Pioneering surgery cuts out scalpel

Pioneering surgery cuts out scalpel

Provided by: Sun Media
Written by: MEGAN GILLIS

Dr. Marc Ruel has pioneered the surgical technique of placing grafts on a beating heart through an incision a little bigger than a paper-clip.

But even more revolutionary is his research at the University of Ottawa Heart Institute into using cells transplanted from the bloodstream to regenerate the heart without using a scalpel at all.

It's made the surgeon, scientist and scholar the first cardiovascular surgeon to win the Royal College of Physician and Surgeons' prestigious gold medal in surgery.

"Our work at the Heart Institute shows the potential to regenerate the heart and takes us one more step toward new treatments to restore heart function," Ruel said. "We are just scratching the surface in this area. But our cardiac surgery research team is still growing, moving us into the future with a new vision of how cardiac research will evolve."

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Ruel won the gold medal for research that suggests that transplanted cells from the patient's bloodstream could be used to regenerate blood vessels, restoring blood supply to the heart.

Ruel studied medicine at the University of Ottawa but left Canada for a fellowship at Harvard University. He was lured back to Canada with a grant from the Canadian Centre for Innovation, which allowed him to set up a lab.

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'Controversies And Advances' Conference For Cardiologists And Heart Surgeons

'Controversies And Advances' Conference For Cardiologists And Heart Surgeons

Main Category: Cardiovascular / Cardiology News

Stem cell therapy for cardiac regeneration and the controversial issue of medicine and the media will be the focus of the keynote addresses at the seventh annual "Controversies and Advances in the Treatment of Cardiovascular Disease" conference. Conducted by Cedars-Sinai Medical Center at the Beverly Hills Hotel on Oct. 4 and 5, the conference is co-sponsored by the California Chapter of the American College of Cardiology, the California Chapter of the Society of Thoracic Surgeons, and Promedica International CME.

Professional differences of opinion often have stood between heart surgeons and cardiologists, and recent innovations in minimally invasive medical procedures have done nothing to reduce the friction. The ongoing debate as to whether it is better to replace and repair aortic and mitral valves surgically or to manage them medically is just one example. And when considering treatment options for Atrial Fibrillation, the choices are even more diverse -- should the physician opt for minimally invasive surgery, drugs or a catheter treatment? And then there is the highly controversial stent issue -- drug-eluting vs. bare metal which is better?

This major symposium -- one of the very few that brings together both cardiologists and heart surgeons -- will directly explore the controversies and latest medical and surgical advances in an open forum. Many subjects will be addressed in debate formats. Others will be lectures presented by highly respected leaders in their fields.

Lawrence K. Altman, M.D., author of the book "Who Goes First? The Story of Self-Experimentation in Medicine" and a member of the New York Times science news staff since 1969, will be one of two keynote speakers. Altman, senior medical correspondent at the Times, has published an average of 100 scientific stories a year and writes the column "Doctor's World." His remarks will focus on medicine and the media.

A clinical professor at New York University Medical School, Altman has received three Howard W. Blakeslee Awards from the American Heart Association and the George Polk Award for excellence in journalism.

Eduardo Marbán, M.D., Ph.D., recently named director of the Cedars-Sinai Heart Institute, will be the second keynote speaker and will discuss stem cell therapy for cardiac regeneration. Prior to joining Cedars-Sinai, Marbán was a member of The Johns Hopkins University School of Medicine faculty for 22 years, most recently serving as chief of cardiology and professor of cardiology, physiology and biomedical engineering.

Editor-in-Chief of the journal Circulation Research and an expert in molecular and cellular mechanisms underlying heart problems, Marbán is widely known for directing major multidisciplinary research programs leading to gene therapy, drug treatment and stem cell discoveries.

