Imagine suffering from kidney disease for months, undergoing difficult and invasive treatments, only to find that surgery is necessary to remove a kidney.
Kidney surgery just got a whole lot easier, now that a surgeon has developed a new surgical technique that requires only one small incision to remove the diseased organ. By inserting a camera and two surgical instruments through the patient's belly button, Dr. Leslie Deane was able to remove a diseased kidney the size of an orange.
From the article:
Dr. Leslie Deane, assistant professor of urology and director of laparoscopy, endourology and robotic urologic surgery at University of Illinois Medical Center at Chicago, inserted a camera and two surgical instruments through a port placed in a one-inch incision in the patient's belly button and remove a diseased kidney the size of an orange. Surgical techniques have been advancing, as better surgical instruments and the introduction of cameras inside the body have made it possible to operate through small incisions. While laparoscopic approaches generally have fewer complications, shorter hospital stays, and faster recovery times than open surgery, they still usually require three to five incisions, each with attendant risks of bleeding, hernia, and scarring.
The technique called single incision laparoscopic surgery, or SILS, "gives us better pain control following surgery," said Deane. "And, of course, there is a much better cosmetic outcome for many patients. The small scar essentially disappears into their belly button."
Deane's surgical team included his chief resident Dr. Alexis Chesrow and senior resident Dr. Hector Pimentel and the nursing staff Elrayna Aten, RN and Annie Marrs, RN.
Chicago resident Eddie Bibbs, 55, is the mother of four grown children and has a number of grandchildren. She says she is not planning on wearing a bikini anytime soon, but was grateful that the simple incision kept bleeding to a minimum during her April 16 surgery to remove a diseased kidney. "I didn't need any transfusion at all," she said.
Bibbs' kidney had become infected months before, requiring insertion of a tube through the back. The kidney eventually failed, necessitating removal. She has been in and out of the hospital since last November and said she had barely been able to leave her house all winter.
On Friday, the day following the three-and-a-half-hour surgery, Bibbs was up walking the hallways of the hospital and looking forward to going home the next day.
"My daughter said I sound much better and I look much better," Bibbs said.
And, she added, "I feel much, much better!"
Deane expects SILS to become a more common procedure as new instruments are developed that are better adapted to the technique. The trend in surgery today is towards minimizing the size and number of incisions to reduce complications and scarring and improve recovery, he said. And with improvements in robotic technologies, the possibilities will be endless.
"I was also surprised to find that I was able to perform the surgery as quickly and safely through the single port as I would have expected from ordinary laparoscopic surgery," said Deane. "In 2009, the indications for 'open' kidney surgery are few."
Thursday, April 23, 2009
Surgeon Removes Kidney Through the Belly Button
Monday, February 23, 2009
Assessment Technique Lets Scientists See Brain Aging Before Symptoms Appear
UCLA scientists have used innovative brain-scan technology developed at UCLA, along with patient-specific information on Alzheimer's disease risk, to help diagnose brain aging, often before symptoms appear. Published in the January issue of Archives of General Psychiatry, their study may offer a more accurate method for tracking brain aging.
Researchers used positron emission tomography (PET), which allows "a window into the brain" of living people and specifically reveals plaques and tangles, the hallmarks of neurodegeneration. The PET scans were complemented by information on patients' age and congnitive status and a genetic profile.
"Combining key patient information with a brain scan may give us better predictive power in targeting those who may benefit from early interventions, as well as help test how well treatments are working," said study author Dr. Gary Small, who holds UCLA's Parlow-Solomon Chair on Aging and is a professor at the Semel Institute for Neuroscience and Human Behavior at UCLA.
Scientists took PET brain scans of 76 non-demented volunteers after they had been intravenously injected with a new chemical marker called FDDNP, which binds to plaque and tangle deposits in the brain. Researchers were then able to pinpoint where these abnormal protein deposits were accumulating.
They reported that older age correlated with higher concentrations of FDDNP in the medial and lateral temporal regions of the brain, areas involved with memory, where plaques and tangles usually collect. The average age of study volunteers was 67.
Thirty-four of the 76 volunteers carried the APOE-4 gene allele, which heightens the risk for developing Alzheimer's disease. This group demonstrated higher FDDNP levels in the frontal region of the brain, also involved in memory, than study participants without allele.
"We found that for many volunteers, the imaging scans reflected subtle brain changes, which take place before symptoms manifest," said Small, who is also director of the UCLA Center on Aging.
Small noted that the brain will try to compensate for any problems, which is why cognitive symptoms may not become apparent until much later.
"This type of scan offers an opportunity to see what is really going on in the brain," he said.
Another subset of the volunteers had mild cognitive impairment (MCI), a condition that increases the risk of developing Alzheimer's disease. These 36 volunteers had higher measures of FDDNP in the medial temporal brain regions than normal volunteers. Those who had both MCI and the APOE-4 gene had higher concentrations of FDDNP in the medial temporal brain regions than volunteers who had MCI but not APOE-4.
