Stomach stapling saves lives
SALT LAKE CITY — Roux-en-Y gastric-bypass surgery reduces long-term mortality by 40%, according to a large University of Utah study published August 23 in the NEJM. After seven years, surgery patients suffered 56% fewer deaths from heart disease, 60% fewer from cancer and a whopping 92% fewer from diabetes. Non-disease deaths, such as those by accident and suicide, were 58% higher in the surgery group, however. Canadian provinces have struggled to keep up with demand for the surgeries in recent years; Ontario has had to send hundreds of patients to the US for the procedure, and wait times are up to eight years in some jurisdictions.

Carrot and stick approach to med errors —
hold the carrot
WASHINGTON, DC — The Bush administration announced in August that the US public insurance plan, Medicare, will stop paying hospitals to fix their own medical errors. The change is essentially a large-scale pay-for-performance incentive, only in inverse — Bush's plan presumes that making errors more expensive will in turn make them more rare. In other words, the government is saying doctors would treat certain preventable conditions (like bedsores and catheter infections) better if they're afraid they'd lose money. Patient advocacy groups are thrilled; doctors and hospital admins, not so much.

Hypnotism cuts breast cancer surgery pain
NEW YORK CITY — Mesmerizing breast cancer patients before surgery reduces their pain and need for anesthetic, according to a study in an upcoming Journal of the National Cancer Institute. Clinical psychologist Guy Montgomery of Mount Sinai in New York City randomized 200 breast cancer patients to receive 15 minutes of hypnotism or a short counselling session. Hypnotized patients at discharge had less pain, nausea, fatigue, discomfort and distress. Stanford psychiatrist Dr David Spiegel hailed the study: "It is now abundantly clear that we can retrain the brain to reduce pain."

Anesthetic wound bath eases post-op pain
PARIS — In other cancer pain relief news, researchers found that a constant stream of anesthetic infused directly into the surgical wound via catheter not only reduces colorectal cancer patients' pain but also shortens their recovery time. The study, in September's Anesthesiology, reports that patients getting the infusion used less morphine and resumed normal bowel function a full day earlier. The technique, already used in plastic and orthopedic surgeries, means a shorter hospital stay for those patients and significant cost savings.

Skin-deep ethics in MD cash graft
PRAGUE — Five Czech physicians and one other health worker have been charged with illegal trading involving Dutch banks, but they're dealing in an unusual kind of currency: human skin. Government lawyers allege the group removed skin from cadavers and then sold it for profit to the Euro Skin Bank in the Netherlands, which uses the skin to treat burn victims. Human tissue can be sold legally in the Czech Republic, but not for more than the cost of the procedure and transport.

Distant docs worsen skin CA
CHAPEL HILL, NC — Patients who have to schlep more than 24km to see a dermatologist have 20% thicker melanomas at diagnosis. The longer the drive, researchers reported in August's Archives of Dermatology, the greater the Breslow thickness (the depth of tumour cells). As it turns out, the relationship is a simple, linear pattern: for every 1km, Breslow thickness increased 0.37%. Also at issue was patients' income. For every 1% increase in poverty rate in a community, its residents' average Breslow thickness jumped over 1%.

Scientists hunt down Huntington's
HAMILTON — A single genetic mutation triggers Huntington's disease (HD), according to a Canadian study in the August 20 Human Molecular Genetics. Under normal circumstances, the protein huntingtin enters the nucleus of brain cells in response to stress, then leaves when the stress is over. The mutation, discovered at McMaster University, makes it impossible for the protein to get out, and it accumulates there until it kills the cell. Researchers believe a drug that stops mutant huntingtin from entering the nucleus could slow the disease.

 

1

2