Safer heart surgery from humble blood pressure cuff

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Main Category: Surgery
Also Included In: Cardiovascular / Cardiology
Article Date: 16 Aug 2013 - 8:00 PDT Current ratings for:
Safer heart surgery from humble blood pressure cuff

Scientists have discovered that inflating a blood pressure cuff on the upper arm immediately prior to heart bypass surgery could decrease risk of heart injury and increase long-term survival rate.

According to the US Centers for Disease Control and Prevention (CDC), around 395,000 coronary artery bypass graft surgeries were carried out in the US in 2010.

Heart surgery, such as coronary bypass, can often cause heart muscle damage, the researchers say. It is linked to reduced long-term survival and can cause severe health outcomes such as heart attacks.

Researchers from the University School of Medicine, Essen, Germany, analyzed the effects of a procedure called remote ischemic preconditioning on 162 patients scheduled to undergo coronary artery bypass graft surgery.

A control group of 167 patients undergoing heart surgery who did not have remote ischemic preconditioning were also monitored.

Remote ischemic preconditioning is a procedure that involves temporarily cutting off the blood supply, then restoring it to an area away from the heart.

The study, published in the The Lancet, looked at whether this procedure affects long-term survival following bypass surgery, and whether it has effects on other health issues, such as stroke and heart attack.

Blood pressure cuff: blood flow of the heart bypass patients was restricted before surgery by simple use of a sphygmomanometer

The patients undergoing remote ischemic preconditioning were:

Anesthetized prior to surgery and had their blood flow restricted for 5 minutes with a standard blood pressure cuff, which was inflated on their upper left arm.They then had their blood supply restored for 5 minutes as the cuff deflated.This procedure was repeated three times.

Following the surgery, the patients' blood concentrations of a substance called troponin 1 was measured. This substance is a biomarker protein that reveals any damage to the heart muscle. A higher concentration of troponin 1 means extensive damage has occurred.

Additionally, the patients were monitored for up to 4 years after surgery in order to see whether remote ischemic preconditioning had any effects on their long-term health.

Results of the study showed that patients who had remote ischemic preconditioning had troponin 1 levels 17% lower compared with those who did not undergo the treatment 72 hours after surgery.

One year after surgery, the findings showed that: Patients who had remote ischemic preconditioning were 73% less likely to have died of any cause compared with patients who did not have the treatment.They were also 86% less likely to die from a stroke or heart attack.

Professor Gerd Heusch of the Institute of Pathophysiology at the University School of Medicine, says:

"The results of our study are very encouraging that remote ischemic preconditioning not only reduces heart muscle injury but also improves long-term health outcomes for heart bypass patients."

The study authors say that it was already common knowledge that remote ischaemic preconditioning helps reduce injury to heart muscle, but they add that this study is the first randomized control trial to provide evidence that the procedure encourages longer survival in coronary bypass patients.

"The beauty of remote ischemic preconditioning is that it is non-invasive, simple, cheap, and safe," said Dr. Matthias Thielmann of the department of thoracic and cardiovascular surgery at the university.

"This procedure could be a promising and simple strategy to protect patients' heart muscle during surgery and hopefully improve health outcomes after surgery," he said.

But in a comment piece at the end of the study, Professor Michel Ovize of the Louis Pradel Hospital in France says that although this research highlights the benefits of remote ischemic preconditioning directly related to the heart, he believes the findings show the potential of possibilities beyond that.

"The incidence of non-heart-related events, such as sepsis or stroke, was lower in the remote ischemic preconditioning group than in the control group, albeit of few events overall," said Prof. Ovize.

"These findings suggest that the effect on the heart might be only one aspect of a much wider effect, and that remote conditioning, unlike local conditioning, might lead to persistent protection."

Written by Honor Whiteman

Copyright: Medical News Today
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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."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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JAMA Facial Plast Surg. Published online August 1, 2013. doi:10.1001/jamafacial.2013.268.

JAMA

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Improving results of cataract surgery by looking at outcomes important to patients

Main Category: Eye Health / Blindness
Article Date: 31 Jul 2013 - 1:00 PDT Current ratings for:
Improving results of cataract surgery by looking at outcomes important to patients

Special issue of Optometry and Vision Science focuses on patient-reported outcome measures

Cataract surgery can lead to good results from a clinical standpoint yet have poor outcomes from the patient's point of view, reports a study, "Analyzing Patient-Reported Outcomes to Improve Cataract Care", appearing in the August issue of Optometry and Vision Science, official journal of the American Academy of Optometry. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Using well-designed and validated tools to assess patient-reported outcomes can lead to new insights for improving the results of cataract care, suggests the study by Mats Lundström, MD, PhD, of Lund University and Ulf Stenevi, MD, PhD, of Sahlgren's University Hospital, Sweden. Their paper is part of a special theme issue on "Measuring the Patient's Perspective" in optometry research and clinical practice.

Study Compares Clinical and Patient-Reported Outcomes of Cataract Surgery

Using a nationwide registry, Drs Lundström and Stenevi evaluated clinical and patient-reported outcome measures in nearly 10,000 cataract surgeries performed in Sweden between 2001 and 2011. For example, a major clinical outcome measure after cataract surgery is visual acuity. But improved visual acuity may not always reflect patient ratings of change in vision from before to after the procedure - especially in performing everyday functional tasks.

Not surprisingly, a comparison of the two sets of outcomes found that patient-reported measures were affected by clinical measures. Factors affecting patient-reported outcomes included visual acuity in both the operated and nonoperated eyes, change in visual acuity in the operated eye, and any other eye-related conditions ("ocular comorbidity").

