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2nd career as nurse
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Hunter
medicine forum beginner


Joined: 19 Oct 2005
Posts: 2

PostPosted: Wed Oct 19, 2005 3:05 am    Post subject: Re: Risks of gastric bypass Reply with quote

Tom wrote:

Quote:
Risks of gastric bypass
New study finds that patients 65 and older are more likely to die
after bariatric surgery than earlier believed

BY RONI RABIN
STAFF WRITER

October 18, 2005, 8:22 PM EDT

Medicare patients who undergo weight-loss surgery face a considerably
higher risk of death than has been reported for other patients in
previous studies, with 2 percent dying within 30 days of surgery and
almost 5 percent dying within a year, a study of Medicare patients of
all ages found. Risks were amplified for men, those over 65 and
patients whose surgeons were less experienced in such surgery.

What about the death rate of non Medicare patients who have the
surgery? Are Medicare patients in poorer health prior to the surgery
than non Medicare patients? Has the death rate tapered off in recent
years?


Quote:

The American Society for Bariatric Surgeons and several earlier
studies have put the death rate from the surgery at 0.5 percent, or
one in 200.

The paper was one of several published yesterday in the Journal of
the American Medical Association that reported sobering results about
the safety of weight- loss surgery.

Another study found patients, whose average age was 42 years old,
were twice as likely to end up in the hospital the year after gastric
bypass surgery as they were the year before, mostly to be treated for
surgical complications. That study, of more than 60,000 California
patients, found low death rates, with 0.3 percent of patients dying
within 30 days of surgery and just under 1 percent dying within the
year.

Despite the findings, an editorial accompanying the papers said
bariatric surgery "remains a fundamental therapy for morbidly obese
patients." Generally, patients must be at least 100 pounds overweight
to qualify for such surgery.

"Under the right circumstances, for an average or low-risk patient,
the mortality risk is very low," Dr. Bruce M. Wolfe, co-author of the
editorial, said in an interview, though he added, "The risk of
complications is very substantial, and the patients need to be
prepared."

Wolfe suggested that the poor outcomes of Medicare patients reflected
a much sicker, disabled population at significantly higher risk than
the average patient coming for weight-loss surgery.

But Dr. Dave Flum, lead author of the Medicare study and an associate
professor of surgery at University of Washington in Seattle, said the
low mortality rates that have been reported in the past for such
procedures were from "the best surgeons reporting the best results.

"This is a procedure that has real risks," Flum said of gastric
bypass surgery. "People should go into it with their eyes open.

"It's a high-risk operation, in a high-risk population, and there's
nothing wrong with saying that. The desire on the part of the
surgical community to minimize the risk is not well-advised."

His study of 16,155 Medicare patients found that men faced double the
risk of death than women, with 3.7 percent of men dying within a
month of the surgery compared to 1.5 percent of women, and 7.5
percent of men dying within a year, compared to 3.7 percent of women.

The risk of dying also increased after age 65, so that almost 5
percent of seniors who had the surgery died within 30 days and 11.1
percent died within a year. Having an inexperienced surgeon also
increased the risk of death.

Concern about the risks does not appear to be discouraging Americans
from having bariatric surgery. A third paper in JAMA estimated that
the number of procedures has multiplied from 13,365 in 1998 to 72,177
by 2002, and was projected to reach 102,794 by 2003. The authors
predicted that about 130,000 procedures will be performed this year
and that the figure could reach 218,000 by 2010. Copyright 2005
Newsday Inc.
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Mortimer Schnerd, RN
medicine forum Guru Wannabe


Joined: 09 May 2005
Posts: 208

PostPosted: Wed Oct 19, 2005 3:48 pm    Post subject: Re: Risks of gastric bypass Reply with quote

Hunter wrote:
Quote:
Tom wrote:

Risks of gastric bypass
New study finds that patients 65 and older are more likely to die
after bariatric surgery than earlier believed


Generally, I prefer not to reply to crossposted spam, but here's something that
bears saying:

Any death rate from bariatric surgery is greatly affected by the skill of the
surgeons performing the work. I've had the Rouen-Y procedure and the surgeons I
picked have NEVER had to return to the OR to fix a complication. Nobody has
died either. These two guys do a ton (pardon the phrase) of procedures, too.

I suspect that less skilled surgeons may be skewing the results quite a bit.



--
Mortimer Schnerd, RN

mschnerd@carolina.rr.com.REMOVE
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Norminn
medicine forum Guru Wannabe


Joined: 05 May 2005
Posts: 157

PostPosted: Wed Oct 19, 2005 4:51 pm    Post subject: Re: Risks of gastric bypass Reply with quote

Mortimer Schnerd, RN wrote:
Quote:
Hunter wrote:

Tom wrote:


Risks of gastric bypass
New study finds that patients 65 and older are more likely to die
after bariatric surgery than earlier believed



Generally, I prefer not to reply to crossposted spam, but here's something that
bears saying:

Any death rate from bariatric surgery is greatly affected by the skill of the
surgeons performing the work. I've had the Rouen-Y procedure and the surgeons I
picked have NEVER had to return to the OR to fix a complication. Nobody has
died either. These two guys do a ton (pardon the phrase) of procedures, too.


