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Sabtu, 21 Januari 2012

Chilean doctors separate conjoined twins

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In this image taken from a video released by Luis Calvo Mackenna hospital, Roberto Paredes, right, kisses his daughter Maria Jose, one of two conjoined twins after she was separated from her sister Maria Paz at the Luis Calvo Mackenna hospital in Santiago, Chile, Wednesday, Dec. 14, 2011. The 10-months-old twins were joined at the chest, stomach and pelvis. (AP Photo/Luis Calvo Mackenna Hospital)

In this image taken from a video released by Luis Calvo Mackenna hospital, Roberto Paredes, right, caresses his daughter Maria Jose, one of two conjoined twins after she was separated from her sister Maria Paz at the Luis Calvo Mackenna hospital in Santiago, Chile, Wednesday, Dec. 14, 2011. The 10-months-old twins were joined at the chest, stomach and pelvis. (AP Photo/Luis Calvo Mackenna Hospital)

In this image taken from a video released by Luis Calvo Mackenna hospital, medical personnel work around one of two conjoined twins after they underwent surgery to be separated at the Luis Calvo Mackenna hospital in Santiago, Chile, Wednesday, Dec. 14, 2011. The 10-months-old twins were joined at the chest, stomach and pelvis. (AP Photo/Luis Calvo Mackenna Hospital)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;");

SANTIAGO, Chile (AP) — Chilean doctors successfully separated conjoined twin girls in a marathon 20-hour surgery, saying Wednesday that the operation went extremely well despite challenges.

The 10-month-old twins Maria Paz and Maria Jose were recovering in an intensive care unit, and doctors said the next two days would be critical as they watch for infections or other possible complications.

Parents Jessica Navarrete and Roberto Paredes kept an anxious vigil at Luis Calvo Mackenna Hospital in Santiago as doctors separated the twins at the thorax, abdomen and pelvis. It was the seventh and most complex operation yet for the twins.

Doctors successfully separated the twins late Tuesday night. Chief surgeon Francisco Ossandon described it as the moment "the girls finished the process of being born."

"Before, they had two souls and one body," Ossandon said.

Surgery on one of the twins was completed early Wednesday after a total of 19 hours, while for the other it took more than 20 hours.

"We had a number of difficulties during the surgery. There were some surprises, but we were able to fix, solve the problems," Ossandon said at a news conference.

He added that the twins came out of the surgery in good condition. Ossandon, however, didn't rule out future complications involving the effects from anesthesia and possible infections.

"We're very happy because we think they've had the best evolution we could have hoped for," he said.

The girls' parents appeared in televised images as they kissed the twins before the operation. Then afterward, the mother and father gazed lovingly at the sleeping girls from beside their separate cribs in the intensive care unit.

Paredes softly placed a hand on one daughter's head.

Some Chilean television stations occasionally broke into their regular programming to broadcast updates from the doctors, both during and after the delicate surgery.

"The next 48 hours will be the most critical in terms of the ... risk they face of dying," said Dr. Carlos Acuna, chief of the intensive care unit. He said the girls faced risks of various organs ceasing to function, and also had kidney and lung problems.

The girls' mother said she was hoping for a miracle when the high-risk operation began Tuesday morning.

The Chilean twins presented a particularly difficult challenge because they were born sharing many of the same internal organs and even urinary system. About 100 people participated in the procedure, including 25 surgeons and anesthesiologists.

Perhaps providing some comfort to the parents was the hospital's history with conjoined twins. Staff there have separated three sets before. A fourth set, however, died during surgery due to cardiac complications.

According to the University of Maryland Medical Center, roughly one out of every 200,000 live births worldwide results in conjoined twins. The overall survival rate is between 5 percent to 25 percent, depending on various factors, including where they are joined.

While rare, such surgeries have become increasingly frequent over the years due to improvements in surgery, anesthesia and critical care, said Dr. Eric Strauch, a surgeon at the University of Maryland Medical Center.

"We've gotten better at dealing with them," Strauch said. "I think people are willing to undertake it more."

He said he has performed surgeries on two sets of twins. The first set, girls from Uganda, survived in 2002 and are now about 10 years old, he said.

