Liver Disease, in San Francisco. Study participants had undergone liver biopsy in the year preceding the study and had a wide variety of liver diseases, including nonalcoholic and alcoholic fatty liver disease, hepatitis C, hepatitis B, autoimmune hepatitis, primary biliary cirrhosis and primary sclerosing cholangitis. Patients ranged in age from 19 to 78, and their body weight ranged from normal to severely obese.

“Results showed that elastography was highly accurate in detecting moderate-to-severe hepatic fibrosis even with the variety in age, types of liver disease and body size,” says Dr. Talwalkar. Among the study’s findings:

* The detection of cirrhosis by MRE when compared to liver biopsy results was 88 percent accurate.

* Patients with nonalcoholic fatty liver disease and no significant inflammation or fibrosis were identified with 97 percent accuracy.

“Using MRE, we can confidently avoid liver biopsies for patients with no evidence of advanced fibrosis, as well as for patients with cirrhosis,” says Dr. Talwalkar.

Liver biopsies, conducted by extracting tissue samples with a needle, can underestimate the degree of hepatic fibrosis about 20 to 30 percent of the time because of the patchy distribution of fibrosis that occurs in the liver. Another drawback is that since liver biopsy is invasive, patients may be reluctant to have a biopsy performed and sometimes delay the procedure when liver disease is first suspected, says Dr. Talwalkar.

“Our goal in hepatology is to be able to diagnose liver disease early so that novel as well as established therapies can be provided to our patients,” says Dr. Talwalkar. Treatment and lifestyle changes can help stop the progression of hepatic fibrosis to liver cirrhosis and liver failure, which would eventually require a liver transplant.

The incidence and prevalence of chronic liver disease is increasing in the United States. Nonalcoholic fatty liver disease has become the most common liver disease and is linked to the growing numbers of patients with obesity and diabetes. The number of patients seeking medical care for hepatitis C is also increasing. This disease, spread by coming into contact with blood contaminated by the virus, slowly damages the liver over decades.

MRE research began at Mayo Clinic about 10 years ago. The technology measures low-frequency acoustic waves transmitted into the abdomen. The wave motions measured are miniscule, 0.01 of the width of a human hair.

The noninvasive procedure takes seconds to conduct. Mayo Clinic is already using MRE to diagnose patients with liver conditions. Research is under way to study how MRE might aid in the diagnosis of Alzheimer’s disease and some cancers.

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The determination of the precise anatomical location of a tumor is the prerequisite for setting optimal parameters for radiation treatment of prostate cancer. This approach guarantees that the ionizing radiation only destroys tumorous cells and does not affect other organs in the vicinity of the prostate.

In a study conducted in cooperation with SMZ Ost (East-Vienna Center of Social Medicine, Danube Hospital), Poljanc and her research associates, Tanja Futschek and Leila Teymournia, used a number of ultrasound examinations that allowed for a precise localization of the patients’ organs from the outside.

In a next step, the scientists analyzed the positioning of 60 patients, and evaluated the deviation of radiation in various spatial directions, such as to the right or left, and upward or downward (using 420 radiation plans for thirty patients). While it takes more time, an ultrasound system makes the shifts in position visible and traceable. If the deviation exceeds 0.8 cm, the radiology technicians are responsible for returning the patient to the correct position to ensure that the radiation only targets the specified area.

In the subsequent study phase, Poljanc and her group calculated normal tissue compensation rates and the probability of tumor control. “This provides us with an overview of the probability that the tumor is targeted directly and the probability of side effects for individual patients,” notes Poljanc. These approaches serve as forecasts and provide clues for the likelihood of healing.

After a study period of some 2.5 years, with generous sponsorship of the Anniversary Fund of the Austrian National Bank, the scientists were able to implement the calculated average positioning inaccuracies in a radiation planning system. Sums up Leila Teymournia: “Depending on the calculation model used, the normal tissue compensation rate can vary widely in the results. While the use of Model A may yield a negligible complication rate, the same process calculated with Model B shows a deviation of up to 40 percent.”

Due to the absence of biological parameters, major discrepancies may result with different models. Nevertheless, the results of calculations can provide physicians with data for improving patient positioning accuracy and therefore, and improvement of treatment success.

As part of their study of different radiation sources, Karin Poljanc, Tanja Futschek, and Leila Teymournia found that localization aids, such as ultrasound systems, are indispensable for accurate proton therapy of prostate carcinomas. In most cases, this combination leads to therapy results with a high level of tissue preservation.

The future establishment of the cancer research and therapy center “Med-AUSTRON” in Wiener Neustadt will implement such a treatment method in Austria.