My base requirement for having any surgery is that the surgeon have a
ton of experience Surprised) A claim for never returning to OR for
complications and no deaths is really difficult to believe for such a
high-risk group. This topic was on the news today, which said
hospitalizations are a good deal more common after surgery than before,
and the procedure (of course) more commonly done on those who can pay.

Quote:
I suspect that less skilled surgeons may be skewing the results quite a bit.


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Mortimer Schnerd, RN
medicine forum Guru Wannabe


Joined: 09 May 2005
Posts: 208

PostPosted: Wed Oct 19, 2005 7:19 pm    Post subject: Re: Risks of gastric bypass Reply with quote

Norminn wrote:
Quote:

My base requirement for having any surgery is that the surgeon have a
ton of experience Surprised) A claim for never returning to OR for
complications and no deaths is really difficult to believe for such a
high-risk group.


In this case, I believe it to be true. Their patients go to one of my sister
units and I have contact with their nurses every day (when I'm at work). I
would have heard if there were problems. I have heard exactly that about other
surgeon's patients.

Hey, I don't work for the surgeon... I work in the county hospital as a staff
nurse in med-surg. Frankly, I'd have still gone for the surgery if they hadn't
had a perfect record because I surely was going to die otherwise... and
relatively soon. Now I'm a normal size, my medical problems have dried up and I
feel I'll be around to annoy others for a few more decades to come.



--
Mortimer Schnerd, RN

mschnerd@carolina.rr.com.REMOVE
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Starlight
medicine forum Guru Wannabe


Joined: 30 Apr 2005
Posts: 186

PostPosted: Mon Oct 24, 2005 2:39 pm    Post subject: Re: Blood transfusions / chronic lung disease Reply with quote

On Mon, 24 Oct 2005 07:25:27 -0500, "NorthShoreCEO"
<NorthShoreCEO@aol.com> posted:

Quote:

"ARoberts" <a-roberts1@comcast.net> wrote in message
news:JN2dnXmth6TLdMbeRVn-uA@comcast.com...

ironjustice@aol.com> wrote in message
news:1130086583.938872.114150@g44g2000cwa.googlegroups.com...
You'll be using the scientific method next, Tom !

Like I said .. before ..

I do the studies in my .. head ..

Saves a lot of .. expense .. and time ..

Plus, you have so much room.



Still ROFLMAO over your reply, ARoberts!


Me too!! I don't read the OP, but that reply was hilarious! Smile
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Starlight
medicine forum Guru Wannabe


Joined: 30 Apr 2005
Posts: 186

PostPosted: Tue Oct 25, 2005 2:13 am    Post subject: Re: Blood transfusions / chronic lung disease Reply with quote

On Mon, 24 Oct 2005 20:45:11 -0500, "ARoberts"
<a-roberts1@comcast.net> posted:

Quote:

ironjustice@aol.com> wrote in message
news:1130181719.242393.176590@g44g2000cwa.googlegroups.com...
It is a matter of .. how MANY .. times .. HAVE .. I .. BEEEEEENNN ..
proven right .. that .. matters ..

Doesn't it ..

Heh .. heh ..

You can TALK all you want .. but when it comes to .. walking .. the ..
talk ..

Heh .. heh ..

Yeah, you walk the talk: you're always putting your foot in your mouth.


lol You guys!!!
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outsor@citynet.net
medicine forum Guru


Joined: 11 Sep 2005
Posts: 569

PostPosted: Fri Oct 28, 2005 9:40 pm    Post subject: Re: Human atherosclerotic lesions / large amounts of ferritin Reply with quote

Note, the iron was not said to cause the disorder but to contribute as one
substance among others which combine to produce the effect, this is
reflected in the use of "induced", which means they had to set up the
context to make it work. They introduced other substances first and then
iron, iron did not start the process that lead to the results, the old dog
and tail question.
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ironjustice@aol.com
medicine forum Guru


Joined: 28 Apr 2005
Posts: 1522

PostPosted: Sun Oct 30, 2005 1:57 am    Post subject: Iron In The Blood, Good; Iron In The Lung, Very Bad Reply with quote

Source: American Physiological Society

http://www.sciencedaily.com/releases/2005/10/051004084839.htm

Source: American Physiological Society

Date: 2005-10-04

Iron In The Blood, Good; Iron In The Lung, Very Bad
Iron, for example, is a nutritional prerequisite to power life itself.
When blood doesn't get enough iron from the gut, we become anemic. One
of the body's coping mechanisms is to produce more of a protein called
divalent metal transporter 1 (DMT1) in the gastrointestinal lining
cells to bring into the body as much iron as possible. Until recently
DMT1 was exclusively studied for its nutritional role in transporting
iron.


