Posts Tagged ‘Professional article’

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Robot surgeon offers scarless surgery for parathyroid

The parathyroid glands are small glands in the neck that produce parathyroid hormone


When 67-year-old Margaret Mulloy started feeling tired and anxious she put it down to her age.
But a routine blood test revealed the Londoner had a problem with four tiny glands in her neck, which needed to be removed. The four pea-sized parathyroid glands control the level of calcium in the blood.When the glands become overactive, calcium levels rise, thereby weakening bones, raising blood pressure and causing kidney stones.In the past Margaret would have faced a neck scar of at least 5cm (2in).But she became one of the first patients in the UK, possibly the world, to have scarless neck surgery after surgeons used the da Vinci robot. The system allows the surgeon to operate through smaller scars within the body with more accuracy compared to conventional surgery.
Ear Nose and Throat (ENT) consultant Mr Neil Tolley, who led the team at St Mary’s Hospital, part of Imperial College Healthcare, said the robot enabled them to make one small cut below the collar bone and three incisions near the arm pit.
“Avoiding a scar is a main benefit,” he said.
“We are achieving the same surgical goal without a scar on the neck.
“We have used this technique on six patients so far.”
Surgical precision
ENT research registrar Mr Asit Arora said all procedures had been successful with minimal blood loss. Robotic-assisted surgery has been used for several years in heart and prostate operations.The principal benefits of telerobotic surgery are improved surgical precision and minimal access capability.It gives the surgeon 3D vision, reduces hand tremor and improves manual dexterity. Margaret said it had certainly made a big difference to her. “It is marvellous,” she said.”I have just got a little mark, but if I had it the old way I would have had a scar. This is much better especially for a younger person.”She added that since her surgery her blood pressure had also dropped.
Human surgeons
Judith Taylor had neck surgery the old-fashioned way several decades ago and was left with a large scar.

Judith Taylor has a neck scar

I had surgery for thyroid cancer 45 years ago when I was 15 and was very self-conscious about the scar when I wore low-cut dresses or a bikini,” said the trustee of the British Thyroid Foundation, a charity which supports those with thyroid disorders. Two more operations on her neck followed, including surgery to remove an over-active parathyroid gland.She said she would welcome a technique that reduced scarring, but what was more important to her was that everyone needing thyroid or parathyroid surgery had access to highly-skilled surgeons whether robotic or human.
She added: “I now wear my scar with pride, and the good news is that, thanks to my surgeons, I have my voice, I still sing as a hobby, I have two remaining functioning parathyroids – and I have my health.”
BBC News

Obesity rise on death certificates, researchers say

There has been a “dramatic rise” in deaths in England in which obesity was a contributory factor, researchers say.
They said death certificates showed there were 757 obesity related deaths in 2009, compared with 358 in 2000.
There were likely to be many more such deaths where obesity was not recorded, the University of Oxford team said in the European Journal of Public Health.

mesure the stomach-image:BBC


It comes as the Scottish government warned of a “ticking time bomb”, saying 40% of Scots could be obese by 2030.
One public health expert said people often did not realise obesity was linked with many serious conditions. The researchers said as obesity was rarely listed as the main cause of death, a simple snapshot of death certificates would not have picked up the rise.
The marked increase was apparent when they included contributing causes of death in the analysis.
Other figures recently released by ministers showed more than 190 people under 65 died as a direct result of obesity in 2009 compared with 88 in 2000.
When contributing factors were included, there were 757 obesity related deaths in 2009 compared with 358 in 2000.
Recognition
About a quarter of adults in the UK are now obese.
Obesity and problems caused by being overweight are thought to cost the NHS more than £3bn a year.
The Scottish government said 40% of Scots could be classed as obese by 2030, if things do not change.
Scotland’s Public Health Minister Shona Robison is due to launch an anti-obesity strategy later.
Study leader Professor Michael Goldacre said although the death certificate figures tallied with rises in levels of obesity in the population over the same period, they did not know before the study whether doctors would be recording obesity on death certificates.
“We know for example obesity contributes to heart disease but if someone dies of heart disease you don’t necessarily expect doctors to note if they were obese.
“But this shows doctors are increasingly recognising obesity as a cause of death.”
He added: “One of the key messages is you can’t rely on underlying causes alone – if you don’t look at other causes you cannot see what is contributing to disease.”
Professor Alan Maryon-Davis, president of the Faculty of Public Health, said people in the “early stages” of obesity did not often realise how dangerous being overweight could be and their weight commonly “creeps up” without them noticing.
“People do not realise how closely linked it is with serious conditions, such as heart disease, stroke, high blood pressure and diabetes.
“We have to take obesity seriously.

By Emma Wilkinson
Health reporter, BBC News

Oral conception. Impregnation via the proximal gastrointestinal tract in a patient with an aplastic distal vagina. Case report

The patient was a 15-year-old girl employed in a local bar. She was admitted to hospital after a knife fight involving her, a former lover and a new boyfriend. Who stabbed whom was not quite clear but all three participants in the small war were admitted with knife injuries.

The girl had some minor lacerations of the left hand and a single stab-wound in the upper abdomen. Under general anaesthesia, laparotomy was performed through an upper midline abdominal incision to reveal two holes in the stomach. These two wounds had resulted from the single stab-wound through the abdominal wall. The two defects were repaired in two layers. The stomach was noted empty at the time of surgery and no gastric contents were seen in the abdomen. Nevertheless, the abdominal cavity was lavaged with normal saline before closure. The condition of the patient improved rapidly following routine postoperative care and she was discharged home after 10 days.

Precisely 278 days later the patient was admitted again to hospital with acute, intermittent abdominal pain. Abdominal examination revealed a term pregnancy with a cephalic fetal presentation. The uterus was contracting regularly and the fetal heart was heard. Inspection of the vulva showed no vagina, only a shallow skin dimple was present below the external urethral meatus and between the labia minora. An emergency lower segment caesarean section was performed under spinal anaesthesia and a live male infant weighing 2800 g was born…

…While closing the abdominal wall, curiosity could not be contained any longer and the patient was interviewed with the help of a sympathetic nursing sister. The whole story did not become completely clear during that day but, with some subsequent inquiries, the whole saga emerged.

The patient was well aware of the fact that she had no vagina and she had started oral experiments after disappointing attempts at conventional intercourse. Just before she was stabbed in the abdomen she had practised fellatio with her new boyfriend and was caught in the act by her former lover. The fight with knives ensued. She had never had a period and there was no trace of lochia after the caesarean section. She had been worried about the increase in her abdominal size but could not believe she was pregnant although it had crossed her mind more often as her girth increased and as people around her suggested that she was pregnant. She did recall several episodes of lower abdominal pain during the previous year. The young mother, her family, and the likely father adapted themselves rapidly to the new situation and some cattle changed hands to prove that there were no hard feelings.

Comments

A plausible explanation for this pregnancy is that spermatozoa gained access to the reproductive organs via the injured gastrointestinal tract. It is known that spermatozoa do not survive long in an environment with a low pH (Jeffcoate 1975), but it is also known that saliva has a high pH and that a starved person does not produce acid under normal circumstances (Bernards & Bouman 1976). It is likely that the patient became pregnant with her first or nearly first ovulation otherwise one would expect that inspissated blood in the uterus and salpinges would have made fertilization difficult. The fact that the son resembled the father excludes an even more miraculous conception.”

British Journal of Obstetrics and Gynaecology
1988