However, more useful information was gained by looking at factors related to better or worse patient-reported outcomes. For example, patients who reported better visual function before surgery or who had poor visual acuity in the nonoperated eye were more likely to have poorer patient-reported outcomes after cataract surgery.

Implications for Decisions about Cataract Care

Ocular comorbidity was also related to worse patient-reported outcomes. These findings may indicate that, as in other chronic diseases, "some patients are too healthy and some too sick to benefit" from cataract surgery, Drs Lundström and Stenevi write. "It is possible that patients who are very satisfied with their vision and have no problems in performing daily life activities should not have cataract surgery at present."

The study also looked at situations where the clinical outcomes were good but patient-reported outcomes were poor - which happened in about seven percent of cataract surgeries. In many of these cases, poor near vision after the procedure was a major contributor to patient dissatisfaction.

There's a growing emphasis on patient-reported outcomes and quality of life in assessing various medical or surgical treatments. But there's been little attention to linking patient-reported outcomes to clinical outcomes in an attempt to improve health care. Age-related cataract is a good model for quality outcome studies: it is a very common, progressive condition that affects daily life and activities, and one for which surgical treatment is effective.

The new study helps vision care professionals in understanding how patient-reported outcome measures might be used to improve on the results of cataract surgery from the patient's perspective. For example, Drs Lundström and Stenevi suggest that surgery could be delayed or not performed in patients who feel they aren't having a lot of problems with daily activities - perhaps especially if they have good near vision.

The special theme issue presents 20 papers on topics related to the use of patient-reported outcomes in vision care. "These papers focus on new tools that are being increasingly used to assess the patient's perspective on a wide range of important conditions, problems, and outcomes," comments Anthony Adams, OD, PhD, Editor-in-Chief of Optometry and Vision Science. "These measures allow us to rigorously measure the outcomes important to patients, and to do so in a very meaningful way."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Optometry & Vision Science: August 2013 - Volume 90 - Issue 8 - p 754-759

Lundström, Mats*; Stenevi, Ulf*

Abstract - Analyzing Patient-Reported Outcomes to Improve Cataract Care

Purpose: The purpose of this study was to analyze three models of how patient-reported outcome measures can be connected to clinical outcome measures in cataract surgery to identify opportunities for improvement of quality of care.

Methods: Three models were used to analyze the following questions: Is there a relationship between clinical parameters and patient-reported outcomes? (1) Is there a relationship between clinical parameters and a good or poor patient-reported outcome? (2) When and why do clinical and patient-reported outcomes diverge? (3) The study material to exemplify these models consisted of follow-up data on cataract extractions collected by the Swedish National Cataract Register in 2008 to 2011. Patient-reported outcome was measured using the Catquest-9SF questionnaire. A total of 9707 pairs of questionnaires completed before and after a cataract extraction were analyzed together with clinical data.

Results: Factors related to any change in patient-reported outcomes after surgery were the preoperative self-assessed visual function, the preoperative visual acuity in both eyes, the postoperative visual acuity, and ocular comorbidity. Factors related to poor patient-reported outcomes after surgery were good preoperative self-assessed visual functions, poor preoperative visual acuity in the better eye, ocular comorbidity, surgical complications, and large refractive deviation. Poor near vision after surgery was the main factor noted in situations where the clinical outcome was good and the patient-reported outcome was poor. Analyses 2 and 3 were the most useful analyses to give ideas for clinical improvement work.

Conclusions: The best models to give ideas for improved quality of care by using a patient questionnaire in our study were analyzing the risk factors for a poor patient-reported outcome and analyzing the factors associated with disagreement between clinical outcomes and patient-reported outcomes.

Wolters Kluwer Health

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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).

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our ear, nose and throat section for the latest news on this subject.

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

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How to Look Like Kate Upton (Without Major Surgery)

Brow tinting is on the rise as supermodels like Kate Upton popularize bold brows. We attempt to replicate the look by testing the service for ourselves.

By Michele Laufik - July 16, 2013

When you say you want to look like Kate Upton, folks' gazes tend to head a bit further south than your eyebrows. But the model's bold brows were exactly what I had wanted since I'd first noticed that other stand-out feature of hers. In order to steal Kate's look—minus the hours-long ab workouts and boob job, I scheduled an eyebrow tinting with celebrity eyebrow pro Joey Healy.

What is eyebrow tinting? A super quick and easy professional service that uses customized shades to enhance your natural brow color. It’s ideal for women with light blonde or gray-flecked brows or color-treated hair. (And, of course, for those of us who want to look like a bombshell swimsuit goddess.)

How it works: First, the esthetician will cleanse your brows. Then, using a tiny artist’s brush, he will sweep on custom-blended dye in the direction of the hair's growth, working towards the temples. Finally, he will wipe off the dye and repeat the process until achieving the desired color, which should last four to six weeks.

What it costs: Prices for eyebrow tinting typically range from $40 to $75, depending on your location.

Where to get it: Our tester went to Joey Healy Eyebrow Studio in New York City, but brow dyeing is on the treatment menu at spas and salons across the country. For safety, you shouldn’t DIY eyebrow tinting.

Our tester's verdict: While my natural brows are actually fairly thick and dark, prior to dyeing, the puny tail ends disappeared into nothingness and left my eyes looking a little droopy and blah. The tinting picked up those barely-there blonde tips, giving more heft to the entire brow.

One of the best parts of the whole experience turned out to be Joey’s awesome shaping—which, when combined with the tinting, seems to have given me a mini face lift. My newly defined brows make me look more bright-eyed, which translates to needing less makeup to disguise my sleepiness.

Overall, it wasn’t a dramatic, O-M-G transformation, but more like a subtle tweak that makes my brows just look more “done” without the hassle of filling them in every morning.

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