But put iron or other air-borne particulates into our lungs and they
can cause health problems ranging from asthma and acute respiratory
distress syndrome to asbestosis and lung cancer.

In a recently-published paper a group of EPA-led lung researchers
reported experiments demonstrating for the first time that "DMT1 is
essential for the transport and detoxification of some metals
associated with an air pollution particle that damages the pulmonary
epithelial surface."

The paper "Divalent metal transporter-1 decreases metal-related injury
in the lung" appears in the American Journal of Physiology-Lung
Cellular and Molecular Physiology, published by the American
Physiological Society. Research was performed by Andrew J. Ghio, Lisa
A. Dailey, Jacqueline D. Stonehuerner and Michael C. Madden from the
U.S. Environmental Protection Agency; Claude A. Piantadosi of Duke
University; Xinchao Wang of University of North Carolina; Funmei Yang
of University of Texas; and Kevin G. Dolan, Michael D. Garrick and
Laura M. Garrick of SUNY-Buffalo.

Lead researcher Andrew Ghio said this breakthrough discovery of DMT1
lung protection could prompt studies of its roles in other organs where
it's found. "For instance, DMT1 is in the liver, kidneys and brain,
where it's not needed for nutritional purposes," Ghio said, "and since
iron is implicated in everything from infections to cancers, it's not
unreasonable to believe DMT1 could serve as a therapeutic target in
those, as well as even Alzheimer's."

Florida 'oil fly ash' tests in normal and DMT1-deficient rats, and in
vitro

Using an "oil fly ash" high in iron and vanadium collected from a
Florida power plant burning low sulfur oil as the insult, the
researchers tested exposure to normal rats as well as "Belgrade" rats,
which are functionally deficient in DMT1 because of a mutation. They
also performed parallel tests in vitro, as well as testing how
"pre-conditioning" with various foreign metallic insults might affect
gene expression and resulting lung damage.

One key to how DMT1 works is by generating two alternatively spliced
messenger RNAs that differ by the presence (+) or absence (-) of an
Iron-Response Element (thus -IRE or +IRE). In contrast to the
gastrointestinal tract where the +IRE form dominates, there is more
-IRE DMT1 in the lung. The paper noted that in the lung, "there is an
IRE-independent iron-regulatory pathway for control of DMT1 expression
of the -IRE isoform of DMT1, whereas the +IRE isoform shows little
response to the metal."

Results show DMT1 doesn't pose risk for cellular damage, but may
prevent it

The authors said that before their results, it could have been argued
that "the chain of events described here (iron exposure increasing -IRE
DMT1 expression leading to metal uptake with sequestration of iron) ...
is just a set of associations." However, the Belgrade data "rule out
these alternatives and support the argument that this chain of events
is a set of causal relationships because (these rats) have defective
DMT1," which diminishes transport activity. "This transport deficiency
in the Belgrade rat renders this animal ineffective at controlling the
oxidative stress presented by the (ash) particle, so that greater
tissue injury results.

"While there is room for other explanatory hypotheses that connect the
injury to the defective DMT1, one can no longer maintain that higher
DMT1 activity places cells at higher risk of damage," the paper noted.

Protective mechanism shuts out too-toxic elements, keeps iron away from
microbes

An interesting finding was that "exposure of respiratory epithelial
cells to vanadium decreased both mRNA and expression of -IRE. Among
multiple metals we have tested (though data wasn't reported in the
paper), iron alone has increased -IRE DMT1 mRA while vanadium and
arsenic have decreased it." Ghio said later that they believe this is
because the lung is designed to handle the iron particles, but that
vanadium is so toxic that the cells realize they can't cope and so they
shut down the transport mechanism.

The paper noted that since the presence of iron increases "DMT1
messenger-RNA and function, we suspect that the lung may have evolved a
specific response to iron in order to protect the epithelial surface
from oxidative stress.... Management of iron in particles is also
critical to minimize the metal ions' availability to microbial invaders
that may arrive with the same particles," it added.

The paper also demonstrated "that control of DMT1 experession in
respiratory epithelial cells differs from that in the intestine because
-IRE mRNA and protein are upregulated by iron, resulting in cellular
iron uptake, and limiting the reactive oxygen species generated by iron
and other redox-active metals."

Next steps

Ghio said the mechanisms uncovered in their experiments so far indicate
that "if we follow the iron, we may be able to change the types of
toxic reactions to all kinds of particulates and fibers and the metals
they carry." In addition, since iron is involved in so many healthy and
diseased states throughout the body further study will be needed to
define its role. He pointed out that research already is underway to
see what functions DMT1 might be playing in the other organs where it
is found, including the liver, kidney and brain.