"The second set survived for about six months after the separation, but they both succumbed to infection," said Strauch, adding that their intestines were unable to function.

He said he knew of another successful case in which two girls were separated and have reached adulthood.

"They're in their 20s and they're just graduated from college," Strauch said. "A lot of them don't do well, but a lot of them do."

Dr. Steven Fishman, a pediatric surgeon at Children's Hospital Boston, said that if twins make it out of the hospital without post-surgery complications, most tend to survive.

"If they're felt to be well enough to go home, in general they will make it long term," he said.

The Chilean twins were born in the Villarrica hospital about 470 miles (760 kilometers) south of Santiago and were kept under constant medical care, surviving with the aid of an artificial respirator.

Earlier this year, doctors separated the twins' legs, urinary tracts, pulmonary systems and other parts of their bodies. They now each have part of a leg that used to be fused together.

During the latest surgery, doctors managed to separate an intestine that had been shared by the two, giving each of them part of it, said Jaime Manalich, the government's health minister, who visited the family at the hospital.

Surgeons weren't able to completely close their abdominal cavities or their thoraxes, and therefore had to use meshing to cover them, Ossandon said. "These are foreign bodies that sometimes the body recognizes as foreign, and that can cause infections," he said.

Maria Jose was the first twin to reach the intensive care unit after the surgery. Her sister Maria Paz, whose operation was more complex due to difficulties in the area near her heart, arrived an hour and 15 minutes later.

They were born in February, and since then have been hospitalized and attached to machines including an artificial respirator.

The girls were still connected to a respirator on Wednesday.

They are to remain sedated for at least three days.

Ossandon said the twins will return to the operating room every two or three days so that doctors can clean their wounds. He called the surgery their "rebirth."

___

Associated Press writer Ian James in Caracas, Venezuela, contributed to this report.

Associated Press

Technology

News

Doctors slap down claim Chavez to die in 2 years

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Venezuela's President Hugo Chavez talks to the media as he arrives at the La Fria airport in the state of Tachira October 20, 2011.

Credit: Reuters/Carlos Garcia Rawlins

By Enrique Andres Pretel and Daniel Bases

CARACAS | Sat Oct 22, 2011 3:22pm EDT

CARACAS (Reuters) - Physicians treating Venezuelan President Hugo Chavez disputed on Saturday claims made by a former doctor of the socialist leader that he would die within two years from his undisclosed cancer.

In the first official public comments on Chavez's health, three physicians dressed in laboratory coats at Venezuela's main military hospital said Salvador Navarrete was uninformed and had just minimal contact with the leader a decade ago.

"The President, from the standpoint of cancer has been diagnosed and treated early. Subject to the appropriate follow-up treatments, the current status is quite satisfactory with an excellent prognosis," Dr. Fidel Ramirez said in a televised midday press conference.

"Navarrete was not Chavez's physician, a trusted party or his family," Ramirez said, adding that Navarrete had no scientific evidence or understanding of Chavez's condition.

Navarrete, in an open letter published by local media on Friday, said he has since fled the country, fearing for his safety after an interview published a week ago quoted him saying Chavez would be dead in two years.

Navarrete attended to Chavez a decade ago and claims he is in touch with some relatives and members of his medical team.

In his letter, Navarrete said the interview with Mexico's Milenio Semanal magazine was intended to combat official secrecy over Chavez's condition. He stood by his original prognosis of Chavez, which caused an uproar.

Chavez's health is the all-consuming issue for the South American OPEC member nation of 29 million people, one year ahead of a presidential election where he wants to be re-elected.

Chavez, 57, returned on Thursday from Cuba where he has received cancer treatments, declaring himself cancer-free in an event that included an open-top caravan to a regional Catholic shrine where he prayed and gave thanks for his recovery.

The three doctors on Saturday still would not disclose the type of cancer Chavez has, four months after surgery to remove a malignant tumor from his pelvis. This was followed by four cycles of chemotherapy treatment.

Experts say it is possible for a patient to be considered cancer free at the time of testing if no cancer cells are found, but that typically no one is considered cured of the disease unless tests are negative for a number of years.

