Using a technique performed at Johns Hopkins but rarely elsewhere, imaging specialists and surgeons have successfully used precision, image-guided technology to glue shut a tangle of abnormal blood vessel growths in a 43-year-old woman's upper lip, face and nose. Surgery had earlier been ruled out because traditional approaches were considered too risky.
Susan Adams, an accountant from Owings, Md., says her arteriovenous malformation (AVM) had caused a decade of spontaneous nose and lip bleeds that were difficult to control, and that more than a half dozen previous operations had failed to stop the bleeding or facial disfigurement.
Adams' condition is rare and notoriously difficult to treat. Her AVM had grown -for no known reason -- between her upper lip and base of her nose. As it grew, her upper lip and skin above it had bulged out, causing the lower-left side of her face to droop. If left untreated, the condition can lead to life-threatening blood loss from a burst vessel.
For her May 14 procedure, which took about two hours at The Johns Hopkins Hospital, interventional neuroradiologist Monica Pearl, M.D., used an ultrathin needle, precisely guided from the outside in by real-time ultrasound scanning and angiography, to puncture Adams' facial skin and several of the outermost and largest tangled blood vessels. Once the needle was inside the abnormal blood vessels, which are no more than 1 to 2 millimeters wide, Pearl injected a glue-like substance to block each vessel and cut off the blood supply to any smaller, abnormal branching blood vessels. Pearl says this effectively destroyed the blood vessels making up the AVM.
Pearl was able to select which blood vessels to block using a contrasting dye injected into the tangle immediately prior to the glue-sealing embolization treatment. Using digital subtraction angiography (DSA) -- in which computer software removes the images of bones and other organs, showing only the blood vessels -- Pearl was able to track reduced blood flow through the AVM after every individual embolization. After three major blood vessels were sealed, blood flow through the tangle became nearly invisible on the DSA images.
Pearl cautioned that the procedure she and her team used is riskier than traditional AVM therapies. Typically, says Pearl, an assistant professor at the Johns Hopkins University School of Medicine who sees an AVM patient about once a week, interventional neuroradiologists and surgeons use the glue sealant to destroy -- from the inside -- the larger, misshapen arteries, using catheters through major blood vessels elsewhere in the body.
This "inside-in" approach usually lowers the risk of any life-threatening bleeding from burst arteries. However, scarring and postsurgical infections from Adams' earlier procedures led Pearl and plastic and reconstructive surgeon Amir Dorafshar, M.D., to decide in favor of an "outside-in" approach. Although, other surgeons had ruled Adams situation too risky for further surgery, Pearl and Dorafshar thought success was still possible if Adams AVM could be sealed.
Once the tangle was glued shut, Dorafshar threaded a protective line of sutures around Adam's facial outgrowth, as protection against any sudden blood loss during Adams' reconstructive surgery, performed immediately after embolization. In that operation, lasting almost four hours, he cut out the destroyed AVM tangle and put Adams' upper lip back together, repairing the mucosa, muscle and skin, and re-aligning her nose.
"Our success with this alternative outside-in approach shows our ability to look at medical problems from a different perspective and the potential capabilities for treating what was once considered untreatable," says Pearl. "People with complex vascular malformations require individualized treatment plans that rely on close collaborations across physician specialties and disciplines."
According to Pearl and Dorafshar, Adams will need three months to fully recover and will require at least one more operation to repair facial scarring.
Thursday, 29 November 2012
Saturday, 24 November 2012
Poor and Often Erroneous Web Info On 'Designer Vagina' Operations
The quality of internet information available for women opting for "designer vagina" procedures is "poor," and in some cases, inaccurate, reveals a small study published in the Obstetrics & Gynaecology edition of the online only journal BMJ Open.
The findings prompt the authors to urge that guidelines be drawn up to improve standards so that women can make fully informed choices about an increasingly popular procedure that has so far hardly been scrutinised.
Cosmetic surgery is available to women who simply don't like the way their genitals look. Procedures include "vaginal rejuvenation" and "G-spot amplification," as well as altering the shape of the external lips (labia) of the vagina.
The authors Googled private providers offering female genital cosmetic surgery and included the first five UK and US websites that came up in the search results.
The content of the information provided by these websites was assessed using 16 criteria, ranging from what, and how, procedures are carried out, to success rates and potential risks.
The researchers also analysed the language used, including the use of terms, such as "labial hypertrophy," implying that the procedure is used to treat a medical condition.