###
Source and funding

The paper "Divalent metal transporter-1 decreases metal-related injury
in the lung" appears in the American Journal of Physiology-Lung
Cellular and Molecular Physiology, published by the American
Physiological Society. Research was performed by Andrew J. Ghio, Lisa
A. Dailey, Jacqueline D. Stonehuerner and Michael C. Madden from the
U.S. Environmental Protection Agency's National Health and
Environmental Effects Research Laboratory, Research Triangle Park,
North Carolina (NC); Claude A. Piantadosi of Duke University Medical
Center's Department of Medicine, Durham, NC; Xinchao Wang of University
of North Carolina's Center for Environmental Medicine and Lung Biology,
Chapel Hill, NC; Funmei Yang from the Dept. of Cellular and Structural
Biology, University of Texas Health Science Center, San Antonio; and
Kevin G. Dolan, Michael D. Garrick and Laura M. Garrick of the Dept. of
Biochemistry, State University of New York, Buffalo.

Research was partially funded by NIH/ National Institute of Diabetes
and Digestive and Kidney Diseases (NIDDK).



Editor's Note: The original news release can be found here.


--------------------------------------------------------------------------------

This story has been adapted from a news release issued by American
Physiological Society.



Who loves ya.
Tom


Jesus Was A Vegetarian!
http://jesuswasavegetarian.7h.com


Man Is A Herbivore!
http://pages.ivillage.com/ironjustice/manisaherbivore


DEAD PEOPLE WALKING
http://pages.ivillage.com/ironjustice/deadpeoplewalking
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Richard Friedel
medicine forum beginner


Joined: 27 Oct 2005
Posts: 2

PostPosted: Sun Oct 30, 2005 7:28 am    Post subject: Re: Iron In The Blood, Good; Iron In The Lung, Very Bad Reply with quote

Wow!

Your next searches will have to be:
asthma + irony
asthma + ironical
asthma + ironing
asthma + ironman
asthma + ferrous
asthma + ferric
asthma + ferrite
and then as the next project, asthma + aluminum etc. Regards, Richard
Friedel
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mcs
medicine forum beginner


Joined: 26 Jul 2005
Posts: 11

PostPosted: Mon Oct 31, 2005 2:09 am    Post subject: Re: Iron In The Blood, Good; Iron In The Lung, Very Bad Reply with quote

---*/INTERPRET, AS A HEALTH CONSCIOUS PERSON i LISTENED to evolved
conventional wisdom and didn't eat too much iron as was explained to us by
experts a decade or so ago.
ultimately maybe this is why I am experiencing problems with my lung? So
now its good to have iron but not breathe it?
<ironjustice@aol.com> wrote in message
news:1130637462.051563.326370@o13g2000cwo.googlegroups.com...
Quote:

Source: American Physiological Society

http://www.sciencedaily.com/releases/2005/10/051004084839.htm

Source: American Physiological Society

Date: 2005-10-04

Iron In The Blood, Good; Iron In The Lung, Very Bad
Iron, for example, is a nutritional prerequisite to power life itself.
When blood doesn't get enough iron from the gut, we become anemic. One
of the body's coping mechanisms is to produce more of a protein called
divalent metal transporter 1 (DMT1) in the gastrointestinal lining
cells to bring into the body as much iron as possible. Until recently
DMT1 was exclusively studied for its nutritional role in transporting
iron.


But put iron or other air-borne particulates into our lungs and they
can cause health problems ranging from asthma and acute respiratory
distress syndrome to asbestosis and lung cancer.

In a recently-published paper a group of EPA-led lung researchers
reported experiments demonstrating for the first time that "DMT1 is
essential for the transport and detoxification of some metals
associated with an air pollution particle that damages the pulmonary
epithelial surface."

The paper "Divalent metal transporter-1 decreases metal-related injury
in the lung" appears in the American Journal of Physiology-Lung
Cellular and Molecular Physiology, published by the American
Physiological Society. Research was performed by Andrew J. Ghio, Lisa
A. Dailey, Jacqueline D. Stonehuerner and Michael C. Madden from the
U.S. Environmental Protection Agency; Claude A. Piantadosi of Duke
University; Xinchao Wang of University of North Carolina; Funmei Yang
of University of Texas; and Kevin G. Dolan, Michael D. Garrick and
Laura M. Garrick of SUNY-Buffalo.

Lead researcher Andrew Ghio said this breakthrough discovery of DMT1
lung protection could prompt studies of its roles in other organs where
it's found. "For instance, DMT1 is in the liver, kidneys and brain,
where it's not needed for nutritional purposes," Ghio said, "and since
iron is implicated in everything from infections to cancers, it's not
unreasonable to believe DMT1 could serve as a therapeutic target in
those, as well as even Alzheimer's."

Florida 'oil fly ash' tests in normal and DMT1-deficient rats, and in
vitro

Using an "oil fly ash" high in iron and vanadium collected from a
Florida power plant burning low sulfur oil as the insult, the
researchers tested exposure to normal rats as well as "Belgrade" rats,
which are functionally deficient in DMT1 because of a mutation. They
also performed parallel tests in vitro, as well as testing how
"pre-conditioning" with various foreign metallic insults might affect
gene expression and resulting lung damage.