"The field of cardiology is poised for a revolution in which cell-based methods will be used to regrow healthy heart muscle after myocardial infarction or in chronic heart failure. Cardiac stem cells (CSCs) show great promise for regenerative therapy. Before 2003, when these resident stem cells within the heart were first discovered, the heart was thought to have little or no regenerative potential," said Marbán, providing a preview of his address.

"We have isolated cardiac stem cells from adult human and porcine endomyocardial biopsy specimens, differentiated them in vitro and characterized their functional properties. They can regrow healthy heart muscle and blood vessels," Marbán continued. "We also have developed methods to isolate and expand CSCs from routine biopsy specimens; they readily become excitable and contractile. These observations provide both a simple method and a solid rationale for the use of CSCs for autologous cardiac regeneration therapy."

Autologous refers to cells reimplanted within one patient, not transplanted from one person to another.

Marbán came to Cedars-Sinai to serve as the first director of the Heart Institute, which integrates and oversees the development of programs in cardiology, cardiac surgery, cardiac imaging and other areas. He has received funding to support three clinical studies reintroducing cardiac stem cells into heart patients, with first enrollment anticipated early next year.

Additional keynote speakers will include Dr. Jack Lewin, CEO American College of Cardiology, who will speak on healthcare reform.

Program directors for "Controversies and Advances in the Treatment of Cardiovascular Disease" include: Gregory P. Fontana, M.D., cardiothoracic surgeon and vice chairman of Surgery; Raj Makkar, M.D., cardiologist and director, Interventional Cardiology; P.K. Shah, M.D., cardiologist and director of the Division of Cardiology; Alfredo Trento, M.D., cardiothoracic surgeon and director of the Division of Cardiothoracic Surgery at Cedars-Sinai; and John G. Harold, M.D., FACC, cardiologist and President, California Chapter American College of Cardiology (ACC), ACC Governor for Southern California, and a recent Chief of Staff at Cedars-Sinai.

Sessions on Thursday, Oct. 4, will address coronary artery disease (part 1), mitral valve and carotid artery disease, arrhythmias and atrial fibrillation, and the future and new techniques. Friday's sessions look at coronary artery disease (part 2), aortic valve disease, congenital heart disease, and surgery and interventional cardiology. Several lectures and/or debates will be presented on each subject.

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Article adapted by Medical News Today from original press release.

The first in Southern California and one of only 10 hospitals in the state whose nurses have been honored with the prestigious Magnet designation, Cedars-Sinai Medical Center is one of the largest nonprofit academic medical centers in the Western United States. For 19 consecutive years, it has been named Los Angeles' most preferred hospital for all health needs in an independent survey of area residents. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities as well as breakthroughs in biomedical research and superlative medical education. It ranks among the top 10 non-university hospitals in the nation for its research activities and is fully accredited by the Association for the Accreditation of Human Research Protection Programs, Inc. (AAHRPP). Additional information is available at http://www.cedars-sinai.edu/.

Source: Sandy Van
Cedars-Sinai Medical Center

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Dr. Kenrick Spence Named Top Orlando Plastic Surgeon

Dr. Kenrick Spence Named Top Orlando Plastic Surgeon

Readers of Orlando Magazine singled out Dr. Spence as their #1 choice for the sixth consecutive year

ORLANDO, FL, -- Orlando Magazine, the chronicle of central Florida lifestyle, awarded Dr. Kenrick Spence top honors this month in its annual poll of "The Best of Orlando."

The plastic surgeon was singled out as readers from around the area voted for their favorite restaurants, stores, personalities and more.Although the magazine noted that "quite a few categories got a good shake-up this year," Dr. Spence took the top spot in Orlando plastic surgery for the sixth year in a row.

"To be named top plastic surgeon again by residents of a community that calls itself 'The City Beautiful' is indeed a high honor," said Dr. Spence.Dr. Spence feels it's the relationships he develops with his Orlando plastic surgery patients that probably make the difference between him and other plastic and cosmetic surgeons in Orlando.