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Scientists from the University of Alcalá (UAH) have designed a prosthesis made of silicon and polypropylene shaped like an “upside down T” that substantially reduces cases of incisional hernias.

Primary hernias are produced by structural defects in tissues, while the incisional hernias arise from a previous aperture in the abdominal wall, usually the scar of a previous surgery. Irrespective of the techniques used, different types of sutures or medical devices used to hold the abdominal wall, the number of incisional hernias has been constant over the last decade.

One of the most susceptible areas for their appearance is the linea alba, especially when oblique-transverse fibres are sectioned, which is what occurs in the longitudinal laparotomy procedures. The likelihood of a patient developing incisional hernias increases with associated risks, such as advanced age, neoplasia related surgery, obesity and related chronic pathologies.

Presented with these circumstances, a research group from the University of Alcalá managed by Professor Juan Manuel Bellón from the department of surgery of the UAH has developed and patented a new device to prevent the occurrence of incisional hernias. This prevention is carried out by the incorporation of prosthesis into the suture of the abdominal wall which is designed to increase the cohesive forces of the scar. The new design and concept of the prosthesis, named Laparomesh has the shape of a upside down T and is made with silicone and polypropylene, which are biomaterials that will not be absorbed by the body.

The goal of the Laparomesh is to create a reinforcement much like a tendon in the linea alba that would efficiently consolidate the suture of the laparotomy and significantly reduce the cases of incisional hernias. Different to the other prostheses of its type, the design by Professor Bellon and his team is placed neither above nor below, but it encloses both apertures of the abdominal wall, attaching itself to the different anatomical planes by means of a polypropylene suture.

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Professor Bellón, stated that the current average number of cases of incisional hernias is around 15% to 20%, and it is estimated to reduce these numbers to 3%-4% using this newly patented mesh.

Scientists at UC San Diego, UC Santa Barbara and MIT have developed nanometer-sized “nanoworms” that can cruise through the bloodstream without significant interference from the body’s immune defense system and—like tiny anti-cancer missiles—home in on tumors.

Their discovery, detailed in this week’s issue of the journal Advanced Materials, is reminiscent of the 1966 science fiction movie, the Fantastic Voyage, in which a submarine is shrunken to microscopic dimensions, then injected into the bloodstream to remove a blood clot from a diplomat’s brain.

Using nanoworms, doctors should eventually be able to target and reveal the location of developing tumors that are too small to detect by conventional methods. Carrying payloads targeted to specific features on tumors, these microscopic vehicles could also one day provide the means to more effectively deliver toxic anti-cancer drugs to these tumors in high concentrations without negatively impacting other parts of the body.

“Most nanoparticles are recognized by the body’s protective mechanisms, which capture and remove them from the bloodstream within a few minutes,” said Michael Sailor, a professor of chemistry and biochemistry at UC San Diego who headed the research team. “The reason these worms work so well is due to a combination of their shape and to a polymer coating on their surfaces that allows the nanoworms to evade these natural elimination processes. As a result, our nanoworms can circulate in the body of a mouse for many hours.”

“When attached to drugs, these nanoworms could offer physicians the ability to increase the efficacy of drugs by allowing them to deliver them directly to the tumors,” said Sangeeta Bhatia, a physician, bioengineer and a professor of Health Sciences and Technology at MIT who was part of the team. “They could decrease the side effects of toxic anti-cancer drugs by limiting their exposure of normal tissues and provide a better diagnosis of tumors and abnormal lymph nodes.”

The scientists constructed their nanoworms from spherical iron oxide nanoparticles that join together, like segments of an earthworm, to produce tiny gummy worm-like structures about 30 nanometers long—or about 3 million times smaller than an earthworm. Their iron-oxide composition allows the nanoworms to show up brightly in diagnostic devices, specifically the MRI, or magnetic resonance imaging, machines that are used to find tumors.

“The iron oxide used in the nanoworms has a property of superparamagnetism, which makes them show up very brightly in MRI,” said Sailor. “The magnetism of the individual iron oxide segments, typically eight per nanoworm, combine to provide a much larger signal than can be observed if the segments are separated. This translates to a better ability to see smaller tumors, hopefully enabling physicians to make their diagnosis of cancer at earlier stages of development.”

In addition to the polymer coating, which is derived from the biopolymer dextran, the scientists coated their nanoworms with a tumor-specific targeting molecule, a peptide called F3, developed in the laboratory of Erkki Ruoslahti, a cell biologist and professor at the Burnham Institute for Medical Research at UC Santa Barbara. This peptide allows the nanoworms to target and home in on tumors.

