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| News and Notes
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The use of endoscopic plication to restore the anti-reflux barrier shows long-term benefits in the treatment of gastroesophageal reflux disease, both in reducing patients' symptoms and their need for prescription antacids, researchers say.
For a study published in Surgical Endoscopy's online edition in December, Douglas K. Pleskow, MD, of Beth Israel Deaconess Medical Center in Boston and his colleagues followed 29 patients with chronic heartburn who were treated with the Plicator device at five sites. They were evaluated for GERD symptoms 12 months after the procedures and again at 36 months. At the one-year mark 59 percent of these patients were completely symptom-free; at the three-year follow-up, 55 percent were. No patients reported adverse effects related to the procedure.
The treatment's effects also remained stable over time, with 21 of the patients reporting that they remained off their daily medication therapy after 12 months and 17 of the patients saying so after 36 months. These patients also reported significantly improved health-related quality of life scores versus the baseline off-medication scores (eight versus 19).
Noting that the study reflects his physicians' early experiences with the Plicator, Dr. Pleskow adds that better techniques for placing its sutures are developed with experience. "We're much better at performing the procedure than when we started out, and the equipment we're using now is much more advanced," he says.
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| Study: Plicator Procedure Extinguishes Heartburn for Years
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The use of endoscopic plication to restore the anti-reflux barrier shows long-term benefits in the treatment of gastroesophageal reflux disease, both in reducing patients' symptoms and their need for prescription antacids, researchers say.
For a study published in Surgical Endoscopy's online edition in December, Douglas K. Pleskow, MD, of Beth Israel Deaconess Medical Center in Boston and his colleagues followed 29 patients with chronic heartburn who were treated with the Plicator device at five sites. They were evaluated for GERD symptoms 12 months after the procedures and again at 36 months. At the one-year mark 59 percent of these patients were completely symptom-free; at the three-year follow-up, 55 percent were. No patients reported adverse effects related to the procedure.
The treatment's effects also remained stable over time, with 21 of the patients reporting that they remained off their daily medication therapy after 12 months and 17 of the patients saying so after 36 months. These patients also reported significantly improved health-related quality of life scores versus the baseline off-medication scores (eight versus 19).
Noting that the study reflects his physicians' early experiences with the Plicator, Dr. Pleskow adds that better techniques for placing its sutures are developed with experience. "We're much better at performing the procedure than when we started out, and the equipment we're using now is much more advanced," he says.
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| Inhalation Agent Linked to Alzheimer's?
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The anesthetic isoflurane results in cell death and is a risk factor for Alzheimer's disease, say scientists at the Genetics and Aging Research Unit of the Massachusetts General Institute for Neurodegenerative Disease in Charlestown, Mass. In a study published in the January issue of The Journal of Gerontology: Medical Sciences, researchers linked isoflurane to the destruction of neuronal cells and the enhancement of amyloid-beta oligomerization, the characteristic mechanism of Alzheimer's disease. These, results, say the study's authors, provide a potential pathogenic link between delirium and dementia.
Researchers exposed H4 human neuroglioma cells to one percent and two percent concentrations of isoflurane for six hours and measured caspase-3 activation (one of the final steps of cell apoptosis) with Western blotting. They discovered that only two percent isoflurane induced the breakdown of brain cells, suggesting isoflurane induces apoptosis in a dose-dependent manner. The researchers believe these results indicate that general anesthesia might precipitate and facilitate the progression of postoperative cognitive disorders.
Caution must be used in transferring these findings to the clinical setting, says William Bray, CRNA, a nurse anesthetist at the South East Alabama Medical Center in Dothan, Ala. Mr. Bray believes it is difficult to predict which patients will demonstrate delirium after induction with isoflurane, especially when dealing with the root causes of a neurological disease like Alzheimer's.
"Isoflurane is but one of the inhalational agents commonly employed in the administration of general anesthesia," he says. "And all agents used, whether inhaled or injected into the blood, cross the blood-brain barrier where they actually affect the patient's sensorium and produce anxiolysis or an altered state of consciousness."
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| Tweaks Likely for Georgia's CON Program
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Georgia's 27-year-old certificate of need statute needs overhauling, according to a 267-page report prepared by a commission of state legislators, doctors and hospital administrators. This is welcome news for physicians' groups who are lobbying to relax the CON law, rated the fifth most restrictive in the nation by the American Health Planning Association, and an ominous sign for all 152 of Georgia's hospitals and hospital associations that want to preserve it.
Although the commission stopped short of repealing the CON rules — the worst-case scenario for the state's hospital lobbyists — it did unanimously approve recommendations to streamline the CON process and to maintain existing CON regulation of freestanding multi-specialty ambulatory surgery centers. On other key points, including the following, it split.
- Should restrictions for general surgeons who want to start new surgical centers be loosened? According to the current rules, general surgeons are not considered to have a "single specialty," thus requiring them to go through the CON process. Orthopedic and plastic surgeons, on the other hand, do receive the single-specialty designation, letting them escape the CON application.
- Should physician-owned, single-specialty surgical centers continue to be exempt from the CON process if the center can be established for less than $1.6 million?
- Should the exemption for physician-owned, office-based, single-specialty surgery centers be abolished and should such facilities be required to obtain a CON under the exact same standards as all other surgery centers? Such applicants wouldn't have to address need criteria, but they would have to commit to indigent and charity care, verify that all their physicians are members of a hospital staff and verify that they're willing to accept emergency room coverage.
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