One key to how DMT1 works is by generating two alternatively spliced
messenger RNAs that differ by the presence (+) or absence (-) of an
Iron-Response Element (thus -IRE or +IRE). In contrast to the
gastrointestinal tract where the +IRE form dominates, there is more
-IRE DMT1 in the lung. The paper noted that in the lung, "there is an
IRE-independent iron-regulatory pathway for control of DMT1 expression
of the -IRE isoform of DMT1, whereas the +IRE isoform shows little
response to the metal."

Results show DMT1 doesn't pose risk for cellular damage, but may
prevent it

The authors said that before their results, it could have been argued
that "the chain of events described here (iron exposure increasing -IRE
DMT1 expression leading to metal uptake with sequestration of iron) ...
is just a set of associations." However, the Belgrade data "rule out
these alternatives and support the argument that this chain of events
is a set of causal relationships because (these rats) have defective
DMT1," which diminishes transport activity. "This transport deficiency
in the Belgrade rat renders this animal ineffective at controlling the
oxidative stress presented by the (ash) particle, so that greater
tissue injury results.

"While there is room for other explanatory hypotheses that connect the
injury to the defective DMT1, one can no longer maintain that higher
DMT1 activity places cells at higher risk of damage," the paper noted.

Protective mechanism shuts out too-toxic elements, keeps iron away from
microbes

An interesting finding was that "exposure of respiratory epithelial
cells to vanadium decreased both mRNA and expression of -IRE. Among
multiple metals we have tested (though data wasn't reported in the
paper), iron alone has increased -IRE DMT1 mRA while vanadium and
arsenic have decreased it." Ghio said later that they believe this is
because the lung is designed to handle the iron particles, but that
vanadium is so toxic that the cells realize they can't cope and so they
shut down the transport mechanism.

The paper noted that since the presence of iron increases "DMT1
messenger-RNA and function, we suspect that the lung may have evolved a
specific response to iron in order to protect the epithelial surface
from oxidative stress.... Management of iron in particles is also
critical to minimize the metal ions' availability to microbial invaders
that may arrive with the same particles," it added.

The paper also demonstrated "that control of DMT1 experession in
respiratory epithelial cells differs from that in the intestine because
-IRE mRNA and protein are upregulated by iron, resulting in cellular
iron uptake, and limiting the reactive oxygen species generated by iron
and other redox-active metals."

Next steps

Ghio said the mechanisms uncovered in their experiments so far indicate
that "if we follow the iron, we may be able to change the types of
toxic reactions to all kinds of particulates and fibers and the metals
they carry." In addition, since iron is involved in so many healthy and
diseased states throughout the body further study will be needed to
define its role. He pointed out that research already is underway to
see what functions DMT1 might be playing in the other organs where it
is found, including the liver, kidney and brain.


###
Source and funding

The paper "Divalent metal transporter-1 decreases metal-related injury
in the lung" appears in the American Journal of Physiology-Lung
Cellular and Molecular Physiology, published by the American
Physiological Society. Research was performed by Andrew J. Ghio, Lisa
A. Dailey, Jacqueline D. Stonehuerner and Michael C. Madden from the
U.S. Environmental Protection Agency's National Health and
Environmental Effects Research Laboratory, Research Triangle Park,
North Carolina (NC); Claude A. Piantadosi of Duke University Medical
Center's Department of Medicine, Durham, NC; Xinchao Wang of University
of North Carolina's Center for Environmental Medicine and Lung Biology,
Chapel Hill, NC; Funmei Yang from the Dept. of Cellular and Structural
Biology, University of Texas Health Science Center, San Antonio; and
Kevin G. Dolan, Michael D. Garrick and Laura M. Garrick of the Dept. of
Biochemistry, State University of New York, Buffalo.

Research was partially funded by NIH/ National Institute of Diabetes
and Digestive and Kidney Diseases (NIDDK).



Editor's Note: The original news release can be found here.


--------------------------------------------------------------------------------

This story has been adapted from a news release issued by American
Physiological Society.



Who loves ya.
Tom


Jesus Was A Vegetarian!
http://jesuswasavegetarian.7h.com


Man Is A Herbivore!
http://pages.ivillage.com/ironjustice/manisaherbivore


DEAD PEOPLE WALKING
http://pages.ivillage.com/ironjustice/deadpeoplewalking
Back to top
Hamish Alker-Jones
medicine forum beginner


Joined: 21 Nov 2005
Posts: 1

PostPosted: Mon Nov 21, 2005 3:17 am    Post subject: Re: Halting the spread of AIDS Reply with quote

Repeating the article doesn't make its opinion any more true.

Funny that there is nothing there about encouraging contraceptive use, or
increasing spending on public health.