Some 72 procedures were mentioned across all 10 sites, although the absence of standard terminology makes it impossible to decipher the exact number offered, say the authors. Terms included "labioplasty" "liposculpting" "hoodectomy" and "hymenoplasty."
Concerns about the appearance of the genitals were mentioned on all the sites, including the visibility of vaginal labia through tight clothing, and an awareness -- courtesy of a partner or magazine pictures -- of larger than normal labia.
Several sites recommended labial reduction to promote a "youthful vulval appearance." One site explained this as: "a woman might have a face lift and look really young until she goes to bed and a partner can see the evidence of ageing there."
Surgery was often recommended to make the labia "sleeker" and "more appealing," and although three sites did mention natural variation in the size and shape of labia, these sites still recommended surgery. And all the sites claimed that it would improve vulval appearance.
The repair of the hymen, the intactness of which denotes virginity, was recommended by some sites as a way of improving "the woman's hidden aesthetics" and to ensure that she would bleed on her wedding night and so be able to "keep [her] head high."
Three websites explained that labial surgery would improve personal hygiene and curb the risk of infections, which the authors say may reinforce negative feelings towards the vagina, known as "pudendal disgust."
Half the websites mentioned that surgery would enhance sexual pleasure.
Only two websites indicated success rates, all of which were 95% or 100%, but what constituted success was not defined. All sites mentioned unsubstantiated social and psychological benefits, including restored confidence and self-esteem.
All 10 sites mentioned risks, but these were downplayed; four failed to mention exactly what these were; and only one gave information on revision rates. Three sites referred to "botched" procedures causing disfigurement and requiring revision performed by other providers.
None of the sites gave a lower age limit for surgery, which the authors suggest "is most disturbing of all," particularly as anatomy changes throughout the lifespan.
The authors accept that their study provides only a snapshot of information available at a single time point. But they do say that theirs is the first attempt to methodically evaluate the quality of information offered to women.
They conclude that designer vagina procedures play on women's fears and that any concerns they may have might be better served by psychological therapies, and creams or emollients rather than surgery.
"This report highlights significant gaps in the breadth, depth, accuracy and quality of clinical information given by some service providers of female genital cosmetic surgery…and highlights a certain degree of distortion to the information provided by medical practitioners in an area that is imbued with value judgement," they say.
The findings prompt the authors to urge that guidelines be drawn up to improve standards so that women can make fully informed choices about an increasingly popular procedure that has so far hardly been scrutinised.
Cosmetic surgery is available to women who simply don't like the way their genitals look. Procedures include "vaginal rejuvenation" and "G-spot amplification," as well as altering the shape of the external lips (labia) of the vagina.
The authors Googled private providers offering female genital cosmetic surgery and included the first five UK and US websites that came up in the search results.
The content of the information provided by these websites was assessed using 16 criteria, ranging from what, and how, procedures are carried out, to success rates and potential risks.
The researchers also analysed the language used, including the use of terms, such as "labial hypertrophy," implying that the procedure is used to treat a medical condition.
Some 72 procedures were mentioned across all 10 sites, although the absence of standard terminology makes it impossible to decipher the exact number offered, say the authors. Terms included "labioplasty" "liposculpting" "hoodectomy" and "hymenoplasty."
Concerns about the appearance of the genitals were mentioned on all the sites, including the visibility of vaginal labia through tight clothing, and an awareness -- courtesy of a partner or magazine pictures -- of larger than normal labia.
Several sites recommended labial reduction to promote a "youthful vulval appearance." One site explained this as: "a woman might have a face lift and look really young until she goes to bed and a partner can see the evidence of ageing there."
Surgery was often recommended to make the labia "sleeker" and "more appealing," and although three sites did mention natural variation in the size and shape of labia, these sites still recommended surgery. And all the sites claimed that it would improve vulval appearance.
The repair of the hymen, the intactness of which denotes virginity, was recommended by some sites as a way of improving "the woman's hidden aesthetics" and to ensure that she would bleed on her wedding night and so be able to "keep [her] head high."
Three websites explained that labial surgery would improve personal hygiene and curb the risk of infections, which the authors say may reinforce negative feelings towards the vagina, known as "pudendal disgust."
Half the websites mentioned that surgery would enhance sexual pleasure.
Only two websites indicated success rates, all of which were 95% or 100%, but what constituted success was not defined. All sites mentioned unsubstantiated social and psychological benefits, including restored confidence and self-esteem.
All 10 sites mentioned risks, but these were downplayed; four failed to mention exactly what these were; and only one gave information on revision rates. Three sites referred to "botched" procedures causing disfigurement and requiring revision performed by other providers.
