Pravda, the famous Russian newspaper, reports an offbeat story: a 40-year old Moscow woman was saved from certain death by her breast implants.

She had been attacked by her former husband, with a knife, after an argument got heated. He apparently tried to stab her in the heart, but the knife got stuck in the middle of her silicone gel breast implant! Interestingly, she had the “gummy bear” style cohesive gel implant (available in Europe, but not here in the USA) – and the implant contents did not leak, but maintained its original shape. According to the surgeons, the knife did not even enter the thorax.

The woman went to her friendly neighborhood plastic surgery clinic again after the fight and had her damaged breast implant replaced with a new one.

Ironically, it was her husband who had suggested the breast enlargement surgery five years earlier. What a crazy world!

In this month’s PRS journal, a study of over 1200 breast augmentation patients reviewed the relationship between incision location and any alterations in the sensitivity of the nipple or areola.

Previous studies in this area were small, and had conflicting results. This study showed, quite convincingly, that the nipple incision for breast augmentation does have significant negative effects, compared to using an infra-mammary (“crease”) incision. In particular:

– the risk of sensitivity changes in the nipple or areolar area was more than doubled (9.5% vs. 3.5%)
– the risk of areolar pain was more than tripled (14.6% vs. 4.1%)

In this study, the was no relationship between implant size and sensory changes, which had been seen in some previous studies.

The authors concluded, that even though the risks of these nerve-related complications were fairly small, it was worth discussing when speaking with patients about the nipple incision for breast augmentation.

Editor’s note: Add this to the higher risk of capsular contracture with the nipple approach, as well. The data seems to show a pattern: the infra-mammary approach for breast augmentation has fewer complications.

Here’s the story of how British plastic surgeons donated their skills and time to successfully separate a pair of conjoined twins that were joined at the head. Well done!

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(Reuters) – Surgeons at a British hospital have successfully separated conjoined twin baby girls in a complex and extremely rare operation, the charity that funded the surgery said on Sunday.

Sudan-born Rital and Ritag Gaboura are “craniopagus” twins, meaning they were born joined at the head.

Conjoined twins are very rare, and only around 5 percent of them are craniopagus. Experts say around 40 percent of those are stillborn or die during labor, and another third die within 24 hours. So for craniopagus twins to survive even beyond early infancy is a one in 10 million occurrence.

Rital and Ritag, who will celebrate their first birthday next week, were so-called Total Type III Craniopagus twins, meaning that significant blood flowed between their brains — presenting surgeons with a particularly difficult challenge.

According to doctors who worked on the case, Ritag supplied half her sister’s brain with blood, whilst draining most of it back to her heart, therefore doing most of the work.

This situation was life threatening because large dips in brain blood pressure can cause several neurological damage.

“The incidences of surviving twins with this condition are extremely rare,” said David Dunaway, a surgeon in the plastic surgery and craniofacial unit at Great Ormond Street Hospital who led the separation of the girls.

“The task presented innumerable challenges.”

The separation of the twins was completed on August 15, and the medical team say the twins do not appear to be suffering any neurological side effects, according to British charity Facing the World, which funded the treatment.

The twins were born in Khartoum, Sudan in September 2010 and their parents — both doctors — asked the charity to organize and fund their separation.

The family flew to London in April, when Ritag’s heart was starting to fail, and the twins were admitted to Great Ormond Street, a world-renowned children’s hospital in central London.

The separation was carried out in four stages by a surgical team who worked for free. Two operations were carried out in May, then another was undertaken in July to insert tissue expanders, and the final separation was completed on August 15.

“Within days the twins were back on the general ward interacting and playing as before. Their laughter and delight in the world has been an inspiration throughout the months of worry,” the charity said in a statement.

“Very soon, their parents will be able to fulfill their dream of taking home two healthy, separate daughters.

How many times have we heard it: “if we can put a man on the moon, why can’t we cure the common cold?” Well, some smart guys from MIT may have figured it out.