He emphasizes patient education to the point that he often provides multiple consultations prior to surgery. He also routinely sets aside time in his daily schedule for one-on-one discussions with patients.Another key to good patient relationships, Dr. Spence feels, is to understand not just patients' physical attributes and aesthetic desires, but to learn about their lives as well. "As a trained, experienced surgeon, it's easy for me to understand 'how' to deliver results.

It's more challenging, and just as vital, to understand 'why.'" Knowing patient motivations helps ensure they are candidates for the procedures they're considering, Dr. Spence explained. It's also a good idea to give thought to 'when' it's the right time for a patient to have a procedure. "We tend to be quite active here in Orlando, and plastic surgery patients sometimes underestimate or overestimate recovery time. When I know about the demands of their jobs and families, I can help them plan."

Dr. Spence has other strategies for ensuring he communicates with patients throughout their plastic surgery experience. Workshops he conducts during the year give prospective patients the information they need to consider all their alternatives and decide whether to pursue plastic surgery in Orlando.

His Web site, devoted to patient education, offers frank, honest information on topics from surgical risks to fees and financing.For more information on Orlando's top plastic surgeon, visit http://www.spencemd.com.

Orlando, Florida plastic surgeon, Dr. Kenrick Spence, specializes in facial plastic surgery, body contouring and breast enhancement for his Orlando area patients. He is fully trained in both cosmetic and reconstructive surgery, and he's certified by the American Board of Surgery and the American Board of Plastic Surgery. For more information, visit the practice on Hillcrest Street in Orlando, call (407) 999-2585, or go to http://www.spencemd.com.

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Navy paid for breast implants for servicewomen

Navy paid for breast implants for servicewomen

THE Australian Navy is paying for women sailors to have breast enlargements for cosmetic reasons, at a cost to taxpayers of $10,000 an operation.Defence officials claim the surgery is justified because some servicewomen need bigger breasts to address "psychological issues''.

Darling Point plastic surgeon Kourosh Tavakoli told The Sunday Telegraph the navy had paid for two officers, aged 25 and 32, to have breast-augmentation surgery at his private clinic. Dr Tavakoli said the women had not been injured but claimed to suffer "psychological'' problems.

"I've had two female officers who have got the navy to pay for breast augmentation for psychological reasons,'' he said. "I know for a fact two patients claimed it back on the navy. They (the navy) knew it was breast augmentation and paid for it.

"I don't know why they pay for it. There's no breast augmentation, that I know of, for medical purposes. You've got to be fair to yourself.'' A Defence spokesman admitted cosmetic surgery occurred at "public expense'' when there were "compelling psychological/psychiatric reasons'', but refused to say how many such cases were taxpayer-funded.

Cosmetic surgery was also provided for servicemen or women who were disfigured by work-related injuries, he said. "Cosmetic procedures undertaken solely for the purpose of preserving or improving a person's subjective appearance will be considered only if the underlying (psychological) problem is causing difficulties that adversely impact on the member's ability to do their job. "Operations purely for cosmetic reasons are not allowed.''

The Sunday Telegraph asked Defence Minister Brendan Nelson, formerly a GP, how many members of the armed forces had received taxpayer-funded cosmetic surgery. A spokesman said figures would not be available until next week.

Australian Defence Association spokesman Neil James defended the practice of taxpayers funding medical proceduressuch as breast enhancement surgery for psychological reasons. He said young men and women were attracted to defence careers because they offered free medical care. This, in turn, improved the efficiency of the force.

"Just as there are in civilian life, there are some females who feel their breasts are too small and if their breasts were bigger, they might be more of a 'normal' woman,'' Mr James said. "If they were lacking in self-confidence, this might provide the measure of self-confidence that would help them tackle their wider job. "There are privacy issues here for people. It's not as if they keep a record of who has had a nose job in the Defence Force over the past 100 years.''