Hammo


On 20/10/05 3:46 PM, in reference to 8r-dnfMpfNKHvMreRVn-hQ@is.co.za, going
by the name of "Briar Rabbit" <Briar@Rabbit.net> wrote the following:

Quote:
Halting the spread of AIDS

The New York Times

MONDAY, OCTOBER 17, 2005

Snip (oh the irony)

http://www.iht.com/articles/2005/10/17/opinion/edaids.php
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Starlight
medicine forum Guru Wannabe


Joined: 30 Apr 2005
Posts: 186

PostPosted: Wed Dec 14, 2005 12:37 am    Post subject: Re: an unsuitable old age: the paradoxes of elder care Reply with quote

On 13 Dec 2005 16:05:59 -0800, "Sbharris[atsign]ix.netcom.com"
<sbharris@ix.netcom.com> posted:

Quote:
Or you manage to succeed and pass your gains to
your kids, confident you've given them a better start than you had,
only to find that the victimology-based system you built now chews THEM
up. That's one of the reasons the Left is so dead set on keeping
race-based biases, and against a system which tests only financial
status. They want to pass their social status gain on to their kids, by
golly, in just same way they were protesting Whitey did, long ago. No
fair economically reshuffling the deck every generation, NOW. Funny now
that works.

Don't forget to mention the HUGE deficit that eventually has to be
paid off, most likely with some of those 'gains' you gave to your kids
and their kids.

The Republicans can only be strong if there is a divided nation.
Their party is best at making sure there is a distinctive chasm
between the haves and the have-nots, between good and evil. They
wave their crosses of morality, crying that our nation is doomed if we
allow gays to marry and have abortions. All the while stealing the
pensions earned by the average joe and the working poor, making sure
the rest of the nation is kept off balance by shouts of orange alerts
and bombs in shoes, using smoke and mirrors to further their conniving
agenda.
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fresh~horses
medicine forum Guru


Joined: 26 Aug 2005
Posts: 501

PostPosted: Tue Dec 20, 2005 6:01 pm    Post subject: the breast cancer information gap Reply with quote

This article was published in RN Magazine, February 2002

The Breast Cancer Information Gap

DIANA ZUCKERMAN, PhD

Breast cancer patients who are considering reconstructive surgery
following a mastectomy may not always receive the safety and
quality-of-life information they need to make a truly informed decision
about breast implants. This former Congressional investigator provides
the data you need to help fill that information gap.

Thanks to early detection, three out of four American women who are
newly diagnosed with breast cancer can safely choose breast-conserving
surgery rather than mastectomy.1 For those who choose a partial or
complete removal of a breast, many patients consider whether or not to
undergo breast reconstruction with implants.

In 1999, the most recent year for which statistics are available,
nearly 83,000 women underwent breast reconstruction.2 Although breast
implants often have the desirable effect of helping to improve a
woman's self-image and body symmetry, their safety remains
controversial. The potential complications include pain, breakage, and
a possible link to fibromyalgia and other diseases.

As a former Congressional investigator reviewing studies submitted
by implant manufacturers to the Food and Drug Administration (FDA), and
in my current work on health policy issues, I have studied firsthand
the research on the safety of breast implants and quality-of-life
issues surrounding them. Here I'll share with you a number of things
I've learned that you and your patients may not be aware of.

Safety issues patients may not fully grasp
There are two types of breast implants and they both have an outer
silicone shell; one type is filled with saline and the other with
silicone gel. Both were on the market for many years before the FDA
started regulating medical devices in 1976. When the agency began
reviewing safety data on medical devices, it gave priority to
lifesaving ones. As a result, the FDA didn't review the safety of
breast implants until 1991.

The FDA started with silicone-gel implants because of concerns that
silicone leakage could be harmful. In 1992, dissatisfied with the
safety data from the manufacturers of these products, the FDA
restricted the use of silicone implants to patients undergoing
reconstruction after mastectomy, women with breast deformities, and
those who had silicone implants that ruptured and wanted them
replaced.3 The FDA further stipulated that these implants had to be
used in ongoing clinical trials, which would enable the agency to track
patient data and evaluate implant safety over time.

In 1999, the FDA reviewed safety data from manufacturers of saline
implants, and, in 2000, approved several styles made by McGhan Medical
Corporation and Mentor Corporation (both in Santa Barbara, Calif.) for
breast reconstruction in women of all ages and breast augmentation in
women 18 years or older.

Although silicone gel implants feel more natural, saline implants
are generally considered safer in the event of rupture. Yet, patients
need to understand that saline implants also have risks.

According to studies the FDA received from manufacturers of saline
breast implants, seven out of ten reconstruction patients will
experience at least one serious complication within the first three
years of receiving an implant, such as pain, hardness, infection, or
rupture of the implant.4 The most common complication - experienced by
almost one-third of the women -- is a condition called capsular
contracture, in which scar tissue tightens around the implant, causing
the breast to become hard, misshapen, and painful.5 Patients who have
breastfed compare the sensation to being unable to nurse their baby for
many hours.

Capsular Contracture - Photos are courtesy of U.S. Food and Drug
Administration/Walter Peters, PHD, MD, FRCSC, University of Toronto

Capsular contracture occurs when the scar tissue, or capsule, that
normally forms around an implant tightens and squeezes the implant. The
Baker grades of capsular contracture range from I (breast is soft and
looks normal) to IV (breast is hard and painful and looks abnormal).
This 29-year old woman suffered a grade IV contracture in her right
breast seven years after placement of a silicone-filled implant.