By common convention, oncologists say a person can be considered cured after two to five years of clean tests.

Dr. Earle Siso Garcia, director of the military hospital, disputed claims that Chavez was having kidney problems.

Navarrete mentioned again in his open letter Chavez has seen a psychiatrist. However, this claim was denied as well.

"The president never ever had psychiatric treatment. This is a total fallacy," said Dr. Rafael Vargas.

(Editing by Vicki Allen)

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Health Management

Two - Question screen can help doctors Spot teen alcohol problems

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Two questions during regular visit to the pediatrician may help identify youth drinking problems, according to a group of national experts organized by the National Institute on alcohol and the alcohol abuse (NIAAA), which has just released the guidelines for the screening of alcohol and treatment.

Despite the national drinking age 21, approximately 7% of Americans 12 - years have been more odd sip of drink alcoholic. According to the age of 18, that proportion rises to 70%. Children who begin drinking before age 15 - outside the parameters adapted as the religious ceremonies or family meals in cultures of drinkers of wine - are four times more likely to develop alcoholism than those who begin later.

Then that drinking deviants beginning is not necessarily to alcoholism, it indicates that the young person may be at high risk for alcohol problems and other psychiatric disorders and may benefit from early treatment.

More: Status: drunk. Can help Facebook ID problem drinkers?

Questions pediatricians should ask according to the NIAAA are as follows, with text amended to be age-appropriate:

You have friends who drank beer, wine or drink containing alcohol in the last year?
You - the last year, had you on how many days have more than a few sips of beer, wine or any drink containing alcohol?

Screening is obviously better when the parents are not present and after the child was informed of the privacy policy of the doctor. In General, pediatricians keep confidential information unless the child is in immediate danger for alcohol-related harm by engaging in activities as the daily drinking or drinking and driving.

The question to what friends drinking tends to predict future alcohol consumption. If the child responds Yes but not in the second, the doctor may welcome the child to avoid alcohol, discuss the risks of alcohol ways they can avoid drinking if their friends continue to do so.

If the child admits to drinking, the NIAAA guide provides physicians of information on the level of risk associated with various amounts of drink at specific ages, as well as advice on the implementation of what is called a "brief motivational intervention" helps people smoking or levels at least cut at least risky drinking.

Brief interventions involve "meet people when they are in," rather than requiring immediate abstinence or entry into an intensive treatment. In a brief intervention - which literally takes 15 minutes or less - the doctor discussed to reduce or eliminate risk behaviour and the means, this objective can be achieved.

More: How Teen Dating Influences Teen drinking

More importantly, however, the focus is on the objectives and the wishes of the patient. The doctor tries to help patients find their own reasons to choose of more healthy behaviour change and then support them, instead demanding or "refusal." Follow-up appointments are made to discuss the progress, sometimes combined with another follow-up medical appointments if the child does not want to disclose a problem at low altitude to parents.

Not surprising, given how short these interventions are, they have been shown to be as effective as more intensive treatment to reduce the consumption of alcohol to teens. They carry low cost and no risk of exposure of adolescents to more deviant peers that can come with the treatment of group for the substance use problems.

If adolescents are found to have ongoing problems or have engaged in threatening behavior such as drinking and driving, the NIAAA guide offers parents and physicians policy advice to find the best care, including treatment more intensive.

More:
Guide for the Parents"href="http://healthland.time.com/2011/02/17/how-to-find-the-best-drug-treatment-for-teens-a-guide-for-parents/">How to find the best treatment of drug abuse for Teens: a Guide for Parents

"We know that alcohol is by far the drug of choice among young people," said NIAAA acting Director Kenneth Warren in a statement. "Minor drinking is also a marker for other unhealthy behaviors and it often goes unnoticed." "This new tool was designed for busy professionals who manage the health and well-being of children and adolescents to conduct fast, screens of the entry into force of the alcohol and brief interventions".

Unfortunately, actually getting physicians to integrate testing into their practice can be difficult, given their time. A 4 000 adult patients NIAAA study revealed that, while 49% were questioned on their consumption of alcohol, only 14% of those with alcohol use has exceeded healthy levels advised this subject by their physicians in their most recent visit.

