The Surgeon

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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According to Heinz-Josef Lenz, M.D., professor of medicine, Keck School of Medicine, USC and the USC/Norris Comprehensive Cancer Center, diet may have a major impact on people’s risk of developing cancer. Colorectal cancer is the third most-common cause of cancer-related death in men and women in the nation.

The most important risk factor is red meat, particularly beef, he says. The countries with the highest beef consumption are the ones with the highest colon cancer risk. White meat such as chicken and pork don¹t seem to be associated with colon cancer risk.

Alcohol consumption is another major risk factor, particularly for women, Lenz notes. To reduce risk, people should limit themselves to one glass of wine per day.

Avoiding alcohol and decreasing intake of red meat can decrease your risk of colon cancer significantly, he says.

People should have rich sources of calcium intake, such as dairy products, daily. It is also important to include fiber-rich foods such as fruits and vegetables and reduce intake of fatty foods. One of the most powerful ways to reduce colon cancer development is vitamin D and calcium.

With easy adjustments in your diet, supplements such as calcium and modest exercise you can reduce your risk of colon cancer by more than 50 percent,² says Lenz.

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One day the doctors may be able to detect early stages of colon cancer without a biopsy. They will can use the new technique developed by researchers at the Stanford University School of Medicine.
This imaging technology is one of many new ways of detecting cancers in the body in real time.
The first research is to detect the colon cancer.

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Women with breast cancer have more aggressive disease and lower survival rates if they are overweight or obese, according to findings published in the March 15 issue of Clinical Cancer Research, a journal of the American Association for Cancer Research.

“The more obese a patient is, the more aggressive the disease,” said Massimo Cristofanilli, MD, associate professor of medicine in the Department of Breast Medical Oncology at The University of Texas M.D. Anderson Cancer Center. “We are learning that the fat tissue may increase inflammation that leads to more aggressive disease.”

Cristofanilli and colleagues observed 606 women with locally advanced breast cancer. These women were classified by body mass index into the following three groups: normal/underweight (24.9 or below), overweight (at least 25 but less than 30) or obese (more than 30). Body mass index is calculated by dividing a person’s weight by their height.

At five years, overall survival was 56.8 percent among obese women, 56.3 percent among overweight women and 67.4 percent among normal weight women. The 10-year survival rate was 42.7 percent among obese women, 41.8 percent among overweight women and 56.5 percent among normal weight women.

The rate of inflammatory breast cancer, previously shown to have worse outcomes than non-inflammatory breast cancer, among obese women was 45 percent compared with 30 percent in overweight women and only 15 percent in women considered normal weight, researchers found.

Risk of breast cancer recurrence was also higher in obese or overweight women. By five years, 50.8 percent of obese women reported a recurrence compared with 38.5 percent of normal weight women. By 10 years, the rate of recurrence was 58 percent among obese women and 45.4 percent among normal weight women.

“Obesity goes far beyond just how a person looks or any physical strain from carrying around extra weight. Particular attention should be paid to our overweight patients,” Cristofanilli said.

Cristofanilli said physicians need to pay close attention to breast cancer patients because commonly used drugs, such as tamoxifen, tend to increase weight gain during treatment.

“We have actually become quite good at managing acute side effects such as nausea in our chemotherapy patients and it goes away within a couple of days,” Cristofanilli said.

“Following the nausea, our patients tend to overeat, which further increases their risk of weight gain. We need to implement lifestyle modifications interventions and develop better methods to follow these patients closely.”

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