Meet “DRACO” – short for Double-stranded RNA (dsRNA) Activated Caspase Oligomerizer. It’s an all-purpose anti-viral agent. So far, in tests in mice, DRACO kills cells infected with viruses, but leaves uninfected cells alone and unharmed. Early testing shows the DRACO concept works to cure 15 different viruses, including H1N1 influenza, adenovirus, and rhinovirus – yes, the one that causes the common cold. It’s not a vaccine; it’s a whole new potential class of anti-viral medications. Here’s a link to PLoS One, the online journal that recently published this study.

DRACO combines two natural processes – detection of viral infection, and apotosis (cell death). The MIT breakthrough was to come up with idea to combine the two separate protein molecules responsible for these processes, and to actually make it work in the lab.

Here’s the concept: normal mammalian cells do not normally produce long strands of double-stranded RNA unless they are infected with a virus. The DRACO has a portion- called protein kinase R – that binds to this abnormal dsRNA. Think of this as the “homing beacon” for the DRACO anti-viral missile.

When two or more DRACO’s bind to the viral RNA and cross-link to one another, the enzyme part of DRACO – called apoptotic protease activating factor 1 (APAF-1) – gets turned on… and destructive enzymes are released, killing the cell and destroying the virus. The missile destroys the target. If there is no viral RNA to be seen, the DRACO missile flies right on by, leaving normal, healthy cells unharmed.

Of course, this work is still very, very preliminary. All sorts of clinical testing needs to be done – but the potential, if the concept works, is huge. Can you imagine: a cure for all viruses?

Very cool stuff. It could be the biggest medical breakthrough since the discovery of penicilli

Here’s an interesting study, courtesy of Medscape. I’ve edited it for brevity.

According to a study published in the online journal Health Affairs, American physicians spend almost 4 times as much on administrative costs related to dealing with insurance plans, compared to physicians in Canada.

According to the research, the staff time to deal with multiple health plans about claims, prior authorizations, and so forth is estimated to cost at least $82,975 per physician per year in the United States, versus $22,205 in Ontario. The study, from the University of Toronto, was partially funded by The Commonwealth Fund, which is pro-single-payer systems.

If the typical administrative costs could be made equal to those in Ontario, potential savings in the U.S. would be about $27.6 billion per year.

American physician practices interact with multiple health plans, with different insurance products, each with its own arcane policies for prior authorization, billing, submitting claims, and determining payment. Canadian physicians work with a single payer with a single set of rules.

Here are some other interesting comparisons:
– Nurses and medical assistants spend 20.6 hours per physician per week on administrative tasks, nearly 10 times the time spent by Canadian practices. The main reason: obtaining “prior authorization”.
– US clerical staffs spend 53.1 hours per physician per week on administrative tasks related to insurance, compared with 15.9 hours in Ontario.
– Senior administrators of US physician practices spend 163.2 hours a year overseeing claims and billing, compared with 24.6 hours a year in Ontario.

As you can see, dealing with insurance plans is a full-time job.

The Canadian system certainly isn’t perfect – waiting lists are common in Canada. Currently, the average wait time between referral from a GP to a specialist for non-emergency conditions is 18 weeks. Canadians typically wait 4.2 weeks for a CT scan, and nearly 10 weeks for an MRI. But of course, there are no co-pays or deductibles. And you can use the insurance plan no matter where you move in Canada, and you don’t lose coverage if you become unemployed. Canadians also pay higher taxes.

While I don’t think the Canadian healthcare system could work here in the U.S. for multiple reasons, this study certainly gives the U.S. system a measuring stick to use in order to reduce the amount of needless bureaucracy that has developed here. Food for thought.

 

BDD, or body dysmorphic disorder, is a problem in which the patient’s own perception of the body or body part doesn’t match the objective reality. Technically, it’s defined by the DSM-IV as “an excessive concern with an imagined or slight defect in physical appearance, leading to significant distress or impairment in one or more important areas of functioning”. As you might expect, we see this issue in our offices among potential cosmetic surgery patients.

