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| New Sedative "Achieves High Level of Satisfaction"
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A new implant and surgical technique promises immediate relief of knee arthritis pain and shorter post-op recovery — and may let patients walk out of your facility just hours after knee replacement surgery — according to Eugene Wolf, MD, the orthopedic surgeon who last month used the technology for the first time in the United States. The implant, called the Oxford system, was developed in England and received FDA approval a little over a year ago.
Unlike total knee surgery, the Oxford system employs a unicompartmental approach to resurface the most arthritic surfaces of the knee while keeping the healthy ligaments and joint surfaces intact. The system also employs a mobile meniscal-bearing insert that protects the knee from the breakdown and loosening that may result from traditional replacement techniques, according to Dr. Wolf.
David Geier, MD, director of the Medical University of South Carolina's Sports Medicine Department and assistant professor of orthopedic surgery, says total joint surgeons disagree about the efficacy of unicompartmental knee replacement procedures. "A total knee may be better for the patient, more reliable and easier to revise," he explains.
Dr. Geier believes it will take several years before the Oxford system becomes commonplace, as total joint surgeons do not routinely perform basic unicompartmental procedures. "Numerous patients have arthritic changes outside of just the medial compartment," he says, "so surgeons who do many unicompartmental procedures may be stretching the indications."
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| Flexible Sigmoidoscopy Could Miss Proximal Problems
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Flexible sigmoidoscopy may be gaining popularity in office settings because it's an easier process than colonoscopy and it requires no general anesthesia. One major drawback, however, is that it may miss proximal cancers in patients — particularly in African-American males, who are at the highest risk of developing these tumors due to genetic and social factors. Two reports presented at Digestive Disease Week 2007 in Washington, D.C., last week indicate the extent of this drawback and reinforce colonoscopy as a standard for colorectal cancer screening.
A review of data from 16,737 screening procedures performed at two Georgia facilities over a five-year period found that African-American patients had a higher risk of proximal cancers than white patients. C. Greg Nesmith, MD, a research fellow at Emory University School of Medicine, found that while white patients had a two-fold higher risk for proximal colon cancer than for neoplasms in other parts of the colon, African-American patients had six times the risk for proximal tubulovillous adenomas and more than ten times the risk for proximal adenocarcinomas. "Flexible sigmoidoscopy would miss these," says Dr. Nesmith. "Colonoscopy would be the preferred method for colon cancer screening."
The incidence of proximal colon cancer dropped for white men and women between 1973 and 2003 but increased among African-Americans, and particularly African-American men, over the same period, according to an analysis of data from a surveillance, epidemiology and end results database conducted by physicians at the Mayo Clinic in Scottsdale, Ariz. The study's author, Ananya Das, says that the American Society for Gastrointestinal Endoscopy endorses colonoscopy for cancer screening despite the trend towards flexible sigmoidoscopy.
In addition to the data from these studies, other research indicates that a large portion of the African-American population receives no screening at all, says Gregory Ginsberg, MD, professor of medicine at University of Pennsylvania School of Medicine and a moderator at the annual gathering.
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| Bariatric Surgery May Cause Neurological Complications
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Patients who have undergone bariatric surgery may develop neurological complications, even decades after the procedure, suggests a study published in the May 22 issue of the online journal Neurology. Katalin Juhasz-Pocsine, MD, associate professor of neurology at the University of Arkansas for Medical Sciences in Little Rock and lead author of the study, says bariatric patients are also at risk for long-term vitamin and mineral deficiencies.
Dr. Juhasz-Pocsine led a research team that reviewed more than 150 patients following Roux-en-Y gastric bypass procedures; twenty-six of those patients developed neurological symptoms. The onset of symptoms ranged from 4 weeks to 18 years, according to the report.
The study does not provide a direct link between nutritional deficiencies and neurological abnormalities, but Dr. Juhasz-Pocsine believes the two may in fact be related. Her personal observation is that infections, changes in lifestyles, stress or other surgeries may unmask subtle neurological symptoms and bring on fast deterioration. "It is essential that patients comply to what is already a recommended vitamin protocol following bariatric surgery," she says. "Many of the patients have borderline normal levels of one or more nutritional elements and with the increased [post-op] demand the patient develops [neurological] symptoms."
According to Dr. Juhasz-Pocsine, those symptoms typically include prickling or numbness of the feet, balance problems, urinary urgency, stiffness of the legs, blurring of vision, memory problems and weakness or fatigue. "Early recognition and aggressive treatment is essential," she says, adding that rapid and excessive weight loss should be investigated and corrected not only in the first year post-op, but also anytime after surgery. "Patient education about these symptoms is a must so they ask for help before irreversible changes occur."
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| News and Notes
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Patients who have undergone bariatric surgery may develop neurological complications, even decades after the procedure, suggests a study published in the May 22 issue of the online journal Neurology. Katalin Juhasz-Pocsine, MD, associate professor of neurology at the University of Arkansas for Medical Sciences in Little Rock and lead author of the study, says bariatric patients are also at risk for long-term vitamin and mineral deficiencies.
Dr. Juhasz-Pocsine led a research team that reviewed more than 150 patients following Roux-en-Y gastric bypass procedures; twenty-six of those patients developed neurological symptoms. The onset of symptoms ranged from 4 weeks to 18 years, according to the report.
The study does not provide a direct link between nutritional deficiencies and neurological abnormalities, but Dr. Juhasz-Pocsine believes the two may in fact be related. Her personal observation is that infections, changes in lifestyles, stress or other surgeries may unmask subtle neurological symptoms and bring on fast deterioration. "It is essential that patients comply to what is already a recommended vitamin protocol following bariatric surgery," she says. "Many of the patients have borderline normal levels of one or more nutritional elements and with the increased [post-op] demand the patient develops [neurological] symptoms."
According to Dr. Juhasz-Pocsine, those symptoms typically include prickling or numbness of the feet, balance problems, urinary urgency, stiffness of the legs, blurring of vision, memory problems and weakness or fatigue. "Early recognition and aggressive treatment is essential," she says, adding that rapid and excessive weight loss should be investigated and corrected not only in the first year post-op, but also anytime after surgery. "Patient education about these symptoms is a must so they ask for help before irreversible changes occur."
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