The guide NIAAA alcohol screening and intervention for youth are located here.

More: Teen Drug Rehab cure drug addiction or create it?

Maia Szalavitz, is a writer of health at TIME.com. Find him on Twitter at @ maiasz. You can also continue the discussion on the time Facebook page Healthland and on Twitter at @ TIMEHealthland.

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More deaths when green doctors place neck stents

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By Frederik Joelving

NEW YORK | Wed Sep 28, 2011 6:21pm EDT

NEW YORK (Reuters Health) - People about to undergo a controversial stenting procedure in the neck might want to check their doctor's credentials first, researchers say.

According to a new study in the Journal of the American Medical Association, patients whose doctors do lots of the procedures are nearly half as likely to die over the next month as those in less-experienced hands.

During the treatment, called carotid stenting, doctors clean out cholesterol buildups in the carotid artery in the neck that sometimes cause strokes. Then they insert a small metal mesh tube, the stent, to prop the vessel open.

But if they're unfortunate, part of the cholesterol deposit might break off during the procedure and be released into the blood stream, producing the dreaded stroke the patient hoped to avoid.

"A little piece of it just flows upstream and can lodge in a smaller blood vessel in the brain," said Dr. Ethan A. Halm, who wrote an editorial about the new findings.

Based on Medicare records of nearly 25,000 procedures, the new study found a 30-day death rate of 1.4 percent in patients whose doctors placed at least 24 stents a year. By contrast, that death figure was as high as 2.5 percent when the doctors did six or fewer procedures annually.

The same pattern held true when comparing the initial and later procedures done by inexperienced doctors.

Dr. Brahmajee Nallamothu, a cardiologist at the University of Michigan in Ann Arbor who led the work, said the findings don't prove that lack of familiarity with the procedure explains the findings.

But he said that is likely to be the case, since there are no uniform standards for the training doctors need to undergo before they can perform carotid stenting.

"Patients shouldn't be shy about asking their physician who is going to be doing this procedure," Nallamothu told Reuters Health. "I think that it's a very fair question. If I were a patient, I would certainly want to know."

Halm added that carotid stenting is not the only alternative for patients with clogged arteries. The more common procedure is surgery, and some doctors recommend sticking just to medications. Especially when people have no symptoms, many believe doing surgery to clean them out is too hazardous.

With drugs alone, he told Reuters Health, the yearly stroke risk can be lowered to less than one percent, challenging the need for a procedure with significant risks.

And he added that the new study doesn't look at the total number of strokes caused by stenting, which tend to outnumber deaths by a factor of three.

"It's particularly important that people weigh the pros and cons of all therapies," said Halm.

In his view, the new results deal a blow to carotid stenting, which has become more and more common since it was approved in 2004. He estimated some 10,000 carotid stenting procedures were performed each year during the study, a number that has likely increased.

"There are a lot of tricky elements to the procedure," Halm said. "The article by Nallamothu shows that more people think they can do it well than actually can do it well."

If people decide that stenting is the right option for them, they might still have a hard time finding an experienced doctor to perform the procedure.

"The easiest piece of advice is to use an expert middle man," Halm said, adding that a neurologist can usually guide patients to an appropriate expert.

Nallamothu said he hoped the new study would spur the development of stricter training protocols and ensure that patients are followed more closely after stenting in the future.

SOURCE: bit.ly/n9JFW2 Journal of the American Medical Association, September 27, 2011.

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Peliculas Online

Dutch doctors urge end to male circumcision

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By Roberta Cowan

AMSTERDAM | Fri Sep 23, 2011 10:49am EDT

AMSTERDAM (Reuters) - Dutch doctors want politicians and human rights groups to speak out and discourage the practice of male circumcision in the Netherlands because they say it is a "painful and harmful ritual," and a violation of children's rights.

Between 10,000 and 15,000 boys are circumcised in the Netherlands each year, mostly for religious reasons and not always with an anesthetic, according to the Royal Dutch Medical Association (KNMG) which represents surgeons, pediatricians, general practitioners and urologists.

"We want to discourage male circumcision, because it is an unnecessary procedure with complications, which violates the integrity of the child," Lode Wigersma, a spokesman for the association, told Reuters on Friday.