None of the sites gave a lower age limit for surgery, which the authors suggest "is most disturbing of all," particularly as anatomy changes throughout the lifespan.
The authors accept that their study provides only a snapshot of information available at a single time point. But they do say that theirs is the first attempt to methodically evaluate the quality of information offered to women.
They conclude that designer vagina procedures play on women's fears and that any concerns they may have might be better served by psychological therapies, and creams or emollients rather than surgery.
"This report highlights significant gaps in the breadth, depth, accuracy and quality of clinical information given by some service providers of female genital cosmetic surgery…and highlights a certain degree of distortion to the information provided by medical practitioners in an area that is imbued with value judgement," they say.
Tuesday, 20 November 2012
Triclosan in Cosmetics and Personal Care Products Can Increase Allergy Risk
Triclosan -- an antibacterial chemical found in toothpaste and other products -- can contribute to an increased risk of allergy development in children. This comes from the Norwegian Environment and Childhood Asthma Study, in which the Norwegian Institute of Public Health is involved. Similar results are reported in the USA.
Triclosan has been in use for decades, but was recently associated with allergies in children in an American study, the National Health and Nutrition Examination Survey (NHANES). The new Norwegian study found similar associations between allergies and triclosan levels measured in children's urine.
The study found that triclosan levels measured in urine were associated with elevated levels of Immunoglobulin E (IgE) and rhinitis (blocked nose/hay fever) in 10 year-olds.
623 urine samples were collected and measured at the Center for Disease Control and Prevention in Atlanta, USA. Approximately 50 per cent of the Norwegian children had detectable levels of triclosan, while 80 per cent of American children had measurable levels. The children had approximately the same amount of triclosan exposure.
Triclosan can change the bacterial flora on the skin, in the mouth and in the intestines. A change in the bacterial composition of "good" bacteria can cause an increased risk of developing allergies (hygiene hypothesis). Therefore, increased use of triclosan and antibacterial products has generally been associated with an increased incidence of allergies.
Reduce consumption
For many years, the health authorities in Norway have called for a reduction in the use of antibacterial products to prevent the development of resistant bacteria.
In a study of triclosan use in Norway in 2001, it was found that 85 per cent of the total amount of triclosan came from cosmetic products, of which 75 per cent were toothpaste. Since this study, triclosan has been removed from a variety of products.
The extent to which Norwegian children are exposed to triclosan is today uncertain. In the USA, where they have annual sampling and monitoring of chemical exposure, there is little evidence that exposure to triclosan is being reduced.
The triclosan study is a collaboration between the Norwegian Institute of Public Health, Oslo University Hospital and the National Institute of Health Sciences (NIEHS) in the USA, where Randi Bertelsen is currently a guest researcher. The project is partly funded by the Research Council of Norway's programme for Environmental Exposures and Health Outcomes.
Triclosan
is used to prevent bacterial growth
does not work against all types of bacteria
added mostly to cosmetic products such as toothpaste, deodorant and soap
also added to kitchen utensils and textiles
little triclosan is absorbed through the skin
significant absorption through the mucous membranes in the mouth (toothpaste)
has been in use for over 40 years in some products
from animal experiments we know that triclosan acts to reinforce the development of Immunoglobulin (IgE) towards allergens.
Triclosan has been in use for decades, but was recently associated with allergies in children in an American study, the National Health and Nutrition Examination Survey (NHANES). The new Norwegian study found similar associations between allergies and triclosan levels measured in children's urine.
The study found that triclosan levels measured in urine were associated with elevated levels of Immunoglobulin E (IgE) and rhinitis (blocked nose/hay fever) in 10 year-olds.
623 urine samples were collected and measured at the Center for Disease Control and Prevention in Atlanta, USA. Approximately 50 per cent of the Norwegian children had detectable levels of triclosan, while 80 per cent of American children had measurable levels. The children had approximately the same amount of triclosan exposure.
Triclosan can change the bacterial flora on the skin, in the mouth and in the intestines. A change in the bacterial composition of "good" bacteria can cause an increased risk of developing allergies (hygiene hypothesis). Therefore, increased use of triclosan and antibacterial products has generally been associated with an increased incidence of allergies.
Reduce consumption
For many years, the health authorities in Norway have called for a reduction in the use of antibacterial products to prevent the development of resistant bacteria.
In a study of triclosan use in Norway in 2001, it was found that 85 per cent of the total amount of triclosan came from cosmetic products, of which 75 per cent were toothpaste. Since this study, triclosan has been removed from a variety of products.