Dr Tavakoli, a member of the Australian Society of Plastic Surgeons, said the navy officers had visited him in 2005 and 2006. Each had had $10,000 worth of surgery, which required a recovery period of at least two weeks. Boosting self-esteem was the biggest motivation for cosmetic surgery, Dr Tavakoli said. The Sunday Telegraph understands Dr Tavakoli is not the usual surgeon used by the navy for reconstructive/cosmetic surgery.

"I don't see a lot of them (naval officers) because they have their own plastic surgeon,'' he said. "I know for a fact they have their own surgeon.'' Last year, a Brisbane surgeon revealed that an army cook had had a taxpayer-funded nose job.

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Plastic surgeons learn new techniques

Plastic surgeons learn new techniques

By...... calgary.ctv.ca
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Canada’s plastic surgeons are in Calgary learning some new techniques, in a new way.

On Friday, an expert in body sculpting performed a surgery in a Calgary hospital.

The surgery was then broadcast live to a conference room, in a downtown hotel, for the other surgeons to see.

The live broadcast allows the operating surgeon to answer questions and explain what is going on.
“I think video really gives something that still images, during a lecture, can never do,” says Dr. Fremont Eaves, a body sculpting expert from North Carolina who performed Friday’s surgery.

Over 120 surgeons are taking part in the annual meeting of Canadian plastic surgeons.

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Smaller breast reduction surgeries provide health benefits and should be reimbursed

Smaller breast reduction surgeries provide health benefits and should be reimbursed

Findings question insurance industry's refusal to cover reduction mammoplasties of less than 1,000 grams

NEW YORK (Sept. 13, 2007) -- Smaller-framed women reap significant health and quality-of-life benefits from breast reductions that involve the removal of under 500 grams of tissue per breast, according to a first-of-its-kind study from NewYork-Presbyterian Hospital/Weill Cornell Medical Center and the New York University School of Medicine.

The finding runs counter to the policies of most U.S. health insurance companies, who typically do not reimburse women for these smaller mammoplasties because insurance companies deem them to be only of cosmetic value. "Of course, as plastic surgeons, we know that isn't true -- you can't apply the same number, in terms of the benefits of excised breast tissue, to different-sized women," says co-author Dr. Jason Spector, a plastic surgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and assistant professor of surgery (plastic surgery) at Weill Cornell Medical College. "Smaller women are going to have proportionally smaller breasts, but for their particular frame, their breasts may still be far too large and uncomfortable," Dr. Spector explains.

The study, appearing in the Sept. 15 issue of Plastic and Reconstructive Surgery (already available online), found that breast reductions of less than 500 grams per breast greatly eased women's back, neck and shoulder pain. The procedures also improved their quality of life by allowing them to exercise more, play sports and choose from a wider variety of clothing.

All of the 59 patients in the study had come to the study's co-author, plastic surgeon Dr. Nolan S. Karp of NYU Medical Center, complaining of pain linked to uncomfortably large breasts. Dr. Karp is associate professor of plastic surgery at the NYU School of Medicine. None of the women in the study had ever undergone any form of breast augmentation before.

On average, the mammoplasties involved the surgical removal of 415 grams of breast tissue per breast (830 grams total), for an average breast reduction of just over 2 cup sizes. Seventeen of the women had less than 750 grams total of breast tissue removed -- an average decrease of 1.7 cup sizes.

Three months and then one year after their surgery, the women were asked about changes in pain and quality of life. They were asked to rate their pain from a score of 1 to 5 (5 being highest). Scores fell dramatically after the reduction mammoplasties -- in categories including lower-back pain, neck pain, headache and bra-strap "grooving." "Women were also greatly relieved that they were more able to engage in healthful activities such as running or playing sports -- demonstrating that breast reduction surgeries have even wider health implications," Dr. Spector says.

None of these findings came as a great surprise to this experienced plastic surgeon. "However, studies like this are needed if we are ever going to reverse the arbitrary ceiling the insurance industry has in place in terms of reimbursing breast reduction surgeries," Dr. Spector explains.