"We could see more advancing disease in those with mild cognitive impairment, who are already demonstrating some minimal symptoms," Small said. "Eventually, this imaging method, together with patient information like age, cognitive status and genetics, may help us better manage brain aging."
According to Small, in the future, brain aging may be controlled similarly to high cholesterol or high blood pressure. Patients would receive a brain scan and perhaps a genetic test to predict their risk. Medications and other interventions could be prescribed, if necessary, to prevent or delay future neurodegeneration, allowing doctors to protect a healthy brain before extensive damage occurs. The brain scans may also prove helpful in tracking the effectiveness of treatments.
PET, combined with the FDDNP probe, is the only imaging technology that offers a full profile of neurodegeneration that includes measures of both plaques and tangles ‹ the physical evidence of Alzheimer's disease in the brain.
"The fact that we can see tau tangles as well as amyloid plaques is critically important in early detection of brain aging, since the tangles are the first abnormal proteins that appear in the brain, long before dementia is clinically obvious to the physician," said Dr. Jorge R. Barrio, a study author and professor of molecular and medical pharmacology at the David Geffen School of Medicine at UCLA.
Such subtleties allow more insight into how the plaques and tangles spread and ultimately how Alzheimer's disease may develop.
Currently, the new FDDNP-PET scans are used in a research setting, but clinical trials are in development to bring the technology to wider patient use.
Tuesday, November 11, 2008
Depression Can Hamper Glucose Control in People With Diabetes
“Our study shows that depression is a major and important comorbidity in people with type 2 diabetes,” said study co-author Leonard Egede, M.D., from the Center for Health Disparities Research at the Medical University of South Carolina.
Through a combination of diet, exercise and medication, people with type 2 diabetes work to keep their blood glucose levels within a certain range. Past research has shown that those who are also depressed have a tougher time doing so. About 30 percent of adults with diabetes have depression and the combination is linked to poor glucose control, higher complication rates, decreased quality of life and increased risk of death.
The current study appears in the November/December issue of the journal General Hospital Psychiatry.
Egede and his colleagues analyzed data from 11,525 veterans (98 percent men) with type 2 diabetes who received medical care at a Veterans Administration facility in the Southeast. The participants’ average age was 66 years and 48 percent were white, 27 percent were African-American and 25 percent were of other races.
Researchers evaluated each participant at three-month intervals from 1997 to 2006, with 36 intervals. At each 3-month interval, clinicians checked their HbA1c level, a blood test that measures long-term glucose control. Experts recommend a target level of less than 7 percent.
Six percent of the participants had depression, researchers determined.
They found that over the four-year period, the HbA1c values in the veterans who were depressed averaged 0.13 percent higher than the veterans who were not depressed. Egede said the difference is quite significant — enough to raise people with diabetes above the desirable range for glucose control, putting them at higher risk.
“The fact that the difference persisted over time and that the depressed group had higher mean HbA1c at all 36 time points was surprising,” Egede said.
The researchers also found that the change in HbA1c among the depressed participants did not differ based on race or age.
Evette Joy Ludman, Ph.D., senior research associate at the Group Health Center for Health Studies in Seattle, said that although the link between depression and diabetes complications might seem daunting, it is possible for adults to follow treatment orders for their depression while also managing their diabetes.
“I think it is a reasonable expectation that health care teams can help patients who have both depression and diabetes manage both conditions,” she said. “I don’t think patients see themselves as a collection of different illnesses and if we take a more proactive, integrated approach to caring for them, it is likely they can benefit. Research currently in the field is addressing that exact question.”
General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Science. For information about the journal, contact Wayne Katon, M.D., at (206) 543-7177.
Richardson LK, et al. Longitudinal effects of depression on glycemic control in veterans with type 2 diabetes. General Hosp Psychiatry, 30(6), 2008.
Monday, October 6, 2008
Using a Fan During Sleep May Reduce Infant SIDS Risk
Newswise — Infants who slept in a bedroom with a fan ventilating the air had a 72 percent lower risk of Sudden Infant Death Syndrome compared to infants who slept in a bedroom without a fan. The study examines an association between better air ventilation in infants' bedrooms and reduced SIDS risk, results appearing in the October issue of the Archives of Pediatric & Adolescent Medicine.