The extent to which Norwegian children are exposed to triclosan is today uncertain. In the USA, where they have annual sampling and monitoring of chemical exposure, there is little evidence that exposure to triclosan is being reduced.
The triclosan study is a collaboration between the Norwegian Institute of Public Health, Oslo University Hospital and the National Institute of Health Sciences (NIEHS) in the USA, where Randi Bertelsen is currently a guest researcher. The project is partly funded by the Research Council of Norway's programme for Environmental Exposures and Health Outcomes.
Triclosan
is used to prevent bacterial growth
does not work against all types of bacteria
added mostly to cosmetic products such as toothpaste, deodorant and soap
also added to kitchen utensils and textiles
little triclosan is absorbed through the skin
significant absorption through the mucous membranes in the mouth (toothpaste)
has been in use for over 40 years in some products
from animal experiments we know that triclosan acts to reinforce the development of Immunoglobulin (IgE) towards allergens.
Sunday, 18 November 2012
Sea Cucumbers And Sea Urchins May Hold The Key To looking Young
Sea cucumbers and sea urchins are able to change the elasticity of collagen within their bodies, and could hold the key to maintaining a youthful appearance, according to scientists at Queen Mary, University of London.
The researchers investigated the genes of marine creatures such as sea urchins and sea cucumbers, known as echinoderms. They found the genes for "messenger molecules" known as peptides, which are released by cells and tell other cells in their bodies what to do.
The study was published online in the journals PLOS One and General and Comparative Endocrinology.
Project leader Professor Maurice Elphick, from Queen Mary's School of Biological and Chemical Sciences, said: "Probably the most exciting discovery from our research was finding genes encoding peptides that cause rapid stiffening or softening of collagen in the body wall of sea cucumbers.
"Although sea urchins and sea cucumbers may not look much like us, we are actually quite closely related to them. As we get older, changes in collagen cause wrinkling of our skin, so if we can find out how peptides cause the body wall of a sea cucumber to quickly become stiff or soft then our research might lead to new ways to keeping skin looking young and healthy."
The scientists analysed the DNA sequences of thousands of genes in the purple sea urchin Strongylocentrotus purpuratus and the edible sea cucumber Apostichopus japonicus and specifically searched for genes encoding peptide messenger molecules. Rapid advances in technology used to sequence genes made the research possible.
"When the human genome was sequenced over a decade ago it cost millions of pounds - now all of the genes in an animal can be sequenced for just a few thousand pounds," Professor Elphick said.
"We also found that sea urchins have a peptide that is very similar to calcitonin, a hormone that regulates our bones to make sure that they remain strong," Professor Elphick said.
"So it will be fascinating to find out if calcitonin-type peptides have a similar sort of role in spiny-skinned creatures like sea urchins."
"These types of advances in basic science are fascinating in their own right but they are also important because they underpin the medical breakthroughs that lead to improvement in the quality of people's lives."
The researchers investigated the genes of marine creatures such as sea urchins and sea cucumbers, known as echinoderms. They found the genes for "messenger molecules" known as peptides, which are released by cells and tell other cells in their bodies what to do.
The study was published online in the journals PLOS One and General and Comparative Endocrinology.
Project leader Professor Maurice Elphick, from Queen Mary's School of Biological and Chemical Sciences, said: "Probably the most exciting discovery from our research was finding genes encoding peptides that cause rapid stiffening or softening of collagen in the body wall of sea cucumbers.
"Although sea urchins and sea cucumbers may not look much like us, we are actually quite closely related to them. As we get older, changes in collagen cause wrinkling of our skin, so if we can find out how peptides cause the body wall of a sea cucumber to quickly become stiff or soft then our research might lead to new ways to keeping skin looking young and healthy."
The scientists analysed the DNA sequences of thousands of genes in the purple sea urchin Strongylocentrotus purpuratus and the edible sea cucumber Apostichopus japonicus and specifically searched for genes encoding peptide messenger molecules. Rapid advances in technology used to sequence genes made the research possible.
"When the human genome was sequenced over a decade ago it cost millions of pounds - now all of the genes in an animal can be sequenced for just a few thousand pounds," Professor Elphick said.
"We also found that sea urchins have a peptide that is very similar to calcitonin, a hormone that regulates our bones to make sure that they remain strong," Professor Elphick said.
"So it will be fascinating to find out if calcitonin-type peptides have a similar sort of role in spiny-skinned creatures like sea urchins."
"These types of advances in basic science are fascinating in their own right but they are also important because they underpin the medical breakthroughs that lead to improvement in the quality of people's lives."
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