Typically, most estimates state that BDD occurs in about 2% of the general population. In most cosmetic surgery offices, that number is probably higher – maybe 10% – due to self-selection of the patients. Now, a new study in this month’s issue of PRS (Plastic & Reconstructive Surgery) suggests that the number may actually be dramatically higher than previously thought in rhinoplasty patients. The new study suggests that one out of three patients (33%) has “at least moderate” symptoms of BDD.

OK, you might say, “so these patients are obsessed with the shape of their nose…isn’t that why you guys are there?” Actually, it turns out that it’s a bad idea to operate on these patients. Even though their nose may look better to you and me, it doesn’t fix their body image. Their self-image is still abnormal after surgery, and they are typically never happy with the surgical result, and have a higher rate of surgical revisions. Furthermore, the BDD patient’s quality-of-life actually deteriorates after surgery. Some BDD patients have even become violent after surgery. So generally, most surgeons try not to operate on patients who have obvious BDD. They need counselling, not surgery.

In this new study from Belgium, 226 patients seeking rhinoplasty were given a standardized questionnaire that had been developed together with psychiatrists, and the results were compared to a control group from the non-cosmetic ENT patient population. The two groups were comparable statistically.

The rhinoplasty group included some patients who wanted improved breathing, and some patients that wanted a better appearance. Overall, 33% of rhinoplasty patients scored high enough on the questionnaire to indicate moderate symptoms of BDD. This increased to 43% when only the aesthetic rhinoplasty patients were evaluated, and 12% in the airway (functional) group. Both of these scores were higher than the 2% seen in the control group. Note: the authors didn’t say that these people had the full blown BDD syndrome, just symptoms of a partial BDD situation.

Not surprisingly, there was no correlation between the objective and subjective evaluation of the nasal deformity…in other words, the patient’s view of themselves was very different than what the professionals saw on examination. This is what would be expected from the definition of BDD.

One more thing: in this study, the famous “SIMON” pattern did not hold up. (“SIMON” is a stereotype of BDD – rhinoplasty patient – the “single, immature male, overly narcissistic”). This study showed an equal prevalence in males and females. Another bit of long-taught surgical lore bites the dust.

Wondering if you have some BDD symptoms? Try this screening questionnaire.

A Phoenix, Arizona physician who had three patients die during liposuction surgery was found guilty of murder and manslaughter last week in Maricopa County Superior Court. He was not a trained plastic surgeon, nor a surgeon of any kind.

Dr. Peter Normann had been an emergency-room physician, certified as an internist, and had never done a residency in plastic surgery. He had undergone six days of training in liposuction and had done some “hands-on training” in liposuction and breast augmentation.

Normann was pronounced guilty of second-degree murder in the deaths of Ralph Gonzalez, 33, of Scottsdale, and Leslie Ann Ray, 53, of California, and of manslaughter for the death of Alicia Santizo Blanco, 41, of Gilbert.

In her closing arguments earlier this week, Attorney Jeannette Gallagher claimed that two of the deaths constituted second-degree murder because of Normann’s “extreme indifference to human life,” and the third death was manslaughter because of Normann’s “conscious disregard of substantial and unjustified risk of death.”

Furthermore, the attorney said, his operating room lacked proper oxygen and monitoring equipment, and he worked without anesthesiologists or nurses, relying on a massage therapist and a former restaurant worker with little or no training as medical technicians.

The massage therapist, who assisted in surgery, has already pleaded guilty to eight counts of unlawful practice of medicine and was sentenced last year to five years in prison.

Source: www.azcentral.com

Editor’s note: There seems to be an ongoing problem with surgery done by untrained physicians, with a lack of trained anesthesiologists, in substandard facilities… and the complications that can happen, as in this sad tale, are not at all good.

Whether you call it aesthetic surgery or cosmetic surgery, it’s still surgery.

It’s always great to see people you know coming up with innovative ideas and making them work successfully. This time, a friend from my time at MGH in Boston, plastic surgeon Geoff Gurtner, MD, has come up with a neat scar-reducing dressing that looks quite promising in early trials.

Here’s the concept: we know that scars get worse if there is a lot of tension across the incision. Even small amounts of tension, like those from day-to-day motion, make a difference, which is why scars on the knee often look so bad. What if we were able to shield the incision from those forces?