Not guarantee to last a lifetime

Patients may also not be aware that a breast implants will break
eventually. A new FDA study shows that most implants break within 10-15
years, although some may break within just a few months.6 One in four
patients has an implant removed within three years because of this
complication and others.4

When the shell of a saline implant breaks, saline leaks out
quickly, or over several days. As a result, the implant gets smaller
and may lose its shape. Although the saline is absorbed by the body,
the deflated implant will need to be surgically removed.

Breast Implant Deflation - Photos are courtesy of U.S. Food and
Drug Administration/Walter Peters, PHD, MD, FRCSC, University of
Toronto

Deflation or rupture of a breast implant can be caused by
instruments during surgery, trauma or injury to the breast, excessive
compression during the mammography, or normal aging of the implant. The
left saline-filled implant in this 30-year-old woman defalted after
five months. The likely cause was the leaf-value design of the implant,
which is no longer being used by manufacturers.

Removing a ruptured silicone implant isn't so simple. Because
silicone gel is "sticky," it can be difficult, if not impossible, to
completely remove from surrounding tissue. When a silicone implant
ruptures, a woman may feel the reduction in size of her breast, bumps,
pain, tenderness, tingling, or numbness. Some women, however,
experience no symptoms at all. Even in these so-called "silent
ruptures," gel may slowly migrate to other parts of the body.

According to a recent FDA study of 344 women, 79% of the women who
had silicone implants for 11-15 years had at least one ruptured implant
but weren't aware of it.7 Their diagnosis was made by means of magnetic
resonance imaging (MRI), which also showed that silicone migrated away
from the broken implant in one in five women.

There is only one study of the health effects of ruptured silicone
implants, and the results, though not conclusive, are disturbing.6 When
the silicone migrated from the broken implant, those women were more
likely to be diagnosed with fibromyalgia or several other painful and
debilitating autoimmune diseases, compared to the other women with
implants. In addition, some women have developed symptoms of lupus,
rheumatoid arthritis, scleroderma, or other connective tissue diseases
that they attribute to their implants. Although most of these concerns
center around silicone implants, similar symptoms have been reported
anecdotally among women with saline implants, where the silicone shell
may "leak" small amounts of silicone.8

Even more disturbing, two recent studies by the National Cancer
Institute found that women with silicone or saline breast implants were
more likely to develop cancer than other women their age, and more
likely to die from brain cancer, lung cancer or other lung disease, or
suicide, compared with other plastic surgery patients.9,10 These
studies, however, didn't include reconstruction patients, and more
research is needed before conclusions can be drawn. Meanwhile, a
connection between breast implants and serious diseases can't be ruled
out.8

Women who have a saline or silicone implant removed but not
replaced may describe the experience as "losing their breast twice,"
but this decision is appropriate for women who want to avoid future
complications.

Talking with patients about their options

An important part of counseling patients is listening without
making assumptions about what patients need or want. Many of us might
assume, for example, that breast reconstruction improves the quality of
women's lives. Yet the most recent research by the National Cancer
Institute concludes that women who undergo mastectomies report the same
levels of satisfaction with their lives whether or not they undergo
reconstruction (with implants or autologous tissue transfers such as
TRAM--transverse rectus abdominus myocutaneous-flaps).11 In fact,
mastectomy patients who underwent reconstruction were more likely to
report that breast cancer had a negative impact on their sex lives than
women who didn't have reconstruction.

Such findings remind us that we can't predict what is best for
patients. What we should do is provide them with options and support
their choices.

Patients who decide to undergo breast reconstruction with implants
may ask your advice about the timing of the surgery. It can take place
at the time of tumor removal or months or years afterwards. Immediate
reconstruction may reduce costs by combining mastectomy and
implantation, although patients may face a longer operation and
recuperation. Other patients may prefer to delay reconstruction so that
they have more time to consider their options or to complete chemo- or
radiation therapy. (For details on nursing care for breast
reconstruction patients, see "Oncology Today: Breast reconstruction,"
RN, April 2000.)

Regardless of the timing of surgery, additional procedures are
often needed to complete the reconstruction. Breast reconstruction with
silicone gel is a one-stage procedure. With a saline implant, the
surgeon must first insert a tissue expander, and, over several weeks,
inject more saline into the expander so that it gradually stretches the
muscle and skin. Eventually, the expander is surgically replaced with a
saline implant.

With either type of implant, at a later point, the patient may want
a skin graft to create a new nipple or may undergo surgery on her other
breast to make the two breasts look more similar in shape and size. So
even if there are no complications, many women undergo several
surgeries.