“Because of its elongated shape, the nanoworm can carry many F3 molecules that can simultaneously bind to the tumor surface,” said Sailor. “And this cooperative effect significantly improves the ability of the nanoworm to attach to a tumor.”

The scientists were able to verify in their experiments that their nanoworms homed in on tumor sites by injecting them into the bloodstream of mice with tumors and following the aggregation of the nanoworms on the tumors. They found that the nanoworms, unlike the spherical nanoparticles of similar size that were shuttled out of the blood by the immune system, remained in the bloodstream for hours.

“This is an important property because the longer these nanoworms can stay in the bloodstream, the more chances they have to hit their targets, the tumors,” said Ji-Ho Park, a UC San Diego graduate student in materials science and engineering working in Sailor’s laboratory.

Park was the motivating force behind the discovery when he found by accident that the gummy worm aggregates of nanoparticles stayed for hours in the bloodstream despite their relatively large size.

While it’s not clear yet to the researchers why, Park notes that “the nanoworm’s flexibly moving, one dimensional structure may be one the reasons for its long life in the bloodstream.”

The researchers are now working on developing ways to attach drugs to the nanoworms and chemically treating their exteriors with specific chemical “zip codes,” that will allow them to be delivered to specific tumors, organs and other sites in the body.

“We are now using nanoworms to construct the next generation of smart tumor-targeting nanodevices,” said Ruoslahti. We hope that these devices will improve the diagnostic imaging of cancer and allow pinpoint targeting of treatments into cancerous tumors.”

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A specially coated metal tube, no larger than a cigarette, could be the key to developing an artificial pancreas to help millions of people with diabetes avoid insulin injections, according to an article scheduled for the May 5 issue of Chemical & Engineering News.

Written by Associate Editor Bethany Halford, the C&EN article points out that researchers have been trying to develop an artificial pancreas for years. Most approaches involve encapsulating healthy islet cells — the pancreatic cells that detect glucose and release insulin — and transplanting them into diabetic patients. But enclosing a large collection of cells has been difficult because the materials designed to hold them are not biocompatible, or optimal for use in the body, Halford notes.

The new device, developed by Joseph P. Kennedy and colleagues at the University of Akron in Ohio, is coated with a permeable polymer membrane that is key to its success. In addition to improving the exchange of insulin and glucose between the islet cells and the blood, the polymer membrane helps increase the supply of oxygen to the cells for improved function and lifespan. The device itself has already shown promise in preliminary animal studies and researchers are looking ahead to clinical trials in humans, the article notes.

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No simple blood test exists to determine which of the millions of people infected with hepatitis C virus will develop cirrhosis of the liver or cancer. Now, researchers are developing new technology to find blood proteins that herald the earliest signs of chronic liver disease. If successful, they hope to extend the use of the technology, and to do the same for many other diseases and to make it commercially available for broad clinical use.

Washington State’s Life Sciences Discovery Fund Board of Trustees has announced that the collaboration between scientists at the Department of Energy’s Pacific Northwest National Laboratory and the University of Washington Liver Transplantation Program in Seattle will receive $4.8 million over the next three years to develop a new proteomics technology and apply it in search of biomarkers for liver disease.

“This is really fantastic,” says grant recipient and lead investigator Dick Smith of PNNL. “This funding will support work that is almost impossible to get funded by conventional sources. The grant brings together a larger program that could have significant positive impacts on the health of people, certainly in Washington, but in the whole country as well.”

The announcement caps a lengthy selection process by LSDF. “This has been a highly-competitive process. The proposals were weighed on their scientific merits and their abilities to utilize this funding to provide statewide economic returns, to build a competitive life sciences industry and to advance the health of, and health care for, our citizens. These newly-awarded grants will leverage substantial additional investment in Washington State by a variety of other funders such as federal agencies and philanthropic organizations,” says LSDF Executive Director Lee Huntsman.

About 1.6 percent of the U.S. population has signs indicating they have been or are infected with hepatitis C virus, and up to 12,000 people each year die from HCV-induced liver damage and cancer. A percentage of infected people develop various levels of liver disease — the worst requiring liver transplants — but doctors have no way of telling who’s most at risk.

PNNL’s Smith is leading development of the new technology at DOE’s Environmental Molecular Sciences Laboratory on the PNNL campus. In collaboration with UW’s Michael Katze, Smith’s group with use proteomics to compare blood and tissue samples from individuals who have advanced liver disease or are healthy to find proteins that indicate the potential for advanced illness.

The researchers’ long term goal is to make such technology efficient and inexpensive enough for use in clinical settings. In addition, Smith’s development plans include making the technology widely applicable to biomarker searches for other diseases.

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