"The smaller-framed woman who comes to us complaining of chronic breast-linked pain is not having this procedure done for a 'lift' or any cosmetic purpose," he says. "Breast reduction surgeries involve some scarring, general anesthesia, and the usual level of surgical risk. Patients are not taking them lightly." Dr. Spector is optimistic that reimbursement policies may change, based on the new findings.

"This is going to be useful data that patients and other plastic surgeons should be able to turn to as they go back and forth with insurance companies trying to get the procedure approved," Dr. Spector says. "Women come in all shapes and sizes, and we're just pointing out that breast reduction -- like many other surgeries -- is definitely not a one-size-fits-all proposal."

Contact: Emily Berlanstein eab2007@med.cornell.edu 212-821-0560 New York- Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College New York-Presbyterian Hospital/Weill Cornell Medical Center New York-Presbyterian Hospital/Weill Cornell Medical Center, located in New York City, is one of the leading academic medical centers in the world, comprising the teaching hospital NewYork-Presbyterian and its academic partner, Weill Cornell Medical College. NewYork-Presbyterian/Weill Cornell provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine, and is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian, which is ranked sixth on the U.S. News & World Report's list of top hospitals, also comprises NewYork-Presbyterian Hospital/Columbia University Medical Center. For more information, visit www.nyp.org

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Lung cancer treatment revamped

Lung cancer treatment revamped

By ASSOCIATED PRESS

Thousands more lung cancer patients each year could be offered surgery or other aggressive therapy under a new system that classifies many tumors as more treatable than in the past.

It is the first big overhaul of a decades-old method used to predict survival and help determine whether a lung cancer patient will have surgery, chemotherapy or be treated at all.

The new guidance is to be presented at a conference of lung cancer specialists in Seoul, South Korea, that starts today. It is expected to be adopted by policy-making groups in the next year.

Lung cancer is the world's top cancer killer, claiming 1.3 million lives each year. In the United States, 213,380 new cases and 160,390 deaths from the disease are expected this year.

Nearly 60 percent of people die within one year of diagnosis, and nearly 75 percent die within two years, American Cancer Society statistics show.

Treatment

In treating it, doctors use a formula called tumor staging. It is based on a tumor's size, how far it has spread and other factors to predict a patient's survival odds and to guide treatment.

The current system was developed from about 5,000 tumor samples from University of Texas M.D. Anderson Cancer Center in Houston decades ago — before improved scanning technology was available to evaluate a cancer's spread.

The new plan is based on 100,000 tumor samples from around the world including Asia, where lung cancer rates are projected to climb because of trends in smoking, unhealthy lifestyles and aging populations.
It keeps four broad groupings but sorts people more precisely based on refined understanding of tumor characteristics.

The result: "There will clearly be shifting of patients from categories not operable to operable" — as many as 10,000 a year in the United States, said Dr. David Johnson, a lung cancer specialist at Vanderbilt University in Nashville, Tenn. He reviewed the plan, which was partly published in a medical journal recently.

Tumor stages

The stage of the tumor at diagnosis is the best predictor of survival. Only 20 percent of cases are diagnosed in Stages 1 or 2, when tumors are small and confined to a lung, Johnson said. About 30 percent to 40 percent are found in Stage 4, after they have widely spread. The rest are in the middle.

Five-year survival rates are 47 percent for Stage 1 and 26 percent for Stage 2, but only 8 percent for Stage 3, and 2 percent for Stage 4, according to the American College of Surgeons.

Most lung cancers are the type called "non-small cell," which is covered by the new staging system. The system was developed by the International Association for the Study of Lung Cancer, a group of lung cancer specialists from around the world.

Dr. Peter Goldstraw, a surgeon at the Royal Brompton Hospital in London, led the project, and Canadian scientists independently validated the recommended changes by comparing survival across geographic regions.

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