"This is not an innocent procedure, we see complications in about 5 percent of the cases, as well as some long-term and psychological implications," he said.

Male circumcision involves the removal of all or part of the foreskin of the penis. It is a ritual obligation for infant Jewish boys, and is also a common rite among Muslims, who account for the largest share of circumcised men worldwide.

The Dutch medical association has urged religious leaders to find alternative rites of passage that are not irreversible and which are not painful for the child.

The practice of female genital mutation has been prohibited by law in the Netherlands since 1993 for all ages.

Last year the Dutch medical association released a report against the practice of circumcision of male children for non-medical reasons, hoping to initiate a public discussion.

Now it is appealing to Dutch politicians to speak out against the practice to help "gradually change the mentality" in society and among religious groups that circumcise their boys.

The doctors group said that contrary to popular belief, circumcision can cause some minor as well as serious complications including bleeding, infection, urethral stricture as well as panic attacks, which it says are particularly common.

It said there was no medical reason to surgically remove a part of the genitals of healthy babies and young children, who are too young to give their consent to the procedure.

The Dutch doctors are not calling for a circumcision ban, for fear the practice will be driven underground.

"We also understand that it (circumcision) is a deeply embedded religious habit so we don't expect it to be over in a few years, so our appeal is if you want to do it then have it done by a doctor with anesthesia," said Wigersma.

The majority of male circumcisions in the Netherlands are done in special circumcision clinics by doctors using anesthetic on Muslim boys between 5 and 7 years, according to Wigersma.

Rabbi Binyomin Jacobs, President of the Dutch Association of Rabbis, said only about 50 male Jewish babies are circumcised in the Netherlands each year.

He disputed the 5 percent complication rate, and said there have not been any problems in the Jewish community due to strict rules about how and when circumcision takes place.

"According to Jewish law, you have to do it (circumcision) the Jewish way," Jacobs said.

The doctors' recommendation to end the practice of circumcision is likely to be controversial given that it involves both Jewish and Muslim traditions.

In a rare show of unity in June, the Dutch Muslim and Jewish communities -- numbering about 1 million and 40,000 respectively in a total population of 16 million -- condemned the government's proposed ban on the religious slaughter of animals as a violation of their religious freedom.

(Reporting By Roberta B. Cowan)

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Peliculas Online

Doctors separate conjoined twins

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18 September 2011 Last updated at 10:36 GMT The twins after their separation

The twins do not appear to have suffered neurological side effects as a result of surgery Twins who were born joined at the head have been successfully separated by a team of British doctors.

Baby girls Rital and Ritag Gaboura, who are 11 months old, were separated on 15 August after four operations at Great Ormond Street Hospital for Children.

They do not appear to have suffered neurological side effects. Only one in 10 million sufferers survive their rare condition.

The Sudanese infants were flown to the UK by the charity Facing the World.

Conjoined twins are very rare and only 5% of conjoined twins are craniopagus, which means they are fused at the head.

About 40% of twins fused at the head are stillborn or die during labour and a third die within 24 hours.

Continue reading the main story

We are very thankful to be able to look forward to going home with two separate, healthy girls”

End Quote Parents of the twins The nature of the twins' condition meant significant blood flowed between their brains.

Ritag supplied half her sister's brain with blood whilst draining most of it back to her heart. It was a life-threatening situation because significant drops in brain blood pressure would cause neurological damage.

The children were born by Caesarean section in Khartoum, Sudan.

The girls' parents, who are both doctors, said: "We are very thankful to be able to look forward to going home with two separate, healthy girls. We are very grateful to all the doctors who volunteered their time and to Facing the World for organising all the logistics and for paying for the surgery.

The twins before their separation (Copyright: Facing the World)

The parents have expressed immense gratitude for the work carried out by the doctors

"We feel very lucky that our girls have been able to have the surgery that they needed, but we also know of other children who need complete sponsorship and families who are searching for someone to help them."

So far, the girls are reacting in the same ways to tests and stimuli as they did prior to surgery which suggests they have not suffered neurological side effects.

However, their young age makes it difficult to determine whether this is definitely the case.