Infants who slept in a bedroom with a fan ventilating the air had a 72 percent lower risk of Sudden Infant Death Syndrome compared to infants who slept in a bedroom without a fan, according to a new study by the Kaiser Permanente Division of Research. The study appears in the October issue of the Archives of Pediatric & Adolescent Medicine. This is the first study to examine an association between better air ventilation in infants' bedrooms and reduced SIDS risk. The finding is consistent with previous research that showed factors influencing a baby's sleep environment may change SIDS risk. Among those factors are sleeping on the stomach and soft bedding, both of which may limit air ventilation around an infant¹s breathing pathway and thus increase the chance of re-breathing exhaled carbon dioxide, said the researchers They explained that fan use is no substitute for practices known to reduce the risk for sudden infant death syndrome, which include: always placing infants to sleep on their backs, putting infants to sleep on firm mattresses and avoiding soft bedding materials like comforters and quilts, providing a separate sleep environment, preventing infants from overheating, and not smoking around infants. ³Although this is the first finding linking fan use to SIDS, concerned parents can take measures to improve ventilation of infants sleep environment, by adding fans in rooms or opening windows. Other studies have found that parents can also reduce the chance of re-breathing carbon dioxide by putting infants to sleep on their back, avoiding soft bedding and overheating, and by using a pacifier,² said study author Dr. De-Kun Li, a reproductive and perinatal epidemiologist at Kaiser Permanente¹s Division of Research in Oakland. The study also found that opening a window in infant¹s room reduced the risk of SIDS by 36 percent compared to babies who slept in a room with closed windows, though this connection was not statistically significant according to the researchers. ³More studies need to be done to determine the exact relationship between the types of ventilation and the risks of SIDS,² said Li, who also authored a 2006 study in the British Medical Journal that found that using a pacifier can reduce SIDS risk by 90 percent. Funded by the National Institutes of Health, this latest study looked at 185 babies who died from SIDS in 10 Northern California counties and Los Angeles County from 1997 to 2000. They were compared to 312 infants of a similar age and from similar socio-economic and ethnic backgrounds in the same counties. Researchers identified SIDS cases through records from the California Department of Health Services and the Los Angeles County coroner¹s office and interviewed participating mothers by trained interviewers in English and Spanish with an average of 3.8 months after the baby¹s death. The study found that if an infant was in a high-risk sleep environment such as sleeping on their stomach or without a pacifier, or sharing a bed with someone other than parents or in an overheated room, using a fan to improve room ventilation was particularly beneficial. SIDS is the leading cause of death among infants aged 1 to 12 months, and the third leading cause of overall infant mortality in the United States. SIDS is defined as sudden death of an infant under the age of 1, which remains unexplained after a thorough case investigation, including an autopsy, examination of the death scene and a review of clinical history. ³Though this needs to be studied further before we can make clinical recommendations, this finding is consistent with the other factors that we know impact the SIDS risk by influencing sleeping environment, such as prone sleep position, soft bedding, and use of a pacifier,² said Dr. Fern Hauck of the University of Virginia Health Systems, who is a SIDS researcher and an American Academy of Pediatrics SIDS Task Force member. ³The finding that better ventilation had a greater reduced risk of SIDS in the presence of other risk factors affecting sleep environment (prone sleep position, bed sharing other than parents -- , high temperature, and not using pacifiers) further supports the hypothesis that environmental factors play a major role in SIDS risk,² Hauck said. Because of the difficult nature of the study (interviewing mothers whose babies had died suddenly), participation was relatively low. Also, in a case-control study, recall bias is always a potential concern. The study involved infants and their mothers from Alameda, Contra Costa, Fresno, Marin, Monterey, Sacramento, San Francisco, San Joaquin, San Mateo, Santa Clara and Los Angeles counties. Other authors on the study included: Kimberly Coleman-Phox, MPH, of the Kaiser Permanente Division of Research and the University of California, Berkeley, School of Public Health; and Roxana Odouli, MSPH, of the Kaiser Permanente Division of Research. More information on reducing the risk of SIDS is available from National Institutes of Health¹s Back to Sleep Campaign, http://www.nichd.nih.gov/sids/. About the Kaiser Permanente Division of Research (http://www.dor.kaiser.org/) The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well being and to improve the quality and cost-effectiveness of health care. Currently, the center's 400-plus staff is working on more than 250 epidemiological and health services research projects. About Kaiser Permanente Research Kaiser Permanente's eight research centers comprise one of the largest research programs in the United States and engage in work designed to improve the health of individuals everywhere. KP HealthConnect� , Kaiser Permanente¹s electronic health record, and other resources provide population data for research, and in turn, research findings are fed into KP HealthConnect to arm physicians with research and clinical data. Kaiser Permanente's research program works with national and local health agencies and community organizations to share and widely disseminate its research data. Kaiser Permanente¹s research program is funded in part by Kaiser Permanente¹s Community Benefit division, which in 2007 directed an estimated $1 billion in health services, technology, and funding toward total community health. About Kaiser Permanente Kaiser Permanente is America's leading integrated health plan. Founded in 1945, the program is headquartered in Oakland, Calif. Kaiser Permanente serves 8.7 million members in nine states and the District of Columbia. Today it encompasses Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the Permanente Medical Groups. Nationwide, Kaiser Permanente includes approximately 159,000 technical, administrative and clerical employees and caregivers, and 14,000 physicians representing all specialties. The organization¹s Labor Management Partnership is the largest such health care partnership in the United States. It governs how more than 130,000 workers, managers, physicians and dentists work together to make Kaiser Permanente the best place to receive care, and the best place to work. For more Kaiser Permanente news, visit the KP News Center at: http://xnet.kp.org/newscenter