The polymer dressing, manufactured by Neodyne Biosciences, is stretched over the incision after sutures are removed. It adheres to skin, and reduces the tension across the wound. It turns out that this simple idea makes a big difference to how scars turn out.

In a small study of tummy tuck patients, the Neodyne dressing was applied to one half of the incision, while the other side received standard post-op care. Surgeons then rated photographs of the scars, 6-12 months post-op, noting a highly statistically significant difference. Lay examiners who saw the photos agreed with the experts.

The product is still in Phase I trials, so it will be quite a while before it is commercially available. I like the idea because it seems to work, fits in with our usual surgical routine, and is convenient for patients – with an obvious outcome improvement.

Photo credit: ehospitalistnews.com

Here’s the story from wbtv.com. (Edited for brevity.)

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NORTH MYRTLE BEACH, SC (WMBF) – After three people were charged with an illegal liposuction procedure in a North Myrtle Beach apartment, the doctor who treated the victim has spoken up to warn others about the threat of uncertified plastic surgeons.

Dr. Ralph Cozart said he was the on-call plastic surgeon at Grand Strand Regional Medical Center in Myrtle Beach Friday when he was called in to respond to a 19-year-old woman who came to the hospital in hemorrhagic shock.

“Had she been 40 or 50 years old, I’m afraid she might not have survived,” Cozart said.

Describing the illegal liposuction procedure done in an apartment, Cozart said, “she wasn’t given the proper fluids to replace the fluids that were suctioned out. The equipment was not sterile. They did not have sterilization equipment at all. They were using bleach to decontaminate the instruments.”

The victim told an officer she arranged the liposuction after seeing a particular advertisement online. She said two people picked her up from Myrtle Beach Mall on Thursday and took her to an apartment in North Myrtle Beach to get the liposuction. The woman said she paid $1,500 up front, and she was expected to pay $1,500 after the procedure. The victim stated she was given several pills, causing her to become unconscious.

She said when she woke up the two people were taking her home. According to the woman’s statement in a police incident report, the woman’s mother took her to the hospital Friday evening after she became sick and continued to bleed from her puncture wounds.

Police arrested Adriana Chica Neibles, 41, of Bogota, Colombia, who they believe was doing procedures for which she was not qualified. Chica Neibles was the person featured in the online advertisement. North Myrtle Beach Police also arrested Nubia Trujillo Rojas, 53, of Nelva, Colombia, and Miguel Trujillo-Orozco, 31, of North Myrtle Beach.

All three people are charged with assault and battery of a high and aggravated nature, practice of medicine without a license, and possession of illegal substances.

Cozart said whether it is online or at an office, the problem of people offering procedures they do not have enough training in is more common than many people think. “There are doctors who say they’re board certified, but they don’t say what they’re board certified in,” Cozart explained. “They may be family practice. They may be internal medicine. It doesn’t mean they’re board certified plastic surgeons if they’re doing liposuction. There’s no law against it. There’s no scope of practice law in South Carolina.”

Editor’s note: There are many “red flags” in this story. This patient got suckered by a price that was “too good to be true”. She didn’t do her research. Sounds like she was lucky to survive!

1) Only have surgery performed by a qualified, Board-certified specialist.
2) Only have major surgery performed in a certified & accredited surgical center or hospital.

Get the word out! The 2011 Race for the Cure – the Susan G. Komen Foundation event for breast cancer awareness and fundraising – is happening October 16th in Orlando at BrightHouse Stadium.

Our office has formed a walking team – and we’ll be there, helping! Our team name is “Fiala’s Breast Friends Forever” – and Denise is our team captain.

You can be a BFF team member too! I’d like to invite everyone who wants to help this excellent cause to come and join our team, and walk with us!

Denise, at our office, has all the info. Call her, and be a BFF! You can also sign up online. Click here, and it should take you to the right area of the Race for the Cure website to sign up to be a BFF!

Mark it on your calendar now, so you don’t forget. October 16. Hope to see you there!! And if you can’t make it…please be a BFF, and support the cause.

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