David Dunaway, from the plastic surgery and craniofacial unit at Great Ormond Street, was the lead clinician and is also a trustee of Facing the World.

He said: "The incidences of surviving twins with this condition are extremely rare. The task presented innumerable challenges and we were all very aware of our responsibilities to the family and these two little girls.

"The Gaboura family have been extremely brave throughout a very stressful journey and their love for their children is clear to see. It is a testimony to the support of the British public that we are able to do any of the charity work that we do."

Facing the World is funded by donations from members of the public.

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Peliculas Online

Overseas doctors 'unready for UK'

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16 September 2011 Last updated at 00:16 GMT By Adam Brimelow Health Correspondent, BBC News Stethoscope

Culture, medical standards and language are all issues The General Medical Council says some overseas doctors come to the NHS with "little or no preparation" for working in the UK.

It says those trained under different cultural and professional standards need more support.

The GMC is planning a basic induction programme for all doctors to help them understand how healthcare is practised in the UK.

Doctors' representatives say the scheme will help to protect patients.

More than one in three doctors registered in the UK qualified abroad. The GMC says the NHS has relied heavily on their skills and dedication, and could not have kept going without them.

But it says they need better support in order to practise safely. The recommendation for an induction programme comes in its first State of Medical Education and Practice report.

This presents a profile of the medical profession and outlines challenges for the future.

Continue reading the main story "In my country, the doctor is a kind of king who can do everything that he wants to, so there were no actual dilemmas because I was brought up in a way that whatever was decided was the right thing.""The whole approach of explaining every aspect of treatment and giving the patient the option to actually make her own decisions, it was something totally new to me.""I have come to know that that the important things in the UK which I didn't really take seriously is confidentiality which is different… in our culture, confidentiality is important but in the UK it is very, very important."It says last year there were 239,270 doctors on the medical register. Just over 150,000 qualified in the UK, a further 23,000 trained initially in the European Economic Area (EEA), and 66,000 completed their medical undergraduate education overseas.

Cultural attitudes

Drawing on a wide range of data including doctors' surveys and patients' complaints, the report concludes that many overseas doctors have problems adjusting to a different cultural, ethical and professional environment in the UK. The GMC says these differences become particularly important in handling the doctor-patient relationship.

The report also says doctors should have specific advice about what will be expected of them, how the health service works and how they will be regulated. It recommends training in communication skills to help them handle sensitive situations and avoid misunderstandings:

"While there are some good local schemes for supporting doctors who are new to this country, there are too many examples of new doctors undertaking clinical practice with little or no preparation for working in the UK. There have also been accounts of locum doctors being sent to undertake duties for which they have not been appropriately trained."

The GMC restates its worry that it is prevented under European law from providing language checks on doctors from the EEA. This became a central concern in the case of Dr Daniel Ubani, an out-of-hours doctor from Germany who killed a patient, David Gray, with an overdose of a painkiller.

The report confirms that the GMC is working with the UK government to change this restriction.

The GMC's chief executive, Niall Dickson, said the regulator was preparing an induction scheme with doctors' employers and professional bodies:

"Developing an induction programme for all doctors new to our register will give them the support they need to practise safely and to conform to UK standards. This will provide greater assurance to patients that the doctor treating them is ready to start work on day one."

Protection for patients

Dr Tom Dolphin from the British Medical Association's Junior Doctor Committee welcomed the move.

"Being a doctor in the UK requires much more that just clinical expertise. It is also important to have highly developed communications skills, knowledge of UK medical ethics and culture, and an understanding of how the NHS works.

"The development of an induction course which helps doctors coming from overseas would do much to help them as they make the difficult transition to practise medicine in another country."

The President of the Royal College of Surgeons, Prof Norman Williams, also gave his support: "Guiding doctors who are new to the UK on how to practise within our professional, language, ethical and legal boundaries is a positive role for the General Medical Council to take on and one the Royal College of Surgeons would strongly endorse.

"We want to see any potential problems headed off before situations develop that might harm patients."

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Peliculas Online

VIDEO: 'induction' for foreign doctors

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September 16, 2011 to help stand 06: 11 GMT

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Overseas doctors 'unready for UK'

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