Breast implant patients should be encouraged to report any pain,
bumps, loss of size or shape, or other symptoms of a problem. Because
the implant can interfere with the detection of a tumor during
mammography, the patient should insist on having a specially trained
technician conduct that test. The technician needs to take precautions
to avoid rupturing the implant during compression and take special
views of the breast to detect tumors that might be obscured by the
implant.

Patients deserve to be given information about what is known and
not known about the safety of breast implants. When they know the risks
and benefits, they will be more satisfied with the decisions they make.
For more information on the safety of breast implants, visit the FDA
website and key in "breast implants" in the search box. The Web site of
the National Center for Policy Research for Women & Families provides
additional links to women's health research. With your help, patients
can make the decision that's best for them.

REFERENCES

1 Zuckerman, D.M. [2000]. The need to improve informed consent for
breast cancer patients. J Am Med Wom Assoc, 55[5], 285.
2 American Society of Plastic Surgeons. "1999 Plastic Surgery
Procedural Statistics." 2000.
www.plasticsurgery.org/mediactr/totalrec99a.htm [5 Nov. 2001].
3 U.S. Food and Drug Administration. "Saline breast implants stays
on market as experts warn about risks." 2000.
www.fda.gov/fdac/features/2000/400_implant.html [26 Oct 2001].
4 U.S Food and Drug Administration. "Saline-filled breast implant
surgery: Making an informed decision." 2000.
www.fda.gov/cdrh/breastimplants/labeling/mcghan_patient_labeling_5900.html
[5 Nov. 2001].
5 US Food and Drug Administration. "Breast implant risks." 2000.
www.fda.gov/cdrh/breastimplants/birisk.html [5 Nov. 2001].
6 Brown, S., Penello, G., et al. [2001]. Silicone gel breast
implant rupture, extracapsular silicone, and health status in a
population of women. J Rheumatol, 28[5], 996.
7 U.S Food and Drug Administration. "Study of rupture of silicone
gel-filled breast implants [MRI component]." 2000.
www.fda.gov/cdrh/breastimplants/studies/birupture.htm. [5 Nov. 2001].
8 U.S. Food and Drug Administration. "Breast Implants: Other
illnesses." 2000. www.fda.gov/cdrh/breastimplants/biill.html [26 Oct.
2001].
9 Brinton, L. A., Lubin, J. H., et al. [2001]. Mortality among
augmentation mammoplasty patients. Epidemiology 12[3], 321.
10 Brinton, L. A., Lubin J. H., et al. [2001]. Cancer risk sites
other than the breat following augmentation mammoplasty. Ann Epidemiol,
11[4], 248.
11 Rowland, J. H., Desmond, K. A., et al. [2000]. Role of breast
reconstructive surgery in physical and emotional outcomes among breast
cancer survivors. J Natl Cancer Inst, 92[17], 1375.


Photos are courtesy of U.S. Food and Drug Administration/Walter
Peters, PHD, MD, FRCSC, University of Toronto.

The article published in RN magazine contained a few errors that
have been corrected in this web version.

http://www.center4research.org/health9.html
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Mr-Natural-Health
medicine forum Guru


Joined: 01 May 2005
Posts: 1807

PostPosted: Sun Dec 25, 2005 12:26 am    Post subject: Re: How about something from the Journal of Holistic Nursing, for a change? Reply with quote

outsor@citynet.net wrote:
Quote:
Pestering, you created this thread in response to me in another thread.

Don't play stupid with me, you piece of s**t!

I was subjected to a long series of vicious attacks by you. I did not
appreciate it then, nor now. I wont let you ever forget about it, scum
bag.

Not now, not never, .... not ever.

Just thought that the piece of science s**t might want to know that he
is nothing but a scum bag, IMHO.

Cheers ... and Merry Christmas.

Hope you choke on your Christmas Dinner. Smile
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Andrew Heenan
medicine forum Guru Wannabe


Joined: 29 Apr 2005
Posts: 112

PostPosted: Tue Jan 03, 2006 11:58 pm    Post subject: Re: Venous leg ulcers and elevation. Reply with quote

"Chris Bacon" <chrispbacon@thai.com> wrote ...
Quote:
A relative has chronic venous leg ulcers, one on each leg. Elevation
is apparently highly recommended. I am looking for information on ways
to elevate the limb(s), bearing in mind that these wounds are painful,
and that my relative's general mobility is poor, due to other
complaints, and to being overweight.

While it's good to see an assessment that extends beyond the wound, I still
think that elevation is much too narrow a solution.

Full assessment to determine the nature of the vascular problem is
essential, but from what you are saying, dietary advice and an exercise
program would be much better than an assumption of 'putting the feet up'.

It would also be useful to further extend that assessment to eliminate other
conditions that might have an impact, including endocrine issues (eg
diabetes and thyroid), cardiovascular, respiratory and autoimmune, if these
have not already been investigated.

To get back on topic, there are plenty of proprietary cushions available,
but I'd wait for the outcome of assessments; a 'common sense' solution might
be all that's needed for limb elevation - and you could save a fortune.
--
Andrew Heenan
http://www.realnurse.net/
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